Workmen Compensation Vs Personal Accident Insurance

In WC policy mediclaim coverage is not possible but medical expenses incurred during accident can be covered alongwith a Personal accident (PA) policy subject to a ceiling based on additional premium.

The difference between a WC policy & PA policy is WC policy covers employment injury suffered in the course & out of employment whereas PA policy covers  any injury suffered 24 hours worldwide. Even an injury suffered at home, resulting in loss of earning capacity can be covered under PA policy.

The premium for WC policy is dependent on the nature of job, wages drawn, age. But PA policy is dependent on earning capacity of the individual. Pay out under WC policy will be in line with WC act & WC Commissioner. PA policy pay out will be based on sum insured under the policy.

WC Policy is a Legal Liability Policy whereas in PA Policy certain Agreed Benefits are granted.

W.C. Policy covers Legal Liability towards employees in case of death or injury sustained by them during the course of Employment. 

PA Policy covers Accidental bodily injuries resulting solely and directly from accident caused by EXTERNAL & VIOLENT means resulting into death or disablement any time during the period of Policy.

In case of WC Policy amount of compensation depend on the nature of injury in case of injury cases. In case of Fatal accidents the compensation is worked out by taking the factors like Age and Income of the person Injured/died. Thus it varies from case to case.

If PA Policy is taken for higher Sum Insured, it may cover compensation payable as per WC Policy; if it is taken for lower Sum Insured, the Award under WC may be more than the cover taken under WC.

The WC Policy covers occupational diseases that might be contracted by workers arising out of and in the course of employment (additional premium around 25%). Occupational disease is totally outside the scope of the PA Cover.

Premium rates under WC Policy depend on the nature of duties in which the workers are involved; 

whereas in PA, Standard Rates are charged for all except for Persons working in underground mines, Explosives Magazines, Workers involved in electrical installation with high tension supply, Jockeys, Circus personnels, persons engagedin activities like racing on wheels or horse back, big game hunting, Winter sports, Mountaineering,  Sking, Ice hockey, Ballooning, Polo and persons engage,d in occupations of similar hazard.

Benefits under ESI are as per WC Policy; whereas PA & Mediclaim policies cover benefits as per their standard terms and conditions. 

PA Covers compensation against Accidental Injury or Death as agreed in the policy and Mediclaim covers reimbursement against hospitalisation upto the limit covered under the policy.