WIBA INSURANCE POLICY

What is the WIBA Insurance policy in Kenya and its legal background?

WIBA (Work Injury Benefits Act) insurance is a policy in Kenya that aims to cover employees and compensate them in the event of employees suffering work-related injuries, illnesses, or death. This policy having been enacted under the Work Injury Benefits Act of 2007 through an act of Parliament, remains very important to the well-being and safety of workers especially employees in high-risk industries such as the construction, manufacturing, transport, and even lower-risk industries.

WIBA insurance policy primarily assists workers and other people from the financial implications of workplace liabilities and at the same time assures employers of negligence claims by providing a proper compensation structure in place enhancing overall employee and workplace protection.

WIBA insurance is enforced under the 2007 Work Injury Benefits Act of Kenya. This act provides a foundation for the employee’s and employers’ duties where the latter participates in employment-related risk. In such circumstances, the employees should be appropriately compensated for such injuries in the course of employment. The legal enactment is implemented by the ministry in charge of industrial relations and employment.

The Ministry’s primary responsibilities in the enforcement of WIBA include:

1. Regulation and Oversight – oversees the compliance of all employers with the provisions of WIBA by ensuring they have adequate insurance policies to cover workplace injuries, illnesses, or deaths.
2. Claims Processing – through the Directorate of Occupational Health and Safety (DOHS), the ministry facilitates the submission, evaluation, and processing of claims under WIBA. It ensures that injured employees or the dependents of deceased employees file their claims in line with the WIBA regulations. They monitor the process to ensure fair and timely compensation for affected workers.
3. Dispute Resolution – in cases where disputes arise over compensation whether due to delays in claim processing or disagreements between employers and employees, they play a mediating role.
4. Inspection and Enforcement – regularly inspect workplaces to ensure that employers have complied with safety regulations, including having valid WIBA insurance policies in place
5. Education and Awareness -educate employers and employees about their rights and responsibilities under the Work Injury Benefits Act. They work to increase awareness about workplace safety standards and the importance of WIBA insurance to both protect workers and minimize employer liability.
6. Policy Review and Amendments – plays an active role in reviewing and updating WIBA policies to reflect changes in the work environment and ensure the legislation remains relevant. This involves consulting with stakeholders such as labor unions, employers, and insurance companies to maintain effective protection for employees.

What are the features of WIBA Insurance?

The main features of WIBA Insurance include:

 WIBA insurance compensates employees who suffer injuries or death while performing their duties. This compensation covers; death where in the unfortunate event of a work-related death, WIBA provides financial compensation to the deceased employee’s dependents. It also covers permanent disability where in the event an employee suffers a permanent disability, WIBA ensures compensation proportional to the severity of the disability. Thirdly, it covers temporary disability where employees who experience temporary disabilities are entitled to compensation for lost wages during their recovery period. In terms of medical expenses, all necessary medical expenses incurred as a result of work-related injuries or illness are covered by the insurance cover.

• Medical Benefits

WIBA insurance provides comprehensive medical coverage where in terms of medical expenses, all necessary medical expenses incurred as a result of work-related injuries or illness are covered by the insurance cover. These expenses include hospitalization costs, surgical expenses, and medication.

These medical benefits help injured employees receive timely and appropriate care without the burden of medical expenses.

• Permanent Disability Compensation

WIBA provides compensation for permanent disabilities based on the extent of damage caused during performing work duties. This is calculated as a percentage of the employee’s earnings before the injury:

For Example: When an employee is permanently injured, a medical professional evaluates the extent of the disability. The percentage of the employee’s permanent incapacity determines the amount of compensation awarded, i.e. a worker who suffers 50% permanent disability might receive compensation equivalent to 50% of their annual earnings.

• Temporary Disability Compensation

This type of temporary disability compensation occurs when Employees who experience a temporary disability that makes them unable to work for a certain period are also entitled to compensation. The benefits are usually calculated as a percentage of the employee’s normal wages. These benefits are paid out until the employee can resume their duties or when the situation becomes permanent.

• Occupational Diseases

WIBA extends coverage to occupational diseases that are a direct result of workplace activities. Employees diagnosed with occupational diseases are entitled to claim benefits similar to those for workplace injuries, including compensation for medical treatment and lost earnings.

These features of WIBA insurance ensure total protection for employees, covering both physical injuries and work-related illnesses while providing employers with a structured and proper way of managing workplace risks that may likely occur.

Why do you need a WIBA Insurance Policy?

WIBA insurance policy is very important as it provides financial protection and security to both employees and employers.

Some of the benefits of WIBA to the employees include:

1. Medical benefits – employees who get injured in their work duties get their medical expenses catered for fully.
2. Peace of mind – WIBA coverage gives the employees assurance that they are well taken of, thus enabling them to work effectively.
3. Income replacement – WIBA coverage provides a continued source of income even when they are injured thus maintaining the same level of financial disability.
4. Disability and death compensation – In the scenario of a permanent disability or unfortunately the employee dies, WIBA provides financial stability to the dependents of the employee as they are well compensated.

The employers also benefit from the WIBA policy. Some of the benefits include:

1. Compliance – WIBA being mandatory in Kenya, having a policy cover ensures employers are compliant with laws and regulations, thus avoiding legal effects and penalties.
2. Financial security – The policy protects the employers from directly compensating injured employees from the business, thus not undermining the continued operations of the business.
3. Work efficiency – Employees end up putting in their best since they are assured of safety thus helping their employers to actualize the vision and mission of the entity.

