Medical expenses cover can be included as an add-on in a workmen compensation insurance policy. Different insurers define the limit of medical benefits differently. Some of these options are:

  • A fixed sum (per case) daily, for the duration of hospitalization
  • The actual amount spent up to the total sum insured as defined at the time of purchase

While a maximum sum insured is compulsorily defined, some insurers may apply the fixed sum. Other insurers may even cover surgical procedures and the cost of transportation to the hospital.

The medical expenses offered under workmen compensation insurance coverage is not a general group health cover. It will only compensate for medical expenses if the injury or cause of sickness is originating from occupational hazards.

Case

Mehak was working for the last two years with M/s M.J Manufacturers as a product manager. The normal workweek for Mehak was from 9 a.m to 6 p.m. The company had its office situated in Mumbai. For the welfare of employees, the company offers various benefits like paid vacation, free cab, a free meal, etc. Considering its business activities, the company had also bought a workmen compensation insurance policy to cover any legal liability in case any of its workers get injured at the workplace or contracted an occupational ailment.

Last year, she had to travel to Chennai where the company had recently opened its factory. Upon reaching Chennai, she directly went to the factory to inspect products and services. However, while inspecting the products, she fell when her feet got entangled in a wire which ran past a machine near her. Her fingers were caught in the machine and they got crushed. She was rushed to the nearby hospital from where she was taken to one of the leading hospitals in Chennai.

Unfortunately, Mehak lost her fingers in the accident. The employees at the Chennai office informed the HR department of the company. As the accident took place during the working hours, M.J Manufacturers agreed to cover the expenses. In this situation, the accident fell within the purview of the worker’s compensation insurance. The employer was legally liable to pay coverage to Mehak and here the workmen compensation insurance helped.

Upon receiving the intimation about the accident, the insurance company asked for claim documents such as a duly filled claim form, the medical prescription, doctor’s and hospital bills, etc. Once satisfied with the documents, the insurer agreed to settle the claim.

Here the insurer offered the following coverages –

  1. Transportation Expenses – Mehak was taken to a nearby hospital immediately after the accident. From there, she was taken to the big hospital. In this situation, the insurer covered the transportation expenses which were incurred while taking her to hospitals i.e.; expenses on taking to the first hospital and expenses on transporting her to the second hospital.
  2. Medical Expenses – Whatever expenses incurred on the treatment in both the hospitals, the insurer covered them. Here the medical expenses were around Rs 50,000; the insurer settled those expenses also. It included surgical expenses as well. The insurer scrutinized medical bills before settling the claim.
  3. Disability – As Mehak had lost her fingers in the accident, the insurer paid disability benefits as well. Here the insurer asked for her salary slip to compute the disability benefits. As it was the permanent disability, the insurer paid disability benefits along with covering her for loss of income.

Here, M.J Manufacturers saved itself by buying a workmen compensation insurance policy as the insurer covered most of the expenses. Not only were medical expenses covered, but the insurer covered other expenses as well. Without the insurance policy, it would have been difficult for the company.

Remember, the insurer covered Mehak’s medical expenses because the accident occurred at a workplace during working hours.