PERSONAL ACCIDENT INSURANCE
SELECTION OF RISKS :
This Insurance is intended to provide for the payment of compensation in the event of the insured sustaining death or disablement by bodily injury, resulting solely and directly from accident caused by external, violent and visible means.
Personal Accident Insurance is a benefit policy and not strictly a contract of indemnity. The amount of Insurance must be regulated by the financial position of the proposer. It is undesirable to grant cover for benefits, which will place the Insured in a better financial position when he is disabled than, when he is following his normal profession or occupation. This may lead to a temptation to prolong the incapacity unduly.
Hence it is important to consider the proposer’s net income and the resultant loss of earning capacity, due to the accident. A reasonable margin may be allowed for extra expenses, which may have to be incurred in the event of disablement. As a general rule, the compensation in respect of Temporary Total disablement must be limited to his income per week.
Documents to be called for to verify the income are:
- Salary Certificate (if the insured is a salaried person).
- Income Tax returns (to verify the income from gainful employment and not from fixed assets).
SUM INSURED :
The capital sum insured should be fixed at the commencement of the policy. No change in capital sum insured in permissible during the currency of the policy.
The minimum premium chargeable under individual policy is Rs.50/-.
Fixation of Capital Sum Insured Under Personal Accident Policies
They may accept maximum CSI under PA policy per person as follows :
Table I- 48 – 60 months salary /income
Table II & III -48-60months salary income
Table IV – 24 months salary / income
There have been several requests for increase in sum insured during the currency of the policy and or at renewal. The request can be considered after obtaining the relevant proof of income and necessary IT returns for the preceding three years. It is always advisable to obtain a proposal form very two years in any case under PA policy as also a letter from the parent organisation/employer for change in Capital Sum Insured, as the case may be.
For the purpose underwriting risks are classified into three groups :
Risk Group I :
Accountants, Doctors, Lawyers, Architects, Consulting, Engineers, Teachers, Bankers, Persons engaged in Administrative functions, Persons primarily engaged in occupations of similar hazard.
Risk Group II :
Builders, Contractors and Engineers engaged in superintending functions only, Veterinary Doctors, Paid drivers of Motor cars and Light Motor Vehicles and persons engaged in occupations of similar hazard and not engaged in manual labor. All persons engaged in Manual labor (except those falling under Group III) Cash carrying employees, Garage and Motor Mechanics, Machine Operators, Drivers of truck or Lorries and other Heavy vehicles, Professional athletes and Sportsman, woodworking machinists and persons engaged in occupations of similar hazard.
Risk Group III :
Persons working in underground mines, explosives, magazines, workers involved in electrical installation with high tension supply, jockeys, circus personnel, persons engaged in activities like racing on wheels or horseback, big game hunting, mountaineering, winter sports, skiing, ice hockey, ballooning, hand gliding, river rafting, polo and persons engaged in occupations/activities of similar hazard.
|Rate of Premium per mile (in Rupees)|
|Table||Risk Group||Risk Group|
|Death, Permanent Total Disablement||0.65||0.90|
|Death, PTD & Permanent Partial Disablement||0.95||1.25|
|Death, PTD, PPD & Temporary Total Disablement||1.50||2.00|
Weekly Compensation Under Table – IV
(A) TTD at 1% of Capital Sum Insured per week upto Maximum 100 weeks –
Maximum weekly benefit not to exceed Rs.5,000/- in any case not exceeding 25% of the actual monthly earning / salary.
(B) For Chief Executives of corporate clients – 1% of Sum Insured per week subject to a Maximum of Rs.10,000/- in any case not exceeding 25% of the monthly salary.
SCOPE OF COVER:
The Company undertakes to pay the Insured or his legal personal representative, the following sums in the event of: –
- If at any time during the currency of the policy the Insured sustains any bodily injury resulting solely and directly from accident caused by external violent and visible means.
A) If such injury, within 12 calendar months of its occurrence, be the sole and direct cause of the death of the insured, the capital sum insured as stated in the Schedule.
B) If such injury within 12 calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of :-
i)Sight of both eyes or of actual loss by physical separation of the two entire hands or two entire feet or one entire hand and one entire foot or loss of sight of one eye and loss of one entire foot or one entire hand-the capital sum insured, stated in the policy.
ii) Loss of two hands or two feet or one hand and one foot, or of loss of sight of one eye and loss of use of one hand or one foot-the capital sum insured stated in Schedule.
