Occupational Accident Insurance: Definition, Options and How to Claim

The risk of accidents at work is unavoidable. Therefore, having work accident insurance can be a solution in providing sum assured or death compensation if the insured employee has an accident while working or on the way to work. Here’s the full explanation.

Getting to know Work Accident Insurance

Work accident insurance or work accident insurance is insurance that is intended for workers or employees of a company. This insurance will provide sum assured or death benefit if the employee (policy holder) has an accident at work or on the way to work.

Meanwhile, as reported by the official BPJS Employment website, the Work Accident Insurance provides protection for the risks of accidents that occur in an employment relationship, including accidents that occur on the way from home to work or vice versa and diseases caused by the work environment .

You can get work accident insurance by having BPJS Employment. BPJS Employment is a social insurance that provides protection to all Indonesian workers, both formal and informal sectors and foreign workers who work in Indonesia for at least six months.

The risks covered by this type of insurance are as follows:

1. Risk of Death

Risks arising from work accidents where the insured or insurance participant dies.

2. Risk of Permanent Disability

The risk of permanent disability is also one of the risks borne by the insurance provider during the insurance period.

3. Risk of Disability is not Permanent

If an occupational accident insurance participant experiences the risk of temporary disability caused by a work accident that occurs, then he or she is also entitled to benefit from this risk.

4. Risk of Medical/Doctoral Treatment/Hospital Costs

The insurance company will also bear the risk of medical expenses or care for insurance participants who have a work accident.

Work Accident Insurance Benefits

The benefits of insurance this include protection against the risk of Work Accidents from traveling to, returning, and at work, as well as business trips. In addition, policyholders will also get unlimited treatment according to their medical needs.

Not only for policyholders, families will also receive compensation for wages, death benefits, and scholarship assistance for two children. Educational scholarships for two children of participants who die or have permanent total disability due to work accidents, a maximum of Rp. 174 million.

For Indonesian migrant workers, specific benefits will be obtained:

1. Health services due to work accidents (JKK) until recovered without cost restrictions.

2. Indonesian Migrant Workers who are proven to be at risk of accidents, acts of violence and rape are given medical treatment until they are cured without any cost restrictions.

3. Failing to leave is not due to the fault of the Prospective Indonesian Migrant Workers in the amount of Rp. 7.5 million.

4. Reimbursement of transportation costs:
A. Land, river, or lake transportation is a maximum of IDR 1,000,000.
B. Sea transportation is a maximum of Rp. 1,500,000.
C. Air transportation at a maximum of IDR 2,500,000.
D. If using more than 1 (one) type of transportation, then a reimbursement of the cost of the sum of the costs of each transportation used with a maximum of each type of transportation will apply as referred to in letters A, B and C

5. Disability compensation:

A. In case of total permanent disability: IDR 100 million.
B. Periodic compensation for permanent total disability of Rp. 4.8 million (paid at once).
C. If you have a partial anatomical defect: % of disability table x Rp. 142 million.
D. Partial function disability compensation: % lack of function x % disability table x Rp.142 million.

6. Rehabilitation in the form of assistive devices (Orthese) and or replacement devices (Prothese).

7. Replacement of denture costs of Rp. 3 million.

8. Loss on the actions of other parties during the trip back to the area amounting to Rp10 million.

9. Scholarships for 2 (two) children are paid annually:

Kindergarten/SD/equivalent IDR 1.2 million.
Junior high school/equivalent IDR 1.8 million.
High school/equivalent Rp. 2.4 million.
Higher education/training Rp. 3 million.

10. Assistance and vocational training are provided to PMI who have a disability due to a work accident.

11. PMI has the right to be given care and treatment in a cooperative health facility due to a work accident and is not returned to Indonesia by the employer.

12. PMIs who are proven to be at risk of acts of physical violence and rape who are returned to Indonesia by their employers are entitled to be given care and treatment at the cooperative health facility.

13. Assistance for PMIs who have been laid off due to work accidents, working period in months:

A. 3 months < 6 months in the amount of IDR 2 million.
B. 6 months <12 months for Rp3 million.
C. 12 months < 18 months in the amount of IDR 4 million.
D. 18 months <3 months before the employment agreement ends amounting to Rp5 million.

14. Replacement of economy class air tickets for the cost of repatriating PMI who has problems and has a work accident with a condition of not dying, a maximum of Rp. 10 million.

