Workmen Compensation

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A worker’s compensation policy applies to accident-related bodily injury or illness due to work. To avail of the benefit of this type of policy, it is important that the worker should have suffered bodily injury or an accident during the policy period. A workmen compensation policy covers the pre-hospitalization charges and the post hospitalization charges of the insured.

When an insured worker or employee is hospitalized for an injury or illness, the major part of the treatment is usually completed during his hospitalization period.

However, some part of the treatment can extend to beyond the period of hospitalization. There are hence usually  expenses incurred on the treatment after the patient is discharged from the hospital. The post hospitalization charges in a workmen compensation insurance policy include the charges that a worker or an employee incurs for regaining wellness against his illness or injury.

The post hospitalization charges in a worker compensation insurance may be determined by:

  • Asserting the cause for the post hospitalization expense
  • Determining the period in which these expenses were incurred after hospitalization of the person

Majority of the post hospitalization expenses incurred in a worker compensation insurance policy are:

  • Medicines prescribed by the consulting doctor
  • Follow-up-visits to the consulting doctor or physician
  • Regular test needed to be conducted for monitoring the progress or the recovery of the patient

While determining the validity of the post hospitalization expenses, it is essential to determine whether the expense is payable according to the policy defined period. To recover the post hospitalization expenses the time limit is 60 to 90 days after hospitalization.

It is essential to understand that expenses related to therapies like acupuncture and naturopathy are not covered by insurance providers under post hospitalization expenses. Insurers will only cover diagnostic charges, consulting fees and medicine costs.

Additional Read: What Are the Different Type of Medical Expenses Covered Under A Workmen Compensation Policy?

The workmen compensation insurance company will require the following documents to cover the post hospitalization expenses incurred by the insured:

  • Copy of the discharge summary with respect to hospitalization
  • Any prescriptions given by the physician for investigations and medication purpose
  • Bills for all the relevant medical prescriptions
  • Bills for any relevant tests or investigation conducted

Case Study:

Ashish, a 34 year, individual worked in a service company. His job required him to work in shifts. During one of his general shifts, he slipped on a wet floor and injured his back severely. After being hospitalized his treatment began immediately. His reports showed that he had damaged his lumbar vertebrae. He was hospitalized for 15 days. Upon recovery, he was discharged from the hospital. However, he was prescribed various medicines and tests by his consulting physician.

Ashish had to get routine check-ups done to investigate his recovery. He also had to take out an x-ray of his spinal cord to assess the recovery of the injury.

Ashish contacted his employer to get benefit from his workmen compensation policy. The insurers surveyed the matter and found that:

  • Ashish was a permanent employee of the service company.
  • He had slipped on the wet floor during his service hours
  • Ashish informed the insurance company within the period of 60 days
  • He provided the bills for his medical prescriptions as well as his x-ray examinations
  • He provided the discharge summary with respect to his hospitalization
  • He provided the bills for his follow-up-checks with the consulting physician

Since Ashish had adhered to all the requirements to get his post hospitalization coverage, the claim was settled by the insurers successfully.

Additional Read: When to File Claim Application under Workmen Compensation Insurance?

If Ashish had also claimed insurance for any other medical charges which did not deal with his back injury took place in his working premises, he would not have got that benefit from the insurance company.