What is a personal accident insurance policy?
The Indian Government, and other private insurance companies, are making strides in the direction of providing their customers the best and most comprehensive financial protection. Most insurance products grouped under the categories of life or health insurance don’t provide protection against disastrous events / unfortunate work accidents / accidental loss of life or the loss of the ability to earn an income. Personal accident insurance provides specific coverage against the loss of life / loss of limbs / disablement / etc. due to accidents of a general nature related to travel or work.
What is the need for a personal accident insurance plan?
Accidents happen every day. From the danger of vehicle accidents during commutes to and from work, to the danger of being hurt by the tools used at work, to the dangers faced because of improper infrastructure, the list is endless. Personal accident insurance gives you the satisfaction of knowing that whatever accident may come to pass, you and your dependants will be financially protected by accidental insurance cover. It covers burns, cuts, broken bones, the cost for ambulances and medical services, hospitalization due to any kind of accident, loss of limbs / eyesight, etc. A larger or smaller range of coverage may be chosen at the time of taking the plan, depending on the insurer.
Why opt for personal accident insurance with life or health insurance?
Life insurance and health insurance are insurance products that cover specific eventualities and offer insurance coverage to mitigate the negative financial implications these eventualities have on the policyholder or his / her dependants.
Life insurance as a product provides a financial benefit to the dependants or nominees of a person who has lost his / her life.
Health insurance as a product acts as a cushion and mitigates the expenses incurred due to hospitalization for whatever reason.
Personal accident insurance as a product provides additional coverage for a wider range of possible accidents or disasters that could occur in our day to day lives. A personal accident insurance policy provides for coverage against the loss of limbs or disabilities caused due to accidents while travelling / commuting / in the workplace / due to the dangerous nature of work / due to external situations, etc. This is the insurance product to be purchased by those who wish to create a financially stable environment against all possible eventualities.
Difference between life, health & accidental insurance plan:
|Term Insurance Plan||Health Insurance Plan||Personal Accident Policy|
|Coverage against financial burdens on the dependants of the policyholder in the event of the policyholder’s death.||Financial aid at the time of hospitalization to mitigate the overall expense incurred.||Coverage for burns, cuts, broken bones, loss of limbs / eyesight / hearing / etc., hospitalization and ambulance charges for accidental injuries.|
Pays out benefit on death.
Pays our benefit on maturity (in some cases).
Pays out benefit on permanent total disability (in some cases).
Pays out benefit on permanent partial disability (in some cases).
Specific plans for women (in some cases).
Pays out benefit after the hospitalization process.
Covers cost of ambulance.
Covers cost of extended hospital rent (in some case).
Covers the cost of wet nurse / hospice.
Specific plans for women (in some cases).
Pays out benefits on death or permanent total disability / partial total disability.
Pays out benefit for temporary disability (in some cases).
Specific plans for women (in some cases).
|Must be taken by everyone who has dependant family.||Must be taken by anyone prone to hospitalization because of health issues / traffic accidents / etc.||Must be taken by anyone who may be hospitalized due to the dangerous nature of work / dangerous commute / exposed to a dangerous work environment / who want to ensure peace of mind against the possibility of general accidents.|
What are the types of personal accident insurance policies available in India in 2016?
Personal accident policies are offered by almost all the top insurance providers in India.
Most insurers offer the basic personal accident insurance policy package which pays out a benefit on death / disability due to personal accidents (wider than the coverage provided by health and life insurance policies).
Some policies even go so far as to pay benefits on temporary disabilities and partial disabilities. Some policies allow for the entire family to be covered as policyholders / the entire workforce to be covered under a group policy.
There are also policies that offer extended coverage against a wider range of eventualities or offer additional benefits payable for specific dangers that are faced by different individuals depending on the amount of risk they’re exposed to every day. Some policies can even be customized.
Factors influencing personal accident insurance premiums:
Different types of insurance products take different factors into consideration while calculating the premium payable and coverage applicable on an individual basis for most customers.
Life insurance policies take factors like age, health, income, etc. into account to determine the premium paying capacity, expected lifespan, etc. of the customer.
Health insurance policies take factors like income, current state of health, etc. into account to determine the expected frequency of hospitalizations, etc. of the customer.
Personal accident insurance policies take factors into account like exposure to risk, employment category, etc. into account to determine the total risk exposure and likelihood of accidental injury, etc. of the customer. Age and income aren’t as big factors in this case.
General categorization of risk levels for different types of occupations:
While different insurance providers may rank or categorize customers in their own way, the generally accepted benchmark for categorizing potential customers is as under:
Type 1: This is the “low risk” category and generally includes:
- Administrators and managers.
