Bangladeshi migrant worker’s ordeal exposes insurance access struggles in Singapore

The distressing experience of a migrant worker in Singapore highlights how employer-centric policies can lead to the denial of proper medical treatment for the worker.

While the Ministry of Manpower (MOM) mandates that employers provide insurance coverage, the authority to submit claims remains solely in the hands of employers.

In a recent incident, a Bangladeshi worker missed a critical opportunity to address a workplace finger injury that required immediate surgery.

Allegedly, this unfortunate situation arose because the employer only issued a Letter of Guarantee for the treatment 33 days after the accident.

Regrettably, by the time the worker, Alom (pseudonym), consulted a doctor, he was informed that it was too late.

Transient Workers Count Too (TWC2), a migrant worker advocacy group, exposed Alom’s ordeal and the challenges he faced in accessing essential medical treatment.

This was purportedly due to his employer’s reluctance to issue the necessary Letter of Guarantee—a formal commitment from the employer to cover the costs of major medical or surgical procedures.

Debbie Fordyce, President of TWC2, underscored the systemic issue wherein employers are permitted to withhold urgent medical treatment even against doctors’ advice.

Not immediately taken to hospital after injury

According to TWC2, Alom suffered injuries to his right index and middle fingers on 25 October last year when he was on a scissor lift. His hand got wedged against a pipe during the incident.

Upon the occurrence, the site safety supervisor attended to him and cleaned the wound.

The manager arrived at about 9 pm. Despite the closure of most general practitioner clinics, Alom was not immediately taken to a hospital emergency department. Instead, he was simply given paracetamol for pain relief.

The following day, Alom was taken on a “doctor-shopping” tour, visiting three clinics. It was at the third clinic where an X-ray revealed an open fracture.

Subsequently, Alom was granted medical leave and provided with a letter to his boss, emphasizing the urgency of surgery within five days.

Employer allegedly attempted to persuade the worker to return to Bangladesh for treatment

Shockingly, in response, the employer and agent allegedly attempted to persuade Alom to return to Bangladesh for treatment.

They promised to cover the expenses for his treatment in his home country and assured him that he could return to work after recovering.

Not swayed by his employer’s persuasion, On 2 November 2023, Alom went to Tan Tock Seng Hospital by himself.

At the hospital, he was asked for a deposit before they would provide any treatment, but lacking the necessary funds, he proceeded to Changi General Hospital.

There, he received some basic treatment as they identified an infection in his wound, and further referred him to Singapore General Hospital.

On 3 November 2023, Alom went to Singapore General Hospital. There, they sorted his infection out and took new X-rays. They told him he needed a Letter of Guarantee to proceed with surgery.

Although Alom was insured, complications and disputes with the employer ensued.

Simultaneously, Alom initiated a salary claim, and according to his account, the boss insisted on the withdrawal of the claim before considering the issuance of a Letter of Guarantee.

While the reason for Alom initiating the salary claim remains unknown, according to the law, the employer is obligated to provide medical treatment.

Challenges faced by migrant workers in accessing insurance

Under the Work Injury Compensation Act (WICA), employers are required to obtain WIC insurance for both local and foreign employees, encompassing two main categories.

The first type addresses work injury compensation, with a statutory minimum coverage of S$45,000 for medical expenses.

These policies also include a disability compensation component, which becomes applicable if the worker sustains permanent impairment, such as the loss of a thumb or an eye.

The second category involves medical insurance aimed at covering treatment for health conditions unrelated to work injuries.

For this type of insurance, the annual claim limit must be at least S$60,000, with a co-payment structure of 75% by insurers and 25% by employers for claim amounts exceeding S$15,000.

However, as highlighted by TWC2, despite the existence of these provisions, accessing coverage from the worker’s perspective remains a formidable challenge.

Employers continue to function as gatekeepers, wielding the authority to decide when to activate the insurance.

Debbie Fordyce said. “If a broken bone isn’t stabilised early, we have no idea how that’s going to grow and impact his daily activities.”

“It may well heal in an awkward manner. Causing delays in accessing treatment will exacerbate pain and harm the mental wellbeing of these men.”

TWC2 further highlighted the issue, stating that by granting employers control over when to utilize insurance cover, a range of conditions can be imposed, undermining the humanitarian objectives behind requiring insurance coverage.

TWC2’s vision for an inclusive insurance system in migrant worker protection

TWC2 proposed a streamlined and more inclusive approach to the current system.

They suggested that work injury and medical insurance policies be centrally listed on a secure platform accessible to workers, employers, insurers, and accredited hospitals.

In this proposed system, both the worker (as the beneficiary) and the hospital (as the care provider) would have the ability to initiate a claim on a policy for medical costs jointly.

“The employer should not be permitted to act as gatekeeper since their interest can be diametrically opposed to the worker’s.”

“After all, it is the worker’s interest that the legislation is meant to serve, and it is thus important to ensure that operationally, it does exactly that,” TWC2 added.

Acknowledging the current complication of categorizing claims under work injury or “medical” policies, TWC2 suggested a cleaner solution.

They proposed redesigning the framework to have one policy specifically for disability compensation and another for all medical interventions, whether work injury-related or not.

“That way, regardless of how to classify an injury, medical care can be given promptly by hospitals – simply by claiming against a single medical cover.”