Personal Accident Policy

Personal Accident Insurance

This policy provides for coverage against Accident Death, Dismemberment, Disability and Medical Expenses following an accident. Accident, is an unexpected event, typically sudden in nature and associated with injury, loss, or bodily harm. Accidents are a common feature of the human experience and result in injury or permanent disability to large numbers of people worldwide every year. Many accidents also involve damage to or loss of property. Accidents can occur anywhere, including in the home, during transportation, in the hospital, on the sports field, or in the workplace. Accidents are unexpected and unplanned incidents which may cause physical injury, disability/dismemberment, and even death, excluding ones caused by an self-inflicted act. Personal Accident policies specifically cater to and fill a critical space in one’s insurance coverage, which is not adequately covered by a life and health insurance policy (as is the case with Disability).

India is home to 1.35 billion people with a population density of 943 persons per square mile (Wikipedia 2018) and this lends itself to a higher propensity of accidents. Infact statistics suggest that over the past years, India has seen a steady increase in the number of accidents every year. It is important to note that all accidents do not result in Death, almost 50% of all accidents lead to Death or Grievous Injuries resulting in a Permanent or Partial Disability or Medical Expenses that need to be paid by the individual. This is where an Individual Personal Accident policy becomes very relevant. An Accidental Death or Disability can result in an immediate loss of income (in case of an earning member or bread winner of the family) and a Personal Accident policy can compensate such financial loss to a certain extent.

According to Source: ‘Accidental Deaths and Suicides in India’ Report 2014, National Crime Records Bureau, Ministry of Home Affairs, the top causes of Accidental Death were as per the chart below:

As can be seen from the chart above, Traffic or Road Accidents are the leading cause of Accidental Deaths across India. According to Road Accidents in India 2016 published by the Transport Research Wing of the Ministry of Road Transport and Highways (GOI), the following are some telling statistics about Road Accidents in India:

The study further illustrates the Major of Road Accidents remaining Speeding resulting in almost 2/3rd of the deaths…Most accidents do not necessarily happen on National or State Highways and that most Road accidents are caused by Newer vehicles:

The data shows that there are 1,317 road accidents happening everyday across India translating into 55 accidents per hour resulting in 17 deaths. The same study also demonstrates that while there has been a marginal reduction in the number of road accidents in the past years, the number of accidental deaths have actually increased…this means that more accidents are resulting in Death of the individual.

The recent 5 years have demonstrated that there has been a swing in the number of road accidents every year as well… Tamil Nadu contributes the maximum share of accidents every year followed by Madhya Pradesh and Karnataka. In terms of cities, Chennai along has the largest number of accidents per year, which is 7,486 (in 2016) as well as the largest number of accidental injuries amounting to 7,349. Delhi contributes the highest number of Accidental Deaths at 1,591 and Ludhiana the Highest Accident Severity which is 69.9 (this means that out of every 100 vehicles, 69.9 meet with an accident every year).

Interestingly Speedbreakers and Potholes contribute to the highest number of accidents and fatalities every year among all road accidents. Speedbreakers alone caused 9,583 accidents resulting in 3,396 deaths, while Potholes contributed to 6,424 accidents and 2,324 deaths.

While minor accidents can ensure there is not much of a financial impact on the individual, a major accident resulting in death or disability can have a severe impact on the financial standing of the person and his family. If the person insured is the sole bread winner, in the unfortunate incident that anything happens to him/her, then the family can be impacted for a longer period of their future. This is where Personal Accident Insurance can mitigate to a large extent the financial distress caused to the individual/family.

What are some of the Key Features (Coverages) of the Personal Accident policy?

The PA policy normally covers:

Accidental Death
The policy will pay the Principal Sum shown in the Policy Schedule if an accident to the insured results in the loss of life.

Accidental Dismemberment
The policy will pay compensation if an injury to you results in dismemberment as mentioned in the policy schedule (a sample table is displayed below). For accidental dismemberment, the principal sum is payable as given in the table:

Both hands and both feet	100%
Sight of both eyes	100%
one hand and one foot	100%
Either hand or foot and sight of one eye	100%
Speech and hearing in both ears	100%
Either hand or foot	50%
Sight of one eye	50%
Speech	50%
Hearing in both ears	50%
Thumb and index finger of same hand	25%

Temporary Total Disability
This is also known as Weekly Indemnity. The insurer will pay a weekly benefit amount during a period of continuous Temporary Total Disability of an insured person
Tuition Benefit
In case of your accidental death to the insured, the policy will pay benefit amount towards your children’s education.
Repatriation Benefit
The policy coverage also includes the expenses for repatriation of the insured person’s remains to the place of residence if it’s more than 150 kms.
Family Transportation Benefit
In the event of an accident that occurred outside 150 km from the insured’s residence, the policy will reimburse the transportation cost of a family member if the physician recommends personal attendance. (up to Rs. 50,000).
Child Enhancement Benefit
Accidental Dismemberment Benefit is doubled for any Eligible Children covered and if payable under this Policy.
Home and Vehicle Modification Expenses
In case of a Permanent Total Disability or Dismemberment to the insured due to any accidental injury, the insurer will reimburse the cost of modifying house (with a ramp) or vehicle (modified to have wheelchair access).
Some Policies offer Add On coverages for Broken Bones and Burns.
Accident Medical Expenses
The policy also covers medical expenses incurred by the insured as a result of an accident sustained during the policy period.

