Navigating Insurance Claims: How to Prove 'Death on Duty' for Workers Compensation?

Points of Concern Regarding Insurance Claim

1. One area supervisor was on duty at night and met with an accident on the road. He died, but he was on his way to supervise another site.
2. His job description was to supervise the area where the company's other laborers were working.
3. The accident occurred at 10:30 pm.
4. The accident took place on the road.
5. The company provided a letter as proof of being on duty to the insurance company.
6. The other two site holders (companies) also provided letters as proof of the area supervisor being on duty.
7. Another co-supervisor also gave a statement confirming the supervisor's duty status.

Despite having all the necessary documents, the insurance company is refusing to pay the claim. They argue that your employee cannot be confirmed as being on duty. I am seeking your advice on this matter.

Dear Pankaj, the last portion of your post is not clear. Do you mean to say that the Insurance Company refuses to admit the claim on the grounds that the deceased could not have been on duty due to the odd hour of the accident? When the employer acknowledges that the employee was on duty when the accident occurred, based on documents and witness evidence, the insurer cannot shirk their responsibility casually. Therefore, the exact contention of the Insurance Company should be made available for further comments. Anyway, if the dependents of the deceased employee file a claim for compensation under the E.C. Act, 1923 against both the employer and the insurer, the Commissioner will make the final decision.

Thank you.

Here is the situation raised for your understanding. I am seeking advice as per the Workmen's Compensation Act of 1923. Is it applicable or not? Based on your experience, what is your opinion?

Regards,
Pankaj Patel

When the Workers' Compensation Insurance Policy covers the Area Supervisor, the insurer cannot refuse to admit the claim for the reason cited unless the investigation conducted by them strongly suggests that at the time of the accident, he was not on duty. Anyway, check with the other employees to see if they mentioned anything contrary to the investigator's findings. As I mentioned earlier, you can acknowledge that the employment and the accident occurred during the course of employment. You can also argue that the liability for compensation rests with the insurance company before the Workers' Compensation Commissioner when the case comes up for a hearing.

Regards

What has been described by Mr. Umakanthan is very much correct. However, please ensure the following aspects:

1. If the deceased was your employee;
2. And has been covered under the policy;
3. And you can prove that pertinent premium/contribution has been remitted to the insurer;
4. He was on duty and died in the course of employment,

then the insurer cannot deny the claim.