This document provides information on workman's compensation insurance. It discusses how the insurance works under the Workman's Compensation Act of 1923, what is covered such as death, permanent total disability and temporary total disability, the claim process, and how quotes are prepared. It also outlines the policy coverage, who qualifies as a workman, important points about premium calculation and documentation required for claims.

1. Workman (Employee)
Compensation Insurance

2. Presentation Path
 How WC Insurance works
 Coverage
 WC Award
 Medical Extension
 Claim Process
 Quote Preparation

3. As per WC Act, 1923
Employer
Employee
(Worker)
During the course of
employment
Work related accident
Death
PTD
PPD
TTD
WC Commissioner
x
WC Policy with ILx
WC Tariff
WC award
x

4.  Covers the liability of the Employer towards his
employees, under:
 W C Act 1923
 Fatal Accidents Act 1855
 At Common Law
W C Insurance

5. The Tariff provides for two forms of insurance viz :-
 Table ‘A’ - Indemnity against legal liability to all employees
(whether or not coming within the definition of the term Workmen)
under the W.C.Act 1923 and subsequent amendment to the said
Act
prior to the date of issue of the policy, the Fatal Accidents Act,
1855 and at Common Law.”
 Table ‘B’ - Indemnity against legal liability under the Fatal
Accidents Act, 1855 and Common Law. (Table ‘B’ policies may not
be issued to cover employees who fall within the definition of
“Workmen” under the Workmen’s Compensation Act, 923 as
amended).
Coverage’s -

6.  Accidents arising out of & in the course of one’s
employment
 Liability of the employer under W C Act for
 Death
 PTD
 PPD
 TTD
Coverage’s -

7. Workman
 Workman is any person employed for the
purpose of the Employer’s trade or business
 An Employer is liable to pay compensation as per
the WC Act for ANY worker, irrespective of
designation or compensation.

8. “During the course of employment”
 WC claims are for accidents within work premises
and during work hours. However, they can also be for
work related accidents beyond the premises and
before or after official hours of work.
 At the time of injury, workman must have been
engaged in the business of the employer and must
not be doing something for his personal benefit.

9.  The term earnings includes regular salary / wages, overtime,
value of boarding / lodging, housing accommodation, bonus and
all perquisites, privileges or benefits in cash or kind.
 Wages adjustment statement should be obtained from the
insured at the renewals and premium to be adjusted accordingly.
 Actual earnings to be submitted to insurance company within
one month of the expiry of the policy.
 All persons should be included in the policy. Selection of
persons are prohibited.
 Usually policy is issued for a period of 12 months, however it
can be less than 12 months in case of specific contracts of work.
 WC is usually on un-named basis.
Important Points

10.  It is mandatory for the employer to pay the WC Award to the
worker.
 A WC policy will indemnify the WC Award.
 Some principal clients mandate that a WC policy is necessary for
a sub-contractor to qualify for the techno-commercial bid.
 No installment facility
 Rates based on benefits of the Ordinances & Common Law of
the Country.
WC insurance- requirement

11.  WC premium depends on:
 Nature of industry
 No of workers
 Monthly wages of workers
 Can be done on an OTC basis as per calculator
 Loadings-
For Terrorism coverage- 40%
For Compressed gas- 30%
For Occupational diseases- 50%
WC premium calculation-

12. Sample Quote – Pre & post Amendment
Sample Quote -

13. Difference – Pre & post Amendment
WC quote
Industry-1 Industry-2 Industry-3
Civil construction Electrical Engg.
before after before after before after
Rate 30 21.4 27.25
No. of Lives 370 370 370
Risk code 47 132 157
Policy Tenure 1 year 1 year 1 year
Discounts No discount No discount No discount
Premium with medical 1385891 2260744 1048871 1655020 1278123 2067253
Premium w/o medical 693119 1130655 524567 827717 639221 1033785
% increase
Premium with medical 63% 58% 62%
Premium w/o medical 63% 58% 62%

14.  SCHEDULE I -- List of injuries
 SCHEDULE II -- List of persons who, subject to the provisions of
section 2(l)(n), are included in the definition of workmen
 SCHEDULE III -- List of occupational diseases
 SCHEDULE IV -- Factors for working out lump sum equivalent of
compensation amount in case of permanent disablement and death
WC insurance -

