Worker’s compensation insurance – how it works and its exclusions

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The Workers’ Compensation Insurance must be hired to handle the injuries of company employees, domestic servants and all those who in one way or another pay service to any entity (individual or collective) being compensated for it.

The only mode where you can hire without identifying the insured in the insurance contract is that of domestic workers (this includes the cleaning of the house and gardener).

There are two ways to take out insurance:

Fixed premium insurance – the policy identifies the names (s) of person (s). The inputs and outputs of persons must be communicated to the insurer. In companies, apply up to 6 employees. Above that, the system applies the variable premium.

Insurance premium variable – consists of sending holiday leaves for the insurer and the monthly premium is paid based on payroll estimates. At the end of the year, if the total remuneration is higher than expected, there is an additional premium calculated on the difference. If it is less, there will be cancellation of the difference.

What is Accident?

- Whoever takes place in time and place of work and service of the employer

- Held on the way home to work and vice versa – is covered from the time that spans the front door to the common areas of the building or street, where a housing

- Held in training when expressly authorized by the employer

- Held in finding employment when there is credit hours granted by law to workers with the cessation process and contract work in progress

- Held at the location where assistance is being provided to the employee because of a previous accident at work

- Held off-site or working time in the performance of certain services by the employer.

What are the guarantees?

Benefits in kind – include medical, surgical, pharmaceutical and hospital and all necessary so that the worker is fully recovered

Cash benefits :

compensation for temporary incapacity to perform the work
lifetime pensions for permanent disability arising due the reduction in the ability to work or gain
subsidies for housing rehabilitation
supplementary assistance by a third person
In case of death, the family pension and death allowance and funeral expenses
These benefits are calculated based on reported earnings.

What are the exclusions?

Occupational diseases
Accidents due to labor disturbances – assaults, strikes, riots, for example.
Accidents caused by terrorist acts, sabotage, rebellion, civil war, …
Accidents caused by wars and invasions
Hernia sac formed
Fines and penalties that befall the policyholder for lack of compliance with legislation
The victim is the policyholder when it is an individual
All those who do not have an employment contract with the policyholder, unless the directors, managers or similar, when paid.
Legally recognized disability as a result of refusal or failure to follow medical prescriptions or intentionally caused
Some additional notes:

- Accidents outside Portugal – up to 15 days of stay, need not inform the insurer, up to 15 days, you have to do. It is advisable to ensure the costs of treatment and repatriation outside Portugal, if you travel a lot.

- If the laws of the State where the accident occurred recognize the right to compensation, you can opt for the more favorable for you

- Insurance against accidents at work is governed by Decree-Law, which means that all insurers have to comply with the standards and procedures defined in the legislation.

- If you want to transfer the insurance to another insurer, make the notice of cancellation 30 days in advance, especially in the regime of variable premium (Sheet Holidays)

- The non-payment of premium or installment premium on the closing date implies the cancellation of the insurance contract, a situation common to all insurance

- Incorrect statements that influence the risk it is hedging or lack thereof, implies the invalidity of the contract and the insurer’s disclaimer of claims. Example: insurance being billed as clerks when the activity is Wholesale Product X in which the risk is higher because it implies storage.

- If the Policyholder does not send all the sheets to the insurance company holidays, it may issue an additional premium of at least 30% of estimated annual premium.