- Insurance
- About Coverfox
- Claims
Personal Accident Insurance policy covers you in case of an unfortunate accident that may be lethal or cause mutilation/disability. Personal accidents caused by rail/road/air accidents, accidents due to falling, collision, fire, by drowning, and other such fateful events. Personal Accident Insurance makes sure that you are covered not only with respect to medical expenses, but also for the loss of income that may occur due to the accident.
The term "accident" can be a little confusing, as different health insurance companies offer policies that may slightly differ. Here, we have grossly spelt out the major stuff for you. We urge you to go through the policy wording while buying Personal Accident Insurance Policy, to know what exactly is (and isn’t) covered.
Let’s get on with a couple of FAQs about Personal Accident Insurance Policies to know more about it.
The Accidental Death cover, which offers a pre-determined compensation to the nominee in case of an unexpected demise or impairment, ensures financial security and stability to the family of the deceased in his/her absence.
Permanent Total Disablement cover financially protects the policyholder’s family in case of his/her lifelong permanent disability.
Permanent Partial Disablement that offers a certain reimbursement to the policyholder’s family assures his/her family of financial security in the event of his/her partial impairment or injury.
A disablement of a temporary nature may lead to a temporary loss of income, resulting in confinement at home. To stop the loss of income for a short period of time, treatment of disablement and injuries also further burn a hole in the pocket of the insured. A Temporary Total Disablement cover not only financially protects the treatment, but also acts as a stable source of temporary income to support the family.
Some of the most important features that an individual searching for an effective Personal Accident Insurance should be looking out for:
Permanent Total Disablement: In case of lifelong permanent disability of the insured, the pre-decided sum is payable to the nominee, that is, the insured policyholder.
Permanent Partial Disablement: In case of injuries to the policyholder that has led to his/her permanent impairment, a specific pre-decided compensation is payable to the insured. The reimbursement is decided by the concerned insurance company on the basis of the extent of injury or impairment.
Temporary Total Disablement: A certain pre-determined compensation is payable to the insured in the case of a short term impairment, resulting in confinement at home. This is generally a weekly payment that is restricted to a certain limit. This reimbursement serves as a compensation for him/her to recover from temporary loss of income, arising from the short term impairment.
Some features that an individual may opt for to increase the effectiveness of a Personal Accident Insurance:
Choose the one that's perfect for you
Accidental Death - A lump sum payment as specified in policy schedule, would be made in the event of the Death due to an accident.
Permanent Total Disablement - A lump sum payment would be made as per scale provided in policy in the event of Permanent Total Disablement due to an accident.
Permanent Partial Disablement - A lump sum payment would be made as per scale provided in policy in the event of Permanent Partial Disablement due to an accident.
Emergency Road Ambulance Charges - Expenses incurred on transportation of Insured Person to a Hospital for treatment in case of an Emergency due to accident.
Education Fund - If a claim under AD or PTD is accepted for an Insured Person, the company will pay up to the sum insured as mentioned in policy schedule, provided that such Dependent Child is pursuing an educational course as a full time student in an educational institution.
Family Transportation - If a claim under AD or PTD is accepted, the company will reimburse expenses incurred in transporting one Immediate Family Member to the Hospital.
Temporary Total Disablement - An allowance would be paid to the Insured to compensate loss of income due to a disability caused by accident.
Transportation of mortal remains - Expenses incurred on transporting the mortal remains of the Insured Person from the place of the Accident or the Hospital to his residence or to a cremation or burial ground.
Sum Insured: Sum insured ranges from Rs. 20 lakh to Rs. 10 Crores.
Post hospitalization expenses: Post hospitalization expenses are covered provided the insured is in the same condition in which he/she was at the time of hospitalization. Also, this is applicable against inpatient hospitalization claim for hospitalization that is admissible by the insurer.
Claim Settlement: For accidental death and permanent total disablement benefit, payment is made to the bank account mentioned by the concerned customer in the application form. After the insurer receives the necessary documents, the settlement amount up to the pre-decided sum insured is transferred within 30 days of receipt of last necessary document.
Organ Donor Benefits: The plan does not include this benefit.
Waiting Period: No waiting period is applicable.
Coverage's:
Accidental Death - The insurance company pays an amount up to a maximum of the pre-decided sum insured on the death of the insured arising because of an accident.
