With the increasing popularity of Chinese medicine consultations, employees may choose to consult Chinese Medicine Practitioners when they are injured. 

Scenario:        
Mr. Chan hurt his back when moving heavy files from the top shelf of the cabinet in his office on 5 September 2008. He consulted a registered Chinese Medicine Practitioner and was given 2 weeks sick leave.

Question:        
Can Mr. Chan successfully claim under the Employees' Compensation Ordinance (ECO)?

Answer:        
With the amendments to the Employees' Compensation Ordinance (ECO) Cap.282* made under the Certification for Employee Benefits (Chinese Medicine) (Miscellaneous Amendments) Ordinance 2006 ("the Amendment Ordinance") which became effective 1 September 2008, if an employee is injured on or after 1 September 2008 as a result of an accident arising out of and in the course of his employment and seeks treatment from a registered Chinese Medicine Practitioner, he/she is eligible for periodical payments (sick leave payment) for his/her period of absence from duty by the employer if the attending registered Chinese Medicine Practitioner grants the employee a sick leave certificate, proving that he/she is temporarily incapable of work for a certain period.
As Mr. Chan was injured on 5 September 2008, i.e. the date of accident was later than the effective date of "the Amendment Ordinance", Mr. Chan can claim successfully for compensation in relation to his work-related injury.

If employees would like to consult Chinese Medicine Practitioners due to injury at work, it is suggested that they should check if the Chinese Medicine Practitioners they wish to consult are registered according to the "Chinese Medicine Ordinance Cap. 549" to avoid failing to fulfil the requirements of the corresponding ordinances.

 *According to Section 2 of Chinese Medicine Ordinance Chapter 549, "Registered Chinese Medicine Practitioner" means "a person whose name appears on the Register and who is registered under section 69 or 85."

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It is very important that all employers declare actual earnings information for all their employees to their insurers to ensure that they have full indemnity insurance protection to meet the potential liability of their employees in the case of accidents arising out of, and in the course of, their employment.

Employers are reminded that according to the average clause contained in the employees’ compensation insurance policy regarding the Policy Limit of Indemnity (which is widely adopted in the market), under-reporting of earnings may result in a proportionate reduction in the insurer’s indemnity for compensable claims. In such cases, employers will have to bear the proportionate share of indemnity for injured employees themselves. If no declaration of actual earnings by the employer is received by the insurer as prescribed in the policy, for the purpose of this clause the earnings estimated by the employer as at the commencement of the Period of Insurance shall be used in lieu of the actual earnings that should have been declared to determine the extent of the under-insurance, if any.

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Personal accident insurance protects customers against bodily injury sustained by means of any sudden, violent and accidental occurrence of external origin. However, many customers misunderstand this and think that all means of bodily injury happening in a sudden manner are covered by personal accident insurance.

Below is an example demonstrating this misunderstanding among customers:

Last Tuesday, shortly after Mrs. Wong went to bed, she kicked away her blanket with a slight movement of her leg when she started to feel too hot. She then discovered that she had sprained her leg and applied muscle rubbing ointment to alleviate the pain. Mrs. Wong went to work as usual the next day and visited the bonesetter during lunch time.

Mrs. Wong kept the bonesetter’s receipt and subsequently filed a personal accident insurance claim. However, her claim was rejected as the assessment result indicated that her accident was not caused by external violence and was not visible. Mrs. Wong’s injury was deemed to be the result of gradual deterioration rather than an accident.

Below are more examples of bodily injuries that are covered and not covered by personal accident insurance.

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Personal Protector 3.0

If an employees' compensation case is not settled due to the employee's failure to complete the sick leave clearance procedure or medical assessment long after recovery and resumption of work, what can an employer do to facilitate the settling of the claim?

In the above circumstance, the employer can settle the case through the paper sick leave clearance scheme for outstanding cases. 

The employer can complete an application form available at the offices of the Employees’ Compensation Division, stating "Application for Paper Sick Leave Clearance for Outstanding Cases" and send it with the relevant information, such as proof of sick leave payment and all of the employee’s sick leave certificates to the appropriate Employees’ Compensation Division branch office. The Employees' Compensation Division of the Labour Department will issue a final reminder of sick leave clearance to the employee depending on the circumstances. If the employee does not respond in a reasonable period, the Employees' Compensation Division will presume that the employee is not suffering from any permanent incapacity or has abandoned his claim for compensation for permanent incapacity. A Certificate of Compensation Assessment (Form 5) will then be issued to both the employer and the employee.

