badge

Sunday, 12 April 2015

Accident Insurance Policy

Accident Insurance Policy is another form of Health Insurance Policy which insures incase of Accidental Death and Dismemberment of the insured. The Policy benefits are paid to the beneficiary in case of death due to accident. Benefits are also provided according to terms and conditions of the policy in case of Total/Partial Disablement suffered in an accident by an insured individual.
The Accident Insurance Policy is offered by Non Life Insurance Companies and is regulated as per the norms set by Insurance Regulatory Authority of India (IRDA).The Accident Insurance coverage is available from Rs 1,00,000/- to anything in Crores. The premium on these types of policy is very nominal and is pretty affordable. The minimum age of the proposer of the policy in most cases needs to be 18 and maximum age of taking a new policy is generally 60 but it depends on the Insurance Companies. Few do not have any maximum entry age limit. Anyone above 3 months can be covered under the policy. The Insurer can claim benefits for any injury sustained during accident which may hamper his/her earning or physical and mental ability.
The Policy offered may be in form of Personal Accident Insurance, Family Accident Insurance or Group Accident Insurance undertaken by Employers.

COVERAGE

The following conditions will be covered in the policy, however there may be few variations in the terms and conditions of the policy offered by different companies.
  • Accidental Death (Full Sum Insured)
  • Permanent Total Disability (Full Sum Insured minus any payments made earlier)

Note: Permanent Total Disability is any such disability has continued for a period of 12 consecutive months and is total, continuous and permanent at the end of this period. The terms of Permanent Disability and Loss related to it is covered in the Schedule of the Policy.
  • Permanent Partial Disability (Percentage of Sum Insured as per terms of Policy)

Note: Injury occurring during the policy period and commencing within 365 Days from the date of the Accident, One suffers a Permanent Partial Disability, Compensation will be paid, provided such disability has continued for a period of 12 consecutive months and is continuous and Permanent, at the end of this period, a percentage of the Sum Insured shown in the Policy Schedule.
  • Temporary Total Disability (Percentage of Sum Assured as Weekly Benefit)

Note: Weekly benefit amount during a period of continuous Temporary Total Disability of the Insured Person resulting from Injury during the policy period after completion of the Elimination Period (Required number of days/week to elapse before benefit is payable).

ADDITONAL BENEFITS

  • Cumulative Bonus (CB) is added to the Sum Insured in respect of each claim free period (no claims reported arising during the previous term of the policy), provided that policy is continuously renewed with any break. A certain percentage is added to the Sum Insured subject to maximum of 50% of the Sum Insured (excluding CB).
  • Even Child Education expenses are covered up by some of the policies. So these are pretty sensible covers for young Individuals with young family.
  • Coverage in the event that an accident leaves the insured missing (forced landing, stranded, sink, wreckage, etc) for more than 1 year and insured’s demise has been reasonably established, payment of the sum to the nominee is also possible.
  • Mobility Cover is provided under most of the Policies, an injury leading to Permanent Total Disablement (PTD) and requires one to use prosthetic devices like artificial arms, legs or eyes, orthopedic braces and medical equipment like wheelchairs or hospital beds, such expenses will also be covered.
  • Coverage may be available for expenses pertaining to reconstructive surgery, advised by medical practitioner in case of an accident leading to Permanent Total Disability (PPD).
  • Expenses are also reimbursed for treatment  of fractures and burns pertaining to a surgery, advised by a medical practitioner in case of an accident.
PAYMENT OF PREMIUM

Insurance in most cases needs to be renewed annually or as the terms and conditions of the policy. The premium for the policy should be paid on or before the due date. However a grace period of 15-30 days is provided after the due date for the renewal of the policy without the loss of continuity benefits. Insurance coverage is not available for the period for which no premium is received.

FREE LOOK IN PERIOD

Insured person/family is allowed a period of 15(approximately) days from the date of receipt of policy to review the terms and conditions of the policy. The policy can returned during that period and refund of the premium may be claimed.

PORTABILITY

Transfer from one Insurance Company to another is also possible, the insured person must apply with details of policy and claims to the insurer as to where and whom the policy needs to be ported.

EXCLUSIONS

  • Some of the general exclusions have been mentioned below, however the list is not exhaustive and may include some more riders depending on policies and terms set by the Insurers under the IRDA guidelines.
  • Any pre-existing injury or physical condition.
  • Any intentional self-inflicted injury, suicide or attempted suicide, sexually transmitted conditions, mental or nervous conditions, insanity, disorder, anxiety, stress or depression.
  • The Insured Person flying in an aircraft other than as a fare paying passenger in a Scheduled Airline.
  • The Insured Person engaging in sporting activities in so far as they involve the training for or participation in competitions of professional sports, unless declared beforehand and agreed by the Company.
  • Insured Person serving in any branch of the military, navy or air-force or any branch of armed Forces or any paramilitary forces
  • Any claim related to Hazardous Activities.
  • Persons whilst working with in underground mines, explosives, press, activities like racing on wheels or horseback, winter sports, canoeing involving white water rapids, any bodily contact sport
  • Claim arising out of mental illness, stress, psychiatric or psycho logical disorders.
  • Being under the influence of drugs, alcohol, or other intoxicants or hallucinogens unless properly prescribed by a Medical Practitioner and taken as prescribed.
  • War, invasion, act of foreign enemy, terrorism, hostilities (whether war be declared or not), civil war, rebellion, revolution.
  • Any Injury directly or indirectly resulting or arising from or occurring during commission of any breach of any law by the Insured Person with any criminal intent.

 CLAIMS PROCESSING

In case of any event as covered under the Policy occurs, the Policyholder or Insured (Person or Nominee) as the case may be shall notify the claim to the
Company within thirty (30) days from the date of its occurrence either through mail or fax or any other medium prescribed by the company.

All the documents related to the treatment and details of the policy should be provided within the stipulated time frame for the processing of the claim.

SETTLEMENT OF CLAIMS

On receiving the final documents or report, the claim shall be settled within a period of 30 days.

If company fails to do so, it has to pay interest above the prevalent bank rate on the outstanding amount till it is cleared.

COMPANIES PROVIDING CRITICAL ILLNESS INSURANCE

Some of the private and public sector companies providing Accidental Insurance is provided below:-

Religare Health Insurance
National Insurance
New India Assurance

There are many other companies too providing the same.

TAX BENEFITS

Tax Deduction is available on the premium pay for Health Insurance U/S 80D up to Rs 25,000/- for Individuals. Senior Citizen can avail deductions up to Rs 30,000/- on the premium paid.

GRIEVANCE REDRESSAL

If you have any grievance against the Insurer or any policy you can get in touch with the IRDAI on the Toll Free Number 155255 or you can also email them at complaints@irda.gov.in

You can also read about other Articles related to Health Insurance in the link given below:-

Critical Illness Insurance

Mediclaim (Cashless) Insurance

Health Insurance

No comments:

Post a Comment