Permanent Total Disablement (PTD) - Sum insured is payable by the insurance company in case of Permanent Total Disablement due to an accident.
Accidental Hospitalization Expenses - Medical expenses incurred in case of hospitalization for a minimum of 24 hours because of injury, within 7 days from the date of accident.
Coverage's:
Accidental Death: Fatal accidents can cause death. Our policy provides up to 100% of the Sum Insured in case the insured loses his/her life in an accident.
Permanent Total Disability: Major accidents decide fate. The company provide benefits based on the Sum Insured in case the insured is permanently disabled in an accident.
Broken Bones: Movement without bones is impossible. The policy provides benefits based on the Sum Insured in case accidents result in broken bones.
Burns: Fire can remove the spark off you. The policy provides benefits based on the Sum Insured in case the insured encounters 2nd or 3rd-degree burns due to accidents while commuting in common transport carriers.
Ambulance charges: The absence of timely help can prove fatal. The policy pays transportation expenses to help reach the nearest hospital, if the insured encounters life-threatening injuries.
Hospital Cash: Accidents can cause a cash crunch. The company provides daily cash allowances for accidents leading to hospitalization.
Coverage:
Death – In such cases, the sum insured chosen by the proposer is payable to the insured.
Permanent Total Disablement – Loss of sight in either or both eyes, or loss of either or both limbs may entitle the insured to avail the capital sum insured.
Permanent Partial Disablement - The loss of sight of one or both the eyes, or the actual loss by physical separation of one entire hand or one entire foot makes the insured eligible for 50% of the pre-determined sum insured.
Temporary Total Disablement – The insurer reimburses the medical expenses incurred by the insured in case of sudden unemployment due to temporary total disablement. The payable amount is 1% of the pre-decided sum insured, but up to a maximum of Rs. 5,000 per week and not more than 25% of the monthly salary.
Coverage:
Death: 100% of pre-determined sum insured is payable to the health insurance policy’s beneficiary on the death of the insured.
Total Permanent Disablement: Total and irrecoverable loss of sight of both eyes or loss of use of two hands or feet or loss of sight of one eye and loss of use of hand or foot. Under such circumstances, the insured is eligible for 100% of sum insured. Total and irrecoverable loss of sight of one eye or loss of use of one hand or foot enables the insured to avail a financial assistance of 50% of sum insured.
Permanent Total Disablement: The insured is eligible for 100% of the pre-determined sum insured in case of permanent total disablement.
Premium: The rate of premium is Rs. 15 for a sum insured of Rs. 25,000. The sum insured is increased in multiples of Rs. 25,000 and premium is charged accordingly.
Coverage:
Accidental Death: 100% of sum insured is payable to the insured in case of accidental death.
Permanent Total Disablement: In such cases, the insured is eligible for 150% of the sum insured.
Permanent Partial Disablement: Specific percentage of the sum insured is payable to the insured for such cases.
Temporary Total Disablement: The compensation payable is at the rate of 1% of the pre-decided sum insured, up to a maximum of Rs. 15,000 per completed week till a maximum 100 weeks.
Coverages:
Death - In case of Death due to accidental bodily injury of the proposer, 100% of Sum Insured would be paid to the Nominee.
Permanent Total Disability (PTD) - In case of PTD due to accidental bodily Injury, 200% of Sum Insured is payable for the proposer.
Permanent Partial Disability (PPD) – In case of PPD due to accidental bodily Injury of the proposer, % of sum insured. The claim payment under Death, PTD & PPD would be restricted to 50% for spouse & 25% for child, provided spouse & child are covered under the policy.
Temporary Total Disability (TTD) - In case of TTD due to accidental bodily Injury of the proposer, weekly benefit would be payable as per the plan opted. The claim payment under TTD benefit would be restricted to 50% for spouse.
Transportation of mortal remains - If we have accepted a claim under Death of you/your family member(s) named in the schedule, then we will pay towards the actual cost of transporting the remains of you/your family member(s) from the place of death to a hospital, cremation ground or burial ground. The amount we pay will be limited to the lower of Rs. 5,000 or 2% of the Sum Assured shown under the schedule.
