Medical expenses cover can be included as an add-on in the workmen compensation insurance policy. Different insurers define the limit of medical benefit in different manners. Some of them are given below:
- A fixed sum (per case) daily for the duration of hospitalization
- 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 cost of transportation to the hospital.
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The medical cover offered under workmen compensation policy 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.
The normal workweek for Mehak was from 9 a.m to 6 p.m. From last two years; she was working with M.J Manufacturers as a product manager. The company had its office situated in Mumbai as well. For the welfare of employees, the company was offering various benefits like paid vacation, free cab, free meal, etc. Considering its business activities, the company had also bought workmen compensation insurance policy as well to cover the legal liability that may arise in case any of its workers is injured at the workplace or contract an occupational ailment.
Last year, Mehak had to travel to Chennai where the company had recently opened its factory. Upon reaching Chennai, Mehak directly went to the factory to inspect products and services. However, while inspecting the products, she fell on a machine when her feet got tangled in a wire which was kept there. Her fingers came between the machine. The accident was so severe that her fingers got crashed under the machine. She was rushed to the nearby hospital from where she was rushed to one of the leading hospitals in Chennai.
Unfortunately, Mehak lost her fingers in the accident. The employees at 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 policy. The employer was legally liable to pay coverage to Mehak and here the workmen compensation insurance helped.
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Upon receiving the intimation about the accident, the worker’s compensation insurance company asked for documents like duly filled claim form, medical prescription, doctor’s bill, etc. Once satisfied with the documents, the insurer agreed to settle the claim.
Here the insurer offered the following coverages –
- 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 Mehak to hospitals i.e.; expenses on taking to the first hospital and expenses on transporting her taking to the second hospital.
- Medical Expenses – Whatever expenses incurred on the treatment of Mehak in both the hospitals, the insurer came forward to cover them as well. 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. 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 workmen compensation insurance policy as the insurer covered most of the expenses. Not only medical expenses, but the insurer also covered other expenses as well. Without the insurance policy, it would have been difficult for the company.
Remember, the insurer covered medical expenses because the accident occurred at a workplace during working hours.