NAATI CCL Japanese Insurance & Claims Practice Dialogues — Worked Examples

Good afternoon. I'm calling about the car accident claim you submitted online yesterday.

はい。事故は2日前に起きて、車が運転できない状態です。修理中の代車は提供されますか？

Your policy includes rental car cover. You're covered for up to eighty dollars a day for a maximum of fourteen days. You can go directly to an authorised rental company.

事故の過失割合はどうなりますか？相手が赤信号を無視したのですが。

A police report and dashcam footage make it easier to establish fault. If the other party is at fault, their insurer covers your costs including repairs and the rental car.

ダッシュカメラの映像はありますが、警察の報告書はまだです。

Police reports take two to four weeks. Meanwhile, back up your dashcam footage — save copies to your computer and email them to yourself as a backup.

車が全損の場合はどうなりますか？

If repair cost exceeds the car's market value, it's classified as a total loss. You'd receive the market value minus the excess, and the car becomes the insurer's property.

ケガの治療費もカバーされますか？首が痛いです。

Yes, your policy includes up to five thousand in personal injury cover. See a doctor and keep all receipts and medical reports. These are needed for the injury claim.

明日医者に行って、認定修理工場にも車を持っていきます。ダッシュカメラの映像はバックアップしました。

Good morning. I'm the claims assessor. I'm here to inspect the storm damage you reported.

はい、どうぞ。木の枝が落ちて屋根が壊れ、水が室内に入ってきました。リビングの天井と壁紙が損傷しています。

I'll photograph and document the extent of the damage. Was any furniture or electronics damaged?

ソファが水でぬれて使えなくなりました。テレビも水がかかって壊れました。

Contents are covered under your contents insurance. Whether you receive the replacement value or a brand-new item depends on the type of policy. Do you have purchase receipts or credit card statements?

ソファは3年前に2,000ドルで購入して領収書があります。テレビは1年前に1,500ドルでカードで買いました。

Your policy is a new-for-old type. That means you're paid the cost of replacing the item with an equivalent new one, not its current market value. That's very favourable for you.

エクセス（自己負担額）はいくらですか？

The excess for storm damage is five hundred dollars. However, the roof, furniture, and television are separate claims. Total payout depends on individual item assessments.

修理にはどのくらい時間がかかりますか？

Roof repairs usually take one to two weeks, but after a major storm there's high demand. I'll prioritise an emergency tarp to prevent further water damage in the meantime.

認定業者をお願いします。できるだけ早く修理を始めたいです。雨が降る前に屋根だけでも直してほしいです。

Welcome. You're thinking about upgrading your health insurance. What prompted this?

妻が妊娠中で、現在のプランでは妊娠やプライベート病院がカバーされないことに気づきました。

An important point — private hospital pregnancy cover usually has a twelve-month waiting period. That means even if you upgrade now, it may not apply to this pregnancy.

それは知りませんでした。それでも公立病院で出産はカバーされますか？

Under Medicare, childbirth in a public hospital is fully covered. Even without private insurance, you'll receive good medical care. Private only adds a choice of doctor and room.

将来の妊娠に備えてアップグレードする価値はありますか？

If you're planning a private hospital birth in future, upgrading now starts the waiting period. Most insurers have a twelve-month wait for pregnancy-related claims.

メディケアリベートとは何ですか？

The government rebate covers part of your premium. The rate depends on your income and age. Lower income earners receive a higher rebate — up to about twenty-five per cent.

歯科と眼科もカバーしたいです。

Dental and optical are included in extras cover. Bundling extras with hospital cover gives you a discount. Compare the annual limits and waiting periods to choose the best plan.

公立で出産して、将来に備えてアップグレードします。歯科と眼科も含めたプランの見積もりをお願いします。

You're calling about a medical expenses claim from an overseas trip. Can I have your policy number?

残念ですが、バリで食中毒になり病院に運ばれました。何が起きたか説明して、ポリシー番号を確認していいですか？

I'm sorry to hear that. Let me check your policy's medical cover limit. Your plan covers up to fifty thousand dollars in overseas medical expenses per trip.

病院で4,000ドルを自分で払いました。返金されますか？

Yes, once you submit the receipts and medical records, you'll be reimbursed. For overseas emergency medical treatment, the excess often doesn't apply. Your policy waives the excess for emergency hospitalisation.

