Importance of Medical Extension Benefit under WC Policy

A medical extension is a provision available in the workmen’s compensation insurance policy. The workman compensation insurance policy is a crucial scheme by which an employer or an organization can exhibit the ability to satisfy the obligations imposed by the employee’s compensation laws in India.

The workmen’s compensation policy may be extended to provide coverage of medical expenses incurred by the employer on behalf of the employee by payment of extra premium 

Some insurance companies may offer different types of medical extension coverage. For instance, one of the top insurers offers 4 options to employers to choose the coverage of hospitalization expenses under the insurance policy.

Choice 1 - With Per Employee and Aggregate Limit
Choice 2 - With Per Employee Limit
Choice 3 - With Aggregate Limit
Choice 4 - Actual Expenses Incurred

The following are the exclusions of the policy where the insurance company will not be liable to pay for the medical expenses:
  • Any accident, injury or disease directly related to war invasion act of foreign enemy hostilities (whether war be declared or not) civil war, mutiny, revolution, insurrection, rebellion or military or usurped power.
  • Contractual Employees: There must be an employer-employee relationship between the policyholder and his/her employees. Employees who belong to the contractors are not covered under the policy.
  • Occupational Disease: Diseases mentioned in Part ‘C’ of Schedule III of the Workmen’s Compensation Act, 1923 do not get coverage under the policy.
The exclusions may differ from insurer to insurer to insurer. Hence, it is vital to go through the policy and add-ons terms and conditions before signing the agreement.
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