Basic Facts of Group Personal Accident Insurance Claim Process!

Group Personal Accident Insurance refers to the group insurance policy designed for the employees under corporate group insurance. It is available for the owner of the companies, board members and employees, which covers the members in case of an accident.

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This insurance policy provides complete financial protection against the expenses occurred due to an accidental death or disablement of the covered employees. However, demise or harm due to any pre-existing diseases is not covered by this policy.

This policy plays an important role in the life of a salaried person because they don’t have to purchase any separate policy to cover any unexpected accidents. This policy can be bought by any company irrespective of the number of employees they have. Also, this policy can be customized according to the needs of the employer. 

That’s why one should know the policy in detail, especially its claim process. But before digging into deep, let’s know the coverage offered under this policy.

Types of Coverage Provided

The scope of coverage under Group Personal Accident Insurance is mentioned below:

  • Medical Reimbursement: All kinds of hospitalization charges and medical expenses related to the injury get reimbursed.
  • Accidental Death: The beneficiary of the insured employee gets the compensation if an injury results into death.
  • Permanent Total Disability: If the insured employee’s accidental injury leads to a permanent disability that continues for over 12 months, then the compensation as per the Sum Insured is paid to the insured.
  • Permanent Partial Disability: If the insured employee gets disabled partially, then 5%-65% of the total Sum Insured is paid by the insurer depending on the terms of the policy, provided the disability continues for over 12 months.
  • Ambulance Charges: If the insured has to be transported to the hospital by an ambulance, the charges get reimbursed.
  • Broken Bones: If the insured employee breaks or damage their bones in an accident then they are eligible to get coverage for the treatment.
  • Education Benefits: If the insured employee dies or faces permanent injury, the policy covers the educational costs of the children the insured.
  • Funeral Expenses: This policy also covers the transportation charges for the mortal remains and funeral expenses if the insured employee dies in an accident.

Now-a-days, organizations are taking extra steps to secure the health and life of their employees. At the time of claim settlement, which are pretty quick in these kind of policies are either paid out to the insured or their nominee and this policy covers all the expenses in the event of any mishappening that results into permanent/partial injury or the loss of life.

Points to Remember Before Purchasing this Policy

There are several points you should keep in mind before buying the Group Personal Accident Insurance Policy:

  • Go through all the plans and the kinds of coverage provided by different insurance companies, compare them online and then choose the one best suited to your needs.
  • The premium amount is dependent on the estimate of risk in the place of work and the level of coverage provided under the policy.
  • Tax benefits are not applicable under this policy so keep it in mind before purchasing it.
  • Coverage for injury or death arises because of any disease or illness will not be provided.

Claim Process for Group Personal Accident Insurance

In case of an accident, the employee needs to inform the employer and the insurance company and follow the procedure to file a claim. There are different procedures for different situations and the documents required are as follows:

Death Claim

  • The nominee has to immediately inform the employer and the insurance office about the incident.
  • After informing, go for the claim and fill all the necessary details with the death certificate, other required documents, FIR report, and the policy documents.

Physical Harm Claim

  • File an FIR at the Police station.
  • Explain the insurance company properly about the accident.
  • A medical certificate will be required as a proof of disability.
  • Medical Prescriptions and Receipts of payment are required.

For Disability Claim

  • Duly filled Claim form
  • Health check-up reports related to the treatment
  • Disability certificate provided by the government or hospital (Permanent disability)
  • Certificate for leaves provided by the company
  • Prescriptions, bills, receipts and statement provided by the doctor and hospital

For Death Claim

  • Claim form with properly filled details and info
  • FIR provided after enquiring in the police station
  • Forensic reports, Autopsy reports after death
  • Certificate of death
  • Monthly payment or salary slips of the employee (last 3 months)
  • Mail/Correspondence message or letter from the employer

Common Documents Required for Claiming the Policy

The documents required to get the Group Personal Accident Insurance are as follows:

  • Proposal Form
  • Declaration Form
  • Medical reports of employee
  • Details of all the employees
  • Previous year’s claim reports or the company

To Conclude

Group Personal Accident Insurance is one of the finest ways for an organization to ensure their employees safety and cover their unwanted expenses as well as earn their trust and respect. Life in unpredictable and it is a good to be prepared for the worse and have a back-up plan to safe-guard your employees’ health and life.

Written By: PolicyBazaar - Updated: 02 May 2022
Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.