Does workmen's compensation-1923 cover only Fatal & Non-Fatal accidents. Does it covers mediclaim or not?

Hi all, Please clarify that, Does workmen's compensation-1923 cover only Fatal & Non-Fatal accidents. Does it covers mediclaim or not? If covers how can we make changes in existing WC Policy.

Presently there is no Workmen Compensation Act 1923, it is renamed as Employee Compensation (EC) Act 1923 and a lot of changes are there. The scope of Mediclaim and EC are different, EC is applicable only for employment related injuries and provides for compensation in such cases whether it is fatal or non-fatal (with at least three days incapacity to work) while a Mediclaim policy can provide relief in cases much beyond EC, depends on its coverage. A mediclaim is to compensate for the expense incurred while EC provides compensation for future loss of earning capacity.

Dear Colleague,

Probably you are asking about Employees' Compensation Policy which supports the employer by taking the risk under the policy to cover the compensation and other support to the employees covered as per the provisions of Employees' Compensation Act 1923.

The Policy you normally take from Insurance Company as an Employer to cover the risk of compensation under EC Act 1923, the scope is different in different Insurance Companies. Hence you need to demand the cover you need for your employees by effectively negotiating and fixing the additional risk cover and Mediclaim or Hospitalization Expenses cover and so on as additional cover by paying additional premium. Hence the Policy which you procure from market will have only standard features like Compensation for fatal or disablement etc. But you can demand your on terms by paying additional risk based premium which many Policies provide as per the broad internal procedures of Insurance Companies. Hence you can discuss with your Insurance Company on this.

Dear Rupeshkumar,

If I remember correctly, I think insurance companies have started extending the benefit of Mediclaim coverage to WC/EC Policies since 2013 with some additional premium. The minimum mediclaim coverage is INR 50,000. Many organizations are using this facility along with the EC policies.

Regards,

Suresh

My organization has an EC policy with Medical Benefits upto 1lakh. The only issue we face is that there is no cashless facility so medical reimbursement is a claim.
The claim gets settled in two parts (a) medical reimbursement and (b) Compensation both are generally credited directly to worker.
Since there is no cashless feature the medical expenses are borne by the affected worker and reimbursed as above or company bears it in which case the amount received as medical reimbursement is then refunded to the company by the worker. This arrangement has been working smoothly and we haven't had any issues in this regard till date.

There was an amendments in the Employee Compensation Act in the year 2009 and subsection 2A was inserted under Section 4 which reads as under:

‘‘(2A) The employee shall be reimbursed the actual medical
expenditure incurred by him for treatment of injuries caused during course
of employment.’’;

After this amendment, it is obligatory on an employer to recover the medical expenses also without any limit.

Under EC Policy, the Insurance Company also give the coverage against the Medical Expenses but cost of the premium goes high.

Dr Kamlesh Agrawal
Mumbai