How to file a claim under Workmen Compensation Insurance?

A Workmen’s Compensation policy covers the financial liability of an employer when its employee suffers from any physical injury during the course of his/her employment. The policy helps the employer cover his financial liabilities as stated under the Workmen’s Compensation Act, 1923. Hence, it is important to know how to file a claim under Workmen Compensation Insurance, since it extends coverage to the employer when the workers suffer from any of the below consequences:–

• Death
• Permanent total disablement
• Permanent partial disablement
• Temporary total disablement

Moreover, most Workmen’s Compensation plans also provide coverage for the legal costs incurred by the employer.

Key Takeaways

• Proactive Notification: Don’t wait for a court notice. The insurer should be informed the moment an accident occurs that could potentially lead to a claim.

• The Supervisor’s Role: The first point of truth is the site supervisor. Immediate documentation of the accident scene and contemporaneous witness statements are vital for claim approval.

• Early Legal Support: A unique feature of WC insurance is that the insurer often begins covering legal defense costs and court discussions long before a final award is granted.

• The “Agreement Paper”: In cases of permanent disability, the law requires a formal agreement between the employer and the worker. This document is a non-negotiable requirement for the insurance payout.

• Evidence Hierarchy: For fatal claims, the “Big Four” documents are required: Death Certificate, Post-Mortem Report, Police FIR, and Witness Statements.

• Form A Compliance: All fatal claims must include “Form A” of the Workmen’s Compensation Act, which serves as the official statutory declaration for the claim.

Additional Read – Why do I need Workmen Compensation Policy?

How to register a claim with the Workmen Compensation insurance company?

Employers insured by a workmen compensation policy should follow the below-mentioned steps. The process below is a necessary step to help employers register a claim with their chosen insurance company.

• Inform the insurer if there is an accident that is likely to result in a worker’s claim
• Inform the insurance company if a worker approaches the worker courts for compensation, under any of the regulatory provisions.
• Contact the supervisor present at the premises of a manufacturing facility immediately at the time of the accident. Besides, document the accident circumstances and statements carefully.
• Fill up the claim form and provide relevant documents pertaining to the claim. Submit the claim to your insurance company or broker.
• A notice, if sent by the workmen commission, should be submitted to the insurance company.
• Insurance companies would arrange for an inspection of the claim
• Following the inspection, the inspector would file a report based on which the insurance company would pay the claim.
• Insurers will begin supporting and paying for the costs as the court discusses the case, and much before giving an award.

Additional requirements for registering a claim under the WC Insurance policy

An employer needs to submit all the bills relating to the claim to the insurance company along with the following documents –

• A declaration report
• Any claim-related report required by the insurance company
• All medical bills relating to a disability suffered along with a medical certificate stating the reason for disability and its expected duration.
• In the case of permanent disabilities,  an agreement paper between the employer and disabled workman needs to execute. It is important as per the rules laid down under the Workmen’s Compensation Act. A medical certificate certifying the disability would also be required.
• In case of death of the workman, additional documents would be required by the insurance company such as a copy of the death certificate, a copy of the post-mortem report, witness statements if they are available, a copy of the police FIR.Form A of the Workmen’s Compensation Act which should be filled in and signed either by the insurance company or by the employer

Summary Table: The WC Claim Lifecycle

The right process to file Workmen Compensation Insurance Claim

The employer should follow the claim process properly.  Furthermore, they should submit all the above-mentioned relevant and required documents pertaining to the claim so that the Workmen’s Compensation policy pays the liability faced by the employer. Following the right claim process will ensure that the claim turnaround time is low, and settle the claims at the earliest. Approach your intermediary to seek more information. The advantage of working with an experienced insurance broker is that they will support you through the entire claims process.

Frequently Asked Questions (FAQs)

1. What is the very first thing I should do if a worker is injured on-site?

A) Contact the immediate supervisor and ensure the worker receives medical attention. Simultaneously, take photos of the scene and record statements from anyone who saw the accident. You must then notify your insurance company or broker immediately.

2. Can I settle a claim “out of court” with the worker?

A) While many employers attempt private settlements, for a WC insurance policy to pay out, the settlement usually needs to align with the formulas in the Workmen’s Compensation Act. For permanent disabilities, a formal agreement paper must be executed and submitted to the insurer.

3. Does the insurance company pay the hospital bills directly?

A) Most WC policies work on a reimbursement basis or via the employer’s liability. The employer typically pays the immediate bills and then submits the medical certificates and original invoices to the insurer for recovery of the legal liability.

4. What happens if the worker goes to a “Worker Court” without telling me?

A) If you receive a summons or notice from a Workmen Commission or court, you must forward it to your insurance company immediately. The insurer has a “Duty to Defend” and will provide legal support to manage the proceedings.

5. Why is a Post-Mortem report mandatory for death claims?

A) The insurer needs to confirm that the death was a direct result of the workplace accident and not due to a pre-existing medical condition or an excluded peril (like intoxication). The post-mortem report provides the definitive medical cause of death required by law.

About The Author

Rahul Kumar 

MBA Finance

With a wealth of experience in the insurance industry, Rahul is a seasoned writer specializing in articles related to workmen compensation policies (WC policies) for SecureNow. With 12 years of experience in the field, he has acquired in-depth knowledge and expertise in workmen compensation insurance, understanding its complexities and nuances. Their insightful articles provide valuable insights into the importance of WC policies for businesses and employees alike, offering practical advice and guidance on navigating the intricacies of insurance coverage. Trust him to deliver informative and engaging content, backed by years of experience and a passion for educating readers about insurance-related topics.