Are Self-Inflicted Injuries Covered Under Workmen Compensation?

Workmen compensation insurance is generally bought by an employer as compensation for its workmen/ employees and their respective family members for income lost because of workplace death or injury. The compensation is paid as per the Workmen Compensation Act, 1923. According to this Act, the employers are legally liable and the employer must provide compensation to the employees against the losses incurred to him/her (employee) due to workplace or work-related accident.

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A worker is eligible to claim the benefit of workmen compensation from his/her employer irrespective of who is responsible. An employer can get coverage or immunity against all these statutory liabilities by using the workmen compensation insurance plan offered by various insurance companies.

So, in this way, a workmen's compensation benefit is 'no-fault' benefits insurance. In this type of system, the workers are eligible to get compensation from his/her employer in case of an accident at the workplace that results in death, injury, or disability to the workmen despite who is responsible. This type of insurance plan is designed on the principle of 'no-fault'. This means that when a worker is injured at the workplace, he/she is eligible to get the benefits of a workmen's compensation policy despite his/her fault. However, there are some circumstances wherein a workman may not be eligible to get the benefits of workmen compensation insurance. These circumstances or situations are:

Excluded Circumstances Under Workmen Compensation

  • Self-inflicted or intentional injury at the workplace.
  • Injury at workplace encountered by a worker while he/she is under the influence of any intoxicating substance or alcohol.
  • Accidents at the workplace are caused as the workers are not adhering to the safety guidelines and rules.
  • Injury because of fighting or horseplay while at work.
  • Violent and unlawful act of workmen compensation policy.

As long as a worker is working with an organization and he/she encounters some injury while at work, then he/she is eligible to file a claim for workmen compensation. However, if the reason for an accident at the workplace is not fully workers' or employees' misconduct, then the court as well as favors the workers.

Let us understand this with an example. Suppose, the workers are doing overtime work for a few weeks. Under the pressure of work, some of the workers had few drinks before completing the final duty of the day. Let us assume that one of the workers, who had alcohol meets with an accident. This can be because of the effect of alcohol or as he was tired. Due to this accident, he encountered substantial injury and filed a workmen compensation claim. In this situation, the reason for the accident was partly because of his fault. However, situations like this can cause a denial of a workmen's compensation claim.

Steps to File Workmen Compensation Claim

A workmen compensation policy provides coverage when a worker faces any of the following circumstances:

  • Permanent total disablement
  • Death
  • Permanent total disablement
  • Temporary total disablement

He/she has to follow the below steps to file a claim in any of these situations:

  • The insurance provider has to be informed as soon as possible after the accident.
  • If the accident has occurred on the premises of a manufacturing plant, then the supervisor of this factory should be informed instantly.
  • The claim has to be filed and all the relevant documents relevant for the claim should be submitted to the insurance company.
  • The employer has to contact the commission of workmen compensation and submit the compensation that is payable to the injured employee. Upon compensation submission, the commission issues a receipt for the claim that has to be submitted to the insurance provider.
  • If the workmen's commission sends a notice, then it should be submitted to the insurance company.
  • The insurance company has to arrange the inspection of the claim.
  • After completion of the inspection, the inspector will file a report based on which the compensation is paid to the employee.

The Final Words!

Workers need to know that the base of workmen compensation is 'no-fault' and hence it is ideal for all the employers to have this insurance policy for their workers for safeguarding the business against any statutory liabilities.   

Written By: PolicyBazaar - Updated: 03 August 2022