If one would like to read the legal requirements for insurance of local workers, both for a trekking agency and for independent hire by tourist, read the rules here:
http://www.tourismdepartment.gov.np/acts-regulations
Travel & Trekking Agency (p.6)
Mountaineering Expedition (p.11)
Tourism Policy (p.15)
“local worker” is the term used for porters below base camp-elevation.
Note the various provisions for “Emergency Rescue”.
From Immigration Rules (p.26):
Facilities to be provided a Nepali citizen who accompanies trekker: (1) A tourist or team, making trekking or trekking agency, shall have procure personal accident insurance for a Nepali citizen who accompanies the tourist or team as prescribed by the Government of Nepal, prior to commencing trekking.
(2) A tourist or team making trekking shall have to provide, the citizen of Nepal who accompanies the tourist .…
As all Nepali bureaucracy this text difficult to understand and interpret.
• The other documents/pages contain a bunch of interesting info for those curious about Nepal, worth browsing through.
Trekkers/agencies often say "guide/porter has insurance" and then pretend everything is OK, thinking coverage is something like their own First World-plan.
I’m from Norway and my travel insurance basically has unlimited amounts on sickness/injury and medevac. Nepali insurance for workers is nothing like this and people need to be made aware.