Difference Between Group Mediclaim And WC

Dear Senior,

Can anyone describe the benefits employees will receive under mediclaim and Workers' Compensation (WC) policies? For example, in Workers' Compensation, can employees receive benefits for injuries?

Regards,
Sunil Prajapati

Dear Sunil,

The Workmen's Compensation Act, 1923 (Now known as Employee's Compensation Act) provides Insurance for legal liability coverage for compensation to the employees for bodily injury or death caused due to accidents / occupational diseases arising out of and in course of employment where the employees are not eligible to be covered under ESI Act.

Mediclaim Insurance is a hospitalisation benefit policy offered by both Public & Private sector general insurance companies. The policy takes care of medical expenses incurred for Hospitalisation/Domiciliary treatment of the insured in case of sudden illness. The Mediclaim Policy  stipulates that a claim is admissible when the insured is admitted in a Hospital/Nursing Home for a minimum period of 24 hours for the treatment.

The coverage of accidental injuries can be covered by extra premium or separate workmen compensation policy can be obtained for accidental injuries caused in and out of employment.

BS Kalsi,

Member since August, 2011

Dear Sir,

Thank you for your reply. In the workers' compensation (WC) policy, if an employee is in the course of employment, such as traveling on the staff bus or being on duty away from company premises for company work, will they be eligible for medical reimbursement?

Secondly, can an employee claim minor injury compensation for incidents like finger cutting that occur during work under WC? Or do we need to have a separate medical policy for such claims? Can we combine Employees' State Insurance Corporation (ESIC) with the WC policy if the employer suggests it?

Please provide your suggestions.

Regards, Sunil Prajapati

Dear Sunil,
I have already mentioned to you that Employee's Compensation Act,1923 is applicable where the employees are not eligible to be covered under ESI Act. Coverage of employees under the ESI Act is the BEST OPTION, if the establishment is meeting the criteria and it falls in the implemented area.The ESI Act provides the following benefits:-
1.Medical Benefit
2.Sickness Benefit (SB)
i) Temporary Sickness Benefit
ii) Extended sickness Benefit (ESB)
iii) Enhanced sickness Benefit
3.Maternity Benefit
4.Disablement Benefit
i. Temporary disablement benefit (TDB)
ii. Permanent disablement benefit (PDB)
5. Dependants’ Benefit (DB)
6.Funeral Expenses
Others:
(a) Rehabilitation allowance
(b) Vocational Rehabilitation
(c) Medical Benefit to Retired persons
BS Kalsi,
Member since August, 2011

Dear seniors,

Can anyone clarify that one of my friends is willing to operate a security manpower supply contract with less than 10 employees at present, and he needs to know the process and procedure to take on those contracts.

Please give suggestions in this regard.

Thanks,
S.M. Mohan

Dear sir,

One of our employees has been working in a steel plant for 12 years. Due to sound pollution, he has experienced a loss of hearing in both ears (up to 50 dB). Is he eligible to receive benefits from the Mediclaim policy? He is covered under the Mediclaim policy, but since he will not be admitted to a nursing home for 24 hours due to the ear loss, he will only receive treatment on an outpatient basis. He now requires hearing aids. Will the insurance company reimburse the cost of the hearing aids under the Mediclaim policy?

Thank you.

Jahangir Hospet,

Please meet the commissioner for employee compensation having jurisdiction over the factory or ESI regional office with all reports and data. The factory inspector/ESI inspector may ask for his earlier medical records from the factory. On the face of it, it looks like a valid case for entitlement of compensation.