帰国便を変更する必要がありました。フライトの変更費用もカバーされますか？

If the flight was changed for medical reasons, the change fee and fare difference are covered. A medical certificate confirming you were unfit to fly is required.

請求の手続きはどうすればいいですか？

Complete the claim form online and upload the receipts, medical records, doctor's certificate, and flight change receipt. Once all documents are submitted, reimbursement usually takes ten to fifteen business days.

旅行保険は毎回買うべきですか？それとも年間プランの方がお得ですか？

If you travel overseas more than twice a year, an annual plan is better value. A single-trip policy costs about a hundred and fifty, while an annual plan is around three hundred.

今後は年間プランにします。今回の請求書類を今日中にオンラインで提出します。

Good afternoon. Your car insurance renewal is due next week. I'm calling to review the renewal details.

はい、3年間お世話になっています。でも更新の保険料が去年より高いようです。なぜですか？

Premiums are recalculated annually based on your car's market value, rising repair costs, changes in accident rates, and the risk profile of your address. This year, repair costs have risen across the board.

保険料を下げる方法はありますか？

There are several options. Increasing your excess lowers the premium. Raising it from five hundred to one thousand dollars saves about a hundred and fifty per year. There are also low-kilometre plans and dashcam discounts.

エクセスを上げるリスクは何ですか？

Higher excess means lower premium but more out of pocket at claim time. With a thousand-dollar excess, even a minor repair like a bumper costs you the full thousand first.

他の保険会社と比較した方がいいですか？

Yes, I'd recommend comparing. Use comparison websites to get quotes from other companies, then come back and negotiate with us. Also check whether your long-term customer discount and no-claims bonus will carry over.

ノークレームボーナスとは何ですか？

Your premium is discounted based on claim-free years. You've had three claim-free years, giving you a good discount. Making a claim would reset it to zero.

比較してから決めます。ノークレームボーナスの証明書を発行してください。

You're enquiring about life insurance. Can you tell me about your family situation and what you're looking to achieve?

妻と第一子が生まれたばかりです。もし私に何かあった場合、家族が経済的に守られるようにしたいです。

Excellent decision. There are several types — term life covers a set period, total and permanent disability, and trauma cover for critical illness. Which interests you most?

いくらの保障が必要ですか？どうやって計算しますか？

A guide is to add up your mortgage, living costs until your child is independent, education costs, and any debts. For most young families, one to one and a half million is common.

月々の保険料はいくらですか？

For someone in their early thirties, non-smoker, office job, one and a half million in term cover costs around sixty to eighty dollars per month. Premiums increase with age.

スーパーを通じた保険は安いと聞きましたが。

Yes, premiums can be deducted from super so they don't affect take-home pay. However, this reduces your retirement savings over time. It's worth comparing both options.

受取人の指定はどうすればいいですか？

You nominate the beneficiary when applying. Naming your spouse is most common. You can also name a trust for minor children so the payout is managed until they're adults.

定期保険とスーパーの保険を組み合わせて検討します。家族を守るために、正しい選択をしたいです。

You've submitted an income protection claim for medical reasons. Can you tell me about the situation?

3か月前に重度のうつ病と不安障害と診断されました。精神科医が当面仕事ができないと判断しています。

Mental health conditions are covered by income protection insurance. Under your policy, after a thirty-day waiting period, you'll receive seventy-five per cent of your monthly salary for up to two years.

支払いはいつから始まりますか？すでに3か月仕事を休んでいます。

Once approved, payments are backdated to day thirty-one. Since you've been off for two months, you'd receive a lump sum for the period after the waiting period.

仕事に復帰できるようになったら支払いは止まりますか？パートタイムから始めたいのですが。

We support gradual return. If you return part-time, the policy pays the difference between your part-time income and your pre-disability income. This makes the transition easier.

必要な書類は何ですか？

You'll need a psychiatrist's diagnosis, treatment plan, certificate of incapacity, payslips showing lost income, and a letter from your employer confirming your absence.

精神的な健康の理由で請求が却下されることはありますか？

Mental health claims aren't automatically rejected. However, pre-existing conditions at the time of taking out the policy must be disclosed. Non-disclosure could void the claim.

書類を集めて今週中に提出します。サポートに感謝します。