Sumo Salad had valid insurance coverage for work injury claims: MOM

SINGAPORE – The Ministry of Manpower (MOM) said salad shop Sumo Salad was covered by a valid insurance policy when an alleged work injury involving a staff member occurred on June 6.

The salad shop’s owner, the late Ms Jane Lee, had submitted an incident report to MOM soon after.

As at June 27, the company had been reimbursed by its insurer for the medical expenses and medical leave wages it had claimed, MOM told reporters during a briefing on Aug 1.

When asked whether there were outstanding claims after June 27, the ministry said the claims process has not concluded as

investigations are still ongoing

.

Before finalising a claim, doctors must assess the extent of an injured worker’s incapacity, which determines the amount of lump-sum compensation for the worker.

MOM added that it has not received any indication from the insurer of potential fraud, but emphasised that the possibility cannot be ruled out. It declined to name the insurer in this case.

Ms Lee died on July 19, a day after she posted two Facebook posts alleging that a former staff member had staged a fall in an attempt to claim workplace injury compensation. She believed her company was targeted because of “an unfortunate gap” in insurance coverage.

Ms Lee also urged MOM and the police to investigate the case thoroughly, as she believed it was a premeditated scheme involving the ex-employee’s husband and possibly a law firm.

The incident has sparked wider discussions about challenges faced by small business owners in Singapore, and the need for stronger safeguards against abuses of the Work Injury Compensation Act (Wica).

MOM said the worker involved in this case is still in Singapore on a Special Pass, which is typically issued temporarily to those whose work permits have been cancelled and are awaiting departure, or for specific purposes such as assisting with investigation and attending court.

MOM said insurers had referred about 12 claims a year for investigation into potential fraud.

This is out of an average of 28,500 claims a year, filed by a roughly equal number of local and foreign workers.

MOM also noted that the median time taken to process a work injury compensation (WIC) claim is about six months, with about 96 per cent of the claims resolved within a year of filing.

Over the last five years, the ministry had prosecuted about two workers a year for fraudulent claims. These workers were jailed between three weeks and 13 weeks. The maximum penalty is a jail term of up to 12 months, or a $15,000 fine, or both.

Employers who fail to buy insurance for their manual workers, and non-manual workers earning $2,600 a month or less, may be fined up to $10,000, jailed up to 12 months, or both.

In the last five years, MOM had prosecuted about two employers a year for such offences.

MOM said the ministry conducts audit checks on employers for their Wica coverage.

“When we detect they do not have any insurance, we will nudge them,” an MOM spokesman said, adding that a grace period is given to employers to buy or renew insurance.

MOM added that over the past three years, 94 per cent of all work injury claims were paid by insurers. For the remaining 6 per cent, most were paid directly by employers exempted from buying the WIC insurance.

Generally, employers with insurance coverage are reimbursed for medical expenses as well as wages paid to workers on medical leave.

The insurer will make lump-sum compensations to workers or their families, which are granted in the event of death, permanent incapacity or incapacity that remains six months post-injury, based on doctors’ assessments.

Workers who fully recover are compensated for their medical leave wages and medical expenses, with no additional payouts.

The ministry also outlined what it said are three layers of safeguards against fraudulent claims.

Insurers are the first line of defence, as they would usually engage loss adjustors to investigate suspicious claims.

The second layer involves doctors, who assess the workers’ injuries and degree of incapacity according to a detailed manual developed with input from senior doctors.

If there are disputes on the degree of permanent incapacity awarded, the case will be referred to the WIC Medical Board for independent reassessment.

Finally, all parties to the claim – workers, employers, insurers – can object to the compensation sum, and refer the case to MOM for a final review.

MOM said workers can make a workplace injury claim under Wica or through the courts under common law, but not both.

Under Wica, employees will be compensated as long as the injury happened in the course of their work. Under common law, they have to prove that their employers were negligent.

There are some exceptions under Wica. For example, workers are not eligible if the injury happened while they were under the influence of alcohol or drugs, involved in a fight, or if they deliberately harmed themselves.

To protect employers from having to make huge payments out of pocket, the compensation amount is capped.

Responding to a question from The Straits Times, an MOM spokesman said a fraudulent Wica claim can also constitute a cheating offence under the Penal Code, although there have not been such cases in recent years.

Those found guilty of cheating can be jailed up to three years, or fined, or both.