The Workmen’s Compensation Insurance Policy provides coverage for an employer’s legal liability to compensate employees for bodily injury or death resulting from accidents or occupational diseases occurring during their employment. This insurance serves as the primary means for employers to fulfill their obligations under worker’s compensation statutes. It offers compensation as outlined in the Workmen’s Compensation Act of India, overseen by the Ministry of Labor.

Scope

This policy covers the employer’s legal liability under the Workmen’s Compensation Act to pay compensation to workers not covered by the Employee State Insurance Act (E.S.I.) for injuries or diseases sustained during employment. It provides indemnity under:

  • Table ‘A’: Covers legal liability to all employees (whether or not classified as “Workmen”) under the Workmen’s Compensation Act, 1923, its amendments, the Fatal Accidents Act, 1855, and Common Law.
  • Table ‘B’: Provides indemnity against legal liability under the Fatal Accidents Act, 1855, and Common Law (Note: Table ‘B’ policies do not cover employees defined as “Workmen” under the Workmen’s Compensation Act, 1923).

Key Benefits

The Workmen’s Compensation Insurance Policy offers legal liability coverage for compensating employees for bodily injuries or death caused by accidents or occupational diseases that occur in the course of their employment. It ensures employers can meet the requirements of the worker’s compensation laws and provides compensation as per the Workmen’s Compensation Act of India, regulated by the Ministry of Labor.

Advantages to the Employer
It’s important to note that when a workman files a claim before the Workmen’s Compensation Commissioner for damages related to their injury, they cannot later file a civil lawsuit against the employer. Likewise, if the workman pursues a claim under common law, they cannot claim compensation under the Workmen’s Compensation Act. The workman must choose their preferred legal recourse, either through the statutory scheme or common law.

Coverages

  • Death
  • Permanent total disablement
  • Permanent partial disablement
  • Temporary disablement
  • Legal costs and expenses, with the company’s consent

Add-on Covers

  • Actual medical, surgical, and hospital expenses, including the cost of transportation to the hospital, for accidental employment injuries.
  • Compensation for diseases listed in Part ‘C’ of Schedule III of the Workmen’s Compensation Act, 1923, that arise out of and in the course of employment.

Exclusions

  • Injuries caused by accidents or diseases directly attributable to war and nuclear risks.
  • The insured’s liability to employees of contractors unless separately declared and covered.
  • Liability assumed by the insured under an agreement.
  • Diseases mentioned in Part ‘C’ of Schedule III of the Workmen’s Compensation Act, 1923.
  • Any changes in statutory provisions after the policy has commenced.
  • Injuries caused by the influence of alcohol or drugs.
  • Willful disobedience of safety orders intended to protect the workman.
  • Willful removal or disregard of safety devices or guards.
  • Occupational diseases not covered by the policy.

Compensation

  • In the event of death due to employment-related injuries: 50% of the deceased workman’s monthly compensation multiplied by the applicable age factor.
  • In the case of permanent total disablement resulting from an employment injury: 60% of the monthly workman’s compensation multiplied by the applicable age factor.

Claim Process

In the event of a claim, the following steps should be taken immediately:

  • Notify the insurer of the loss, provide a full written statement of the claim, detailing the nature and extent of the loss, and include an estimate of the damage. Delays in notifying the insurer may jeopardize the claim, as they may refuse to accept liability for the loss/damage.
  • Take all necessary actions to reduce the loss/damage and liability.
  • Identify the proximate cause of the loss and assess its type and extent to ensure it falls within the policy’s scope.
  • Provide full cooperation to the insurer for a thorough loss assessment.
  • Submit any required records and proof, as requested by the insurer, to determine the extent of the loss and liability under the policy.
  • Provide necessary documents such as the claim form, policy copy, Workmen’s Compensation Award letter, and incident report.