C) If such injury within 12 calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of
i) Sight of one eye or actual loss by physical separation of one entire hand or one entire foot, -50% of the capital sum insured stated in the policy.
ii) Total and irrecoverable loss of use of a hand or a foot without physical separation-50% of the capital sum insured.
D) If such injury shall as a direct consequence permanently, totally and absolutely disable the Insured from engaging in any employment or occupation of any description whatsoever, then-lump sum equal to 100% of the capital sum insured.
The benefits under items b, c and d are known as permanent total disablement benefits.
E) If such injury shall within 12 calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of use of or the actual loss by physical separation of the following, then the percentage of the capital sum insured as indicated below shall be payable. This benefit is called permanent partial disablement benefit.
The company shall not be liable under the policy for
- Compensation under more than one of foregoing sub-clauses in respect of the same period of disablement.
- Any other payment after a claim under one of the sub-clauses (a),(b), (c) or (d) has been admitted and becomes payable.
- Any payment in case of more than one claim under the Policy during any one period of insurance by which the maximum liability of the Company in that period would exceed the sum payable under sub-clause (a) of this policy.
- Payment of weekly compensation until the total amount shall have been
ascertained and agreed.
- Payment of weekly compensation in respect of Death, Injury or Disablement of the Insured :-
A) From intentional self-injury, suicide or attempted suicide.
B) Whilst engaging in Aviation or ballooning or whilst mounting into, or dismounting from or travelling in any balloon or aircraft other than as a passenger (fare paying or otherwise) in any duly licensed type of aircraft anywhere in the world.
C) Directly or indirectly caused by general diseases or insanity.
D) Arising or resulting from the Insured committing any breach of law with criminal intent.
6.Payment of compensation in respect of Death, Injury of Disablement of the Insured due to or arising out of or directly or indirectly connected with or traceable to: war, Invasion, act of foreign enemy, hostilities (whether war be declared or not), Civil War, Rebellion, Revolution, Insurrection, Mutiny, Military or Usurped Power, Seizure, Capture, Arrests, Restraints and Detainment of all kings, princes and people of whatever nation condition or quality.
7. Payment of compensation in respect of death of or bodily injury or any disease or illness to the insured :-
A) Directly or indirectly caused by or contributed to by or arising from ionizing radiation’s or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception, combustion shall include any self-sustaining process of nuclear fission.
B) Directly or indirectly caused by or contributed to by or arising from nuclear weapons material.
Provided also that the due observance and fulfillment of the terms and conditions of this policy (which conditions and all endorsements hereon are to be read as part of this Policy) shall so far as they relate to anything to be done or not to be done by the Insured be a condition precedent to any liability of the Company under this policy.
8. PREGNANCY EXCLUSION CLAUSE:
The Insured under this policy shall not extend to cover death or disablement resulting directly or indirectly caused by, contributed to or aggravated or prolonged by childbirth or pregnancy or any consequence thereof.
GROUP PERSONAL ACCIDENT INSURANCE :
The following two types of policies can be issued.
Type ‘A’ : Covering employees of a firm /company / Association or Club (i.e. with employer – employee relationship)
These are further divided into two types :-
- Named employees and
ii . Unnamed employees
Type ‘B’ : Covering members of an Institution / Society /Association / Club (i.e. with no employer – employee relationship.)
This group can also be bifurcated into :-
- Groups where members could be named and identified.
‘ON DUTY’ COVERS :
If P.A. cover is required only for the restricted hours of duty (and not for 24 hours) a reduced premium equivalent to 75% of the appropriate premium should be charged. The cover is meant for employees, taken out by employer for accident to employees arising out of and in the course of employment.
‘OFF DUTY’ COVERS :
If cover is required for only for the restricted hours when the employee is not at work and / or not on official duty a reduced premium of 50% the appropriate premium can be charged. A suitable endorsement may be incorporated with policy.
GROUP DISCOUNTS :
Group policies may be issued covering more than 1 person. However, group discount as per the following scale can be granted only if the number of insured persons in a group exceed 100.
No. of Persons Discount (%)
upto 500 NIL
501 – 2000 5
2000 – 5000 10
5001 & above 15
- The Group Discount should not be reviewed during the currency of the insurance.
- Any other discount / bonus other than specified (like total abstainers bonus, renewal bonus, life policy holders bonus or double benefit etc.,) are not admissible.