Personal Accident Policy (Individual)
We all are exposed to the risks of accidents in our day to day lives. Despite all possible precautions accidents do occur which may result into disablement or loss of limbs or sometimes even death. This policy provides compensation in the event of insured sustaining injuries, solely and directly from an accident caused by violent, visible and external means, resulting into death or disablement be it temporary or permanent.
What is covered under the Personal Accident Policy
If at any time during the currency of this Policy, the Insured Person shall sustain any bodily injury resulting solely and directly from accident caused by external, violent and visible means, then the Company shall pay to the insured or his / her legal personal representative(s), as the case may be, the sum or sums hereinafter set forth, that is to say:
(a) If such injury shall within Twelve calendar months of its occurrence be the sole and direct cause to the death of the Insured, the Capital Sum Insured (CSI) stated in the Schedule .
(b) If such injury shall within twelve 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 the actual loss by physical separation of two entire hands or two entire feet or of one entire hand and one entire foot, or of such loss of sight of one eye and such loss of one entire hand or one entire foot, the Capital Sum Insured in the Schedule .
ii) Use of two hands or two feet, or of one hand or one foot, or of such loss of sight of one eye and such loss of use of one hand or one foot, the Capital Sum Insured stated in the Schedule .
(c) If such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of
i) the sight of one eye, or of the actual loss by physical separation of one entire hand or of one entire foot, fifty percent (50%) of the Capital Sum Insured stated in the schedule :
ii ) total and irrecoverable loss of use of hand or a foot without physical separation, fifty percent (50%) of the Capital Sum Insured stated in the Schedule . NOTE: For the purpose of Clause (b) and Clause (c) above, ‘physical separation’ of a hand or foot means separation at or above the wrist and/or of the foot at or above the ankle respectively.
(d) If such injury shall, as a direct consequence thereof, immediately, permanently, totally and absolutely, disable the Insured from engaging in any employment or occupation of any description whatsoever, then a lump sum equal to hundred percent (100%) of the Capital Sum Insured.
e) In such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the total and irrecoverable loss of use or of the actual loss by physical separation of the following, then the percentage of the capital Sum Insured as indicated below shall be payable. :
|LOSS||% OF CAPITAL SUM INSURED|
|i)||Loss of toes – all||20|
|Both Great phalanges||5|
|One Great phalanx||2|
|Other than great, if more than one toe lost each||1|
|ii)||Loss of hearing both ears||50|
|iii)||Loss of hearing one ear||15|
|iv)||Loss of four fingers and thumb of one hand||40|
|v)||Loss of four fingers||35|
|vi)||Loss of thumb both phalanges||25|
|Loss of thumb-One Phalanx||10|
|vii)||Loss of index finger- three phalanges||10|
|Loss of index finger – two phalanges||8|
|Loss of index finger- one phalanx||4|
|viii)||Loss of middle finger- three phalanges||6|
|Loss of middle finger – two phalanges||4|
|Loss of middle finger- one phalanx||2|
|ix)||Loss of ring finger- three phalanges||5|
|Loss of ring finger – two phalanges||4|
|Loss of ring finger- one phalanx||2|
|x)||Loss of little finger- three phalanges||4|
|Loss of little finger – two phalanges||3|
|Loss of little finger- one phalanx||2|
|xi)||Loss of metacarpals – first or second ( additional)||3|
|Loss of metacarpals–third, fourth or fifth(additional)||2|
|xii)||Any other permanent-Partial disablement||As assessed by the doctor|
f) If such injury shall be the sole and direct cause of Temporary Total Disablement, then so long as the Insured shall be totally disabled from engaging in any employment or occupation of any description whatsoever, a sum at the rate of one percent (1%) of the capital Sum Insured, stated in the Schedule per week, but in any case not exceeding Rs. 20,000/- per week in all under all policies. Provided that the compensation payable under the foregoing Sub-Clause (f) shall not be payable for more than 100 weeks in respect of any one injury calculated from the date of commencement of disablement and in no case shall exceed the Capital Sum Insured.