15.  Fatal claim: 50% of the monthly wages * relevant factor( age
dependant)
 PTD: 60% of the monthly wages * relevant factor( Age dependant)
 PPD: 60% of the monthly wages* relevant factor( a/d) * disability%
as per schedule of WC Act
 TTD: Half monthly wages * pro-rata days reckoned as per Dr’s
report. For claims less than 28 days, deductible of 3 days.
WC award

16. Relevant factor
 Example of WC Award calculation -
Age Relevant
factor
Award for Death Award for PTD
16 228.54
(50% x 8000 x 228.54)
= Rs. 4,57,080
(60% x 8000 x 228.54)
= Rs. 5,48,496
65 99.37
(50% x 8000 x 99.37) =
Rs. 1,987,40
(60% x 8000 x 228.54) =
Rs. 2,38,488

17.  Attendance register/ wages register.
 Proof that workman was on duty.
 FIR/ Panchnama/ Inquest/ PM etc for Fatal cases.
 FOR PTD/ PPD cases certificate from the Civil
Surgeon.
 Form A/ Form L
 Money to pay to Labour Court.
 Penalties/ Interest beyond 30 days.
Claim documents

18. ICICI Lombard U/W guidelines
 WC Exclusions
 Not to be underwritten
 Occupational diseases add-on
 Caution list of type of industries
 Treaty exclusions

19. WC exclusions
 War & allied perils
 Liability to employees of contractor
 Any employee who is not a workman within the meaning of the
law
 Any contractual liability
 For any injury as a result of workman under the influence of
drinks or drugs
 Wilful disobedience of the workmen to an order / rule framed for
the purpose of securing the safety of the workmen
 Wilful removal or disregard by the workman of any safety guard
or other devise provided for the purpose of securing his safety

20. Caution list: (not to be underwritten)
 Construction- height more than 9 meters
 Fire crackers – manufacturing/ trading
 Petrol pumps
 Risks involving manufacturing and/ or supplying and/ or
producing, storing, filling, breaking down, transporting of the
following are not to be underwritten
 Fireworks, ammunition, fuses, cartridges, powder,
nitroglycerine or any explosives.
 Gases and/or air under pressure in containers.
 Butane, methane, propane, and other liquefied gases.
 Celluloid and pyroxylin.
 Petrochemicals and also chemicals of a toxic, noxious, explosive
and/ or highly flammable nature.
 Asbestos and/ or asbestos products.

21. Treaty exclusion
 Construction, maintenance and demolition of towers,
steeples, bridges, dams and chimney shafts.
 Not applicable to pedestrian bridges, flyovers and other
walkways and road bridges longer than 3000 meters
and road bridges with unsupported span longer than
100 meters.
 Excavation and tunneling work in connection with mining,
quarrying and for tunneling work exceeding 200 meters and
Underground and/or underwater mines and/or underground
services in connection therewith.
 However, this exclusion shall only apply where more
than 20 people are working at the same location at any
one time.

22. Treaty exclusion contd.…
 Quarries where explosives are used.
 Contractors engaged exclusively in wrecking or
demolition of buildings and/ or scrap metal
merchants.
 Oil and gas companies - drilling, producing,
refining and distributing (other than general retail
distributors whose main occupation is not
otherwise excluded)
 Offshore rigs
 Sub aqueous work (underwater work)

23. Treaty exclusion contd.…
 Shipbuilding, ship repairing and ship breaking
other than pleasure crafts, stevedoring and/or
longshore work.
 Aircraft crews in respect of flight risk. However,
this shall not apply to aircraft which are set aside
for non fare paying executive use and which are
crewed by six persons or less.
 Ship crews other than on inland vessels or on
vessels operating within territorial waters.
However, this shall not apply to a vessel crewed
by six persons or less.

24. Treaty exclusion contd....
 Fire brigades other than those formed provately
for loss prevention purposes.
 Service in any kind of armed forces (military,
police, security services).
 Operation of railways, other than sidings.
 Employees employed on a permanent basis in
USA and/or Canada.
 Professional sports team.

25. Thank you