What are the Advantages of buying a Personal Accident Insurance Policy?

Imagine a situation where there is a breadwinner in the family who meets with a serious accident that results in Death or Disability. This will immediately result in a loss of income for the family that can never be replaced immediately. If the insured had availed Home Loans, Car Loan or Personal Loans that need to be repaid, the financial stress comes immediately on the family of the insured. Apart from this, there are normal monthly household running costs that need to be taken off…this is where a Personal Accident Policy comes in handy for the insured member and their families. The advantages of having a Personal Policy include:

Financial Security for the family in case of Death or Disability to the Principal Insured
Sum Insureds for Personal Accident Policy is available upto Rs.1 crore depending on the classification of the insured in terms of income and occupation
The PA policy is very competitively priced – the insured gets a significant coverage for a low premium
Most Personal Accident Policies offer coverage on a Worldwide basis as well as a 24X7 coverage irrespective of where and when the unfortunate incident occurs
No Medical Tests required and Documentation is only the Proposal form.
Relatively Simple and Transparent documentation for filing a claim as well.
Personal Accident Insurance is available irrespective of age and health and since there is an Escalation Benefit for the Sum Insured, it is advisable to start the coverage at an early age.
Provides a Credit Shield to the insured against Loans/Mortgages etc in case of unfortunate Death or Disability

Unique Features

Customisation :
Most insurers offer plans that can be have Sum Insureds ranging from Rs. 5 lacs upto Rs. 1 crore.As an Add-on, you can also take an Accidental Weekly Benefit* upto Rs. 10,000.

Flexibility:
Most Personal Accident policies are designed for your convenience – you can pick and choose benefits best suited to you and your family. You can choose the Sum Insured against all the available options. You can also choose between having a Personal policy or a Family policy.

Escalating benefits:
If the policy is renewed, the sum(s) assured increases by 5% each year, up to 25%. For example, if you take one unit of Rs. 10,00,000 and renew the policy for the next year, your insured amount becomes Rs. 10,50,000 for the same premium.

Convenient options to choose:
Self Option where you insure yourself for Accidental Death & Dismemberment, or Accidental Death & Dismemberment along with Permanent Total Loss of use. Family Option where, you can also insure your family for Accidental Death & Dismemberment, or Accidental Death & Dismemberment along with Permanent Total Loss of use.

Free-look period :
The insured will have 15 days to evaluate their policy and in case of any disagreement, can get it cancelled and the premium will be refunded.

Grace period :
The insured gets a grace period of 30 days to renew your policy, however coverage would not be available for these 30 days.

Additional Features (with Family Option)

Education allowance: In case of Accidental Death, 10 percent of the principal sum assured is paid towards the insureds’ children’s education benefit.
Repatriation of remains: A fixed amount will also be reimbursed for the repatriation of the insured person’s remains.
Modification allowance: In case of Permanent Total Disability or Dismemberment, an amount depending on the chosen Sum Insured, will be reimbursed towards the cost of modifying the insured’s house or vehicle, to combat Disability.
Double Dismemberment benefit for children: For the insured’s children who are automatically insured, Dismemberment benefit doubles.
Family transportation: If, due to an accident, the principal insured is confined to a hospital outside 150 kms of his residence, the insurer will reimburse, a fixed amount towards the actual transportation expenses incurred by an immediate family member to reach the insured person.

What are the Exclusions under the Persona Accident Policy? Some to the key exclusions under this policy include:

Suicide, self-inflicted Injury or Illness, mental or nervous disorder, stress or depression, AIDS/HIV
Being under the influence of drugs, alcohol or other intoxicants
Participation in any actual or attempted felony, riot, crime
War, Civil War, invasion, insurrection, revolution, act of foreign enemy, hostilities (whether War be declared or not)
Ionising radiation or explosives or exposure to substances with dangerous properties
Congenital anomalies or any complications or conditions arising thereof
Participation in Adventure Sports

What are the Documents required to be submitted at the time of a claim to the insurer? The standard documents required to be submitted to the insurance company at the time of a claim include:

Claim Form
Death certificate of the insured
Disability Certificate issued by a Medical Practitioner (in case of Disability/Dismemberment)
Medicine bills (if the claim is for Accidental Medical Expenses)
Postmortem report
FIR report
Any other documentation as required by the insurance company depending on the claim.