- Professionals like doctors, architects, teachers, and lawyers.
- Office workers and those who hold desk jobs with minimal interaction with power tools, etc.
- Similar professions.
Type 2: This is the “medium risk” category and generally includes:
- Manual labourers.
- Machine operators.
- Paid vehicle operators / drivers of heavy vehicles.
- Cash carrying employees.
- Builders and contractors.
- Veterinary doctors.
- Similar professions.
Type 3: This is the “high risk” category and generally includes:
- Mine workers (in underground mines).
- Engineers working with high tension power supplies.
- Circus performers.
- Dangerous sports like river rafting, etc.
- Mountaineers, etc.
- Similar professions.
Depending on the assessment report of individual cases, the insurer will determine which risk bracket the customer falls into, and adjust the policy accordingly.
Benefits and coverage under accidental insurance plans:
Generally, personal accident insurance plans offer the coverage of financial protection for the following eventualities or occurrences:
- Accidental death: If the insured party meets his / her untimely and unfortunate demise due to an accident, the nominees or dependants of the policyholder will be paid a death benefit in order to cover his / her dependants from financial insecurity.
- Permanent total disability: If the insured party is rendered totally disabled and in a way that is permanent and is beyond medicine’s ability to heal, he or she will be entitled to a benefit pay out as per the insurer’s guidelines. Even if the disability arises within a year of the accident, the insurance provider will be liable to pay the policyholder a benefit.
- Permanent partial disability: If the inured party is rendered partially disabled in a way that is permanent and is beyond medicine’s ability to heal, he or she will be entitled to a benefit pay out as per the insurer’s guidelines. Some insurers define partial disability in different ways, and include clauses that state that the disability will be considered only if the disability impedes the policyholder from earning a regular income.
- Temporary total disability: Some plans include a temporary total disability coverage which states that if the policyholder is rendered totally disabled even on a temporary basis (due to an accident), he or she is entitled to a benefit pay out. Temporary total disability means that the policyholder can be restored by medicine and treatment to his / her original working and productive capacity.
- Temporary partial disability: There are a few personal accident insurance policies that cover temporary partial disabilities that happen due to accident. The policyholder will be eligible for the benefit pay out on the insurer’s terms if he or she has been rendered incapable of generating an income through productive work due to an accident.
- Dismemberment: Many policies have benefit pay outs for dismemberment of any kind that happens due to accident whether at work or in transit, etc. Many insurers have predefined percentages and ratios in which the benefit will be payable to policyholders who lose arms, legs, fingers, toes, eyes, etc. due to accidents.
- Burns: Most insurers provide this as an optional extra coverage, and this additional insurance covers the possible death or dismemberment that could happen because of burns (that are caused by chemicals, fire, etc.). The cost of treatment of these burns is reimbursed to the policyholder after hospitalization for the same.
In addition to these, the personal accident insurance policies also reimburse the policyholder on certain expenses that are incurred as a result of the accident, as mentioned below:
- Reimbursement of hospitalization expenses: The insurer will reimburse either all or a part of the expenses incurred at the hospital that are a direct result of an accident. Medical expenses, room rent charges, the doctor’s and nurse’s fees, cost for medical tests, etc. are taken into consideration for the reimbursement.
- Hospitalization daily allowance: Depending on your insurer, you may or may not be eligible for a daily cash allowance for expenses arising when hospitalized. This daily allowance to meet unforeseen hospital expenses that arise due to accident can be given for up to 30 or even 45 days of hospitalization.
- Education grants: Depending on the insurer chosen, the policyholder may or may not be eligible for this benefit pay out. The insurer pays out an additional amount that is to be used for the tuition fee payment for the dependent children of the policyholder. This is a common benefit available across many insurers.
- Reimbursement of expenses for transportation of mortal remains: Some insurers even cover the cost of the transportation of the mortal remains of the policyholder.
Exclusions in Personal Accident Insurance:
Personal accident policies have some exclusions. These can change or vary in their nature depending on the insurer in question.
The official and comprehensive list of exclusions, and the terms and conditions therein will only be communicated to the policyholder in the official wordings of the policy document that he or she is given at the time of taking the policy.
A general list of exclusions is given below. In most policies, exclusions include but are not limited to the following:
- Intentional injury: If the death, permanent total disability, permanent partial disability, temporary total disability, temporary partial disability, burns, broken bones, dismemberment, etc. is determined to have been caused intentionally, or due to intentional negligence, the claim will not be honoured.
