Industrial Relations
+1 Other

Dear Sir,
One of our employee met with an accident one month before during office duty, near office only and broken his right shoulder. he has not been hospitalised, but his treatment is still going on. We contacted our iHR deptt and also our nsurance company by which we have our group mediclaim policy but they said they require atleast one day hospitalisation. in this case please suggest how can we claim these expenses from insurance company and if insurance company do not give, should we claim this from employer.
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1. Who assigned the duty?
2. Is there an authorisation to go out and attend to duty?
3. How did the accident occur?
4. Did he report accident to the Company immediately?
5. Is he covered under ESI?
6. If he has not reported accident, why did he not report?
We need to answr these questions and a few more.
In an emplyment injury, there are two issues involved
1. Medical expenses
2. Wages for the days absent
Is he attending to duty? and still undergoing treatment?
What is the cost invoulved on mdical?
Based on all these information,advice can be extended
T Sivasankaran
If the injury sustained is while on duty then obviously the cost must be borne by the company, whether the insurance claim is available or not. Group Mediclaim policy is made by deducting the salary from the employee so it is mainly for sickness and not for any accident while on duty. For such accidents, it will normally covered by the Workmen Compensation Policy or ESIC. If the same cannot be claimed then it must be paid by the company and his absence period till he is fit to join the duty will be considered as sick leave and it must be paid.
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