All You Need to Know About Personal Accident Insurance

The future is unpredictable. We all carry a risk of accidents that can cause death or disability. There is more probability of accidental disability. This risk can be covered through personal accident and disability cover. This cover can be bought either as a rider with a life insurance or as a separate insurance product.

Personal Accident Insurance provides financial protection to you and your family against death, bodily injury, and disability caused by an accident. This claim is paid either through one-time payment or installment for a period.

Please note that the proximate cause of death or disability needs to be an accident only (which means a sudden impact. For example, a cardiac patient had an accident and died after 20 days. Though the proximate cause is an accident but death has happened due to cardiac arrest and the claim will be denied.

Inclusions of Personal Accident Insurance?

A personal accident insurance policy covers:

1. Accidental Death: Only accidental death and not natural death will be covered. A 100% sum assured is given to the nominee in case of accidental death.
2. Permanent Total Disability (PTD): A lifelong total impairment that prevents you from engaging in any kind of occupation such as loss of sight of both eyes, actual loss by physical separation of both hands or both feet or one entire hand or one foot, etc. A specified sum insured is paid to the policyholder or a 20% sum assured is paid for 5 years.
3. Permanent Partial Disability (PPD): A partial loss of a body part or sensory organ specified in the policy document. A specified sum is paid to the policyholder.
4. Temporary Total Disability (TTD): Bodily injury that prevents you to engage in your occupation for a period of time. The company will provide a weekly allowance to compensate for the loss of income.

Exclusions of Personal Accident Insurance?

1. Natural death of the policyholder
2. The policyholder had a pre-existing injury or a disability
3. Suicide attempt by the policyholder
4. Policyholder suffering from a mental disorder
5. Committed a criminal act that caused the injury
6. Policyholder took a part in a war activity that caused the injury
7. Childbirth or pregnancy-related complications
8. The policyholder was under the influence of alcohol or drugs at the time of the incident.
9. The accident is caused in a criminal activity.

These are some of the exclusions. Carefully read your policy document to know other exclusions of the policy.

Here’s a Case of Claim Rejection in Personal Accident Insurance

Mr. Rahul had a personal accident insurance policy. He met with a severe rail accident while going to his office. The accident caused severe injuries to the lower leg. He had a right leg knee amputation to save his limb. His wife notified the insurance company about the permanent disability and submitted the claim form along with the necessary documents to the insurance company.

The company rejected the permanent disability claim as their investigation found that Mr. Rahul was diagnosed with post-traumatic limb ischemia right low limb with LI Fracture. According to them, it was temporary. Also, they found no evidence of any kind of permanent disability due to the accident.

The couple was confused as they don’t know how to make the insurance company understand that it was a genuine case of permanent disability. Then they saw the episode of Shark Tank in which Insurance Samadhan appeared. His wife approached us with the case. We verified all the documents of Mr. Rahul’s case and came to the conclusion that he had a permanent disability due to the rail accident.

We guided the couple in approaching the insurance company. We helped them to resolve the case and get the claim money within 5 months. 

How to Apply for a Personal Accident Claim?

1. Immediately notify your insurance company after the accident. You can call on customer care number or visit their website to inform them online.
2. Submit the duly filled claim form along with policy documents to your insurance company
3. You also need to submit other documents as per the case (death, permanent disability, partial disability, etc.).
4. The insurance company will investigate the case and ask for further documents (if required).
5. After investigating, the company will decide whether to approve the claim or deny it.
6. If the claim is approved, then the company will pay the claim amount through check or transfer it to your bank account.
7. If the claim is denied/rejected, then the company will send you a rejection letter, stating the reason for the claim rejection.

If you are not satisfied with the claim settlement, you can reapply.

Click here to know the process of claim in a group personal accident insurance

Documents to Be Submitted

1. A death certificate and post-mortem report (in case of death)
2. Disability certificate (in case of disability)
3. Doctor’s Report
4. FIR copy
5. Medical certificates
6. Medical bills
7. Photograph of the accident site
8. Panchnama

If you face any issues, then you can contact Insurance Samadhan. Insurance Samadhan has resolved 14500+ customer grievances related to insurance. If you want any guidance, then you can contact us. We’ll be happy to help you.

Click on the below links to read some cases resolved by Insurance Samadhan:

Cashless claim rejection

Mis-selling in a life insurance policy

Dengue Claim Rejection