Fatal and Non-fatal Accidents in a Workmen Compensation Policy

A workplace accident is an unexpected and unplanned event that causes harm or injury to an employee or worker. Such accidents can result in a wide range of outcomes, from minor injuries to severe or even fatal consequences.

Workplace accidents are typically classified into fatal and non-fatal categories based on the severity of the injury. Let us understand fatal and non-fatal accidents in detail.

Fatal Accident

Fatal accidents are workplace incidents where there is a high risk of losing an employee or worker due to accidents. In such accidents, employees might die or suffer severe disabilities.

These types of accidents typically involve significant trauma or exposure to hazardous conditions, such as machinery malfunctions, falls from heights, fires, or exposure to toxic substances.

In the case of a fatal accident, the worker may die immediately or succumb to their injuries over time, leaving their family and dependents without a primary source of income.

Non-Fatal Accident

While these accidents may not be life-threatening, they can still cause significant harm, leading to injuries that may result in temporary or permanent disability.

These types of accidents can range from minor injuries, such as sprains or cuts, to more severe conditions, like broken bones, fractures, or even permanent impairments, like loss of mobility or sensory function.

A workmen's compensation policy online is insurance coverage designed to protect employees and employers in the event of worksite-related injuries or accidents. It provides financial support to workers who are injured while performing their job duties, covering medical expenses, rehabilitation costs and lost wages.

Under the WC policy coverage, fatal accidents or incidents that lead to worker death are covered. However, the policy does not cover non-fatal accidents unless they cause disablement lasting more than three days.

Under a WC policy coverage for fatal accidents, the family of a deceased employee or worker will receive a lump sum amount based on the worker’s wages. The purpose of the policy is to offer financial compensation to the dependents. The compensation helps the deceased family cope with a challenging period.

However, if a worker suffers a disability as a result of an accident, then the WC insurance policy offers them some relief.

Also Read: Workmen Compensation Insurance

Disability is classified into different types based on the severity of the accident, and the compensation amount is decided based on the type of disability the worker suffers.

Temporary Partial Disability

If an employee suffers a temporary partial disability that lasts for more than three days due to a work-related accident, the employee will receive compensation under the workers' compensation policy. This refers to situations where the injury does not prevent the employee from working entirely but reduces their ability to perform their usual job duties.

Temporary Total Disability

This refers to the condition where an employee or worker is temporarily unable to work at their full capacity due to work-related accidents. Such employees will receive compensation under the WC policy coverage. The employee is eligible to receive 25% of their monthly wages paid in accordance with sub-section (2) of the Workmen’s Compensation Act, 1923.

Permanent Partial Disability

It refers to a situation where an employee suffers a permanent injury due to a workplace accident or illness, but the injury only partially impairs their ability to perform work.

Unlike temporary disabilities, which eventually heal, permanent partial disabilities result in lasting impairments that may affect the worker's ability to perform certain tasks or function at full capacity.

The compensation amount is decided based on the nature of the injury, employee wages and percentage of disability.

Permanent Total Disability

This refers to a condition where an employee suffers a work-related injury or illness that results in a complete and permanent loss of the ability to perform any work. This means the employee is entirely and permanently disabled, unable to return to their job.

The compensation amount is typically calculated as a percentage of the employee's wages and is determined by the severity of the disability and the extent to which it affects the worker’s earning capacity.

Also Read: What are the Types of Workers' Compensation Insurance?

There are various scenarios which are not covered under the workmen's compensation policy online.

• The plan does not cover any injury or accident caused by war, invasion or acts of foreign enemies.

• Any accident or injury that occurs outside the specified place of employment unless the employee was there for business.

• Any occupational disease that an employee contracts.

• Any accidents or injuries that are caused under the influence of drugs or alcohol.

• Any self-inflicted injuries resulting from intentional acts are not covered under the plan.

• The plan does not cover injuries caused by employees' wilful negligence, such as not following safety protocols.

If an employee or worker has sustained an injury at a worksite that is fatal or leads to disability, then they are eligible to file a workmen’s compensation claim. Below is the Step-by-Step guide to filing a claim.

• Step 1: Employees need to report accidents to their employers to file a claim. It is crucial to inform employers as soon as possible. Furthermore, the injury sustained by the employee should be qualified under the workmen's compensation policy.

• Step 2: The employer needs to inform the insurance provider or respective authorities about the incident. It is crucial to inform the insurance provider as soon as possible to avoid the claim being rejected.

• Step 3: Employees must complete the claim form and submit it to the employer along with other necessary documents. Proper documentation is crucial for a successful claim process.

• Step 4: The employer will file a claim request after receiving a claim form and other documents from the employee.

• Step 5: Once the claim request has been raised, the insurance provider will assign a surveyor to inspect the incident. The surveyor will visit a site and investigate the incident.

• Step 6: The surveyor will prepare a report based on their finding and submit it to the insurance provider. Based on the surveyor report, claim form and other documents, the insurance company either rejects or accepts a claim request.

• Step 7: If the claim has been approved, the entitled worker or employee will receive a confirmation, and within a few days, the compensation amount will be credited to their account.

• Step 8: If the claim has been rejected, the employee may request that the insurance company reconsider its decision. They can provide additional documents to support their claim request.

Also Read: How to Apply for Workers Compensation

Understanding fatal and non-fatal accidents in a workmen's compensation policy is crucial for employees and employers, as it ensures that both parties are aware of their rights, obligations and protections in case of a workplace injury.

Generally, fatal accidents are covered under the workmen's compensation policy online. However, non-fatal accidents are not covered unless they cause disability that lasts more than 3 days. These accidents can have financial and legal implications if you do not have a workmen's compensation policy.

TATA AIG offers various SME insurance plans to ensure employee safety, such as customised worker's compensation policies based on your workforce needs.

• Can pre-existing diseases be eligible for workmen's compensation claims?

  No, pre-existing diseases are generally not covered under the Workers' Compensation Act.

• Can you name fatal incidents under the Workmen Compensation Act?

  Fatal incidents typically include accidents resulting in death due to workplace injuries like falls from heights, accidents involving machinery, electrocution, drowning, or being struck by falling objects and more.

• Can false documentation lead to claim rejection for workmen's compensation?

  Yes, false documentation can lead to the rejection of a workers' compensation claim. Under the Workmen Compensation Act of 1923, in India, submitting fraudulent or incorrect information, such as falsifying injury details, medical reports, or the cause of the accident, etc, can result in the claim being denied.