What are the major exclusions under Workmen Compensation Policy?
A Workmen’s Compensation Policy provides financial protection to the employer in case the employee suffers an injury, death, or disability during the course of employment. The employer is liable to compensate the employee when he/she suffers an injury during the course of the employment. A Workmen’s Compensation Policy takes care of this financial liability faced by the employer and pays the employee for the injuries suffered. It covers financial expenses arising due to physical injury, partial or total disability, and occupational diseases of workers while on duty or because of their employment
However, the Workmen’s Compensation Policy excludes some instances from policy benefits. If the employee suffers an injury or death due to some below-mentioned instances then the claim would not be admissible under the Workmen’s Compensation Policy.
Major exclusions of workmen compensation policy
Exclusions of workmen compensation policy are as follows:
Injuries incurred during war and invasion
An injury, death, or disabilities occurring due to war, attacks, invasions, etc. is not the fault of an employer. Hence, the settlement for associated contingencies in case of wars and attacks does not need to be done by the employer.
Injury due to terrorist activity in the office premises
Terrorist attacks in the business premises are not the responsibility of an employer. Hence, he is not liable to compensate the employee for any loss in case of terrorist attacks.
Costs payable to third-parties
The compensation cover excludes costs paid to third parties that are not workers or employees. When hired third-party contractors, laborers, consultants suffer an injury, disability or death then the Workmen’s Compensation Policy would not provide the coverage. This is because these employees are not full-time employees of the company.
Attempt to suicide or self-harm
The policy does not cover self-attempted injuries and suicide attempts by the employee. It only covers accidental injuries, not intentional ones.
Injury suffered when intoxication
Similarly, injuries or disabilities suffered during working hours under the influence of drugs or liquor is inadmissible under the WC policy.
Injuries Suffered Outside Work are also excluded.
Any type of injury, death or disability of an employee outside of his/her employment is excluded from the policy coverage. The employer is not liable for any physical injuries suffered by the employees, outside of work.
Compensation for Injuries Payable by the Employer under an Agreement
Some businesses enter a contractual agreement, while hiring workers, to compensate them for specific injuries that may occur during their employment. The workmen policy will not settle the claim and make payments if these are through a contractual obligation. One such benefit is a contractual death benefit. This is typically insured through other products such as a group term life.
- Routine injuries falling under the minor category
- The Workmen Compensation act, 1923 does not recognise some potentially injury-causing incidents and hence these are excluded
- The policy excludes injuries not causing partial disablement but continuing for more than 3 days. Hence, the injury should result in a partial disablement and continue for more than 3 days for getting policy benefit.
- The employer is not responsible to pay in case of failure on part of the employees to follow safety protocols
- The policy does not cover diseases as mentioned under Part C of the Workmen’s Compensation Act
- Incidents causing an injury but not recognised under the laws and rules of the Workmen’s Compensation Act, 1923.
These items above are the major exclusions of a Workmen Compensation Policy. The policyholders should know these exclusions so that they can know when to make a claim under their policy.