Navigating Workmen Compensation Claims and Settlements After an Employee's Tragic Death

Dear All, One of our employees has died in a major accident while going to his site in an Auto Rickshaw provided by the office. In this case, we have a Workmen Compensation Policy & Nagarik Suraksha Policy. We have already informed both insurance agents through the official email id.

Claiming Workmen Compensation

Our Policy Agent doesn't know the procedure for claiming Workmen Compensation. Is there any court procedure? Who is responsible for filing the case and to whom?

Procedure for Full and Final Settlement

Also, what is the procedure for Full and Final settlement in the case of death? The employer has already paid all the expenses including Post Mortem, FIR, ambulance, and other medical expenses.

Hi Neha, I appreciate the gesture of your office meeting the expenses post his tragic death. For all purposes, you should have the following documents in sufficient numbers, wherever possible:

1) FIR Copy
2) Death certificate (ensure it mentions the wife of the deceased employee)
3) Aadhaar card & PAN Card (of both the employee and the spouse, children)
4) Address & ID proof (some authorities may not accept PAN Card)
5) Bank SB A/c passbook
6) Nomination forms signed by the employee (check with your office, they should be in their files. Gratuity claim, EPF & EPS, DLI (was he covered by ESI?)
7) The spouse, wife of the deceased, should take color photos, passport at least 10 copies, a few with family - i.e., wife and all children.
8) Arrange with a Notary, an Affidavit declaring the wife is the legitimate recipient of all F & F settlement as the heir and the children will have no objection if the settlement is paid to the wife (mother).

I hope you won't mind, please assist the wife so that she will collect and sign all the F & F settlement forms with all attachments so that the claims are processed smoothly without any hindrances. You can also help to download the required forms from the website of EPFO/EPS & Gratuity portals. Also, please check whether the deceased employee was subscribing to any Life insurance policy; if yes, claims should be processed in that office as well.

If you would need any specific guidance, please continue this thread. Wish you a hassle-free process.

Responsibilities of the Employer and Nominee

The opener/operator of the master policy, i.e., the employer, as well as the nominee, has the responsibility to inform the insurance company within 24 hours of such incidents. Thereafter, the insurance company deputes their TPA to visit and check the facts within 3 working days. They carry forms with them, which are to be filled and signed by the nominee. The TPA shares their contacts along with officer details with the nominee for further development queries.

Guidance for Agents

If the agent is not aware of the formalities, he can ask his Development Officer to guide him to submit the claim and process. Annexures and requisite documents differ for different policies.

Dear Neha,

When a Workman's compensation insurance policy is taken by the employer, the liability of the employer is automatically taken care of by the insurer under section 13 of the EC Act, 1923. If death or disability is caused to an employee due to an employment accident, the employer's primary duty is to inform the insurer with complete details. Normally, the insurance company will conduct an inquiry and verify the genuineness of the information and work out the compensation payable as per the policy conditions and arrange for disbursement of the amount to the affected employee. However, in death cases, they will not pay the compensation directly to the employee or the employer but ask the dependent(s) to file a claim before the area Commissioner for Workmen's Compensation. Upon the orders determining the compensation by the commissioner, the insurer would deposit the amount with the commissioner for disbursement.

In such a case, the employer has to ensure the following:

1) Whether the employee is covered under the policy and the accident occurred during the course of employment.
2) If yes, whether the premium paid was on par with the actual or statutory minimum wages.
3) The employer should inform the dependents to file a claim before the commissioner.
4) When the claim is filed, he should appear before the commissioner when called and admit the facts of employment, accident, death, and the insurance.

Employee Compensation Claim Process

The employee compensation claim must be made before the Commissioner under the EC Act, providing all required details and the compensation amount. The amount is disbursed after the due process is completed in the court of the Commissioner.

Dear Neha, senior members have already explained and advised you in detail. The legal heirs of the deceased may also get compensation under the Motor Accident Claim, provided they have sufficient documentary evidence.

Regards,
Suresh