- Injuries from civil or foreign wars: If the death, permanent total disability, permanent partial disability, temporary total disability, temporary partial disability, burns, broken bones, dismemberment, or hospitalization, etc. is determined to have been caused due to the participation of the policyholder in any civil or foreign armed conflict, the claim will not be honoured.
- Injuries that occur due to being under the influence of alcohol or drugs: If the death, permanent total disability, permanent partial disability, temporary total disability, temporary partial disability, burns, broken bones, dismemberment, or hospitalization, etc. is determined to have been caused due to the policyholder being under the influence of alcohol or drugs, the claim will not be honoured.
- Accidents that occur while riding a two-wheeler that’s over 150cc: If the death, permanent total disability, permanent partial disability, temporary total disability, temporary partial disability, burns, broken bones, dismemberment, or hospitalization, etc. is determined to have been caused because of an accident while the policyholder was operating a two-wheeler with an engine capacity of over 150cc, the claim will not be honoured.
- AIDS / HIV / STDs: If the death, permanent total disability, permanent partial disability, temporary total disability, temporary partial disability, burns, broken bones, dismemberment, or hospitalization, etc. is determined to have been caused because the policyholder suffers from an STD, the claim will not be honoured.
- Injuries that occur due to active involvement in violent public disorder / labour disturbances: If the death, permanent total disability, permanent partial disability, temporary total disability, temporary partial disability, burns, broken bones, dismemberment, or hospitalization, etc. is determined to have been caused due to the policyholder being involved in any sort of public disturbance, riot, protest, demonstration, strike, labour disturbance, etc., the claim will not be honoured.
- Injured on duty with military / paramilitary / police force: If the death, permanent total disability, permanent partial disability, temporary total disability, temporary partial disability, burns, broken bones, dismemberment, or hospitalization, etc. is determined to have been caused in the policyholder’s due course of duty with any paramilitary, military, or police forces, the claim will not be honoured.
- Injuries arising from participation in unsafe sports: If the death, permanent total disability, permanent partial disability, temporary total disability, temporary partial disability, burns, broken bones, dismemberment, or hospitalization, etc. is determined to have been caused due to the policyholder’s participation in unsafe sports like mountaineering, river rafting, bungee jumping, etc. the claim will not be honoured.
- Claims arising out of past illness / sickness: If the death, permanent total disability, permanent partial disability, temporary total disability, temporary partial disability, burns, broken bones, dismemberment, or hospitalization, etc. is determined to have been caused as a result of an existing medical condition or the worsening of an existing illness / sickness, the claim will not be honoured.
- Claims arising out of pregnancy / childbirth / related issues: If the death, permanent total disability, permanent partial disability, temporary total disability, temporary partial disability, burns, broken bones, dismemberment, or hospitalization, etc. is determined to have been caused due to the policyholder’s pregnancy, childbirth, or any related issues, the claim will not be honoured.
There are usually more exclusions that are covered comprehensively in the official policy wordings that the customer receives at the time of taking the policy.
Individual and group insurance under personal accident policies:
Individual personal accident policy: These are the most common types of personal accident policies, where the policyholder opts for insurance cover to protect him / herself and his / her dependants from potential financial instability. Under an individual policy, the policyholder can sometimes bring his / her parents / dependants under the coverage of the plan, and still maintain the policy as an individual policy.
Group personal accident policy: These policies apply to groups of people with something in common - usually employment type and location. Most insurers offer their personal accident policies in the form of group policies with slightly modified terms and conditions. An entire group of workers, or a demographic of people with something in common can take this policy if their exposure to a potentially dangerous work or living environment is larger than most others.
Tax benefits with personal accident insurance policies:
Unlike life and health insurance policies which offer the policyholder some amount of tax rebate under various sections of the Income Tax Act, personal accident policies do not have any tax benefits. These policies exist only to ensure that the policyholders are able to perform their duties without the additional worry of loss and financial instability due to death, dismemberment, injury, etc.
Which is the best personal accident insurance plan for me?
Depending on your specific requirements, you can pick out a personal accident insurance plan that’s relevant to you. Depending on the insurance provider you choose, you may even be able to customize it to suit your specific needs. Check out our article wherein, we have compiled a list of best accidental insurance policies in India:
How to file a claim on your personal accident insurance plan:
Depending on your insurance provider, the claims policy may be different, or require the submission of certain additional documents.
The general process of submitting a claim is given below, right from the moment of injury.
- Notify the insurer at the time of the accident: As soon as the accident occurs, even before or while on the way to the hospital or treatment centre, the insurance provider is to be intimated that an accident has occurred involving the policyholder. The policy number or reference number should be communicated to the insurer so that they can register that a claim has been opened.
