PUBLISHED AUGUST 20268 MIN READ労災保険法 ARTS. 7 · 12-5 · LSA ART. 76
WHICH SYSTEM, THEN WHICH CATEGORYTWO DECISIONS IN ORDER — NOT ONE
1
Which system?どちらの制度か
Arising from work or commuting → Industrial Accident Compensation Insurance 労災保険. The Health Insurance Act carves these out entirely.
2
Which category inside 労災?労災の3類型
業務災害 · 複数業務要因災害 · 通勤災害 — three, not two. Each is tested differently and named differently.
NOT THE GATE · 入口ではない
The employer’s approval
Recognition is the Inspection Office’s call. A refusal to certify is not a refusal of the claim — it becomes a statement the office weighs.
→ THE WORKER CLAIMS DIRECTLY
An injury or illness arising from work or commuting is, in principle, outside health insurance entirely. It is handled by Industrial Accident Compensation Insurance (労災保険) instead.
So the first question is never “how much does health insurance pay?” but “which system does this belong to?” — and only then, inside 労災, “which of its categories applies?”
1
The two gates of a 業務災害
BOTH MUST BE PASSED · 業務災害は二つの門で判定する
01 · 業務遂行性 — WERE YOU UNDER THE EMPLOYER’S CONTROL?
Whether the worker was within the employer’s control and management at the time — on the job, on the premises, on assigned duties. This is the entry gate: no control, no 業務災害.
02 · 業務起因性 — DID THE WORK CAUSE IT?
Whether there is a causal relationship between the work and the injury or illness — in doctrinal terms, whether a risk inherent in the work materialized. A causal link, not mere coincidence of time and place.
Both gates must be passed. Being on the premises during a private act — a lunch-break errand of one’s own — can satisfy 遂行性 yet fail 起因性.
2
The commute, precisely
通勤の範囲 — 寄り道は限定条件 · 労災保険法7条
A reasonable route and method between home and work, between two workplaces, or between a posting and the family home. Deviation is tightly limited — and it has three states, not two.
A
Trivial actsささいな行為
Buying a drink on the route, using a toilet. Never a break at all — the commute continues throughout.
B
Deviation / interruption逸脱・中断
A cinema, a bar off-route. The commute ends — for the deviation and everything after it. This is the default for a real detour.
C
The narrow exception日常生活上必要な行為
A listed daily-life act done to the minimum: buying daily necessities, medical treatment, voting, vocational training, caring for a family member needing care. The detour itself is still uncovered, but the commute resumes once back on the route.
3
Three categories
労災の3類型 — READ THE BENEFIT NAME
業務災害 OCCUPATIONAL
複数業務要因災害 MULTIPLE-EMPLOYMENT-FACTOR *
通勤災害 COMMUTING
What is tested
業務遂行性 and 業務起因性.
The combined burden across two or more jobs, assessed as a whole — for a worker no single job would have covered alone.
Whether the movement is 通勤 under Art. 7.
Benefit wording
補償e.g. 療養補償給付, 休業補償給付.
複数事業労働者e.g. 複数事業労働者療養給付.
NEITHER MARKERe.g. 療養給付, 休業給付. Plain names signal a commuting case.
First 3 days
Employer must cover the 3-day waiting period. LSA Art. 76
No employer duty; insurance benefits begin from the 4th day.
No employer duty — the LSA compensation rule does not reach commuting.
4
Four things that are not inputs
四つの「関係ない」 — WHAT DOES NOT AFFECT THE RIGHT
NATIONALITY · 国籍
Irrelevant. A person who works is a worker; coverage does not turn on nationality or even on whether the work was authorised.
LEAVING THE JOB · 退職
Irrelevant. The right to receive benefits is not changed by resignation. Art. 12-5
EMPLOYER’S DENIAL · 会社の不認定
Not required. A claim can be filed without the employer’s certification; the Inspection Office decides. The employer has no standing to challenge a grant. Sup. Ct. 4 Jul 2024
NO ENROLMENT · 未手続
Irrelevant to the worker. Cover exists by operation of law once the business starts (Premiums Collection Act Art. 3); an unfiled employer is billed later, but the worker is still paid.
5
The families of benefit
給付の種類 · AMOUNTS IN A SEPARATE NOTE
療養 MEDICALTreatment for the injury or illness.
休業 ABSENCEFor lost earnings while unable to work, from the 4th day.
傷病 INJURY & ILLNESS PENSIONWhere it has not healed after a set period and is serious.
障害 DISABILITYWhere a disability remains after healing.
遺族 · 葬祭 DEATHSurvivors’ benefit and funeral costs.
介護 CAREWhere constant or occasional nursing care is needed.
6
How a claim actually moves
請求は労働者が行える
THE WORKER CLAIMS
The right to claim belongs to the worker (or survivors), not to the employer. The employer’s role is to certify facts — not to authorise.
IF CERTIFICATION IS REFUSED
The claim can still be submitted. The Inspection Office receives it and, in practice, asks the employer for a written statement of its reasons for refusing.
WHO DECIDES
The Labour Standards Inspection Office — not the employer — determines whether the case is covered.
HEALTH INSURANCE USED BY MISTAKE
Where health insurance paid for what was really a work injury, the treatment is transferred onto 労災; the two do not both cover the same event.
FOUR EQUATIONS THAT DO NOT HOLD成り立たない四つの等式
≠
Off the clock ≠ off the hook 通勤中も労災の対象
≠
The 補償 marker ≠ every category 給付名の識別子は3類型で異なる
≠
Employer’s denial ≠ your denial 会社が認めなくても請求できる
≠
No enrolment ≠ no coverage 未加入でも労働者は保護される
WHAT THIS MEANS FOR YOUR POLICY
“The company hasn’t recognised it as 労災” decides nothing.
Branch first on relation to work: employment / multiple-employer-factor / commuting — three categories, not two. A 業務災害 needs both gates, and passing one is not enough. Model the commute as a state machine on a reasonable route, where a deviation is an off-route flag that only the listed daily-life acts can clear on return. Do not treat nationality, current employment, employer certification, or enrolment status as inputs to the coverage decision — none of them is. And read the benefit name: 補償 marks an employment case, 複数事業労働者 a multiple-employer one, and a plain name a commuting one.
WHO WRITES THESE
Wakana Chiba, Tokutei Sharoushi
Licensed Labor and Social Security Attorney in Japan
Wakana Chiba is a Tokutei Sharoushi — a nationally qualified and registered Labor and Social Security Attorney in Japan. She advises employers on Japanese employment law, workplace rules, working time, employment documentation, and labor and social insurance procedures, translating complex statutory requirements into policies and operations that work in practice.
Legal analysis and review of Japanese primary sources are performed by Wakana Chiba. English terminology is checked against the Japanese Law Translation Database and official MHLW materials. While AI may be used to draft initial texts, all published conclusions have been reviewed by the author.
TSUKURU-HR.COM / GLOBAL · COOKIE POLICY労災保険 = INDUSTRIAL ACCIDENT COMPENSATION INSURANCE · LSA = LABOR STANDARDS ACT 労働基準法 · * DESCRIPTIVE TRANSLATION; THE CURRENT JLT TEXT PREDATES THE 2020 AMENDMENT · AS OF AUGUST 2026 · GENERAL INFORMATION, NOT LEGAL ADVICE
