Claims for Work Injury Compensation can be made either by the Work Injury Compensation Act (WICA) or Common law. In both cases, a strategic procedure has been set in order to provide fast processing of the insurance claims so that the insured can be compensated at the earliest.
The procedure is as follows:
STEP 1: REPORTING – the accident must be reported to the employer immediately after it happens. Based on the information and the severity of the accident, the compensation will be determined. In case there is no real threat or injury to the insured, work injury compensation will not be given.
STEP 2: FILING A CLAIM – the employee or insured has the freedom to choose his claim from either the work injury compensation or common law. He must file a claim within one year from the accident.
STEP 3: MEDICAL ASSESSMENT – the insured has to undergo medical assessment in order to receive the compensation. The doctor has a list of guidelines and treatment that he needs to exercise in order to understand the seriousness of the injuries based on which the payable amount is calculated. Once the insured receives the medical report, the insured or claimant must promptly submit it to the hospital or treatment center along with the medical fees stipulated by the hospital. The fees are paid by the employer. Follow ups of appointment dates and undergoing treatment is mandatory for the claimant. The claimant cannot work if he is found to be unfit by the doctors who treat him. If there is a case of doubt, the claimant can seek the advice of the doctor. The claimant cannot be forced to work when he is still in the recovery phase and advised by the medical experts to take time off from work. If the claimant is forced, he can request for assistance from the MOM (Ministry of Manpower). But the claimant has to be sincere in his appointments. If he continuously changes doctors or does not attend the medical assessment, the compensation can be suspended.
STEP 4: COMPENSATION AMOUNT – once the medical assessment is performed and the medical report is ready, the report is submitted to the Ministry of Manpower where a Notice of Assessment (NA) is issued to the insured, employer and the insurer. The amount of compensation is mentioned in the NA. If there are any conflicting opinions about the NA, a notice of objection can be raised within 14 days to the Commissioner of the Ministry of Manpower.
STEP 5: CLAIMS – if there is no objection, the amount of compensation can be claims within 21 days after the issue of the Notice of Assessment.
These clear guidelines help make the compensation procedure clean and mess-free. When such well-established procedures are in place, malpractices can be kept at bay.