Global incidents of major natural catastrophes are becoming increasingly common in recent years. Seismological research has shown earthquake-prone Japan to be at particular risk from not only inland earthquakes, but also from repeat incidents of major earthquakes such as the Tokai, Tonankai, and Nankai earthquakes. In such an eventuality, earthquake insurance is expected to play a part in ex-post recovery efforts from the damage caused by these earthquakes, with the Japanese government developing special support programs. The previously low penetration rate of earthquake insurance in Japan, however, meant that it did not play a significant role in recovery efforts following the 1995 Great Hanshin-Awaji Earthquake. Despite recent progress in improving the system and an increasing awareness of the risks from earthquakes, the penetration rate of earthquake insurance in Japan remains at approximately 20%. In this study we discuss the current state and issues of earthquake insurance in Japan.