In this way, the employer can send the original of Form 5, sick leave certificate(s) and periodical payments record to the insurance company in order to settle the employees’ compensation claim. 

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Many people may not be aware that if they unfortunately encounter travel-related problems, other than the travel insurance thay have taken out, they can also enjoy protection provided by the Travel Industry Compensation Fund (TCIF),which is an effective regulatory control over the operation of Hong Kong's travel industry:

Firstly, if a travel agent goes bankrupt, the affected customers are entitled to receive from the TICF an ex gratia payment of up to 90% of the tour fare paid. This coverage is outside the scope of travel insurance cover.

Secondly, if customers are injured or killed in accidents whilst touring abroad, they or their relatives can claim from the Package Tour Accident Contingency Fund Scheme, which is operated by the TICF. On successful application, the following ex gratia payment will be granted:

As you can see from the above table, the maximum amount of financial relief to the victims may not be enough to cover the necessary expenses. If, unfortunately, customers are injured during their trips and need medical evacuation or emergency services, the cost can be as high as millions of dollars. Therefore, taking out a proper travel insurance plan is critically important.

In general, travel insurance provides necessary coverage that may cover most of the expenses. Take MSIG's iTravel Plus (Single Trip) as an example, it provides:

• Up to HK$2 million cover for worldwide emergency medical evacuation and repatriation after treatment
• Deposit guarantee for hospital admission
• Hospital cash
• 24-hour worldwide travel assistance services

It is suggested that all travellers take out travel insurance and you can remind them to consider the coverage and the cover limit rather than the premium as their primary concern. By the way, although the coverage granted by the TICF is limited, it can still complement the travel insurance taken out by your customers. If your customers would like to claim from the TICF, you can remind them to prepare all necessary documentations especially the receipts issued by the licensed travel agents franked with 0.15% levy payment.

Review your customers' insurance plan now!

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Mr. Wong was injured in a traffic accident while on his way to the airport in Singapore heading back to Hong Kong after a business trip. He was slightly injured and was sent to a hospital in Singapore. His attending doctor granted him one day sick leave after treatment.

Mr. Wong filed his insurance claim for his sick leave periodical payment and medical expenses under employees' compensation with his employer the next day when he arrived back in Hong Kong. However, his claim was rejected by the insurance company. Why did the insurance company reject this claim?

The employees' compensation settlement of an insurance company is subject to the Employees' Compensation Ordinance (ECO). Under ECO regulations, in the absence of a sick leave certificate certified by a registered medical practitioner in Hong Kong, the claim for sick leave periodical payment is not substantiated. As a result, Mr. Wong's claim was rejected.

In respect of Mr. Wong's claim for his medical expenses, according to the ECO Chapter 282 Section 10AA, an employer is not liable to pay medical expenses for his employees incurred outside Hong Kong, unless and until a certificate has been issued by the Commissioner under Section 10B (1)(b) stating the amount of such medical expenses. As Mr. Wong's medical expenses were not endorsed by the Commissioner, his case was rejected in accordance with ECO Chapter 282 Section 5 (2) (a), which states that an employer is not liable to pay compensation to his employee in respect of any injury arising out of and in the course of his employment if the injury, other than an injury which results in partial incapacity of a permanent nature, does not incapacitate the employee from earning full wages at the workplace at which he is employed.

Accidents can happen at any time. In order to enjoy comprehensive cover, customers are advised to take out their own personal accident insurance which provides cover against bodily injury incurred in an accident anywhere in the world.

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Employees’ Compensation
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These days, personal accident insurance has become a necessity in peoples’ daily lives. However, each member of a family, from the youngest children to the most elderly have different personal insurance protection needs. As a result, it is not only essential to fully understand the real needs of customers and their families, but also to distinguish between family personal accident protection products and general personal accident protection products when recommending the most suitable plan for your customers and their families.