- Notify the insurer at the time of hospitalization: The second time the insurer needs to be called is to inform them of the nature of the injury caused due to accident. While hospitalized, all the documents relating to the diagnosis, treatment, and billing of the policyholder is to be maintained in an organized fashion so as to be understood easily in the reimbursement stage of the claims process. The insurer is to be notified of the hospital in which the policyholder has been admitted for treatment, and of the nature of the injury.
- Fill out claim form and maintain documents: A representative from the insurance company will then be dispatched to the hospital or current address of the policyholder to verify the claim and collect the relevant documents for processing.
- Submit police report, if any: Most insurers will require an FIR from the police station in the jurisdiction of where the accident took place. This is usually only required for traffic accidents or accidents arising due to infrastructural collapse, etc. This is a requirement in cases of traffic accidents or criminal cases.
*Please note that all promotions, amounts, tenures, repayment requirements, time frames, interest rates, other rates, charges, fees, ceilings, requirements, criteria, features, benefits, exclusions, calculations, ratios, ratings, terms and conditions mentioned above are as of April, 2016, and are subject to change at any time. All banks / NBFCs / insurance providers / financial service providers / companies, etc. mentioned above retain all rights to modify, replace, or add to or subtract from any of the above, in any way, at any time, and at their own discretion. You are requested to reconfirm the same with your chosen bank / company / NBFC / insurance provider / financial service provider, etc. before making any financial commitments.
News About Personal Accident Insurance
Railway passengers soon have to pay only 92 paise as premium for availing personal accident insurance cover
Indian Railways will be soon introducing a travel insurance policy carrying personal accident cover, where travellers will have to pay only 92 paise as premium while booking online railway tickets. This insurance policy will be launched along with top insurance companies like Shriram General Insurance, Royal Sundaram General Insurance and ICICI Lombard General Insurance. By paying a premium of 92 paise, customers can get cover for up to Rs. 10 lakhs. Indian railways will start off by launching the scheme only for online railway ticket bookings and will later on extend it to season ticket travellers. The personal accident insurance cover under this policy will include the following:
- Rs. 10 lakhs for death
- Rs. 10 lakhs for permanent total disability
- Rs. 7.5 lakhs for permanent partial disability
- Rs. 2 lakhs for hospitalisation due to injury and e) Rs. 10,000 for transportation of mortal remains.
Untoward accidents will be inclusive of terrorist attacks, dacoity, robbery, shootout, riots and a passenger accidentally falling off a train. Other types of accidents will include train collisions and any incident happening between the origin and the destination.
22nd August 2016
Aditya Birla Launches a New Health Insurance Subsidiary
Aditya Birla Health Insurance is one among the new health insurance providers that has been registered with IRDA. This health insurance company is a joint venture between MMI Strategic Investments (Pty) Limited (MMI) of South Africa and Aditya Birla Financial Services Limited (ABFSL). The company recently received its Certificate of Registration and will be providing health insurance policies to the general public soon. With this move, the total number of new health insurance providers who have registered with IRDA has gone up to 6.
19th July 2016
Delhi Government plans new insurance scheme for accident victims
Minister of Health under the Delhi Government, Satyendar Jain revealed that the state government is planning on launching a new insurance scheme for accident victims. The scheme will treat accident victims free of cost. In accident cases, timing is the key and doing away with payment of hospital fees will speed up the process. The idea is to fully utilize the infrastructure available at government hospitals by adding air-conditioned rooms and using the public-private-partnership model for services such as MRI, CT Scan and Dialysis.
With so many doctors and medical institutes, Delhi should be the centre of medical activity and the present state government aims to join hands with various government and private medical institutes and retired doctors to make the medical infrastructure in the city, better.
5th July 2016
Health and Personal Accident Insurance Drive Growth in 2015-16
A major chunk of the growth seen in the insurance industry during the financial year 2015-16 was driven by health insurance and motor insurance. The health insurance industry is known to have grown by 22% and collected a total of Rs 24784.02 crore in premiums last year. The chief of underwriting and reinsurance for ICICI Lombard, Mr. Sanjay Datta has expressed his confidence that this year the growth will be almost the same as last year and maybe even better. The figures, however are a bit lower than the growth that was seen in the years before since the government had shut down the Rashtriya Swasthya Bima Yojana, a mass insurance program, in a lot of districts. Even personal accident insurance saw a similar growth of about 22%. The premiums collected under this head totalled an impressive Rs 2585 crore in 2015-16.
6th May 2016