A work compensation policy is an insurance mandated by the government for employers to ensure the well-being of their employees or workers. This insurance is beneficial for both employers and employees. It gives financial protection to employers against the statutory liabilities that may arise from claims related to workplace accidents. The policy compensates the employees for the loss when they suffer injury, death, or disability due to a workplace accident as per the provisions of the Workmen Compensation Act, 1923.
How does workers’ compensation insurance work?
Workplace accident insurance provides coverage for medical benefits, death compensation, and wage replacement to disabled workers when the loss is caused due to workplace accidents or illnesses. As per Workmen Compensation Act, 1923 the employer is held responsible for the loss suffered by employees in workplace accident. When the insured event occurs, the worker can make a claim. The insurance company assists the employer in fulfilling statutory obligations. They compensate for the worker’s claim.
For example, let us say a construction worker injures his back and suffers temporary disability as he falls off the ladder while working at a construction site. In this case, the work compensation policy online compensates the employee for the treatment of injury along with wage replacement benefits as per the provisions of the workmen compensation law.
However, work compensation policy claims can sometimes get denied for various reasons. It is important to understand the factors that adversely impact the work injury compensation insurance claims to avoid rejection. Let us understand the factors:
Delay in reporting the injury
Delayed reporting of injury at the workplace can lead to denial of work compensation policy claims on the grounds of the seriousness of the injury suffered. Insurance companies may raise a question on delayed reporting of workplace accidents that lead to injury while validating the claim. This can also make claim apprehensive ultimately leading to rejection. Hence, it is crucial to report the incident as soon as it occurs.
Inadequate paperwork
The claim process involves paperwork that supports the unforeseen event. Incomplete documentation or not meeting the compliance deadline can lead to claim rejections. For example, missing important medical documents can result in a claim application rejection and can delay the process of settlement. However, submitting the paperwork on time with complete details does not give complete assurance of claim approval. You can only reduce the chances of denial.
Authenticity of the claim in work compensation policy
The authenticity of the claim is an important factor in a work compensation policy. Medical records and the proofs play a major role. Proof includes photos of the incident, witness statement, etc. that proves the authenticity of the claim.
Treatment from non-authorized centres
If the employees get treatment from medical centres that are not authorized by the insurance companies, the claim may not get processed. The claim can also get delayed in cases of the treatment that is received from medical centres that are not authorized by the insurance company. However, work compensation policy claims are approved for treatments from unauthorized centres only in cases of emergency treatments.
Pre-existing conditions in Work Compensation Policy
In case employees claim compensation for injuries that pre-existed even before the workplace accident or in case of aggravation of pre-existing injuries, the claim might get rejected. The insurance company may counter the claim for such pre-existing conditions.
Dispute claim by employer
Employers can also dispute the work compensation claims if they believe the injury is not serious, it is a pre-existing injury, or for any other reasons. In such cases, the work compensation policy claim may be impacted negatively.
Inconsistent statements
Inconsistency in the claim statement and the medical record can also negatively impact the work compensation policy claims.
Apart from these factors, the influence of alcohol and not following safety rules, can also adversely affect workmen’s compensation claims. It’s also important to seek the help of a Workmen’s compensation attorney for a smooth settlement of the claim process.
Conclusion
To sum up, work compensation policy plays a crucial role in keeping up business continuity and maintaining the well-being of the workforce. Understanding the factors that affect work compensation claims can help in a smooth and hassle-free claim process.