Children's Education bonus in case of Death or Permanent Total disability of proposer: Rs.5000/- for a child or Rs. 10,000/- maximum towards the cost of education of up to 2 of your dependent children who were under the age of 19 on the date you met with Accidental Bodily Injury.
Hospital confinement Allowance: Rs. 1000/- per day for a maximum of 30 days of hospitalization.
Accidental Hospitalization Expenses: Reimbursement of the cost of medical expenses due to accidental injury up to Sum Insured.
Cumulative Bonus - For every claim free year, you are eligible for Cumulative Bonus (CB) of 10% of sum insured. Maximum cumulative bonus would be 50% of sum insured up to 5 claim free years.
Coverages:
Permanent Partial Disablement: It provides for payment of compensation for bodily injury caused by accidental, violent, external and visible means resulting in Permanent Partial Disablement within 12 (twelve) calendar months of occurrence of such injury.
Temporary Total Disablement: It provides for payment of compensation for bodily injury caused by accidental, violent, external and visible means resulting in Temporary Total Disablement. The compensation shall be payable for the temporary period for which the Insured Person suffers from total disablement due to accidental bodily injury.
Coverages:
Accidental Death: Pays the nominated family member the sum insured for the tragic loss and provides for financial support to the family.
Permanent Total Disablement (PTD): Pays between 50 to 100 percent of the sum insured, based on severity of injury and loss due to the accident.
Permanent Partial Disablement (PPD): Pays a predefined percentage of the sum insured, based on the severity of loss due to the accident.
Fractures: In the event of a fracture, we will provide you coverage within the range of 50 to 100% of your sum insured in order to help you recover without any hassles.
Burns: If you suffer from burns due to accident, get coverage of sum insured in the range 10% to 100% depending on the degree of burn.
Child Education: In the event of an accident resulting in insured’s demise or PTD, the child’s education will be covered, ensuring that their future is not compromised.
Reconstructive Surgery: In case of injuries caused by an accident require you to undertake any diagnostic tests such as CT scan, MRI, etc. as advised by a Medical Practitioner, you can do so without a worry. Tests should be done within 3 months of occurrence of injury to be covered under this accident policy.
Domestic Road Ambulance: If an accident related injury requires emergency medical evacuation, we’ll reimburse the ambulance expenses incurred.
Reconstructive Surgery: If your injury (PTD or PPD) requires the care of a Qualified Nurse, expenses incurred will be covered, if need for the same is prescribed by a medical practitioner.
Coverages:
Death: 100% of the pre-decided sum insured is payable to the policy’s beneficiary on the death of the policyholder.
Permanent Total Disablement (PTD): 100% of the sum insured is paid to the insured in such cases.
Loss of two limbs/two eyes or one limb and one eye (PTD): The insured is eligible for availing 100% of the sum insured under such circumstances.
Loss of one limb or one eye (PTD): In these cases, the insured is eligible for 50% of the sum insured.
Permanent Partial Disablement (PPD): The insured is offered 1% to 75% of the sum insured, as per policy conditions.
Coverages:
Accidental Death: It provides for payment of compensation on the insured person's death caused by bodily injury arising out of accidental, violent, external and visible means and resulting in death within 12 (twelve) calendar months of occurrence of the accidental injury.
Permanent Total Disablement: It provides for payment of compensation for bodily injury caused by accidental, violent, external and visible means resulting in Permanent Total Disablement resulting from an accident.
Permanent Partial Disablement: It provides for payment of compensation for bodily injury caused by accidental, violent, external and visible means resulting in Permanent Partial Disablement within 12 (twelve) calendar months of occurrence of such injury.
Temporary Total Disablement: It provides for payment of compensation for bodily injury caused by accidental, violent, external and visible means resulting in Temporary Total Disablement. The compensation shall be payable for the temporary period for which the Insured Person suffers from total disablement due to accidental bodily injury.
As the name suggests, such personal accident insurance plan is customized to offer its benefits to an individual only, that is, the insured. The benefits offered by such plans are more extensive than group personal accident insurance plans. They protect the insured against unforeseen mishaps, and offers cover against demise or long term and short term impairment or injuries.
