Workmen Compensation

Protect all your employees from medical emergencies

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Key Benefits

  • Accidental Death & Disability Cover
  • Permanent Partial Disability
  • Weekly Compensation Cover
  • Accidental Medical Expenses
  • Compensation Amount Related to Salary
  • Occupational Diseases
  • Unnamed Policy (Workers)

Legally Covers

  • Workmen Compensation Act 1923
  • The Fatal Accidents Act, 1855
  • Duty at Common Law

Health Cover Up
to ₹50 Lacs

    What is Workmen Compensation?

    The Workmen’s Compensation Insurance Policy provides for legal liability coverage for compensation to your employees for bodily injury or death caused due to accidents/occupational diseases arising out of and in the course of employment.

    Why do you need Workmen Compensation?

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    Protect Your Workforce

    Comprehensive protection for your employees against workplace risks.

    Compliance Made Easy

    Ensure legal and financial safety with a robust compensation plan.

    Emergency Support Assurance

    Be prepared to meet medical and financial obligations effectively.

    Safety and Security First

    Strengthen your employer-employee bond with reliable compensation.

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    Why choose Insurance Manager to protect your business?

    Comprehensive Protection for Your Workforce

    Ensure employee well-being with complete health insurance coverage.

    Comprehensive Protection for Your Workforce

    Ensure employee well-being with complete health insurance coverage.

    Cost-Effective Group Insurance Plans

    Affordable plans with benefits like maternity, critical illness, and dependent coverage.

    Cost-Effective Group Insurance Plans

    Affordable plans with benefits like maternity, critical illness, and dependent coverage.

    Peace of Mind for Employers and Employees

    Reduce financial stress with cashless claims and reimbursement options.

    Peace of Mind for Employers and Employees

    Reduce financial stress with cashless claims and reimbursement options.

    Boost Employee Productivity and Retention

    Build loyalty and motivation by easing economic and mental burdens.

    Boost Employee Productivity and Retention

    Build loyalty and motivation by easing economic and mental burdens.

    Who’s this for?

    Employees
    Human Resources Manager
    Get a Quote

    Who’s this for?

    Employees
    Human Resources Manager
    Get Quotes

    What does Workmen Compensation cover and exclude?

    Plan Coverage

    Medical Expenses

    Coverage for Treatment of Work-Related Injuries

    Disability Compensation

    Support for Temporary or Permanent Disability

    Death Benefits

    Financial Aid for Family in Case of Employee Death

    Rehabilitation Costs

    Support for Physical or Occupational Rehabilitation

    Loss of Earnings

    Compensation for Income Loss Due to Injury

    Legal Expenses

    Coverage for Legal Fees in Claims Cases

    Accidents During Work Activities

    Protection for Work-Related Accidents Offsite

    Occupational Diseases

    Coverage for Diseases from Work-Related Exposure

    • In-patient treatment 24 hours a day
    • Pre-existing disease
    • Pre and Post hospitalization
    • Domiciliary hospitalization expenses
    • Reimbursement of cost of health check-up
    • All day care procedure
    • Family floater to covers member’s immediate family such as a spouse, dependent children, dependent parents, etc.
    • Maternity benefits
    • Dental treatment
    • Cost of spectacles, contact lenses
    • Waiver of waiting period
    • Waiver of first-year exclusions
    • Reimbursement of ambulance costs
    • Baby day one care
    • Vaccination benefits
    • Increased room rent limits
    • Corporate buffer
    • Out-patient treatment (OPD Card)
    • Root canal surgery
    • In-hospitalization expenses due to sickness or accidents
    • Room and boarding expenses as provided by the hospital/nursing home.
    • Nursing expenses.
    • Surgeon, anesthetist, medical practitioner, consultants or specialist fees.
    • Anesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines and drugs, diagnostic materials and X-Ray, dialysis or chemotherapy.

