Step-by-Step Guide to Filing a Workmen Compensation Claim

Workmen compensation policy is an insurance coverage where employers compensate the employee or their family in case of accidental death, disablement, etc. This insurance coverage is mandated under the Workmen’s Compensation Act 1923.

Under workmen's compensation cover, employers are liable to compensate employees or their family members for accidents or injuries they might suffer at the workplace during the course of their employment.

Also Read: Workman Compensation Insurance Policy and its Benefits

Filing a workers' comp claim is straightforward. The employee or employer must know the steps to filing a workers' compensation claim. Below are the key steps of workers' compensation claims.

Step 1: Reporting Workplace Injuries

One of the essential steps of a workers comp claim is reporting workplace injuries sustained by employees at the workplace to the employer. The injured employee or worker needs to inform the employer about the incidents in writing to the employer.

The incident should be reported within 30 days of the incident. Besides this, the injury sustained by the worker should be qualified under the workmen's compensation policy.

Step 2: Notify Insurer or Respective Authorities

After getting a work incident report from an employee, the employer must notify the insurance provider and respective authorities about the incident. It is crucial to inform the insurance provider as soon as possible after the incident. If required, then inform local police and labour authority, as it might help with the claim process.

Step 3: Necessary Paperwork

Another crucial step in the worker’s comp claim process is necessary paperwork. Proper documentation is crucial for successful claims.

If the paperwork is not correct, the insurance provider can reject the worker's claim. The employer will guide the employee through the documentation that needs to be submitted with the claim form.

Step 4: Filing of Claim Form

The employee needs to fill out the claim form and provide it to the employer. The employer will then file the claim with the insurance provider. Along with the claim form, all the other documents, such as medical bills, incident reports, the nature of the injury and more, also need to be submitted.

Step 5: Coordinate with Assigned Claim Team

Upon filing a claim, an insurance provider will assign a professional to investigate the incident. The surveyor will assess the workplace to verify if the claim filed is legitimate or not. Based on their assessment, they will draft a report. It is crucial to provide accurate information about the incident to the surveyor.

Step 6: Approval or Denial of Claim

The surveyor will submit the report to the insurance provider, who will then either approve or reject the claim request. If the insurance company approves the claim, the entitled person will receive the confirmation.

Within a few days, the decided amount will be credited to their bank account. However, if the worker is not satisfied with the payable claim amount, he may contact the legal authority to file workmen's compensation cases and receive a valid claim.

Furthermore, if the insurance provider has rejected the claim, the employee or worker may request the insurance company to reconsider its decision. In addition, they can appeal to the workmen's compensation board upon denial of the claim.

Step 7: Return to Work

Once the employee has recovered from their injury and is able to return to work, they are required to provide written notice to both the insurance provider and the employer. Furthermore, if a worker has sustained an injury that impacts his work, the insurance provider will pay disability benefits based on the severity of the injury.

Also Read: How to Apply for Workers Compensation

Here is a list of documents that need to be submitted when filing a workers' comp claim based on the categories.

In Case of Minor Accidents

• Duly filled worker compensation claim form

• Identity proof

• Employer’s ID proof

• Salary slip for the last three months.

• Evidence and proof of incidents

• Medical expenses report such as hospital bills, prescriptions, etc

• Detailed report of the accident

• Payment proof of medical expenses

In Case of Death

• Copy of FIR

• Workmen Compensation Act Form A

• Post mortem report

• Death certificate

In Case of Permanent Disability

• Report from treating doctor about the percentage of disability

• Evidence and photographs of the injured person showcasing the disability

In Case of Temporary Disability

• Fitness or medical certificate from attending doctor

• Leave certificate from the employer

The workmen's compensation policy online does not provide coverage in all incidents. Below are some of the injuries that are not covered under the workmen's compensation policy such as:

• Any kind of self-inflicted injury or accident.

• Any injuries sustained due to fighting.

• Injuries or accidents occur under the influence of alcohol.

There are certain things to keep in mind when filing a workers comp claim to avoid rejection from the insurance provider. These pointers are:

Do Not Lie

One essential tip for filing a successful claim for a workers' compensation policy online is not to lie about the injury to the insurance provider. A worker or employee must be truthful about the incident. Any kind of false information may lead to the claim rejection and may also invite legal consequences in some cases.

Maintain a Record

Another crucial tip for successful workmen's compensation claims is to keep a record of the injury and its impact on working conditions. This documentation comes in handy when filing a claim, as it will help insurance providers assess the injured person’s condition.

Proper Communication

Proper communication is also crucial for workmen's compensation claims. By responding promptly to insurance provider or employer requests, employees can expedite the claim process.

Get Back to Work When You Are Well

Another thing to keep in mind for workmen's compensation policy claims is to take an ample amount of time to fully recover. Rushing back too soon to work may jeopardise one's health and can also affect the claim request.

Understand Your Rights

Lastly, it is crucial to know your rights while filing a workmen's compensation claim. For instance, if the insurance company rejects the claim request, the employee can also appeal the rejection. Furthermore, if an employee is not happy with the compensation amount, they can also challenge it in court.

Knowing the workmen's compensation claim process is crucial for both employees and employers. For employees, understanding the process ensures they can file a claim successfully, helping them receive compensation for medical bills and other expenses resulting from workplace injuries. This financial support is essential during times of need, as it covers healthcare costs, rehabilitation and lost wages.

For employers, having a clear understanding of the claim process helps mitigate financial liabilities. Workplace accidents can create additional burdens on a company, not only in terms of medical expenses but also potential legal costs. Therefore, many businesses invest in workmen's compensation cover to protect both their employees and themselves, ensuring that claims are handled efficiently and minimising the financial impact on the company.

TATA AIG offers various SME insurance plans, like a workmen's compensation policy online, that are customised to your unique business needs.

Can I claim for lost wages under the workmen's compensation cover?

Yes, you can claim lost wages under workmen's compensation cover. Suppose you are injured at work and unable to return to your job for a while. In that case, the compensation will typically cover a portion of your lost wages, helping you maintain financial stability during recovery.

What to do if I fail to report a work incident on time?

If you fail to report a work incident on time, it is important to take action as soon as possible. First, report the incident to your employer or HR department immediately, explaining the delay and providing all relevant details about the injury or incident.

How much time does workmen's compensation take to process?

The time it takes to process a workmen's compensation claim can vary depending on several factors, such as the severity of the injury, the complexity of the case and local regulations. On average, it may take anywhere from a few weeks to a few months for a claim to be processed.