Personal Accident Insurance: Coverage, Claim & Exclusions

Updated: 01-09-2023 06:42:47 AM

One can never predict an accident; similarly, one can never predict its outcome. Thus, to minimise the financial costs related to such unfortunate events, one can opt for personal accident insurance. This insurance comes with protective coverage against accidental death and disability.

What is Personal Accident Insurance?

Personal accident insurance gives financial protection for not only unfortunate events arising from accidents, but also for income loss because of the accident. Any of the unfortunate events caused due to road, rail and air accidents, collision, fire, explosion, and others are covered under this insurance. The insurance also financially compensates if due to the accident you suffer from disability which prevents you from working. Thus, the insurance also gives monthly income to help you carry on with life.

This insurance can also be offered as a rider under life insurance. However, in such a situation, the policyholder will not get to enjoy all the benefits provided under a standalone policy.

Types of Personal Accident Insurance

Broadly speaking, there are two types of personal accident insurance – Individual Personal Accident Insurance and Group Personal Accident Insurance.

• Individual Personal Accident Insurance:The first one is meant for individuals and it offers more coverage compared to the group insurance type. It covers not only death due to accident, but also short- and long-term disability due to accidents.
• Group Personal Accident Insurance: This kind of insurance is provided by employers for their employees. Such plans offer basic coverage and does not include the benefits included under a standalone policy.

What all Personal Accident Insurance Covers?

 Policyholders can enjoy the following benefits under personal accident insurance policy:

1. Accidental Disability: Any policyholder,who is partially or totally disabled, (physical impairments and inability to do work) can claim for accidental disability coverage. Total disability can be permanent or temporary.
2. Accidental Death: A policyholder can claim for accidental death coverage in case of any unfortunate death due to an accident.
3. Accidental Dismemberment: Any accident that results in loss of limbs, fingers, toes, sight, permanent paralysis and others comes under accidental dismemberment.
4. Terrorism Act: Any injuries caused by terrorists to the insured are also included in the insurance.
5. Hospital Cash: Under this, payment of money is made each day subjected to some maximum days, if any accident lead to hospitalisation

Eligibility Criteria

 An individual whose profession involves great risks should always consider buying a personal accident insurance to protect themselves and the family. Otherwise, anyone above 18 years of age is eligible to buy the policy. The maximum entry age is usually 65 years. However, this age varies for different providers. For some providers, it can also be between 5 and 65 years.

Personal Accident Insurance Claim Process

In order to file personal accident insurance claims on time after an eventuality, policyholders must be aware of the process so that they don’t waste time in approaching the insurance provider. Let us look at the process:

• After the accident, immediately inform the customer care of the insurance company through the website or the customer care number
• Provide the policy documents
• Provide the duly filled in claim form
• Submit other required documents as per the case – death, partial disability, total disability, etc.
• In the next step, the insurance company conducts a scrutiny to understand the authenticity of the claim
• If approved, the company will transfer the payment in your account
• If rejected, the company might seek other documents, and if it is still not satisfied, it might reject the claim

Documents Required for Claim Process

In order to get the personal accident insurance claims on time, it is important to be aware of the documents to be submitted to the insurance provider. Different sets of document are needed for different types of claims. Let us look at some of the documents, though this might vary with the provider.

• Duly filled in claim form
• Death certificate
• Disability certificate from doctor
• Post-mortem report
• Doctor’s report
• FIR copy
• Medical certificate
• Medicine bills
• Discharge summary, if hospitalised
• Investigation report

Cases Where you Can’t Claim Personal Accident Insurance (Exclusions) 

Under Personal Accident Insurance Policy, there are some major inclusions and exclusions that policyholder or any individual should know. As some of the exclusions and inclusions may differ according to the plans provided by different insurance companies, it is better that individual should know about the plan before purchasing it.

• Intentional suicide attempt
• Pre-existing disability or injuries
• Accidents caused due to intoxication like drugs and alcohol
• Childbirth or pregnancy
• Taking part in unsafe and dangerous sports
• Non-allopathic treatments
• Committing criminal act or suffering from mental disorder

Companies Offering Personal Accident Insurance in India

Today, you can enjoy the benefits of personal accident insurance after buying it both online and offline. Some of the companies offering personal accident insurance in India are:

• Max Bupa Health Insurance
• Bharti AXA General Insurance
• HDFC ERGO General Insurance
• Religare
• The New India Assurance
• Liberty Videocon General Insurance

Advantages of Buying Personal Accident Insurance

It is better to be careful than to feel sorry later. Hence, it makes sense to buy a personal accident insurance to manage the financial risks related to accidents and other problems. Let us look at some advantages of a personal accident insurance:

• If the policyholder suffers from temporary total disability, he/she is entitled to receive weekly or daily financial benefits
• You can also get personal accident cover for your family along with one for  yourself
• Some of them cover funeral costs as well

Also Read: Max Bupa Personal AccidentCare Insurance Plan

FAQs

Q1. Does a personal accident plan give global coverage?

Yes, a personal accident insurance plan provides worldwide coverage.

Q2. Do I need a personal accident plan if I have a desk job?

Although the risk is low for a desk job, uncertainties come unannounced and thus it is always better to be prepared for any unwanted emergencies.

Q3. Do I need to submit a medical test to apply for a personal accident insurance plan?

No. There is no need to go for any medical test to purchase a personal accident plan.

Q4. Is there any education benefit too in a personal accident cover?

Yes, companies like SBI General, ICICI Lombard and Reliance General do provide Education Fund.

Q5. If a person dies due to a disease, will the family of the deceased get death benefit under the personal accident cover?

Death due to any reason other than accident is not covered in the policy.

Q6. Can I cancel the policy in between the policy period and get premium back?

Yes, there is a free-look period which usually lasts for 15 days from the commencement of the policy during which one can cancel the policy if they want to and premium thus paid will be paid back. No claims must be made in this free-look period.