Surgery not covered by insurance, says boss. Go back to India instead

Posted by on July 21, 2018 in Articles, Stories

By Nicholas Lee based on an interview in May 2018

The crowd at TWC2’s food programme grows as the hour for the breaking of the Ramadan fast approaches. Among the non-Muslims is Paranthaman Arulvendan, registering himself with TWC2 for the first time. But he’s not new to Singapore. Arul has been working here since the age of 21.

As I sit Arul down, his story begins to flow. Beginning his stint in Singapore in 2008 as a welder, Arul has worked about nine years with six different companies, doing a wide range of work. He has been supporting his mother back in India; his father passed away when he was eight years old.

I note his unusual fluency in English, peppered with local slang.

Arul’s most recent employer was a company that installed and repaired roller shutters. He performed a variety of tasks: welder, driver and handyman, while supervising a team of Bangladeshi, Malaysian and Chinese workers. Arul was the only Indian national in his company, which left him isolated from his workmates. One’s nationality and ethnicity are often brought into prominence while working abroad; the sense of kinship and familiar cultural idiosyncrasies amongst fellow countrymen is one of the few comforts for foreign workers here.

Sharp pain

It was 6pm, and he was packing up for the day. As he was pulling down a roller shutter, he felt a strong, sharp pain in his right groin that left him staggering. In pain, he told his Singaporean colleague that he needed to go to a doctor.

The colleague didn’t think he was empowered to make the arrangements. “Siao ah, work so many, you go doctor who arrange for me?!”

Undeterred, Arul consulted his boss who suggested, according to Arul’s account, that he see a doctor only when there were lull periods in his work. This is no different from being told “Don’t see a doctor”. Lull periods did not exist in his job.

As the pain subsided, Arul tried to carry on as usual. But six additional days of driving, heavy lifting and other labour intensive duties took their toll; pain returned with greater intensity. No longer able to “tahan” [withstand], he went to Geylang Polyclinic on his own, from where he was referred to the Singapore General Hospital (SGH). The polyclinic prescribed ‘Light duties”.

Despite this note from the doctor, Arul says he was pressured to continue work as usual, potentially aggravating his condition.

At SGH, Arul was diagnosed with an inguinal hernia, a protrusion of fat or small intestine through the tissues of the groin. Surgery was recommended, and it would cost $8,000. Upon seeing the letter, his boss was vehement that it was not an expense he could claim under work injury insurance. “This one cannot claim, you go back India”. He added something about how the doctor’s memo was not specific about the circumstances of his injury, and that the note did not explicitly state that it was work-related.

At this point in his recounting, Arul laments to me: Ten years of honest, hard labour in Singapore, yet he’s being treated no better than an object, something quickly disposed of when no longer of use. He worries for his mother; his income has ceased and he is unable to send her money.

Coming back to the sequence of events, Arul soon lodged a work injury claim with the Ministry of Manpower (MOM).

The boss changed his stance. He now offered Arul $1,000, provided he went back India to have his surgery done. Arul could come back to work for him three months later, the boss said.

Arul declined.

Since then, it’s been a merry-go-round, dragged by the company between SGH and his dorm, time and time again. As Arul tells it, each time his boss requested for a different doctor in the hope of convincing the practitioner to provide a memo that would specifically state that the condition was not work-related. Each time the doctor refused to entertain the request. Meanwhile, surgery was delayed.

It has been over a month since the incident, and Arul has not had restful sleep since. He suffers pain while standing, sitting and going to the loo. His only relief comes when lying down, but it is replaced by mental anguish and thoughts of home. Over and over again, he revisits the question: should he have accepted the offer and gone home for quick treatment? For right now, he is left to endure pain while his boss continues to find ways and means to evade responsibility.

What defines a workplace injury?

The scope of the Work Injury Compensation Act (WICA) covers any personal injury “arising out of and in the course of employment”. Since Arul was still at work, and was closing a roller shutter when he was seized with pain, it would, on the face of it at least, fall within this definition. The employer need not have worried that his insurer could get out of it.

What may be more interesting would whether the employee had a preexisting condition or a predisposition to a condition, and if so, whether this would rule it out as a work-related injury.

Hernia comes from a weakness of the abdominal wall. Was it a preexisting condition? A predisposition? Does it matter even if it was?

A recent High Court judgement [2018 SGHC 118, Hauque Enamul vs China Taiping Insurance (Singapore) Pte Ltd and Kim Techology and Systems Engineering Pte Ltd] throws light on this question. In it, the Justice George Wei referred (in para 40) to an earlier case [2006 4SLR(R) 507 Narayansamy s/o Ramasamy] wherein the judge there said:

an injury by accident within the meaning of the [WICA] contemplates:
(a) an injury that was unexpected by the workman;
(b) which was caused or contributed to by something done by or to the workman in the course of this employment.

Justice George Wei also referred (in para 42) to another judgement [2012 1 SLR 15 Pang Chew Kim]. He quoted from there these words:

Being a piece of social legislation, the WICA should be interpreted purposively in favour of employees who have suffered injury during their employment.

It does not seem necessary for the employer to seek an explicit statement from any doctor that Arul’s condition was a work accident. In any case, how could any doctor who didn’t witness the incident know? There is enough precedent to consider the unexpected appearance of a hernia as within the scope of WICA. Perhaps, as Arul believes, the boss had other reasons for shopping around for a cooperative doctor.

It should be highlighted at this juncture that if one looks at the entirety of legislation surrounding responsibility for medical treatment for work permit holders, parliamentary intention is quite clear. Besides WICA and its requirement to purchase work injury insurance, there is also the Employment of Foreign Manpower Act, whose subsidiary legislation requires all employers of foreign workers to purchase medical insurance of at least $15,000 in value. Whether work-related or not, the employer should be providing medical care if urgently needed. The question of whether the reimbursement for expenses should come from the WICA insurer or the medical insurer can be decided later.

In other words and in TWC2’s view, Arul’s employer should not have been delaying the hernia operation at all, causing unnecessary suffering to him.

TWC2 is an organization that is dedicated to assisting low-wage migrant workers when they are in difficulty. We are motivated by a sense of fairness and humanity, though our caseload often exceeds our
means.

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