AAR Work Injury Benefits Act (WIBA) Insurance Proposal

AAR Work Injury Benefits Act (WIBA) -This policy covers the employees of the Insured whilst on duty and engaged in the execution of the Insured’s business &/or any project undertaken by the Insured, against accidental bodily injury, disablement, or death.

The injury or illness must arise out of and in the course of employment.
Compensation is payable in accordance with the provisions of the WIBA Act 2007.

The maximum benefit is set at 96 months’ salary.

The main difference between GPA and WIBA is that WIBA is occupational while GPA is 24-hour coverage.

The following are benefits payable under Work Injury Benefits Act

• Death Paid as 8 earnings.

• Permanent total disability: Meaning the loss of one limb or eye, or two or more limbs or eyes, or permanent total disablement. The extent of disability is determined by the labor officer after filling in the DOSH FORM 1. PTD is also 8 years of earnings

• Accidental Temporary Total Disablement Note that it is from “usual” occupation. But the inability solely to take part in sports and pastimes cannot be “disablement” in this sense. “Partial” disablement means disablement from a substantial part of the usual occupation. This is what is referred to as
weekly benefits are limited to 104 weeks.

• Accidental medical expenses. This benefit, unlike the others, is on an Indemnity basis, i.e. it reimburses (up to the limit of 100,000) expenses actually incurred.

A new trend in the market is where GPA and WIBA are combined to form WIBA PLUS, meaning that if an accident occurs the insurer will determine whether its occupational or not and pay it under the relevant cover.

The advantage of taking out WIBA plus is that employees are covered comprehensively at an affordable premium.

Exclusions under WIBA

• Any accidental death or injury occurring outside the normal working hours of the employee;
• Any liability of the Insured which attaches by virtue of an agreement but which would not have attached in the absence of such agreement;
• Any injury by accident or disease sustained outside the Geographical Area by any employee whose contract of service is not made in Kenya and is not subject to the Laws of Kenya;
• Any injury by accident or disease sustained by any employee who is below the age of eighteen years.
• Any injury caused or contributed directly or indirectly by the deliberate and willful misconduct of the employee.
• Any liability arising out of any court proceedings;
• Any liability arising out of pre-existing medical conditions unless the same had been declared.
• Any sum which the Insured would have been entitled to recover from any party but which cannot be recovered due to an agreement between the Insured and such party;
• Any business or occupation was other than that described in the Schedule, unless and until relevant particulars have been supplied to and accepted by the Insurer and endorsed in the Policy.

AAR WIBA Plus

GROUP PERSONAL ACCIDENT insurance pays the benefit (or benefits) stated in the schedule if the insured is killed or disabled by an accident. “Accident or Accidental” is understood to mean something violent, visible, and external to the person insured.

This is a worldwide 24-hour cover and the cover is worldwide.

WORK INJURY BENEFITS ACT INSURANCE – AN ACT of Parliament to provide compensation to employees for work-related injuries and diseases contracted in the course of their employment and for connected purposes.

WIBA ACT 2007 confines “Accident” to mean arising out of and in the course and scope of an employee’s employment and resulting in personal injury, diseases, or death.

Scope of WIBA PLUS

WIBAPLUS is a policy that combines WIBA and GPA. In effect, all accidents that occur outside the scope of employment will be paid for by the GPA part of the policy while those that occur within the scope of employment will be responded to by the WIBA section of the policy.

Benefits Under WIBA PLUS

Death
This refers to the Death of the insured occurring within the policy period resulting directly and independently of any other cause but from a sudden, accidental, forceful visible, and violent bodily injury. This also includes disappearance without a trace for over 365 days.

The policy responds by paying 96 Months’ salary.

Permanent Total Disablement
This refers to Total disability that manifests within 12 calendar months of the date of the accident, that renders the Insured incapable of attending to their usual occupation or engaging in any occupation or employment for compensation or profit for which he is reasonably qualified by reason of his education, training, or experience, provided such disability is total, continuous and permanent.

The policy responds by paying up to 96 months’ salary for 100% permanent total disability.

Medical Expenses
The actual cost of medical, surgical, hospital and related expenses necessarily and reasonably incurred for treatment of injuries resulting from an accident.

For example prescribed drugs, emergency road ambulance evacuation, surgical fees, and other procedures authorized by a qualified medical practitioner.

This is paid on reimbursement up to a limit of KShs 100,000/-

Temporary Total Disablement
This is a disability that renders the Insured entirely incapable of attending to his usual occupation but for a period longer than 1 week.

The policy responds by paying weekly earnings up to a maximum of 52 weeks.

Funeral Expenses
These are expenses incurred in disposing of the body of the diseased ensued following accidental bodily injury resulting in death.

The policy responds by paying KShs 30,000/- for every diseased employee.

Why AAR WIBA Plus

1. AAR WIBA plus is very cost-effective. It offers a 30% savings while for both the benefits of WIBA and GPA as opposed to when an employer purchases the two policies as stand-alone.
2. It provides the employer with very comprehensive cover that ensures that the employer complies with the provisions of the WIBA ACT while at the same time the employees are covered 24 hours for all accidental injuries.