Personal Accident
A personal accident cover is a Policy which covers an individual or family in the event of injuries, disability or death caused solely by violent, accidental, external and visible events. PA insurance provides 24-hour worldwide insurance protection. The Policy is part of complete Health Insurance Plan for any family as in case of an accident the hospitalization expenses could be covered in a Mediclaim Policy but a loss of breadwinner to the family or loss of pay in case of him being bedridden for few months or any permanent disability can be compensated by the PA policy. The policy helps to tide over any financial hardship that family may face due to any of aforesaid reasons.
COVERAGES
The types of cover vary from insurance company to insurance company but it usually includes:
• Accidental death- Payment of sum insured in case of death of an insured person due to an accident.
• Permanent Total Disablement (PTD) - Lump sum payment of a pre-defined percentage of the sum insured basis the severity and disability caused by the accident.
• Temporary Partial Disablement (PPD) - Lump sum payment of pre-defined percentage of the sum insured basis the severity and disability caused by the accident.
• Hospitalization benefits- Reimbursement of medical expenses up to a limit incurred on accidental hospitalization of the insured person.
• Temporary Total Disablement (TTD) - Payment to compensate for the loss of income in case the insured person is not able to work due to an accident.
• Cremation Ceremony- Lump sum payment for performing the cremation ceremony.
• Broken Bones – Lum sum payment of a pre-defined percentage of sum insured basis the severity of fracture caused due to an accident.
• Loan Secure – Payment of outstanding principal loan amount in case of death or permanent total disability of the insured member. The outstanding principal loan amount would not include any arrears or penalties levied by the bank or financial institution.
• Adventure Sports – Payment of sum insured in case of death or permanent total disability of insured member while he/she was engaged in adventure sports in a non-professional capacity and under the supervision of trained professional.
• Emergency Road Ambulance Charges – Reimbursement of expenses incurred on an ambulance used to transfer the insured person to a hospital following an accident.
ELIGIBILITY
Individual Personal Accident plan covers all the age brackets, from children to elderly members of the family.
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Age Eligibility Relation
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Min Entry Age (years)
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Max Entry Age (years)
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Policy Holder
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18 | 69 |
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Adult Dependent
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18 | 69 |
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Child Dependent
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91 days | 25 |
*children aged between 91 days to 5 years can be covered only if either of the parents is covered under the same policy.
SUM INSURED (SI) Eligbility
| Realtionship | Eligible For |
| Policy holder (salaried) | 20Xannual income Policy holder |
| Policy holder (businessman/self-employed) | 25Xannual income Non-earning |
| Non-earning spouse/dependent parents | 50% of policy holder SI; Max up to 1 Cr |
| Child dependent | 25% of policy holder SI; Max up to 25L |
| Earning spouse (salaried) | 20X annual income; max up Policyholder SI |
| Earning spouse (businessman/self-employed) | 25X annual income; max up to policyholders SI |
EXCLUSION
The policy will not compensate for any claim arising due to:
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Self-inflicted injury, suicide or attempted suicide or abuse of intoxicants or hallucinogens including drugs and alcohol.
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Participation in actual or attempted felony, riots or civil commotion.
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If engaged in adventure sport unless Adventure Sports benefit is opted by insured.
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Participation or involvement in naval, military or air-force operations, any breach of law with criminal intent.
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War or any act of war, the act of foreign enemy, public defence, rebellion, revolution, insurrection, military or usurped acts, chemical, radioactive or nuclear contamination. Pregnancy or childbirth or its complications, external congenital diseases.
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HIV/AIDS, sexually transmitted diseases.
This policy covers only Accidental Death and hence death due to any other reason other than accident will not be covered under this policy
You can opt for Accident In-patient Hospitalization benefit under the policy that pays for accidental hospitalization up to the specified limit.
There is No maximum exit age for this policy.
There is a no waiting period under this policy
.
This Policy applies to accidental events occurring anywhere in the world.
Tax Benefit is not applicable to Personal
Accident Policies.
There is no pre- policy requirement in this policy. However any Pre- existing disabilities have to be declared on the Proposal Form and the case may be underwritten based on the level of disability.
Proof of income is required only in the case of Accidental Death sum insured exceeding ₹ 25, 00,000/-.
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Immediate Expenses
:
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Accidental Out-patient Hospitalization
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Hospital Cash
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Transport of Imported Medicine
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Purchase of Blood
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Family Expenses
:
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Marriage expenses for Children
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Education Fund
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Home Maker Care Allowance
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Pet Care
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Multiple Member disability
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Elderly care
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Education Fund for disabled dependent Child
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Loan Secure (optional)
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Transportation Expenses
:
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Road Ambulance
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Air Ambulance
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Family Transport Benefit
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Incidental Expenses
:
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Modification of Residence/Vehicle
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Cost of Prosthetics
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Treatment Expenses
:
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Permanent Total Disablement
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Broken Bones
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Permanent Partial Disablement
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Burns
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Head & spinal Injury
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Coma
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Accidental Inpatient Hospitalization & Restore Benefit (optional)
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Total Temporary Disablement (optional)
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Intimation to the Company:
You or the nominee is required to inform and lodge the claim with the insurance company.
Detail of the incident
You or nominee has to submit a detail of the accident and the loss you have faced due to the accident.
Documents need to be submitted incase of partial disability;
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Claim Form
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Medical Fitness Certificate
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Original reports
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Original Prescriptions
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Aadhar Card Copy
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Cancel Cheque of Company
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Policy copy, if required
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FIR Copy, if required
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Insurance company can ask for more papers/ details for the process of the settlement of claim.
Documents need to be submitted incase of Death of the Policy holder;
Documents need to be submitted incase of Weekly Benefits in a situation of partial disability
Documents need to be submitted incase of permanent disability.
Documents need to be submitted incase of hospital expensesIntimation to the Company
You or the nominee is required to inform and lodge the claim with the insurance company.
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General Insurance Policy
