Personal Accident Insurance

During these times when people have to adhere to strict timelines, work longer hours, attend tours and meetings, the working class is always on the go. To minimize the risks associated with mobility, it is essential for individuals to obtain Accident Insurance coverage for themselves and their families.

Subas Tiwari

Is Personal Accident Cover so important?

Indeed, in the era of globalization and the continuous mobility of the workforce, which includes self-employed individuals, businessmen, and traders, it is crucial to prioritize securing sufficient insurance coverage for oneself and their family members, including dependent parents or in-laws. This ensures that in unforeseen situations, there is no reliance on bank loans or borrowing from friends or relatives to cover medical expenses. By having adequate insurance, individuals can swiftly access necessary treatments and return to work promptly.

So, before we embark upon the task of finding out a suitable accident policy for individuals, let us find out why it is a must to be covered for accident insurance & what are the benefits/riders & common exclusions?

What is Personal Accident Insurance?

Personal accident insurance covers injuries or death that has been caused due to an accident. This is one of the most affordable and limited form of life & health insurance policy that is mostly availed by people who are travelling frequently by road, water or airways.

Why is it called Personal Accident Insurance?

There are accident insurance policies for Group Cover taken by organizations for their employees’ benefit (Group Accident Insurance) & there are those where the Corporate-employer takes accident insurance cover for their employees called Corporate Accident Insurance. So the term’ personal” denotes ‘individual’ accident insurance policies (where family floater options are also available).

Why do you need to have one?

Personal accident insurances cover the policyholder against death or disability due to an accident. All general insurance companies offer these policies. Firstly, it will provide financial support to the policyholder if he is disabled after an accident. Secondly, the magnitude of the mishap doesn’t matter; even minor ones like falling off a bicycle and breaking an arm, or fracturing a leg while playing football are covered by the policy.

PSU insurers offer cheap personal accident covers while private insurance companies offer a wider range of benefits, but the premium rates are higher. You can take a cover of up to 8 times your annual salary. Apart from the basic death and permanent disability cover, you can buy additional protection against partial and temporary disability, even loss of livelihood.

It’s important to understand the terms and conditions clearly before you buy a policy. For example, hospitalization benefit can be availed of only if the policyholder is admitted within seven days of the accident and is hospitalized for at least 24 hours.

How does it work?

One has to pay a monthly, quarterly or yearly premium that remains the same till the entire policy coverage period. A cash benefit can be availed as reimbursement when the policy holder has got a major accidental injury. Compensation is provided if the insured person dies due to accident. The coverage is generally valid even when you are out of the country. No medical check-ups are required prior to availing the personal accident insurance policy. It is important to pay the premium in time so that you can enjoy the benefits of this policy. You can also add your family members under this policy.

What is covered?

Accidental death– On the event of death due to accident, the policy holder’s family (or nominee) gets accidental death compensation of Sum Insured Value just before death (usually 100%+ no claim bonus). Some insurance policies also provide for reimbursement by way of payment of lump sum on education expenses of 2 kids under the Education Fund.

Accidental permanent disability– It means the policy holder has lost one or more limbs due to an accident or one or more parts of his/her body has been dismembered. The insured person is liable to get a certain amount as reimbursement of treatment cost (usually 100% to 125% of Sum Insured).

Accidental permanent partial disability- It means loss of one index/thumb finger or one ear or loss of vision in one eye or loss of one hand/arm/leg, which is a partial damage of permanent nature which is irreversible. Here the compensation is a calculated percentage of Sum Insured.

Accidental temporary disability– It means the policy holder has got severe injuries which have made him/her temporarily disabled/physically disadvantaged (physically challenged). In this case, he/she is entitled to get a lump sum compensation for the number of days where he/she is not able to work.

Medical reimbursement for health complications that has arisen from the accident– Many personal accident policies also provide reimbursement for medical complications that has arisen due to an accident, like treatment of mental trauma (cost of medicines or cost of psychiatric counselling sessions), and so on.

What are not covered? (EXCLUSIONS)

The following could be the most common exclusions (not covered) in the Personal Accident Insurance Policy Cover. Take adequate care to read them, understand the implications & take an informed decision to buy.

Suicide
Self-inflicted injuries
Influenced by liquor and drugs
Any pre-existing conditions or infirmity
Hazardous sports or careers (such as deep sea diving, working in mines, circus; in Army, Air Force or Navy, Airplane Pilots, etc)
Use of alternate systems of medical treatments (such as AYUSH)
War situations, mental disorders and pregnancy/childbirth

(These are only illustrative & not exhaustive)

Comparison of Accident Insurance Vis-à-vis Health Insurance and Term Plan Insurance