Employers often offer a personal accident insurance plan to their employees in the form of a group cover. Such insurance policies usually include only the benefits of a basic plan, and exclude certain benefits of a standalone policy. The premium for such personal accident insurance plan is lower since insurers offer a discount based on the size of the group. The provisions of group plans are as per the provisions laid down in the IRDA Act, 1999, and supported by the Government of India. In case the benefits of a group personal accident insurance plan prove to be insufficient, an employee can purchase a separate personal accident insurance policy, especially designed for individuals.
Personal Accident cover pays out when the following for occurrences take place:
Choose the one that's perfect for you
While buying the Personal Accident insurance policy, one should always keep in mind the limitations of this policy. The following scenarios are not covered in the Personal Accident Insurance plans:
The basic benefit of Personal Accident insurance is that it safeguards you against any unseen unfortunate accidents that may occur at any time. It supports you in the time of medical expenses and/or loss of income due to an accident. The following are a few of the many benefits of the personal accident insurance policy.
Logically, we all know that accidents can happen to anyone, anywhere. But the fear center of our brain fires a denial reaction and we always end up thinking that it will never happen to us. But if we think practically, there’s a fair chance that it can happen to any of us. And accidents may lead to a spectrum of outcomes, right from a simple bruise to incapacitating disability or even death.
A part of being an adult is that we have the sensibilities to think practically and secure our future, if given a chance. Personal accident cover gives us that chance. In short, it is beneficial for everyone who is at a risk of meeting with an accident, which is everyone.
Choose the one that's perfect for you
You get Expert Advice: With so many choices, it may get overwhelming and confusing as to which insurance policy to go for (trust us, "too many choices" is a thing). Turn to us for our health experts to guide you through the process giving you our inputs wherever you need. As Coverfox is not affiliated with any insurance company, count on us for unbiased opinions that are in your best interests.
You get a team of Service Managers: Your point of contact in Coverfox, who will help you out with your claims, endorsements or any other services you need to avail. They will follow up for you and get you the best claim settlement amount you can get from your health insurance company. And we are just a call away! This brings us to our next point.
You Can Avail Post Sales Assistance: Once we sell the policy, our job is not done. We assist you in the processes that follow post-sales; processes that would have otherwise taken up your time and energy. Get assistance with claims, endorsements etc.
Get the Job Done with Zero Paperwork: We help you buy a health insurance policy with little paperwork. You get your policy document in your inbox within 5 minutes of buying it! We also help you keep your documentation at one place, where it is easily accessible to you.
Tax benefit can be availed on the annual premium payments on Personal Accident Insurance plans that insure policyholders against dismemberment, physical impairment or death, as per Section 80D of the Income Tax Act, 1961. However, the primary criteria for selecting an insurance plan should be the financial protection and security that it offers, and not just the tax benefits that he/she will become eligible for.
A Personal Accident Insurance is suitable for every individual across age groups, health conditions, occupations, etc. Therefore, it is wise for everyone to have a personal accident insurance cover. Such an insurance plan is especially necessary for those who have mortgages and car/two wheeler loans against their names. This is because personal accident insurance plans offer repayment benefits to the insured who have loans or mortgages. The premium for personal accident insurance plans is determined by insurance companies on the basis of your occupation, and not your age.
Choose the one that's perfect for you
What might be the best personal accident insurance plan for one individual might not be the same for another. A plan that will be the best suited for you can be determined by keeping certain factors in mind while purchasing it. The online medium has made the purchase of a personal accident insurance plan easy and convenient as it can be done irrespective of your location.
Here are the factors that you need to consider to buy the best personal accident insurance online:
Benefits: Look for a personal accident insurance with the maximum benefits offered irrespective of your location. Some of the benefits that it must cover are Accidental Benefit, Total and Partial Permanent Disability cover, and Temporary Total Disablement cover.
Benefits to family: If you have dependents in your family, you would probably prefer opting for a personal accident insurance plan that benefits your family in case of your unforeseen death or permanent disability. The higher the compensatory amount for your family, the better will it be for them.
Premium: The lesser the premium amount for the maximum benefits offered, the better it is for you.
Insurance Company: The reputation of the insurance company depends on factors like the number of years in the insurance industry, and more specifically, its current claim settlement ratio. Compare between various leading insurance companies on the basis of these factors to take a conscious decision.
Coverage in Foreign Countries: It will be a wise decision for you to purchase a personal accident insurance plan that covers you when you are travelling outside India.
