Personal Accident Policy

What is Personal Accident Plan

Personal Accident Plan is an insurance policy that provides compensation in case the insured person meets with any bodily injury caused solely and directly by some violent, external and visible means resulting in death, injury, disability (permanent, total or partial disablement) as stated in the guidelines of the insurance company providing the cover. The sum insured will generally depend on the income of the person taking such insurance cover.

Some examples of the types of accidents covered under this policy are rail, road or air accident, injury due to burns, drowning, snake bite, fall, injury due to bursting of gas cylinder, etc.

Key terms:

  • Bodily injury : A disease due to accident, excluding disease due to natural cause and mental shock.
  • Solely & directly : Must be caused directly by an accident, independent of any other influencing factor, viz. Breaking of a leg only and not any infection from it shall be covered.
  • Accident : A completely unforeseen, unplanned incident.
  • Disablement : When a person, because of an injury, is unable to engagehim/ herself in any form of business or occupation.

The policy may be issued to an individual or to a group. An individual may have the option of adding on his/her children, but at a reduced level of cover.

What does the Insurance Cover

  • Death : In case of demise of a person his legal heirs are entitled to the sum insured.
  • Disability : Classified under the following heads:
    • Permanent Total Disability: This is a total and irrecoverable injury which prevents a person from engaging in any occupation. Eg. Loss of eyes, physical separation of limbs, person in coma, paralysis etc.
    • Permanent Partial Disability: This is partial in nature like the loss of a finger or toe. Here, the compensation is determined by the percentage of the disability, as defined in the policy document.
    • Temporary Total Disability: It comprises all disability which is total in nature but has the option of being cured after a certain time period. Payment made (by the Company) is on weekly basis.
  • Carriage of dead body : A partial reimbursement over and above the sum insured is made in case of transporting a dead body of the insured from the area of accident which is not the individual’s place of residence.
  • Education for children : In case of death or permanent disablement of the insured the Company pays for the education of up to two children provided each is below 25 years of age.
  • Modification of house: If modification of the residence is warranted for the free movement of a disabled person, the expense incurred is borne by the Company as per the pre-agreed guidelines.

Personal Accident Plan is an insurance policy that provides compensation in case the insured person meets with any bodily injury caused solely and directly by some violent, external and visible means resulting in death, injury, disability (permanent, total or partial disablement) as stated in the guidelines of the insurance company providing the cover. The sum insured will generally depend on the income of the person taking such insurance cover.

Exclusions from the Policy

  • Intentional self-injury, suicide
  • Injury sustained in state of intoxication
  • Injury during aviation (duly license standard type) or ballooning
  • Injury directly or indirectly caused by venereal diseases
  • Injury while committing any beach of law
  • Injury due to service in armed forces
  • Injury resulting directly or indirectly from child birth or pregnancy

Our Recommendation

We are recommending the Personal Accident Plan (Secure) of Religare Health Insurance Company Limited.

Religare Health Insurance Company Limited is a specialist health insurance company engaged in the distribution & servicing of health insurance products. Religare is promoted by the founders of Fortis Hospitals, which owns or manages 68 hospitals in India; SRL Diagnostics, Asia’s largest network of diagnostic labs with over 1100 collection centers and Religare Wellness, a nationwide chain of stores offering pharmacy and wellness products.

It should be also noted that we will earn commission for selling this Personal Accident Plan from the insurance company.

Secure (Personal Accident Cover)

This personal accident cover is a thoughtful endeavour from Religare Health Insurance. It covers all possible facets of expenditure that may arise if and when the Insured meets with an accident. The wide array of coverage includes accidental death, disablement, hospitalization, ambulance and nursing facilities, reconstructive surgery along with provision for dependents under certain circumstances.

Key Features:

  1. Accidental Death
  2. In case of death of an insured person on account of any accident or injury occurring within the policy period, the Company pays the sum insured within twelve calendar months from the date of occurrence of the said injury.
  3. Permanent Total Disablement (PTD)
  4. The Company pays a lump sum amount equal to the Sum Insured in the event of Accidental Death or Permanent Total Disablement of the insured within 12 calendar months of the date of occurrence of the injury, within the policy period.
    INSURED EVENT % OF INSURED SUM PAYABLE
    Total and irrecoverable loss of sight of both eyes, or actual loss by physical separation of two entire hands or two entire feet, or one entire hand and one entire foot, or the total and irrecoverable loss of sight of one eye and loss by physical separation of one entire hand or one entire foot 100
    Total and irrecoverable loss of use of two hands or two feet or one hand and one foot or sight of one eye and use of one hand or one foot 100
    Total and irrecoverable loss of one eye, or of the actual loss by physical separation of one entire hand or one entire foot 50
    Total and irrecoverable loss of use of a hand or a foot without physical separation 50
    Paraplegia or quadriplegia or hemiplegia 100
  5. Permanent Partial Disablement
  6. The Company pays a sum up to an amount as agreed upon in the policy certificate in the event of Permanent Partial Disablement of the insured within 12 calendar months from the date of occurrence of the injury within the policy period.
    INSURED EVENT % OF INSURED SUM PAYABLE
    Total and irrecoverable loss of hearing in
    • one ear or
    • both the ears

