Personal Accident
This policy offers compensation in case of death or bodily injury to the insured person,
directly and solely as a result of an accident, by external, visible and violent means.
The policy operates worldwide and is a 24 hours cover.
Different coverages are available ranging from a restricted cover of Death only, to a
comprehensive cover covering death, permanent disablements and temporary total
disablements.
Family Package cover is available to Individuals under Personal Accident Policy whereby
the proposer, spouse and dependent children can be covered under a single policy with a
10% discount in premium.
Group personal accident policies are also available for specified groups with a discount
in premium depending upon the size of the group.
Scope
This policy is basically designed to offer some sort of compensation to the insured
person who suffers bodily injury solely as a result of an accident which is
external, violent and visible. Hence death or injury due to any illness or disease
is not covered by the policy.
The following types of coverages are offered under a Personal Accident policy:-
Table D
Table C
-
Coverage under Table D
-
Loss of two limbs / both eyes / one limb and one eye wherein 100% of the capital sum insured
is payable.
-
Loss of one limb or one eye wherein 50% of the capital sum insured is payable.
-
Permanent Total Disablement other than above e.g. paralysis due to an accident, wherein 100%
of the capital sum insured is payable.
Table B
Coverage under Table C
Permanent Partial Disablement i.e. where a part of the body becomes permanently disabled due to an
accident, e.g. total and irrevocable loss of use of a finger due to an accident. In such cases, a
percentage of the capital sum insured as specified in the policy is paid.
Table A
-
Coverage under Table B
-
Temporary Total Disablement i.e. where the insured person becomes temporarily disabled from
undertaking any work as a result of an accident for e.g. fracture of legs. In such cases, a
weekly payment of 1% of the capital sum insured subject to a maximum limit, is paid for the
number of weeks or part thereof (maximum 100 weeks), during which the insured person is
totally disabled.
The insured can claim only under any one of these sections as a result of any one accident.
The policy also covers expenses incurred for carriage of dead body from place of accident to the
residence subject to a limit of 2% of the capital sum insured or Rs.2,500 whichever is less.
Under an Individual Personal Accident policy or Family Package Policy, an education fund is
payable for a maximum of 2 dependent school going children, in case of death or permanent total
disablement of the insured person.
Add on covers
Individual and group personal accident policies can be extended to cover medical expenses incurred
in the treatment of an accident covered under the policy, subject to a limit of 10% of the sum
insured or 40% of the death / disability compensation claim payable, on payment of additional
premium.
The policy issued to Indian personnel working in foreign countries on civilian duty can be extended
to cover War risk on payment of additional premium.
The policy can also be restricted to cover Personal Accident risk during duty hours only or during
off-duty hours only with discount in premium. It is also possible to issue group P.A. policy
excluding the death benefit subject to a group life policy covering death benefit being taken for
the same group of persons for the same policy period.
The insurance provides compensation in the event of death or disability directly due to accident.
Who can take the policy?
Any adult residing in India can take the policy covering himself / herself and dependent family
members between the ages of 5 and 70yrs.
How to select the sum insured?
It is very difficult to put a value to a human life. Hence the principle of indemnity cannot be
applied in this policy. However it becomes necessary to apply some yardstick for fixing the sum
insured so that human lives are not overvalued for ulterior motives.
Hence the capital sum insured is restricted to 72 months income from gainful employment.
This means that income from property, shares etc. will not be taken into account. For non working
spouse, the sum insured is restricted to 50% of the sum insured of earning spouse subject to a
maximum of Rs. 1,00,000/- and for dependent children to 25% of the sum insured.
In Individual Personal Accident policy, facility of cumulative bonus is given whereby the capital
sum insured is increased by 5% every year on claim free renewals subject to a maximum of 50%. This
cumulative bonus is available only under tables A, B & C.
