The Insurer’s liability under Worker Compensation Insurance in the case of occupational disease is defined as per Common Law or the Workers Compensation Act 1923. As per the Act, an occupational disease is defined as a disease which a worker has been inflicted with while in service of the employer. It should be proven, though, that the disease contracted is related to the occupation of the worker. If the worker has been working with the insured for a continuous period of 6 months, the insured is liable to pay compensation to the worker if the latter has been inflicted by a disease related to the work or work environment.
Examples of occupational diseases which fall under this policy are=
- Bronchopulmonary disease which has been caused by flax, hemp and sisal dust (Byssinosis)
- Skin diseases which have been caused by physical, chemical or biological agents and
- Occupational asthma which has been caused by recognized sensitizing agents which are inherent to the work process.
The insured will also be liable for compensation in case the worker had a disease before any injury at work, and this disease has been aggravated due to work environment or work-related cause.
The insured will not be able to defend himself on the basis that the worker had the disease prior to working with him. In order to determine the compensation to be paid, the wages amount to be taken into consideration should be the wages given to the worker at the time of termination of employment of the latter or at the time of approaching the insurer and not on the date the occupational disease has been proven to have been contracted.
For the last five years, Mr. Jeevan Saran was working with T.S Electrical Company as a senior electrician. His job duty included welding of different electrical parts.
However, from the past few months, he was experiencing breathing issues and constant coughing problems. When the situation deteriorated further, he went to his doctor for treatment. At the hospital, medical tests were conducted on him. The blood test report indicated exposure to isocyanates, which develop in welding fumes— a well-known cause of occupational asthma.
The doctor prescribed some medicines and suggested a one-week bed rest. Jeevan informed his manager about his medical condition and asked for seven days leave, which was granted to him.
When Jeevan re-joined the office, his manager advised him to approach the workmen compensation insurance policy to get compensation. As his disease was an occupational ailment, it came under the purview of workmen compensation insurance policy.
In this case, Jeevan filed the claim under workmen compensation insurance and asked the insurer to compensate him for the medical expenses of asthma which occurred because of his occupation. Upon receiving the claim intimation, the workmen compensation insurer asked for the complete account of the ailment along with the doctor’s report to prove that the asthma was actually associated with his job.
T.S Electrical Company always asks for a medical test report from its new employees. It is done to ensure the job applicant is physically fit for working in the electrical company. Jeevan also submitted the medical report at the time of joining the company.
The workman’s compensation insurance company asked for the medical report of Jeevan, which he submitted at the time of joining the company. The report was required because the insurer wanted to confirm that asthma was not the pre-existing ailment.
The HR division of T.S Electrical Company provided Jeevan’s medical report to the insurer.
Now the insurer had all the important documents related to the claim, which its claim department thoroughly inspected and verified. Once it was ascertained that the claim was related to an ailment which the insured developed during working hours, the insurer agreed to settle the claim accordingly.
The insurer approached T.S Electrical Company to know the salary of Jeevan. At the time when Jeevan visited the doctor for the treatment, he was earning Rs 8,000/month. By the time he reported the claim, his salary was increased to Rs 10,000/month due to an appraisal which was pending for the last few months.
Now, the workers’ compensation insurance company considered the revised salary of Jeevan, i.e., Rs 50,000 and settled the claim on the basis of it.