Group Personal Accident Cover

Accidents create financial problems for the insured and dependents alike. Group personal accident insurance offers complete coverage in the event of death or disablement of the policyholder due to accidents occurring anywhere in the world.

Group personal accident insurance is a comprehensive cover that can be bought for large as well as small groups, such as bank customers, employees, schools, colleges, and corporates. Irrespective of the size of your group, you can buy customizable group personal accident cover to suit the requirements of your group members.

In addition to offering such basic benefits as accidental death and permanent partial/total disability coverage, various group accident covers offer an option to choose additional benefits for all or selected members of the group. The group personal accident cover also offers discounts on the basis of the number of members.

What Does It Cover?

The group personal accident insurance offers the following coverage:

  • Accident Death: If the insured succumbs to death after an accident, the insurer will pay the principal amount
  • Permanent partial/total disability: If the injury causes a partial/permanent disability to the insured which continues for a year, the insurer will pay compensation up to the sum assured.
  • Weekly Benefit: The insured is entitled to get a weekly compensation if they are fully disabled for a temporary period due to an accident.
  • Ambulance Charges: If the policyholder meets with an accident and is taken to a hospital, the policy offers reimbursement of ambulance charges.
  • Mortal remains transportation: The policy reimburses the cost incurred in moving the mortal remains from the accident site to hospital, residence or cremation ground.
  • Broken bones: A lump sum amount is paid for broken bones resulting from an accident. The policy clearly states which broken bones will be covered under the plan.

What it doesn't Cover?

Usually, group personal accident insurance doesn't offer coverage in the following cases:

  • Natural death
  • Injury caused while under the influence of drugs or alcohol
  • Violation of law
  • War and nuclear perils
  • Pregnancy or childbirth
  • Ionizing radiation or radioactivity

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What is Group Personal Accident Insurance?

Ans:

Group Personal Accident Insurance policy provides your beneficiary with a benefit in the unfortunate event of your accidental death and disability. It covers injury or death due to accidents. It covers the following:-

1. Accidental Death: 

The insurer provides a compensation to the nominee, subject to the death of the policyholder due to severe bodily injuries arising from an accident due to a visible, violent external means.

2. Permanent Total Disablement:

a. Loss of 2 Limbs (both hands or both feet or one hand and one foot)
b. Loss of a Limb and an eye
c. Complete and irrecoverable loss of sight of both eyes
d. Complete loss of hearing in both the ears and speech

3. Partial Permanent Disablement: Some benefits might vary with Insurer. The same will be mentioned in the policy document.

i. Use of one foot or one hand (without separation)
ii. Loss of speech
iii. Loss of toes – all
iv. Loss of toes great – both phalanges
v. Loss of toes great – one phalanx
vi. Loss of toes other than great, if more than one toe lost: each
vii. Loss of hearing – both ears
viii. Loss of hearing – one ear
ix. Loss of four fingers and thumb of one hand
x. Loss of four fingers of one hand
xi. Loss of thumb – both phalanges
xii. Loss of thumb – one phalanx
xiii. Loss of index finger – three phalanges
xiv. Loss of index finger – two phalanges
xv. Loss of index finger – one phalanx
xvi. Loss of ring finger or middle finger or little finger – three phalanges
xvii. Loss of ring finger or middle finger or little finger – two phalanges
xviii. Loss of ring finger or middle finger or little finger – one phalanx
xix. Loss of a Limb
xx. Complete and irrecoverable loss of sight of an eye
xxi. Each arm at the shoulder joint
xxii. Each arm to a point above elbow joint
xxiii. Each arm below elbow joint
xxiv. Each hand at the wrist
xxv. Each thumb
xxvi. Each index finger
xxvii. Each other finger
xxviii. Each leg above center of the femur
xxix. Each leg up to a point below the femur
xxx. Each leg to a point below the knee
xxxi. Each leg up to the center of tibia
xxxii. Each foot at the ankle.
xxxiii. Each big toe
xxxiv. Each other toe
xxxv. Each eye
xxxvi. Hearing in each ear
xxxvii. Sense of smell
xxxviii. Sense of taste

4. Temporary Total Disablement: Some benefits might vary with Insurer. The same will be mentioned in the policy document.

a. Injury to vertebral body that causes damage in spinal cord
b. Skull (excluding nose and teeth)
c. Pelvis
d. Chest (all ribs and breast bone)
e. Shoulder (shoulder blade and collar bone)
f. Arm
g. Leg
h. Vertebra – vertebral arch excludes coccyx
i. Wrist (collies or like fractures)
j. Ankle (Potts or similar fracture)
k. Coccyx
l. Hand
m. Finger
n. Foot
o. Toe
p. Nasal bone

5. Accidental Medical Expenses:

Reimburses the costs of medical expenses incurred by an insured person within 12 months of the date of loss resulting from an Accident

6. Hospital-Cash

Additional per day cash in hand to meet the daily needs of the employee in case of Income loss when insured is being hospitalized for more than 1day (number of days may vary with the policy terms)

Why is Group Personal Accident coverage important?

Ans:

Life is uncertain. As per Global Status Report on Road Safety 2013, one person dies every 4 minutes due to a road accident in India. Personal accident insurance becomes relevant when such accidents take place.

How is the Premium amount of Group Accident Insurance determined?

Ans:

The premium amount is determined by the occupation of people. Professional mountaineers, pilots, miners have to pay higher premium rates than people with low risk jobs, such as bankers, professors, IT professionals.

What are the documents required for a claim?

Ans:

When making a claim, you will be required to produce complete personal information (name, age, gender, address, ID proof) along with the death certificate, FIR report, post-mortem report, medical bills, and medical certificate.

Do we need a group accident policy, as we already have a group Health policy?

Ans:

The risks covered are different. Health insurance covers medical treatment costs, particularly hospitalization. Personal accident covers accidental death and dismemberment and loss of Income when the insured is hospitalized. That’s why you need a separate accident insurance policy.

What is not covered under Group Personal Accident Policy?

Ans:

1. Self-inflicted injuries

Injuries arising from participation in a risk-involving sport, such as Sky Diving, Scuba Diving, Bungee jumping etc are not covered, typically. A few policies have started covering these as well.

2. Participation in a criminal act

3. Intoxication

4. AIDS/HIV

5. Terrorism

6. War or Civil War

Expert Speak

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As an adult, what would you say are the major concerns that need protection in your life? i’d rate death, disability, critical illness, general health and well-being, old age and saving for children as the top points of anxiety for all. while we can’t prevent time and fate, what we can do is create a financial cushion to protect us and our loved ones. insurance does this and allows us to do th... [Read more]

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