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. Since the employee suffers a contingency while in the employment of the employer, the employer is liable to compensate the employee for the injury suffered. A Workmen’s Compensation Policy takes care of this financial liability faced by the employer and pays the employee for the injuries suffered.

There are some instances in which the Workmen’s Compensation Policy does not pay a claim. These instances are called exclusions and if the employee suffers any injury or death due to such instances, the claim would not be admissible under the Workmen’s Compensation Policy. The major exclusions of the policy include the following –

  • Incidents which cause an injury but which are not recognised under the laws and rules of the Workmen’s Compensation Act, 1923
  • An injury, death or disabilities which happen due to war, war-like situations, attacks, invasions, etc. are not covered. This is because such activities are not under the control of the employer and so the employer cannot be held responsible for the associated contingencies
  • Terrorist attacks in the business premises would not be covered. Such attacks are also not under the control of the employer and so the responsibility to compensate the employee for the loss of such attacks is not on the employer
  • If the business hires third party contractors, labourers, consultants, etc. any injury, disability or death caused to such third-party employees would not be covered by the Workmen’s Compensation Policy. This is because of the fact that these employees are not full-time employees of the company
  • Self-attempted injuries and suicide attempts by the employee would not be covered because the policy only covers accidental injuries, not intentional ones
  • If the employee is under the influence of alcohol of drugs due to which he/she suffers an injury, disability or death during the course of employment, no claim would be paid under the Workmen’s Compensation Policy
  • Any type of injury, death or disability suffered by the employee outside of his/her employment would not be covered. This is simply because outside employment, the employer would not be liable for any physical injuries suffered by the employees.
  • If the employer has a contractual agreement with the employee for compensating the employee for specific injuries which might incur during the course of employment and the injury occurs, the Workmen’s Compensation Policy would not pay the claim
  • Injuries which are not fatal are not covered
  • Injuries which do not result in a partial disablement continuing for more than 3 days would not be covered. This means that the injury should result in a partial disablement which should continue for more than 3 days
  • If security devices are intentionally removed or when the employee does not follow safety protocols and then suffers an injury, the injury would not be covered
  • Diseases which are mentioned under Part C of the Workmen’s Compensation Act would not be covered

These are the major exclusions of a Workmen’s Compensation Policy. The policyholders should know these exclusions so that they can know when to make a claim under their policy.