    Major Exclusions

    Exclusions in Workmen Compensation Insurance

    A Comprehensive Overview of Non-Covered Scenarios

    Pre-Existing Illnesses & Coverage

    Affecting Insurance Claims

    Initial Policy Period: Limitations on Illness Treatment

    What Is Not Covered Within the First 30 Days of the Policy

    First Year Illness Exclusions

    Key Diseases Not Covered in Initial Policy Year

    Pregnancy-Related Claims & Workmen Compensation

    Understanding the Exclusion of Pregnancy in Compensation Policies

    Non-Conventional Treatments Exclusion

    Ayurveda, Homeopathy, and Naturopathy Not Covered

    Substance Abuse & AIDS Exclusions

    How Substance Abuse and HIV-Related Claims Are Not Covered

    Cosmetic Surgery Exclusion

    Non-Medical Treatments Not Covered

    • If the appropriate waiver is not opted for, then the policy will not cover
    • Treatment of pre-existing illnesses.
    • Any treatment for illnesses/diseases within the first 30 days of the policy, unless it is an accident.
    • Treatment of specified illnesses for the first year of the policy.
    • Certain diseases like hernia, cataract, piles, sinusitis, etc are excluded during the first year of operation in the cover.
    • Any claim arising out of or traceable to pregnancy.
    • Ayurvedic, homeopathy, naturopathy or any other form of local medication.
    • Alcoholism, drug abuse, and AIDS.
    • Dental treatment or surgery unless it requires hospitalization.
    • Cost of spectacles.
    • Vaccination and inoculation.
    • Cosmetic treatment.

    Scope of Coverage

    Accidental Death (PA Death)

    Coverage for the death of an employee as a result of a workplace injury. The employee's dependents receive compensation.

    Permanent Total Disability (PTD)

    If an employee is permanently disabled and cannot work again, compensation is provided to cover the loss of future income.

    Permanent Partial Disablement (PPD)

    If an employee becomes partially disabled but can still perform some tasks, they are compensated for the reduced capacity.

    Temporary Total Disablement (TTD)

    Provides compensation for employees who are temporarily unable to work due to injury but will return to full capacity after recovery.

    Temporary Partial Disablement (TPD)

    Provides compensation for employees who return to work but cannot do so at full capacity due to partial disability.

    Major Exclusions

    Non-fatal Injuries

    Injuries that do not result in death are typically not covered under this insurance policy.

    Substance Abuse

    Injuries occurring while an employee is under the influence of alcohol or drugs are excluded.

    Contractor Employees

    Claims made by employees of independent contractors (not directly employed by the policyholder) are excluded.

    Policy Amendments

    Changes made to the policy after it is activated are generally not covered.

    Add-ons Provided under Workmen Compensation Policy

    Sub-contractor Cover

    If a contractor hires a sub-contractor without WC coverage, the contractor can add this specific coverage to ensure the sub-contractor's employees are covered under WC.

    Medical Extension

    This add-on extends medical coverage for workers who are hospitalized for more than 24 hours due to an injury or illness incurred at work.

    Terrorism

    A specialized add-on covering losses caused by terrorist attacks, extending the WC coverage beyond conventional accidents.

    Occupational Disease

    Covers illnesses caused by the workplace environment, including conditions like Compressed Air Disease from high or low-pressure areas such as tunnels or underwater sites.

    Your Journey to Insurance Manager

    Need Awareness and Research

    Identifying and understanding client needs.

    Policy Selection and Purchase

    Helping choose and buy the right insurance plan.

    Policy Use and Management

    Supporting effective policy usage and queries.

    Claims Filing and Resolution

    Assisting in filing and resolving claims efficiently.

    Policy Renewal or Cancellation

    Policy Renewal or Cancellation
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    Claims Process

    Claim Intimation

    Claims must be reported to the insurance company within 24 hours of the incident.

    Required Documents

    Claims require documentation related to the injury, including medical reports, employee details, and loss reports.

    Claim Review and Settlement

    Once documents are submitted, the insurer investigates the claim. If any queries arise, they will request further documents.

