How to file a claim under WC policy?

How to file a claim under WC policy?

The Workers’ compensation law mandates all companies and organisation that fall under the workmen compensation act to abide by the rules and provide WC plan to their employee. A workmen compensation insurance plan is specially designed insurance that caters to the workplace against accidents or injuries. The plan provides cover to employers/business owners and compensates them in the unfortunate event of any injury, accident or occupational diseases.

To understand what the policy covers, read the inclusions and exclusions in WC policy

documents in workmen compensationDocuments Required

To avail the workmen compensation insurance policy, the following are some of the primary documents that the employer or relatives of employees need to provide.

  • A proposal form for the claims
  • Any reports and investigation report that the insurer requires
  • A declaration form to be signed and filled up
  • Supporting documents as requested by the insurer

steps in workmen's compensation policyThe process

Should the worst happen and an employee meets with an accident or injures themselves during the working hours, they need to claim their WC insurance plan. The entire process is as follows

  • The insurer must be informed about the accident, be it disability of the employee or the death of an employee.
  • If the incident takes place in a manufacturing unit or factory, the factory inspector or supervisor must be informed of the same.
  • Any supporting documents or other relevant information should be provided to the insurer. Depending on the plan and also the type of industry in question, you might have to file a first information report with the nearest police station. In such an event, a copy of the same must be provided to the insurer.
  • Reach out to the workmen compensation commission and deposit the compensation claim that the employee is entitled to. The commission would provide you with a receipt of the claim, the same must be passed on to the insurer.
  • At times, the WC commissioner might send some notice to the employee or the employer, the same must be handed over to the insurance company.
  • Insurance companies usually have investigators to look over the claims, you might need to cooperate with the investigator.
  • You would need to submit the following documents
    • Claims form that if filled up and signed
    • Bills pertaining to the claims

Apart from the general documentation mentioned above, specific cases might need additional documentation. On furnishing that additional documentation, you can proceed with the claims for WC insurance plan. The following are the additional documents required for specific claims.

  • Disability claims (Temporary)
    • All medical bills related to the treatment and hospitalisation
    • A medical certificate that mentions the cause of the disability and the anticipated duration of recovery
  • Disability claims (Permanent)
    • Agreement papers between the injured worker and their employer as per the rules laid out by the Workmen Compensation Act
    • A medical certificate citing the disability and that it is permanent
  • Claims of Death
    • A copy of the death certificate of the worker
    • A copy of the post-mortem report of the worker in question
    • Statement of witnesses if any available
    • Workmen Compensation Act’s Form A duly filled and signed by the insured or employer in this case
    • A copy of the First Investigation Report or FIR
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