The benefits are not limited, there are so many that we might not be able to cover in this article but it’s a vital tool to both employers and employees.

Who needs WIBA insurance in Kenya?

WIBA Insurance is mandatory for all employers in Kenya regardless of the size or type of industry in question, whether formal or informal. This applies to workers or employees operating on a full-time, or part-time basis. In Kenya, all employers with more than one or more employees are required by law through the WIBA Act (2007) to ensure their employees are well covered and protected in case of any unexpected event. The government through the ministry responsible for labour and social protection enforces the law by ensuring all employers are compliant.

Even though WIBA insurance is mandatory for all employers across all industries, certain industries are highly crucial due to them being more prone to workplace hazards. They include:

1. Construction industries – this is one of the highest-risk sectors with the workers highly exposed to heavy machinery, hazardous materials, and heights risk. WIBA insurance cover protects construction workers from accidents such as falls, in case of machine malfunctions and injuries that may occur.
2. Manufacturing industries – workers or employees employed in the manufacturing industry, interact with machines, chemicals, and other materials that are highly dangerous. Some of the tasks are repetitive, heavy lifting, and exposure to various temperatures, this environment might cause various risks to employees. WIBA Insurance provides coverage to employees in case any unexpected occurs during the working period.
3. Agriculture sector – The agricultural industry involves the use of physical labor, farm chemicals, and machinery, which poses a great risk to farm users in terms of physical injuries or occupational diseases. WIBA insurance covers both large-scale and small-scale users.
4. Transport and Logistics industries – Employees in this sector include drivers, loaders, and other workers who are highly exposed to risks such as road accidents, loading injuries, or any other injuries that may occur when working. WIBA is very important to employees in this sector to give them peace of mind knowing they are eased from financial stress in case of any unexpected incident.
5. Mining and quarry industry – Those working in this industry face significant threats such as cave-ins, explosions, or respiratory diseases caused by dust and fumes when they are working. WIBA is very necessary in protecting these workers by providing financial security.

These are some of the high-risk industries but not limited to energy industries, hospitality and tourism, healthcare, and many other industries that expose their employees easily to risks.

This policy is also very important in low-risk industries such as office-based industries, even though the likelihood of occurrence of accidents or any other risks may be lower compared to a high-risks, environment, the risks can still occur. WIBA policy protects employees in case of any event that may hinder their ability to continue working seamlessly.

WIBA compliance by all employers not only protects the employees it also mitigates legal risks and financial losses.

How to access WIBA policy in Kenya?

Employers can access WIBA policy easily anywhere in Kenya online or offline but there’s a need to evaluate various policies to ensure comprehensive coverage and also to line with the employer’s financial budget. That’s why we are here to help you.

How is the WIBA claiming process in Kenya done?

For WIBA insurance to be effected by the insurer to the insured, there must be a process to be followed so that the compensation can be done in case an accident occurs. The process involves:

1. Report the incident – The injured employee should report the injury to their employee as soon as possible. The matter is also reported to the director of occupational and safety and health services.
2. Medical examination – the injured employee will have to undergo a medical examination carried out by a qualified and registered medical practitioner in a registered medical facility. The practitioner will assess the extent of injury or illness and its effect on the employer’s ability to continue working.
3. Filing the claim form – The employer, the injured employee, or any authorized representative fills out the WIBA claim form commonly referred to in Kenya FORM DOSH or WIBA 1. This form includes all the details about the accident occurrence, medical reports from medical practitioners, and any other documents that may be required.
4. Claim Evaluation – Once the WIBA claim form is filled, the form is submitted to the insurer. The insurer will have to evaluate the claim based on the medical report, the occurrence of the accident, and the situation of the injured employee.
5. Compensation – If the insurer accepts the claim, then all the compensation is provided. In case of occurrence of death, the dependents of the deceased are compensated.

At times there may arise disputes regarding the amount awarded or the insurer declines to compensate due to various reasons that need to be provided by the insurer. In the case of this incident:

• Dispute resolution – if any dispute arises either from the amount compensated or the insurer declines to compensate, the matter is referred to the director of occupational safety and health services, to resolve the matter. The director investigates the matter and makes a determination. If the ruling, is not accepted by either party it can be challenged in a court of law.
• Compensation – Once a dispute is resolved, the payment of the compensation is paid out in line with the terms and conditions.

The process is formulated in a way that all the parties operate within the law and the injured employee or their family receives timely and fair compensation.

What are the challenges the WIBA Insurance policy implementation faces in Kenya?

There are various challenges in the WIBA insurance policy implementation, that are faced by the parties involved. Some of the challenges include:

1. Low awareness

Many citizens in Kenya, both employers and employees lack proper and sufficient knowledge of WIBA insurance and its importance. This has led to most employers, not being compliant.

1. Slow compensation

Due to the many steps involved in the compensation the process has been viewed as slow thus reducing acceptability by the citizens. The insurance stakeholders have come up with ways to ease the process and speed it up.

1. Disputes

Disagreements often come up between employers, employees, and insurers regarding issues like the extent of injuries or illness, compensation amount, or any other issue that may arise thus prolonging the claiming process.

1. Low coverage in the informal sector

Currently, the informal sector employs a huge percentage of the workforce in Kenya. This sector largely fails to implement WIBA policy due to the process being more rigid, though mechanisms are being introduced to make the process flexible.

Although there are other challenges, efforts are being put in place to minimize the challenges and everything more seamless.

In conclusion, it’s worth noting that WIBA is very crucial in promoting workplace safety and a proper working environment for all employees and also benefits employers.