    Turnaround Time (TAT)

    Claims are typically processed within 4 calendar days from receipt of all necessary documents. Failure to submit documents within the TAT may result in claim rejection.
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    Employer's Liability (EL)

    • EL Insurance : This covers the employer's liability in case an employee files a claim under the Workers' Compensation Act. Employers are legally required to ensure that their workers are protected, and this policy is designed to manage that liability.
    • Claims for Employees : Employees earning different salary levels (e.g., ₹4,000, ₹8,000, ₹15,000) can file claims under this policy in case of injury or death.

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    Submission

    Effortlessly submit your claims with our fast, simple, and user-friendly interface.
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    Assessment

    Our team thoroughly reviews your claim with care, keeping you updated in real time.
    Under Review

    Resolution

    Receive your claim payout quickly and securely. Your satisfaction is our priority.
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    When can I Claim?

    A claim under Workmen Compensation can be registered in the below circumstances:

    • Employee Death: Claim for accidents or occupational hazards causing death.
    • Workplace Injuries: Covers medical costs and lost wages for on-duty injuries.
    • Occupational Diseases: Claims for illnesses caused by work conditions.

    Frequently Asked Questions (FAQ)

    What medical expenses are covered?
    The policy includes:

  • Hospitalization, surgeries, medications, consultations, emergency care, and rehabilitation.

  • Excluded treatments: Alternative options like acupuncture, homeopathy, or naturopathy may not be covered.
    • What factors affect the premium calculation for Workmen’s Compensation (WC) Insurance?
    The premium is determined based on several factors:
  • Number of Workers – More employees mean higher premiums.

  • Nature of Industry – High-risk sectors like construction have higher rates.

  • Employee Salaries – Higher wages increase the compensation value.

  • Industry Classification – Each industry has different risk levels.

  • Safety Standards – Better safety practices may lower premiums.

  • Claim History – A history of frequent claims may raise premium costs.

  • Business Location – Risk-prone zones (e.g., seismic areas) can affect pricing.
    • What is the maximum compensation limit under WC Insurance?
  • The compensation limit is typically ₹3 lakh per claim.

  • For higher coverage, additional policies may be required.
    • What is meant by ‘Course of Employment’?
    An injury is considered covered if it happens:
  • During work hours or

  • While performing tasks incidental to work (e.g., field visits, office errands).
    • How does WC differ from GPA and ESIC?
    • Workmen Compensation (WC): Provides compensation for injuries or illness resulting from workplace accidents.

    • Group Personal Accident (GPA): Covers employees in case of accidents, but doesn’t typically cover occupational diseases.

    • Employee State Insurance Corporation (ESIC): A social security scheme offering medical and other benefits to employees, typically for larger establishments.
    What challenges are commonly faced during WC claims?
    • Delays in injury reporting

    • Incomplete or late document submission

    • Disputes on claim eligibility

    These can lead to claim rejection or delayed settlements.
    Does WC Insurance cover occupational diseases?
    Yes, WC covers occupational illnesses like:

  • Lung diseases from dust, hearing loss from noise, or repetitive strain injuries.

  • Compensation includes medical costs and lost wages.
    • What types of coverage are included in WC Insurance?
    WC Insurance typically covers:
  • Death Benefits – Compensation to family in case of an employee’s death.

  • Temporary Total Disability (TTD) – Covers income loss during full temporary inability to work.

  • Temporary Partial Disability (TPD) – For employees who return to work in a reduced capacity.

  • Permanent Total Disability (PTD) – Lifetime compensation for full permanent disability.

  • Permanent Partial Disability (PPD) – Compensation for lifelong reduced work capacity.
    • How does rating work for WC Insurance?
  • Risk-Based Rating – Industries are rated based on risk involved.

  • Multiple Risk Coverage – Employers with varied roles (e.g., production, sales) may be rated per role or by the highest risk category.
    • Are contract, sales, or office staff covered?
    Yes, if they are legally recognized under the Employees’ Compensation Act, they can be covered.
    What should be considered when insuring licensed contractors?
  • Employers must assess whether to cover only direct employees or the contractor's entire workforce, depending on the contract and risk profile.
    • What are the penalties for non-compliance?
  • Failing to deposit premiums or follow WC protocols can lead to legal penalties under the Workmen’s Compensation Act.