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Accident means any sudden, unintended and fortuitous external and visible event, which might cause bodily injury or which leads to a physical disability or death.
Yes you can include your family. There are various packaged plans, which we have and hence the inclusion of your family will depend on the plan that you will opt for.
Mediclaim policy is designed to cover the hospitalization expenses arising out of illness, sickness & accident. PA policy on the other hand is a benefit policy & the benefits are paid to the insured on the prescribed scale on happening of an accident leading to admissible claim under the policy. PA policy can be extended to cover the reimbursement of the medical expenses on payment of extra premium.
Loss of, or loss of use of, specified members of the body resulting from accidental bodily injury is called dismemberment.
Doctor certified total and continuous loss or impairment of a body part or sensory organ specified
Doctor certified disablement which entirely prevents You from engaging in your usual occupation or employment or any other occupation or employment for which You are suited by reason of education, training, experience or skill or if not employed, from engaging in any and every occupation for the remainder of Your life
Doctor certified inability to engage in your usual occupation or employment
No, personal accident policy does not cover natural death. Only deaths due to accident will be covered.
Benefits under the Accident Policy are as mentioned.
Death 100 % of Sum Insured
Permanent Total Disablement 100 % of Sum Insured
Loss of two limbs / Two eyes or one limb and one eye 100 % of Sum Insured
Loss of one limb or one eye 50 % of Sum Insured
Permanent Partial Disablement Varies from 1% to 75% of Sum Insured depending on the disablement
Temporary Total Disablement 1 % of Sum Insured per week subject to a maximum of Rs 5000 per week for a maximum period of 100 weeks
Details are mentioned in policy certificate provided by us.
The standard exclusions under the policy are as under:
Any claim in the same period of insurance exceeding the Sum Insured
Suicide, attempt thereat, VD, criminal breach of law, influence of liquor / drugs
Pregnancy related claim
War and nuclear perils
For details of exclusions refer the policy documents.
The coverage offered under the policy is on worldwide basis. So the policy covers any accident happened even abroad. However policies are also issued which are locations or time basis. Please check the policy document for the confirmation.
Hospital Cash allowance pays a fixed daily benefit to an insured person for being admitted in a hospital because of an accident. The benefit amount and the number of days for which the payment will be made are based on the cover taken by you. The Amount paid is compensation and is not restricted to actual expenses that one incurs in the Hospital.
Note: Hospital cash allowance is an additional cover under accident policy on payment of additional premium.
Amateur sports will be covered. While you are covered for most of the normal, non- hazardous sports, Professional sport and any racing are not covered.
The following activities and sports are not covered by the policy: Whilst working in underground mines, explosives, magazines, workers involved in electrical installation with high tension supply, jockeys, circus personnel, Engaged in activities like racing on wheels or horseback, big game hunting, mountaineering, winter sports, rock climbing, pot holing, bungee jumping, skiing, ice hockey, ballooning, hand gliding, river rafting, polo and persons engaged in occupation / activities of similar hazard.
Yes you will be covered only if travel in the Plane as a passenger and if the death is due to physical injury caused by the hijackers or if such hijacked plane meets with an accident
NO - Only people traveling as a passenger on a registered standard airline are covered.
The following is the indicative list of documents required for processing a claim.
Documents required for death claims include:
Attending doctor’s report
Original death certificate
Original / attested post mortem / coroner’s report
Attested copy of FIR / Panchnama
Police Inquest Report, where applicable
Documents required for disablement claims include:
Original disability certificate from the doctor
Investigation / laboratory reports and other medical case papers
Original discharge summary if hospitalized
Police Inquest report, where applicable
In case of permanent total disability, disability certificate from competent authority.
Documents required for weekly benefit claims include:
Attending doctors report
Employee leave certificate with grade / designation
The claim can be intimated by either writing to us at the address mentioned in the policy or just give a call at the toll free number, mentioning the policy number / certificate number and name of insured and we shall take the claim process forward.
MLC Copy, a Medico – Legal certificate is the certificate signed by the policeman and issued by the hospital for medico legal cases (cases where police need to be kept informed). On admission to the hospital, hospital medical staff will identify the cause or nature of illness / disease / accident and if required will inform the police about the case. Policeman will visit the hospital to enquire the cause and sign the MLC Copy.
For Personal Accident
The indicative list of documents required for each type of loss is mentioned below:
Weekly Benefit Claims
Attending Doctors Report
Original Disability Certificate from the Doctor, if any
Fitness Certificate from the Doctor
Investigation / Lab Reports (X-Rays reports with films & other reports etc)
Original Admission / Discharge Card, if hospitalised
Employers Leave Certificate with grade / designation
Original Death Certificate
Original / attested Post Mortem / Coroners Report
Dismemberment / Disablement Claims
In case of PTD claims – Disability Certificate from Govt. Registered Medical Practioners.
Child Education Support Claims
Certificate issued by the respective educational institute under which the child is taking the education clearly eliciting his name, his father & mother name, his age, nature of education he is taking, and expected time frame when the said education would be completed.
Other documents would be same as mentioned under Death OR Dismemberment / Disablement Claims.
Accidental Medical Expenses Claims
Original Hospital Discharge Card
Original Final Hospital Bill along with break-up
Cash-memos for the medicines along with supporting prescriptions.
Investigation Bills and payment receipts for same.
Other documents would be same as mentioned under Weekly Benefit OR Death OR Dismemberment / Disablement Claims (As per the applicable case).
Life Support Benefit claims
Documents would be same as mentioned under Dismemberment / Disablement Claims
Hospital Cash Allowance Claims
Original Hospital Discharge Card along with the documents same as mentioned under Weekly Benefit OR Death OR Dismemberment / Disablement Claims (As per the applicable case).
Loan Protector Claims
Documents pertaining to the loan availed from the financial institution clearly eliciting the EMI per month, balance no of months the EMI is applicable and the balance amount under the loan. (The said documents should be duly authorized by the respective financial institution from which the client has availed the loan).
Other documents would be same as mentioned under Death OR Dismemberment / Disablement Claims (As per the applicable case).
Repatriation Benefit and Funeral Expense Claims
Original Cash-memos for the expenses incurred for preparing your (insured person) body for burial or cremation and transportation of your (insured) body to your (insured’s) city of residence
Document eliciting the normal place of residence of the deceased covered under the policy issued. E.g.: Certified copy of electricity bill, telephone bill, etc.
Other documents would be same as mentioned under Death claim.
Adaptation Allowance Claims
Original Cash-memos for the expenses incurred by the insured / client to modify his vehicle OR make some changes in his house as necessitated by a Permanent Total Disability which resulted from an accident covered under this Policy along with the payment receipts.
Certificate issued by the attending doctor certifying the necessity to modify his vehicle OR make some changes in his house as necessitated by a Permanent Total Disability which resulted from an accident covered under this Policy.
Family Transportation Allowance Claims
Document eliciting the normal place of residence address of the deceased covered under the policy issued. E.g.: Certified copy of electricity bill, telephone bill, etc.
Certificate issued by the attending doctor certifying the personal attendance to the insured / claimant / patient by an immediate family member due to an accident covered under this policy.
Original Bills for the expenses incurred by the immediate family member for transportation by the most direct route by a licensed common carrier to the place of confinement of the Insured Person along with the payment receipts.
The list given is indicative in nature. Further additional documents may be called for depending on the nature of the claim.
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