Exclusions: Be thoroughly aware of the policy exclusions to avoid misunderstandings later.
| Insurer and Insurance Plan | Plan Basis | Entry Ages | Sum Assured Amounts (INR) | Accidental Death Benefit | Permanent Total Disability | Temporary Partial/Total Disability | Permanent Partial Disability | Medical Expenses Reimbursement | Ambulance Charges Cover |
|---|---|---|---|---|---|---|---|---|---|
| Apollo Munich Individual Personal Accident Standard | Individual and Family | (Minimum - 91 days To Maximum – 69 years) | (Minimum – 1 lakh To Maximum – 50 lakhs) (Minimum – 5 lakhs To Maximum – 5 crores ) | Yes, equal to Sum Assured + bonus (if any) | Yes, equal to Accidental Death Benefit | Temporary total disability – 10% of ADB | Yes, equal to Accidental Death Benefit | (Standard - Yes – 5% of ADB) (Premium - Yes, subject to INR 100000) | Yes, subject to INR 2000 |
| Bharti AXA Smart Individual Personal Accident | Individual only | (Minimum – 18 years To Maximum – 70 years) | (Minimum – 10 lakhs To Maximum – 30 lakhs) | Yes, equal to Sum Assured | Yes, subject to 150% of Accidental Death Benefit | No | Yes, equal to 2-75% of Sum Assured | Yes. Daily Hospitalisation Cash of INR 1000 till a period of 50 days | No |
| Religare Secure Personal Accident Insurance | Individual | (Minimum - 91 days To Maximum – 70 years) | (Minimum – 15 lakhs To Maximum – 25 crores) | Yes, equal to Sum Assured | Yes, equal to Accidental Death Benefit | Yes, under Mobility Cover | Yes | Yes, subject to INR 100000 | Yes (under variants) |
| Bajaj Allianz Premium Personal Guard Plan | Individual and Family | (Minimum – 5 years To Maximum – 65 years) | (Minimum – 10 lakhs To Maximum – 25 lakhs) | Yes, equal to Sum Assured | Yes (under variants), subject to Sum Assured | Yes (under variants), subject to 75% of Sum Assured | Yes (under variants), subject to 75% of Sum Assured | Yes, lesser of 40% of medical bills or actual bills | No | >
| ICICI Lombard Personal Protect | Individual | (Minimum – 18 years To Maximum – 80 years) | (Minimum – 3 lakhs To Maximum – 25 lakhs) | Yes, equal to Sum Assured | Yes, equal to Accidental Death Benefit | No | No | Yes (under allowance and reimbursement) | No |
| HDFC ERGO Personal Accident Insurance | Individual and Family | (Minimum – NA To Maximum – 65 years) | (Minimum – 2.5 lakhs To Maximum – 15 lakhs) | Yes, equal to Sum Assured | Yes, equal to Accidental Death Benefit | No | No | Yes, INR 250 to INR 500 per day | Yes, INR 1500 to INR 2000 |
| Star Health Accident Care Individual Insurance | Individual and Family | (Minimum – 5 months To Maximum – 70 years) | (Minimum – 5 lakhs To Maximum – 15 lakhs ) | Yes, equal to Sum Assured | Yes, equal to 150% of SA + bonus (if any) | Yes | Yes | Yes, till 25% of valid claim or 10% of SA subject to INR 500000 | Yes, till INR 5000 |
| United India Personal Accident Insurance | Individual and Family | (Minimum – 5 years To Maximum – 70 years) | (Minimum – 25000 To Maximum – 10 lakhs) | Yes, equal to Sum Assured | Yes, equal to Accidental Death Benefit | No | Yes, up to 95% of SA | Yes | No | >
| Oriental Janata Personal Accident Policy | Individual and Family | (Minimum – 10 years To Maximum – 80 years) | (Minimum – 25000 To Maximum – 5 lakhs) | Yes, equal to Sum Assured | Yes, equal to Accidental Death Benefit | No | Yes, maximum of 50% of Accidental Death Benefit | No | No |
| Reliance Personal Accident Policy | Individual and Family | (Minimum – 5 years To Maximum – 70 years) | (Minimum – 5 lakhs To Maximum – 10 lakhs) | Yes, equal to Sum Assured | Yes, equal to Accidental Death Benefit | Temporary total disability subject to 1% of the SA and not more than INR 5000 per week for 50 weeks | Yes, maximum of 50% of Accidental Death Benefit | Yes, lesser of 40% of medical bills paid or 20% of relevant sum assured | No |
| National Insurance Individual Personal Accident Policy | Individual and Family | (Minimum – 5 years To Maximum – 70 years) | NA | Yes, equal to Sum Assured | Yes, equal to Accidental Death Benefit | No | Yes | Yes | No |
| New India Personal Accident Policy | Individual and Family | (Minimum – 5 years To Maximum – 70 years) | Maximum – 72 months of income from gainful employment | Yes, equal to Sum Assured | Yes, equal to Accidental Death Benefit | Temporary total disability, payment of 1% of SA per week for a maximum of 100 weeks | Yes, maximum of 50% of Accidental Death Benefit | No | No |
Inform your insurance company: Get in touch with the insurer as early as possible. They need to be informed that an accident involving the insured has taken place, along with the reference number or policy number, for them to register the claim and initiate the claim settlement process.