Exceptions in Work Accident Insurance

You should know that not all will be covered by Occupational Accident Insurance. Here are the exceptions to this insurance that you should understand.

Accidents that occur due to intentional or carelessness of the person who insures or the insured.
Fighting or attempting suicide and committing other criminal acts.
Some complaints of diseases such as brain disease, mental disorders, or the insured is in a drunken state.
Pregnancy, miscarriage, childbirth, or other treatment.
Accidents that occur while the insured is in court, detained, or sentenced.
Natural disasters such as earthquakes, ocean waves, and volcanoes.
War or military action from a foreign country or civil insurrection.
Driving an airplane illegally or without a valid license.
Nuclear radiation or radioactive contamination.

The Best and Cheapest Work Accident Insurance in Indonesia

For those of you who want to have Work Accident Insurance, here are the recommendations from Risdosagala.

BPJS of Employment

BPJS Employment participation includes Work Accident Insurance. According to PP No. 44 of 2015 concerning the Implementation of the Work Accident Insurance and Death Benefit Program, work accident insurance (JKK) is a benefit in the form of cash and/or health services provided when a participant experiences a work accident or illness caused by the work environment .

The benefits of the JKK program are getting better due to changes in the increase in benefits as regulated in Government Regulation Number 82 of 2019 concerning changes to PP Number 44 of 2015 concerning the Implementation of Work Accident Insurance and Death Benefits Programs. among others:

Health services (care and treatment), Handling, including comorbidities and complications related to work accidents and occupational diseases
Compensation in the form of money
The Return to Work Program is in the form of assistance to participants who experience work accidents and work-related illnesses that have the potential to experience disability, starting from participants entering hospital treatment until the participant can return to work.
Promotive and Preventive Activities to support the realization of occupational safety and health so as to reduce the number of work accidents and occupational diseases.
Rehabilitation in the form of assistive devices (ortheses) and/or prostheses for Participants whose limbs are lost or not functioning due to a Work Accident for each case with a benchmark price set by the Government General Hospital Rehabilitation Center plus 40% (forty percent) of this price as well as the cost of medical rehabilitation.
Scholarship Benefits

The BPJS Employment contribution amount consists of 2% paid by workers and 3.7% paid by employers. The BPJS Employment JHT contribution for non-wage workers is 2% of the wages reported every month.

Simas Personal Accident

In addition to BPJS Employment, if you want to use private insurance you can choose Simas Personal Accident. This product is a type of insurance that provides benefits when the policyholder dies due to an accident during the insurance period.

The insurance company will pay an insurance benefit of one hundred percent of the sum insured until the insurance ends if the insured dies due to an accident at work or at work or within 90 calendar days of the accident occurring.

The types of guarantees provided are:

Risk of Death due to Accident
Permanent Disability due to Accident
Hospitalization costs due to Accident
Motorcycle Risk Expansion

Simas personal accident provides 5 choices of Sum Insured which consist of:

Rp10,000,000,-
IDR 25.000.000,-
IDR 50,000,000, –
Rp75,000,000,-
Rp100,000,000,-

The Insured Candidate Age Limit is 18 to 60 years old.

Takaful Personal Accident Insurance

Takaful Insurance has a product called Individual Personal Accident Takaful. This is a sharia personal accident insurance product that provides benefits in the form of payment of compensation to the beneficiary (heir) if the insured dies or permanent disability (total and partial) due to an accident during the period of policy.

The benefits provided are death compensation, total permanent disability compensation, and partial permanent disability compensation. The advantage of Personal Accident Takaful Insurance is that this insurance is purely sharia insurance which is managed based on sharia principles under the supervision of the Indonesian Ulema Council (MUI).

How to Claim Work Accident Insurance

How to claim work accident insurance may be different for each insurance company. However, in general, what you have to do to file a claim are:

Report accidents at work as soon as possible before the expiration date
Write a complete chronological letter of the accident including the time and location of the accident accompanied by photo evidence if any.
Complete claim requirements documents such as claim forms, identity cards, policy documents, and so on.
Send the document to the address of the insurance company, either through an agent, by post, or by coming directly to the branch office.
Wait for the claim process until the sum assured is transferred after the claim is approved.

Having work accident insurance can provide peace of mind for you and your beloved family. Because, if there is a risk, the insurance company will bear the risk.

To get the right work accident insurance product, Risdosagala is ready to help find the best solution. Come on, check out life insurance, car insurance, and health insurance at Risdosagala.

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