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Personal Accident Insurance

What is Personal Accident Insurance?
Personal Accident is an insurance cover wherein, in the event of the person sustaining bodily injuries resulting solely and directly from an accident caused by EXTERNAL, VIOLENT & VISIBLE means , resulting into death or disablement.

What type of events are covered under Personal Accident Insurance?
An accident may include events like:
  • Rail / Road / Air Accident
  • Injury due to any collision/fall
  • Injury due to Bursting of gas cylinder
  • Snake-bite, Frost bite/Dog bite
  • Burn Injury, Drowning, Poisoning etc
These are only illustrative and not an exhaustive list of type of accidents.

What is scope of cover & benefits available under Personal Accidental cover ? Personal Accidental policy covers accidental death, permanent total and partial disablement apart from temporary total disability, apart from riders such as education grants.

Does this policy cover medical expenses incurred due to accident ?
Yes, on payment of additional premium, medical expenses reimbursement can be covered. These expenses are payable, in case, if the claim is admitted under the basic policy cover.

Is the claim payable in case of natural death ?
No, it is payable only in case of accidental death

Do I get my premium / some portion back in case I don’t make a claim.

Do I get premium accumulation back after some years in case I don’t make a claim.

What are the other types of covers available for covering accidental injuries ?
Contact individual companies for exact details on product

What is the age limits under personal accident cover ?
This Policy is available to persons between the age of 5 and 70 years (Male & Female). In case of Family Package covers, the age of children should be between 5 to 19 years. The age ceiling of 70 years can be relaxed in special conditions subject to suitable premium loading.

Are there any territorial restrictions applicable to the policy ?
No, the coverage under this policy is WORLDWIDE however, claims, if any, will be paid in Indian currency only.

What is the basis of arriving at the sum insured ?
Sum insured is based on various factors namely:
  • Income from gainful employment
  • Type of occupation
  • Age as on date of proposal
  • Period of insurance
  • Conditions prevailing at the place from where the proposal is made etc
Are personal accidental policies are available for long term?
Generally Personal Accident policies are maximum for one year only. However, depending upon the requirement of the proposer it can be offered for a period which could even be lesser than 12 months.

What is permanent total/partial and temporary disablement ?
(i) When an insured person sustains accidental injuries resulting in loss of limb (as per the table of losses for Dismemberment/PTD) and is certified by a medical specialist that the injury is of a permanent total or permanent partial nature, then only the insured shall deemed to be permanently totally/partially disabled.
(ii) Temporary total disablement arises when a person is not in a position to perform the duties that he performing immediately prior to the accident, which has to be certified by a medical professional. These are general interpretation for easy understanding & not legal wording.

What is the compensation available in the event of the insured sustaining Temporary Total Disability ?
In the event of an accidental injury resulting in temporary total disablement ( to be confirmed by the attending physician )the insured shall be entitled to a compensation @ 1% of sum insured per week subject to a maximum of 104 weeks.

Can non-earning individual take Personal Accident Insurance cover ?
A proof of income such as ITR , salary slip etc is required for claims. A non earning individual can have policies like Janta Personal Accident Policy , Gramin Personal Accident Policy etc

Is there any discount for getting family cover?
It depends upon company to company

Can a cover be granted to a proposer where war and war like situation prevails? Under normal circumstances where war and or warlike situation prevails PA cover is not offered. However, on payment additional premium the same can be got covered.

What is cumulative bonus ?
If the insured person does not prefer any claim in the expiring policy, he is entitled to a sum equivalent of some % ( say starting 5%) as cumulative bonus for every such claim free year subject to maximum of 50% (or as decided by the respective company) as cumulative bonus. It effectively means the sum insured under the renewed policy will be increased by 5% every year without charging any additional premium.

Is there any grace period for renewal of policy ?
There is no grace period for continuity of insurance cover and policy cover expires on the last day of policy period.

What is an Assignment ?
Assignment means that in the event of fatal accident of the insured person, the compensation is made to the assignee on the basis of his full and final discharge. In case the assignment is not made under Personal Accident Policy, the insurance company insists for SUCESSION CERTIFICATE from the Court for settlement of claim compensation, which is a time consuming, lengthy & cumbersome procedure.

Is there any tax benefit under Personal Accident like covers?
There is NO TAX BENEFITS for the premium paid under these types of cover.

What the insured has to do in the event of accident ?
  • Immediate written notice should be given to the Insurance Company with all particulars
  • Claim from duly completed along with the following documents should be submitted
  • Medical Certificate about the nature and extent of accident resulting injuries
  • Medical Examiner’s Report
  • Details of treatment rendered by the attending Doctor/Hospital/Nursing home
  • Certificate from the employer to the effect that the Insured was on leave during the period
  • Fitness certificate
IN THE EVENT OF ACCIDENTAL DEATH - The following documents are required to be submitted:
  • Post-mortem Report
  • F.I.R./Police Report
  • Punchnama
  • Departmental Inquiry, if any
  • Report of Doctor/Hospital/Nursing Home
  • Death Certificate
Is there a free Look-in /look-in period available ?

Can I cancel my policy midway?
Yes ,one can cancel the insurance policy

Can I get my money/unused premium refunded?
The refund essentially depends upon the company and would be on short rate period. Customer must check the short rate calculations to avoid any heartburns later
Claims procedure – General step by step procedure
  • Immediately inform the insurance company as soon as possible by Phone , SMS , Letter , Email and take the claim number
  • Collect the following indicative list of document
  • Deposit the completed claim form with the insurance company
  • Answer/satisfy the insurance company for query’s if any
  • Advise the payment receiving mechanism
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