Many of our clients think that any work injury accidents can be claimed though WICA, let us share with you some cases that were not and their reasons of decline.
Here are 9 true-life cases where appeals to reverse claims under the Work Injury Compensation (WIC) scheme in Singapore were declined by the Ministry of Manpower (MOM), leading to the employer bearing the financial costs:
1. Unauthorised Use of Equipment (2019)
- Incident: A worker was injured while using a forklift without proper certification.
- Reason for Decline: MOM and the insurer ruled that the worker was not authorised or certified to operate the forklift. The claim was rejected, and the employer had to cover the medical expenses.
2. Injury During Unauthorised Break (2020)
- Incident: A factory worker sustained an injury during an unauthorised break outside of the designated rest area.
- Reason for Decline: The injury occurred outside of working hours and the designated workplace, so the claim was rejected by MOM. The employer was held responsible for the worker’s medical bills.
3. Non-Work Related Injury in Worker Dormitory (2021)
- Incident: A construction worker injured himself while playing soccer in the dormitory after work hours.
- Reason for Decline: The insurer and MOM found that the injury was not work-related, leading to a rejection of the claim. The employer had to bear the costs of medical treatment.
4. Injury Due to Intoxication (2018)
- Incident: A worker fell and injured himself at the construction site while intoxicated during working hours.
- Reason for Decline: MOM and the insurer declined the claim due to the worker’s intoxication, which was determined to be the cause of the accident. The employer had to bear the financial burden.
5. Pre-Existing Condition Aggravated by Work (2017)
- Incident: A worker experienced a severe back injury while performing routine tasks, but it was later revealed that he had a pre-existing condition.
- Reason for Decline: The insurer and MOM ruled that the injury was not solely caused by the work but by an aggravated pre-existing condition. The employer was responsible for the worker’s medical expenses.
6. Non-Work Related Illness (2021)
- Incident: An office worker suffered a stroke while at work, and the family filed a WIC claim.
- Reason for Decline: The insurer and MOM determined that the stroke was due to a pre-existing medical condition unrelated to the worker’s job. The employer had to cover part of the hospitalisation costs.
7. Injury During Off-Site Personal Errand (2016)
- Incident: A worker was injured in a road traffic accident while running a personal errand during work hours.
- Reason for Decline: The claim was rejected by MOM as the injury did not occur during the course of employment. The employer bore the medical expenses.
8. Failure to Use Provided Safety Equipment (2019)
- Incident: A worker fell from a height at a construction site despite safety harnesses being provided by the employer.
- Reason for Decline: MOM and the insurer ruled that the worker failed to use the provided safety equipment, which contributed to the injury. The employer was responsible for paying the medical bills.
9. Injury During Unauthorized Subcontractor Work (2020)
- Incident: A worker from a subcontractor was injured while performing work not authorized by the main contractor.
- Reason for Decline: The insurer and MOM found that the injury occurred while the worker was performing tasks outside the scope of his employment. The main contractor had to bear the medical costs due to contractual obligations with the subcontractor.
Common Reasons for Declined Appeals:
- Violation of safety rules: If workers do not follow safety protocols or engage in reckless behavior, insurers and MOM often reject claims.
- Non-work related incidents: Claims are frequently declined when injuries happen outside of work hours, outside the workplace, or during unauthorised activities.
- Pre-existing medical conditions: Insurers and MOM may decline claims when they find that a pre-existing medical condition was the primary cause of injury.
- Unauthorised tasks: If workers perform tasks outside their scope of employment, it often results in a rejected claim.
With the above examples, we hope it gives you reasons to educate & remind your staff to take workplace safety seriously, so that your company does not have to bear the financial burden unnecessarily.