Workmen’s Compensation policy is the primary solution for employers to safeguard themselves against statutory liabilities to their employees. With a good workmen compensation policy, employers can exhibit their potential to meet the statutory obligations imposed by the workmen’s Compensation Act, 1923. Therefore, must know to make a claim under a workmen compensation policy.
Coverage Offered by Workmen Compensation Policy
The workmen compensation policy covers an employer’s liability to an employee in the event of a workplace accident or illness leading to death or disablement arising out of or during the course of employment. Compensation payable under the policy is laid out as per the terms of the Worker’s Compensation Act, supervised by the Ministry of Labour. The policy covers the below-mentioned consequences –
- Death caused in a workplace accident or due to job-related illnesses
- Permanent total disablement
- Permanent partial disablement
- Temporary (total or partial) disablement
Workmen’s compensation policy provides cover for medical expenses incurred for treating the injured employee and also legal costs incurred by the employer. Click here to read about policy exclusions.
Though the policy works on a ‘no fault’ basis, claiming the benefit from workmen’s compensation policy involves certain procedures. Before the claim process starts, every injured employee needs to be given immediate medical attention. Once the primary aid and immediate medical care are given, a process can be started to claim worker’s compensation.
Workmen compensation claim procedure
The primary medical report is important at the time of filing workmen’s compensation claims. It serves as an official record for injuries sustained and works as a base for workmen compensation payments. However, employees can also seek a second opinion if they are not satisfied with the first one as per the statutes of workmen compensation.
Follow the below-mentioned simple process for claiming benefits of workmen compensation policy:
Notification to employer
The first thing to note when claiming the workmen’s compensation benefits is to inform the employer about the injury or illness. The employee should report the workplace injury or illness caused due to work to the employer as soon as it occurs. Even after seeking medical care and treatment, sometimes employees may have to see a medical practitioner. Within the insurance company’s network as a part of the claim process. The employee needs to give written notice to the employer within the deadline mentioning all the details such as date, time, and place of injury, complete description of the accident or illness. Delayed reporting of claims may lead to claim denial.
To qualify for the claim under workmen compensation, an employee’s illness or injury needs to be job-related. Some of the workmen compensation examples are – slip and fall accidents at work, overexertion, machinery accidents, violence at the workplace accidents at construction zones, etc.
Inform the supervisor
It’s important to inform the supervisor or factory supervisor immediately after the mishap takes place in the factory or manufacturing unit. Delay in reporting to the supervisor can be an impediment in getting claim benefits swiftly.
Gather information
The employer must provide the relevant claim forms and list of documents required for a claim to the employee after the reporting.,. The employee needs to gather information regarding workmen’s compensation benefits and about returning to work. Claim forms may vary depending on the type of illness or injury and the insurance company.
Submission of documents
An employee needs to fill up the relevant claim form, and submit it along with required documents to the employer. The requirement of documents may vary depending on the nature of the claim. Some common documents as required for workmen compensation claims are:
- Duly filled and signed claim form
- Medical reports with details of the injury
- Statement of witnesses
- The medical certificate with details of disablement (cause and anticipated recovery duration)
- Death certificate, in case of death compensation claims
- Post-mortem report
- Memorandum of agreements as per Workmen’s Compensation Act, 1923
First Investigation Report (F.I.R) from police, in case of death claims, etc.
Reporting to workmen compensation commission
On receipt of claim documents, the employer should submit the details of compensation payable to employees to the workmen compensation commission. Thereafter, the workmen compensation commission issues the claim receipt, then needs to submit to the insurance provider.
Inspection of the claim
Once the employer submits all the claim documents to the insurance company, the company will appoint an official to carry out an inspection of the claim. It’s important to co-operate with the investigator by providing all the information needed. Then submit a report to the insurance company post the inspection of the claim.
Approval or rejection of claims
After verification of claim documents submitted and based on the inspection report, the insurance company will accept or deny the claim. In case of claim approval, employees can get compensation for the loss of income, medical and legal costs depending on the compensation terms of the Workmen Compensation Act, 1923. In case, the claim does not qualify and the insurer rejects the claim, the employee can appeal or ask the insurer to review the decision. The workmen’s compensation commission is then informed about the decision.
Employers duty to mitigate accident risks
After an employee returns to work post his recovery, employers need to provide safety training and take preventive care measures to mitigate the risk of accidents.
Despite implementing safety measures and risk control methods, accidents are still unavoidable at the workplace. Workmen’s compensation policy safeguards both employer and employee during such unfortunate mishaps at the workplace. It’s important to know the coverage offered and also exclusions in workmen’s compensation policy before claiming the benefits.
Understanding the claim process helps to expedite the entire process of the claim. To reap the maximum benefits, it’s also important to have the right workmen’s compensation policy. Click here to buy the right workmen’s compensation policy.