Get in touch with the insurer after hospitalization: After the insured has been hospitalized, the insurer has to be informed about the name of the hospital where the insured is being admitted. After diagnosis at the hospital, they need to be kept updated about the nature and extent of the injury or disablement caused by the accident. Essential documents related to the diagnosis, medication, treatment and receipts of hospital bills have to be submitted to the insurer for easy and hassle free claims settlement.
Submit FIR, if necessary: Insurance companies may ask the insured’s family to submit a copy of FIR, issued by the police station where the accident had taken place. This is generally mandatory for accidents caused as a result of specific reasons like collapse of infrastructure, etc. or criminal cases.
Fill up the claim form: A representative from the insurer will get in touch with the insured relative(s), who had initiated the claims process, at the relevant hospital or registered address of the policyholder. This is an essential part of the claims process as it enables the insurer to verify the claim and collect the essential documents.
Choose the one that's perfect for you
Personal Accident Insurance: Personal Accident Insurance financially protects individuals on meeting with an accident. The payout is a lump sum amount that extends up to a pre-determined sum insured. However, the payable amount is decided on the basis of the extent of injury and the type of accident.
Critical illness Insurance: On the other hand, critical illness policy pays a lump sum when the insured is diagnosed with one of the critical illnesses that is covered by the plan. The payout is decided by the severity of the critical illness.
Personal Accident Insurance: Personal Accident Insurance covers medical expenditure incurred towards accidental injuries leading to death and disabilities. Majority of the plans do not cover hospitalization expenses, and none of them offer cover for pre and post hospitalization expenses. There are additional benefits like Hospital Daily Cash, Burns, Broken Bones, Ambulance Allowance, etc., which policyholders can opt to enhance the effectiveness of the Personal Accident Insurance Policy.
Health Insurance: Health Insurance Policies cover medical expenses towards injuries and illnesses. Apart from hospitalization, pre and post hospitalization is also covered by such insurance policies. Death and disability is not covered by it. Some of the additional benefits offered are Room Rent Waiver, Critical Illness, Hospital Cash, Personal Accident, Top Up and Super Top Up.
Every insurance company usually have their unique calculations for premium payments, depending on the cost of the basic plan and costs of add-on covers opted for. Modern insurance companies often offer the facility of an online calculator that enables prospective policyholders to get an estimate of the premium that they will be eligible for on the personal accident insurance plan and add-on(s) chosen by them.
Choose the one that's perfect for you
“My personal accident insurance policy had been of great help when I was temporarily disabled due to a bike accident. Since I was completely bedridden, I had to take a long leave from work without pay. Had I not purchased this insurance plan, I don’t know how I would have been able to pay my treatment expenses as well as that of my regular household expenditures.” – Akash Sehgal
“So glad I had a personal accident insurance policy to pay my expensive hospital bills, home expenses and even reimburse the premium payment for my car loan. Otherwise, my family would have been completely lost.” – Nidhi Sharma
“The group personal accident insurance policy from my employer had been a saviour when I’d met with a road accident. I’m thankful to my organization for extending this benefit to all its employees.” – Neel Mehra
