EMPLOYMENT INJURY

 

What is Employment Injury Benefit?

It is a payment to insured persons who are incapable of work because of an injury sustained as a result of an accident or alleged accident arising out of or in the course of employment, or certain types of diseases which one may contract as a result of the work one is required to perform.

 

It is mandatory for all employers to insure all employees, regardless of age, against employment injury.

 

Contributions of .5% of insurable earnings are paid into the Employment Injury Scheme solely by the employer.

 

EMPLOYMENT INJURY BENEFITS

Provided under the Employment Injury Branch of the Scheme are:

1.      Injury Benefit.

2.     Disablement Benefit

3.     Medical Expenses

4.     Funeral Grant

5.     Death Benefit

Constant attendance allowance

 

 

INJURY BENEFIT

 

This is a weekly payment to an insured person while he is incapable of work because of an accident arising out of and in the course of employment, or from a prescribed disease.

 

DURATION OF INJURY BENEFIT

Injury Benefit is paid up to a maximum period of 52 weeks, as long as the incapacity exists.  After that period your doctor must re-assess your disability to determine your eligibility for the Disablement Benefit.

 

 

 

HOW TO CLAIM INJURY BENEFIT!

 

·     Report the accident to your employer or someone in authority as soon as possible.

·     Visit your doctor immediately, or go to the hospital. Ask the doctor to certify your injury on the Medical Report Form.

·     Complete and sign the Claim Form and submit it to the National Insurance Office as soon as possible. (Be sure to answer all questions)

 

 

Claims must be submitted within 15 days from the date of the accident or from the date of development of the disease

 

The daily rate of Injury Benefit is 70% of average weekly insurable earnings of the insured person divided by six.

 

 

Employers are required to investigate the circumstances of an alleged accident and submit a written report to the Board within a period of ten working days from the date on which the accident or alleged accident occurred.

 

MEDICAL EXPENSES

 

 

WHAT PAYMENTS ARE MADE?

 

A.    Medical, surgical, dental and hospital treatment, skilled nursing services, and the supply of medicines.

B.    The supply of fittings, maintenance, repair and renewal of artificial limbs, dentures, spectacles and other apparatus and appliances.

C.    The cost of traveling for the purpose of obtaining any of the above.

 

 

For Medical Expenses to be paid:

 

·       The expenses must he reasonable and reasonably incurred.

·     The expenses must relate to obtaining treatment which is provided so as to secure maximum effectiveness at minimum reasonable cost.

·     The fees or charges constituting the medical expenses must not be more than would be properly and reasonably charged to the insured person as if he were paying them HIMSELF.

 

HOW TO CLAIM MEDICAL EXPENSES!

ü     Keep ail bills and receipts for drugs, medication, doctor's fees, traveling, hospitalization, etc., safely.  You will have to submit these with your claim.

ü     Complete the Medical Expense Claim Form and submit to the National Insurance Office.

 

Details of the nature of the treatment which you received, both as an in-patient and as an outpatient must be indicated on the form.

 

 

 

 

DISABLEMENT BENEFIT

A benefit which is payable if, at the end of the period for which Injury Benefit is payable, the insured person is suffering from a loss of physical or mental faculty as a result of the injury or disease. The benefit may be either a Pension or a Grant.

 

If the disability is a loss of 30% or more of physical or mental faculty then a Pension is paid. The pension is paid for life or until the disability ceases. If the disability is a loss of less than 30% of physical or mental faculty then a Grant is paid. This is a lump sum payment.

 

CONSTANT ATTENDANCE

 

A person qualifies for an additional allowance (known as" a constant attendance allowance") if the injured person whose disablement is 100% requires the constant help of another person. This allowance is equal to one-half (1/2) of the disability pension.

 

WHEN TO CLAIM DISABLEMENT BENEFIT

 

Immediately on the conclusion of the payment of Injury Benefit the medical assessment should be done and a claim submitted.

 

FUNERAL GRANT

To qualify for a Funeral Grant, death must have resulted from personal injury caused by accident arising out of and in the course of employment, or from a prescribed disease. The amount of a Funeral Grant is $3,600.00. The grant is payable to the person who has met or is liable to meet the cost of the funeral of the deceased insured person.

 

DEATH BENEFIT

Where death occurs as a result of an employment accident or a prescribed disease arising out of or in the course of insurable employment, Death Benefit is paid to the dependent of the deceased insured person in the following order or priority:

 

A.    Widow

B.    Widower

C.    Unmarried children including adopted children, stepchildren and illegitimate children under sixteen years or up to eighteen years if in full time education.

D.    Any other person including children, not qualifying under (c) and whom the Executive Director adjudges to be a dependent.

E.    Any named beneficiary who does not qualify under any of the above.

 

The dependent person should submit a claim as soon as possible after death of the insured person. However, the Time Limit for claiming the Employment Injury Death Benefit is six months from the death of the insured.

 

The National Insurance Scheme - "Employment Injury Benefits" leaflet gives general guidance on information regarding employment injury. It must not be treated as a complete and authoritative statement of the law on any particular case.