    20
    75
    Loss of toes
    • All
    • Both phalanges of great toes bilateral
    • Both phalanges of one great toe
    • Both phalanges of other than great toes for each toe

    20
    5
    2
    1
    Loss of four fingers and thumb of one hand 40
    Loss of four fingers of one hand 35
    Loss of thumb
    • Both phalanges
    • One phalanx

    25
    10
    Loss of index finger
    • Three phalanges
    • Two phalanx
    • One phalanx

    10
    8
    4
    Loss of middle finger
    • Three phalanges
    • Two phalanx
    • One phalanx

    6
    4
    2
    Loss of ring finger
    • Three phalanges
    • Two phalanx
    • One phalanx

    5
    3
    2
    Loss of ring finger
    • Three phalanges
    • Two phalanx
    • One phalanx

    4
    3
    2
    Loss of Metacarpus
    • First or second
    • Third, fourth or fifth

    3
    2
    Permanent partial disablement not otherwise provided for under those mentioned above Such % of the sum insured is determined by medical assessment carried out by the company’s approved practitioner and does not exceed 50%
  7. Fractures
  8. The Company pays a sum up to an amount as agreed upon in the policy certificate in the event of injury resulting in fracture within the policy period.
    DESCRIPTION OF FRACTURE % OF INSURED SUM PAYABLE
    Hip or pelvis (excluding thigh or coccyx): multiple fractures, at least one compound fracture and one complete fracture 100
    Hip or Pelvis (excluding thigh or coccyx): all other compound fractures 50
    Thigh or Heel: multiple fractures, at least one compound fracture and one complete fracture 100
    Thigh or Heel: At least one complete fracture 50
    Lower leg, skull, clavicle, ankle, elbows, upper or lower arm (including risk but excluding Colles-type fracture) : All other compound fractures 30
    Colles type fracture of the lower arm: if complete fracture 100
    Colles type fracture of the lower arm: if compound fracture 50
  9. Child Education
  10. The Company will pay an amount as specified in the policy certificate to the child of the Insured in case there is a pay out on account of Accidental Death or PTD to the Insured.
  11. Major Diagnostic Test
  12. The Company provides reimbursement for any major diagnosis viz. CT Scan, MRI etc which had been carried out within 3 months of the occurrence of an injury, with written advise of a sanctioned medical practitioner. Injuries which are considered are those that can be claimed under Accidental Death, PTD or PPD.
  13. Disappearance Clause
  14. In case an Insured person’s body cannot be located following a wreckage of a common carrier, forced landing, sinking or any such event which may be classified as resulting from Act Of God, the Company pays a lump sum admitting the claim under “Accidental Death”. However, if it is later discovered that the person has somehow survived, then he must pay the Company back the entire amount that was paid to his next of kin.
  15. Mobility Cover
  16. For any claim filed under PTD, the Company pays for prosthetic devices, orthopaedic braces, and durable medical equipment as prescribed in writing by the treating medical practitioner. The pay outs are made in accordance with the agreements made in the policy statement.
  17. Burns
  18. The Company provides payment in case an injury results due to second or third degree burns suffered by the Insured person
    DESCRIPTION OF BURNS % OF SUM PAYABLE
    Third Degree burns of 30% or more of the total body surface area 100
    Second Degree burns of 30% or more of the total body surface area 50
    Third Degree burns of 20% or more, but less than 30% of the total body surface area 80
    Second Degree burns of 20% or more, but less than 30% of the total body surface area 40
    Third Degree burns of 10% or more, but less than 20% of the total body surface area 40
    Second Degree burns of 10% or more, but less than 20% of the total body surface area 20
    Third Degree burns of 5% or more, but less than 10% of the total body surface area 20
    Second Degree burns of 5% or more, but less than 10% of the total body surface area 10
  19. Domestic Road Ambulance
  20. If a claim is made under Accidental Death, PTD or PPD, the Company provides reimbursement for and emergency evacuation and any necessary medical care enroute, as applicable, to the Insured person.
  21. Nursing Care
  22. The Company pays for a qualified nurse if recommended in writing by an authorised medical practitioner as a part of the treatment process (perform or facilitate in performing the daily activities) of the Insured.
  23. Reconstructive Surgery
  24. If a claim is made under PTD or PPD, the Company is liable to pay for the required reconstructive surgery of the Insured, carried out within 30 days of the accident/ injury.
  25. Repatriation of mortal remains
  26. When claim is payable under Accidental Death clause, the Company pays for the transportation of the Insured person’s body from the place of death to either the last known address of the Insured, as per the records of the Company, or to any venue as requested by the next of kin.
  27. Accidental Hospitalization (ADD ON)
  28. Company may reimburse the hospitalization expense for day care. A lump sum amount will be paid for each day of stay for a maximum of 5 days, subject to deduction of two days, or shall reimburse the transportation cost of hospitalization to another city (equivalent to its economy class airfare) where hospitalization is three days from the occurrence of the injury, for a minimum period of five consecutive days. ALL SUCH PAYOUTSARE SUBJECT TO AGREEMENTS AS SPECIFIED IN THE POLICY DOCUMENT.
    Policy Options
    Plan Detail Secure 1 Secure 2
    Sum Insured (in Rs.) 10 Lac 15 Lac, 20 Lac, 25 Lac & 30 Lac
    Accidental Death Sum insured Sum insured
    Permanent Total Disablement Yes Yes
    Permanent Partial Disablement Yes Yes
    Fractures Up to Rs. 50,000 Up to Rs. 1,00,000
    Child Education No 10 % of Sum insured
    Major Diagnosis Tests No Up to Rs. 15,000
    Disappearance No Sum insured
    Mobility Cover No Up to Rs. 15,000
    Burns No Up to Rs. 10,00,000
    Domestic Road Ambulance No No
    Nursing Care No No
    Reconstructive Surgery No No
    Hospitalization Expenses Up to Rs. 1,00,000 Up to Rs. 1,00,000
    Daily Allowance Rs. 500 per day, Max for 5 days Rs. 500 per day, Max for 5 days
    Compassionate Visit Up to Rs. 15,000 Up to Rs. 15,000