Firstly, family personal accident insurance will protect children, adults and the elderly by offering cover that varies depending on the different risks each family member is exposed to. For example, customised protection that covers children during indoor and outdoor school activities to broken bone benefits for the elderly. Secondly, the minimum insurance age in a general personal accident protection product is from 16 years of age onwards, but the minimum insurance age of child protection in a family personal accident insurance plan could be as low as 6 months. When children reach a certain age, they are allowed to transfer from a children’s plan to an adult plan. Additionally, with policies such as MSIG’s “Family Personal Protector”, the premiums for the basic elderly plan will not increase as a result of the insured’s age.

Accidents always happen in unexpected situations and you will never be in a position to know exactly what will happen next. Therefore, it is essential to take out a family personal accident insurance plan with comprehensive coverage to ensure that you and your family members are protected at all times.

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Personal Protector 3.0

Mr. Fung was a worker in a courier service company. He was injured at work on 1 May 2016 and was granted sick leave from 1 May 2016 to 30 December 2016. Form 7 and Form 5 were issued on 1 May 2017 and 14 May 2017 respectively. The employer made periodical payments to Mr. Fung during his sick leave period but refused to pay the compensation of HK$40,000 for permanent incapacity within 21 days of the issue of Form 5, giving as the reason another monetary dispute between themselves.

Warning letters were issued to the employer and copies sent to the insurance company for follow-up action. Mr. Fung then filed his employees' compensation claim in court and lodged a complaint against the employer for non-payment of compensation at the Labour Department. Although the payment was finally settled in court by the insurance company in early 2018, the employer was prosecuted for late-payment of compensation under Chapter 282 section 16A(9)(b) of the Employees' Compensation Ordinance (ECO) and for non-payment of the surcharge under sections 16A(10)(a) and 16A(10)(b).

It is the employers' duty to observe the timelines and requirements of the ECO and to settle an employees' compensation to avoid prosecution. If employers have any enquiries about a claim, they can consult their insurance company.

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Employees’ Compensation
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Ms Chan used to walk to her office and home every day. Unfortunately, she accidentally slipped on the staircase of a flyover on the way to work last Wednesday when the red rainstorm warning signal was hoisted. She was injured and unable to move, and was finally taken to the hospital. 

Ms Chan knew that she had the protection of employees’ compensation insurance, but she was not familiar with the coverage. She thought that employees’ compensation insurance only covers accidents that happen while travelling to the office by public transport when the black rainstorm warning signal is hoisted. Therefore, she did not file a claim with her company and instead settled the medical expenses by herself. 

In fact, Ms Chan’s accident was under the coverage of the existing Employees’ Compensation Ordinance (the “Ordinance”), so she could actually have filed an employees’ compensation claim with her company. Put simply, an accident happening to an employee shall be deemed to arise out of and in the course of his/her employment if it happens to the employee when, within the duration of a gale warning, or of a rainstorm warning, he/she is travelling between his place of residence and his/her place of work, by a direct route within a period of 4 hours before the time of commencement of his/her working hours for that day or to his/her place of residence, within a period of 4 hours after the time of cessation of his/her working hours for that day. Normally, tropical cyclone warning signals No. 8 or above or red and black rainstorm warning signals are the named circumstances covered by the Ordinance.

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Scenario:
Mr. White had a stroke during his trip in China. He would like to be repatriated to receive treatment in Hong Kong rather than being admitted to a local hospital. What would be our professional advice?

It is a common misconception that the cover limit of travel insurance for repatriating to receive treatment in Hong Kong is as much as the cover limit for receiving treatment locally. In order to provide proper and immediate treatment to our customers during their trips, the cover limit for local medical treatment expenses in our travel insurance plan can be up to HK$1,000,000. The cover limit is high because the medical treatment costs for foreigners are usually higher than those for local residents. Besides, we have also provided medical expenses cover of up to HK$50,000 for our customers to have follow-up treatment in Hong Kong.

In Mr. White's case, we had pointed out to him the difference between the two above-mentioned clauses. We explained that the intention and nature of our travel insurance plan is to allow our customers to receive immediate treatment cover outside Hong Kong. Mr. White showed understanding despite his insistence to return to Hong Kong. Therefore, as a friendly reminder, we asked him to seek better protection from his other medical insurance policy, while the MSIG travel plan served as a secondary protection for his medical expenses. Consequently, we only had to cover his repatriation and in-patient treatment in a Hong Kong government hospital.

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iTravel Plus (Single Trip)
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