Under a workmen compensation insurance policy, a buyer can purchase medical expenses cover as an add-on. 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.
Some insurers apply the fixed sum while a maximum sum insured is compulsorily defined. Other insurers do 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 originates from occupational hazards.
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 am to 6 pm. 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 on inspection, she fell when her feet entangled in a wire running past a machine near her. Her fingers came under the machine and got crushed. The management took her to a nearby hospital but she was shifted from there to one of the leading hospitals in Chennai later.
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 intimation about the accident, the insurance companyasked 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 –
- Transportation expenses – Mehak was treated at a nearby hospital immediately after the accident. Later, she got medical treatment ata big hospital. The insurer covered the transportation expenses incurred while taking her to hospitals i.e.; expenses on taking to the first hospital and expenses on transporting her to the second hospital.
- 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.
- 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. The insurer offered disability benefits thus providing cover for loss of income since it was a case of permanent partial disability.
Here, M.J Manufacturers saved itself by buying a workmen compensation insurance policy as the insurer covered most of the expenses. It covered not only the medical expenses, but also paid for otherexpenses.. Without the insurance policy, it would have been difficult for the company. Although, the courts determine the liability, in this case the insurer -MJ Manufacturers and Mehak agreed to a settlement without going through the legal process.
Remember, the insurer covered Mehak’s medical expenses because the accident occurred at a workplace during working hours.
Get medical cover
Hence, taking medical cover as an add-on to the workmen compensation policy is a wise thing to do for employers. It saves you from incurring heavy financial and medical liabilities. Incurring the huge medical expenses of employees also helps build strong goodwill in the market and adds value to the organization.
Know the different types of medical expenses covered as part of workmen compensation policy. Choose the right one with the help of an expert insurance consultant.