Indicative General Documents for Settlement of Claim
In Case of Death of Employee
- Claim form
- Confirmation that the accident has happened in the course of employment
- Age proof for the deceased employee
- Complete Medical Papers
- Post Mortem Certificate
- Copy of Order of the WC Commissioner for the award passed
- Statement of Wages
- Muster Roll of the employees
In Case of Permanent Total Disablement and Permanent Partial Disablement
- Claim form
- Confirmation that the accident has happened in the course of employment
- Age proof for the disabled employee
- Complete Medical Papers
- Disability Certificate of the attending doctor
- Copy of Order of the WC Commissioner for the award passed
- Statement of Wages
- Muster Roll of the employee
- Proof for Payment
In case of death and Permanent disablement claims, the claim would be processed only after the full compensation is
deposited before the WC Commissioner.
In Case of Temporary Total Disablement
- Claim form
- Confirmation that the accident has happened in the course of employment
- Complete Medical Papers
- Fitness Certificate from the attending doctor
- Statement of Wages
- Muster Roll of the employee
- Complete list of workers employed as on Date of Accident under all categories
- The Company reserves the right for appointing of an investigator for the claim.
- On receipt of the above documents by the Insured, the claim will be processed.
- Earnings, Wages and Salaries shall mean the employees total remuneration paid or fallen due for payment including
overtime, value of board and/or lodging, housing accommodation, bonuses and all other perquisite privileges or
benefits in kind or money, received by the employees from the employer in connection with their employment.
Or
As specified under Workmen Compensation Act, 1923.
Or
The Sum insured available under the policy. Whichever is less.
In Case of Medical Extension Claim
Insured will immediately send the written intimation to the insurance company for
lodging the medical extension claim.
Following documents need to be submitted to insurance company :
- All the actual bills
- Original detailed discharge summary
- Original hospital bill – Consolidated counter signed by Insured / Patient
- Bill Break-up
- Original Investigation Reports
- Pharmacy Prescription and Bills
- Claim form with signature of claimant
The WC claim needs to be deposited necessarily with WC Commissioner of the Area,
unless orders to the contrary are obtained from him. The discharge of WC Commissioner is sufficient discharge for
insurers.
Quantum of Claim
The amount of claim payable under WC Policy is strictly governed by the WC ACT
and depends upon two factors:
- Monthly wages of the employee
- Age of the Employee. Based upon the age the WC ACT specifies a Factor Multiplier Table
Ultimate Authority
The WC claim needs to be deposited necessarily with WC Commissioner of the Area, unless orders to the contrary are obtained from him. The discharge of WC Commissioner is sufficient discharge for insurers.