g) in the event of death of the insured person due to accident as defined in the policy, outside his/her residence, the Company shall reimburse expenses incurred for transportation of insured’s dead body to the place of residence subject to a maximum of 2% of the capital Sum Insured or Rs. 2500/- whichever is less. This includes funeral expenses.
h) in the event of death or permanent total disablement of the insured due to accident as defined in the Tariff, the policy shall also provide compensation towards Education Fund for the dependent children as below:
1. if the insured person has one dependent child below the age of 23 years, an amount equal to 10% of the CSI subject to a maximum of Rs. 5,000/-.
2. if the insured person has more than one dependent child below the age of 23 years, and amount equal to 10% of CSI subject to a maximum of Rs. 10,000/-
The payment as above will be made along with the CSI of the same person/s who is/are entitled to receive the CSI :
1. The benefit under this extension will be available on the basis of the original CSI only and not on the cumulative bonus.
2. The age limit of 23 years shall apply on the date of accident and not at the beginning of the policy year.
Provided that if there be any other subsisting P.A. insurance(s) in the name of the insured and benefit under this regulation becoming payable under all such policies. The total amount so payable shall be limited to a maximum of Rs. 5,000/- in case there is one dependant child and Rs. 10,000/- in case there is more than one dependent child. The amount so payable shall be borne by all the policies in proportion to the original sum insured.
i) Compensation for loss of employment: the compensation payable, in the event of loss of employment due to total disablement, will be at 1% of the capital sum insured or Rs. 15000 whichever is less.
The cover is worldwide
Special Additional benefits with payment of extra premium
Medical Expenses (When opted for an additional premium) : The accident portion can be extended to include Medical Expenses to the extent of 25% of valid admissible claim amount subject to payment of additional premium at the rate of 10% or to the extent of 50% of valid admissible claim amount subject to payment of additional premium at the rate of 25% on basic premium for accident cover. The payment of medical expenses shall be subject to the policy terms, condition, exception and definition provided therein
What is not covered under the Personal Accident Policy
The Company shall not be liable under this Policy for:
1. Compensation under more than one of the foregoing Sub-Clauses i.e. (a), (b), (c) and (d) except (e) in respect of the same period of disablement.
2. Any other payment after a claim under one of the Sub-Clauses (a), (b), (c) or (d) has been admitted and become payable.
3. 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-clauses (a) of this Policy.
4. Payment of weekly compensation until the total amount shall have been ascertained and agreed.
5. Payment of compensation in respect of Death, Injury or Disablement of the Insured (a) from intentional self-injury, suicide or attempted suicide, (b) whilst under the influence of intoxicating liquor or drugs (c) whilst engaging in Aviation or ballooning or whilst mounting into, dismounting from or traveling in any aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world, (d) directly or indirectly caused by venereal disease/s, or insanity, (e) arising or resulting from the insured committing any breach of law with criminal intent.
6. Payment of compensation in respect of Death, Injury or 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 so ever.
7. Payment of Compensation in respect of death of, or bodily injury or any disease of illness of the Insured:
(a)directly or indirectly caused by or contributed to by or arising from ionizing radiations 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 weapon 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 Insurance under this Policy shall not extend to cover death or disablement resulting directly or indirectly caused by, contributed to or aggravated or prolonged by child-birth or from pregnancy or in consequence thereof.
a) Compensation payable under clause (a), (b), (c) and (d) of the policy viz. death, loss of limb(s) sight and permanent total disablement arising out of accidental injuries shall be increased by 5% thereof in respect of each completed year, during which, the policy shall have been in force, prior to the occurrence of an accident for which capital sum becomes payable but amount of such increase shall not exceed 50% of the capital sum insured stated in the schedule herein.
b) This clause shall not in any way alter the annual character of the insurance for the right of the company to decline to renew or to cancel this policy as hereinafter provided. The earned cumulative bonus will not be lost if the policy is renewed within 90 days after its expiry.
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