Personal Accident Policy

Accident means a sudden, unforeseen and unexpected event caused by external, violent and visible means (but does not include any illness or disease) which results in physical bodily injury (but does not include mental, nervous or emotional disorders, depression or anxiety) :
A Personal Accident policy is intended to compensate for  loss caused by an Accident,as under
Benefits:
1) Accidental Death -If an Insured Person suffers an Accident during the Policy Period which becomes the cause of death within 365 days from the date of the Accident, then full Sum Insured is paid to the nominee.

2) Permanent Total Disablement –If such an accident leads the Insured to Permanent total disability within 365 days from the date of an accident then the compensation will be paid as follows:-

Types of PTD % of Sum Insured
Loss of 2 Limbs (both hands or both feet or one hand and one foot) 100%
Loss of a Limb and an eye 100%
Complete and irrecoverable loss of sight of both eyes 100%
Complete and irrecoverable loss of speech & hearing of both ears 100%
Loss of a Limb 50%
Complete and irrecoverable loss of sight of an eye 50%

 

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    3) Permanent Partial Disablement– Incase an Accident leads to Permanent partial Disablement i.e. Disablement is irrecoverable however it is partial then  policy would pay the amount as per the table or as certified by the doctor :-

    Loss of: % of Sum Insured
    Each arm at the shoulder joint 70%
    Each arm to a point above elbow joint 65%
    Each arm below elbow joint 60%
    Each hand at the wrist 55%
    Each thumb 20%
    Each index finger 10%
    Each other finger 5%
    Each leg above centre of the femur 70%
    Each leg up to a point below the femur 65%
    Each leg to a point below the knee 50%
    Each leg up to the centre of tibia 45%
    Each foot at the ankle. 40%
    Each big toe 5%
    Each other toe 2%
    Each eye 50%
    Hearing in each ear 30%
    Sense of smell 10%
    Sense of taste 5%

    subject to the limit of sum insured

    4) Temporary Total Disablement (TTD)– TTD cover has to be obtained in addition to the PA sum insured depending on your income eligibility form Rs.5,00,000 to Rs.15,00,000/-. This benefit is applicable when a person due to an accident cannot do / is prevented to do his daily work pertaining to employment however this is just a temporary disablement & will get recovered within a short period in such scenario policy  will pay weekly benefit (1% of TTD Sum Insured per week upto 100 weeks max). Housewives & Students are not eligible for this benefit.

     

    5) Emergency Ambulance Charges – If it is necessary to immediately transfer the insured person to the hospital policy will in addition pay the actual expenses incurred while transferring or max Rs.2000.

    6) Education Fund – If   claim under AD & PTD is admitted then policy will in addition pay 10% of AD SI or Rs.20000 whatever is lower for 2 dependent children.

    7) Family Transportation – If  claim under AD & PTD is accepted  then in addition policy will pay the actual expenses incurred/1% of AD SI/max 1 lac while transporting one immediate family member to the hospital where insured person is admitted following an accident, however the destination should be atleast 200km from the insured house.

    8) Transportation of Mortal Remains – In addition to the claim settled in case of AD policy will also pay Actual expenses /2% of AD SI / max 10000 incurred while transporting the mortal remains (dead body) to the cremation or burial ground.

    9) Accident Medical Expenses (In patient)– If the claim under AD,PTD,PPD or TTD is accepted then policy will in addition pay the medical expenses incurred by the Insured due to an accident up to Rs.1,00,000/-

    Broken bones – A lump sum payment would be made as per scale provided in the policy, in the event of fracture of bone due to an accident.

     

    Indicative premium:

     Sr. No.  Sum Insured  TTD / Week  Basic Premium  TTD Premium  Total Premium
                1               5,00,000           5,000            1,344                 153            1,497
                2             10,00,000         10,000            1,958                 430            2,388
                3             15,00,000         15,000            2,571                 644            3,215
                4             25,00,000         15,000            3,798                 644            4,442
                5             50,00,000         15,000            6,866                 644            7,510
                6         1,00,00,000         15,000         13,002                 644         13,646
                7         2,00,00,000         15,000         25,274                 644         25,918
                7         5,00,00,000         15,000         62,090                 644         62,734

    for Risk group I, including GST


    Exclusions:

    • Self-inflicted injury, suicide or attempted suicide or abuse of intoxicants or hallucinogens including drugs and alcohol.
    • Participation or involvement in naval, military or air-force operations, racing, diving, aviation, rock or mountain climbing, any breach of law with criminal intent.
    • War or any act of war, act of foreign enemy, public defense, rebellion, revolution, insurrection, military or usurped acts, chemical, radioactive or nuclear contamination.
    • Pregnancy or childbirth or its complications, congenital internal & external diseases, HIV/AIDS, sexually transmitted diseases, Pre-existing conditions & their complications.
    • Please refer to the Policy Wording for the complete list of exclusions.

    For complete details refer to Actual policy wording