    POLICY TERMS

    Duration 1year to 3 years
    Free Look Period Within 15 days of receipt of policy
    Minimum entry age 91 days
    Maximum entry age 70 years
    Maximum renewal age Lifelong
    Age of Proposer 18years or above
    Relationship Covered Legally married spouse, children, parents, brothers, sisters, parents-in-law, grandparents, grandchildren, uncle, aunt, nephew, and niece.
    Renewal terms
    • The policy terminates at the end of the policy period if not renewed by mutual agreement (in accordance with IRDA rules and regulations, as applicable) between the Company and the insured by paying the renewal premium before policy end date and in any event before the expiry of the grace period..
    • Renewal may be denied on grounds of fraud, misrepresentation of facts, moral hazard or non-co-operation by the Insured.
    • The policy may be withdrawn by the Company after due approval from the IRDA. Under such circumstances it is possible to renew the policy under the then prevailing Health Insurance Product or its nearest substitute approved by the IRDA. The policy holder is duly intimated during withdrawal or renewal of the policy.

    Claim Process:

    Claim is generally settled by the process of reimbursement; however, for add-on benefits of Accidental Hospitalization, one may avail of the Cashless facility. The claim form along with the required information documents must be sent to the Company. In case of any missing document the Company will send a deficiency letter to the claimant. On receipt of the completed set of documents, the Company releases a cheque for the admissible amount along with a settlement statement in the name of the Policyholder.

    Exclusions of The Policy:

    • Any pre-existing injury or physical condition
    • The Insured learning to operate any aircraft or performing duties as a member of the crew of any aircraft or scheduled airlines
    • Intentionally self-inflicted injury, sexually transmitted condition, anxiety, depression etc.
    • Influence of drugs, alcohol etc.
    • In case of war, war-like situation, capture, arrest, etc.
    • Participation in felony, riot or in case of criminal misdemeanour, breach of law due to criminal intent
    • Infection with HIV, AIDS,ARC or venereal diseases
    • 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 upon by the Company in writing, subject to additional premium being received and incorporated accordingly in the Policy
    • 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 explosives or in underground mines or press, activities like racing on wheels or horseback, winter sports, canoeing involving white water rapids, and any other bodily contact sport
    • Any treatment traceable to pregnancy, miscarriage, abortion etc.
    • Congenital anomaly
    • Bacterial infection