Chapter XII Application for Examination

①A person that is dissatisfied with the action executed concerning an Insurance Benefit (including the action pertaining to a request for issuance of a Certificate of Insured Person and action concerning a Certification of Needed Long-Term Care or Needed Support Certification) or an action concerning an insurance premium and other levies pursuant to the provisions of this Act (except for a Fiscal Stability Fund contribution, payment and delinquent charge as prescribed in Article 157, paragraph (1)), may apply to a Certification Committee for Long-Term Care Insurance for an examination.

②An application for examination as referred to in the preceding paragraph shall be deemed to be a judicial claim in terms of postponement of the completion and renewal of prescription.

A Certification Committee for Long-Term Care Insurance (hereinafter referred to as "Certification Committee for Insurance") is to be organized in each prefecture.

①A Certification Committee for Insurance is to be comprised of groups of committee members as listed in each of following items and said fixed number is the number provided by said each item:

②A committee member is appointed by the prefectural governor.

③A committee member is part-time.

①The term of a committee member is to be three years, however, provided that the term of a member filling a vacancy is for the duration of the remaining term of said predecessor.

②A committee member may be reappointed.

①A Certification Committee for Insurance is to have one chairperson that is elected by the committee members, from among the committee members representing the public interest.

②In the event that a chairperson becomes unable to serve, a member that has been elected in accordance with the provisions as set forth in the preceding paragraph performs the duties of the chairperson.

①Expert investigators may be appointed to a Certification Committee for Insurance in order for said expert to investigate special matters concerning a case of an application for examination of action executed concerning a Certification of Needed Long-Term Care or a Certification of Needed Support.

②Expert investigators shall be appointed by a prefectural governor from among persons with relevant knowledge and experience concerning the health, medical care, or public aid of an Insured Person Requiring Long-Term Care, etc.

③Expert investigators are part-time.

①A Certification Committee for Insurance is a council consisting of two (2) members, and selected for appointment to said Certification Committee for Insurance from among the chairperson, all the members representing Insured Persons and members representing Municipalities, and from among the members representing the public interest except for the chairperson, and administers the cases of application for examination (except for those cases requiring action concerning Certification of Needed Long-Term Care or Certification of Needed Support).

②A case of an application for examination regarding an action concerning Certification of Needed Long-Term Care or Certification of Needed Support is to be administered by a council consisting of persons designated by the Certification Committee for Insurance from among the members representing the public interest.

③The fixed number of members constituting the council referred to in the preceding paragraph is the number specified by Prefectural Ordinance.

①A council as set forth in paragraph (1) of the preceding Article may not conduct a meeting nor make any decisions without the attendance of a majority of members including one or more member representing Insured Persons, a member representing Municipalities, and a member representing the public interest respectively, and a council as set forth in paragraph (2) may not conduct a meeting nor make any decisions without the attendance of all members that comprise said council.

②A decision of a council as set forth in paragraph (1) of the preceding Article is determined by a majority of the members present, and in case of a tie vote, matters are decided by the chairperson.

③A decision of a council as set forth in paragraph (2) of the preceding Article is decided by a majority of the members who constitute said council.

①An application for examination must be conducted by a Certification Committee for Insurance of the prefecture that includes the area of the Municipality that executed the action for said matter.

②In a case that a Certification Committee for Insurance lacks jurisdiction in the matters of an application for examination, the Committee must immediately transfer said case to the competent Certification Committee for Insurance and provide notification of said fact to said applicant of said examination.

③When a case is transferred, it is deemed that said application for examination was submitted originally to the Certification Committee for Insurance that accepts said transfer.

An application for examination must be requested with a document or orally within three months from the day following the date when the applicant learns that the action regarding a matter was executed, however, provided that this provision does not apply to a case when there is prima facie evidence to prove that said application for examination was not submitted within said period due to justifiable cause.

A Certification Committee for Insurance, when an application for examination has been filed, except in the case where it dismisses that application for examination pursuant to the provisions of Article 24 of the Administrative Complaint Review Act, must notify the Municipality that executed the original action and other interested persons.

①A Certification Committee for Insurance, when it determines necessary to conduct proceedings, may request reports or opinions of the person requesting said examination or other relevant person, order to appear and conduct hearings, or direct a physician or other person appointed by said Certification Committee for Insurance (referred to as "Physician, etc." in the following paragraph) to conduct a diagnosis or other investigations.

②A prefecture must pay the travel expenses, a daily allowance, and accommodation charges, or pay remuneration, pursuant to the provisions of a Cabinet Order, to said relevant person that appears before said Certification Committee for Insurance pursuant to the provisions of the preceding paragraph or Physician, etc., that conducted said diagnosis or other investigation.

In addition to those items as prescribed in this Chapter or in the Administrative Complaint Review Act, other necessary matters and procedures of an application for examination and a Certification Committee for Insurance are determined by a Cabinet Order.

An action of rescission or disposition of a matter as prescribed in Article 183, paragraph (1) may not be filed until a ruling with regard to the application for examination pertaining to said disposition of a matter has been determined.