Personal Accident Insurance	Health Insurance	Term Plan Insurance
Sum assured is payable against injuries/disabilities/death/other related expenses caused by accident, subject to exclusions & individual limits	Sum is available for hospitalization expenses only during the life of the insured	Sum assured is payable on death of the insured only
Chances of meeting with an accident is higher in today’s times	Chances of getting hospitalized for diseases are comparatively slimmer	Chances of death of the assured are much slimmer if either/both policies are taken
Premium amount is cheaper compared to other policies	Premium is higher of these two policies	Sum assured is huge & taking this into account, premium is reasonable
Premium is fixed on the basis of nature of job and/or working conditions (not based on age of the insured )	Premium is fixed on the basis of age, health history, lifestyle, etc	Premium is fixed on the age & nature of job and/or working conditions, health history, lifestyle, etc

Additional Benefits (Covers) Built into the Policy (FREE –NO COST TO PREMIUM)

There is no standardized format in the policies to look for. The offering in the product of Accident Insurance Policy of an Insurance Company varies from that of another. However, we shall look into some of the additional benefits of which some of them could be offered to the policy-seeker, and which could be built-into the policy.

Education grant to children (limited to 2 children)
Transportation expenses of mortal remains subject to cap
Travel expenses of 1 relative subject to cap
Purchase of blood
Transportation of imported medicines
Repatriation Benefit & Funeral Expenses
Burn injuries
Mobility cover (prosthetic/artificial devices and/or orthopedic braces to enable the mobility of the insured
Fracture expenses
Domestic road ambulance
Reconstructive surgery
Home/Vehicle modification expenses

Rider Benefits (OPTED BY THE INSURED WITH COST TO PREMIUM)

The following could be offered to specific needs as the insured may perceive, but additional premium will be loaded.

Life support benefit
Hospital cash allowance
Adaptation allowance
Accident hospitalization
Winter sports cover
Home convalescence
Loss of employment benefit

Procedure for Pre-Claim Filing (Important pre-filing procedures)

Hospitalization benefit can be availed of only if the policyholder is admitted within 7 days of the accident and is hospitalized for at least 24 hours.
After the accident, one also has to submit the following;
Doctor’s certificate for the disability that prevents one from attending work
F.I.R
Policy copy
Claim form duly filled & signed by the insured/claimant/nominee
Post-mortem report (in case of accidental death)
Death Certificate
Spot Panchnama (certified copies)
Medical/Hospital report
Discharge Card
Doctor’s prescription
Medical/Pharmacy Bill
Any other document required by the relevant insurance company to process the claim

The following important points needs to be looked into

Contrary to public perception, premium paid on the Personal Accident Insurance Policy is NOT ELIGIBLE for any Income Tax benefits.

This kind of policy is not much canvassed by Insurance Agents as commission paid on such policies to them by the insurance company is too low.

For buying this policy, no medical checkup is required to be undertaken by the insured.

These policies can be purchased ONLINE & portability option is also available.

Do you Know Your ATM Card (Debit Card/Credit Card) Comes with Accident Insurance Cover?

In today’s time, most people use ATM cards. Due to ATM, we do not need to carry a lot of money with us. Money can be withdrawn anytime and anywhere with the help of this facility. But the ATM card does not work only for withdrawing money. Many other facilities are also available with the ATM card, whose information is not given to us. One of these facilities is your Accidental Insurance.

Yes, whether the ATM card is of a private bank or a government bank, complimentary insurance cover is also available with each card. This accidental cover can be from 25 thousand to 20 lakh rupees. The amount of insurance is decided according to the category of ATM card. In case of death or accident of the ATM card holder, this insurance can also prove to be the support of the dependents. Let’s know about it.

How do I make a claim?

The only condition for availing of the accidental hospitalization or death insurance cover is that the card should have been in use within 90 days prior to the accident. For the insurance cover to be applicable, the debit or credit card could have been used either at ATM, point of sale (PoS) or on e-commerce platforms, within the mentioned 90-day period.

The claim can be made bank branch where the cardholder has an account. It is not be noted that the claim has to be made no later than 90 days of the accident. Any claim made after 90 days might be rejected. The beneficiary of the claim could be the nominee on the account of the cardholder or legal heir.

It is also to be noted that this claim made with the bank of the cardholder will not affect claim process of any other external insurance provider. The claim can be made by submitting some documents to corroborate accidental death or permanent disability.

For example, for availing SBI’s RuPay card insurance, the following documents are needed:

Claim Form duly completed and signed.
Original copy of Death Certificate.
Original or Certified copy of FIR / Police report giving description of the accident.
Original or Certified copy of Post Mortem Report along with Chemical Analysis/FSL reports wherever applicable.
Aadhar copies of Cardholder and Nominee.
Declaration from Card Issuing Banks duly signed by authorized signatory and bank stamp specifying that:

Cardholder is holding a RuPay card on RuPay issued IIN and mention the 16 digit card number.

Compliance of 90 days transaction criteria (to be supported with transaction log/account statement from the bank’s system).

Nominee Name and his banking details (including Passbook copy).

Brief description of Accident as per FIR translated in English or Hindi.

Bank official’s Name and contact details with email ID.