Employer legal liability is covered by workmen's compensation insurance. When an employee is hurt while on duty, it helps employers pay for medical and legal expenses. In the same way, an employee's medical expenditures are covered by a group health insurance policy. The functions of the two coverings are distinct. For the same accident, an employee may receive coverage from either health insurance or workmen's compensation insurance. It is based on the indemnification premise that the insurance provider only has to cover the actual loss. 


According to their needs, employers can choose either one of these policies or both. By managing and protecting their company and personal risks and guaranteeing that their employees have prompt and hassle-free claims experiences, Raghnall offers clients end-to-end claims management services under group health and workmen's compensation.

Claim Settlement for Group Health and Workmen's Compensation Insurance

The same injury cannot be covered by both group health and workmen's compensation insurance policies. As a result, the wounded will receive nothing more than the loss. The loss is compensated on a proportional basis if the injured worker seeks both group health insurance and worker compensation from the company. For example, both insurance plans include medical expense coverage. The claim will be split between the two insurers if a worker contacts both of them for the settlement of medical bills.


Due to the stigma attached to such claims, some employers may prevent injured worker’s from getting workmen compensation insurance. Additionally, a worker might be unable to prove that his illness or injury is connected to his job. The amount of a workmen's compensation claim must also be determined by the court before it can be paid. The completion of this might take some time. As a result, such employees opt to contact their group health insurance provider.


If the injury results in permanent disability, the covered worker should seek workmen's compensation insurance. Along with paying for medical expenditures, it also replaces lost wages. Group health insurance, on the other hand, only covers medical expenses and does not cover income losses. Similarly, if an employee dies or has a partial or entire disability, group health insurance will not pay any benefits. This must be claimed through workmen's compensation insurance.

Claim Procedure for Workmen's Compensation Insurance

  • a) After an incident happens, the insured must notify the insurance provider without delay.
  • b) Immediately notify the factory inspector of the accident if it occurs at the production facility.
  • c) The claim must subsequently be submitted in writing together with all appropriate documentation.
  • d) A representative of the insurance company verifies the claim.
  • e) In accordance with the outcome of the verification, the insurer may approve or refuse the claim.

Claim Procedure for Group Health Insurance

  • a) Inform your insurance provider of your membership number.
  • b) Pay all hospital expenses.
  • c) When requesting compensation, be sure to include all appropriate paperwork, including invoices, medications, discharge summaries, and more.
  • d) Download the refund form from the insurance website and complete it.
  • e) Send the insurance company the completed forms and the medical bills.
  • f) Once the claim is accepted, a payment will be sent. The procedure typically takes 20 days to complete from the moment that all paperwork is received.

We, at Raghnall, a renowned risk advisor and leading insurance broker in Mumbai, can help you understand the key differences between group health insurance and workmen's compensation insurance plans, guide you in selecting the proper policy, and assist you in settling if the need arises.

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