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Consumer Alert! Your Personal Accident Insurance policy may not cover all these; Find out

Priyadarshini Maji
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Personal Accident Insurance is an important insurance cover that offers the insured financial protection against uncertainties due to accidents, such as accidental bodily injuries, partial or total disabilities, temporary or permanent disability resulting from an accident, and accidental death. Accidents in India are increasing at an alarming rate. As per recent reports from the Ministry of Road Transport and Highways, in 2018 there has been a rise of 1.68 per cent in the number of accidents.

Accidental insurance policies, however, come with their own set of limitations. They do not extend cover for just an accident that you might get yourself into. Hence, while opting for a policy, know what all will you be covered for and what will be left out from your policy cover.

What is Personal Accident insurance policy?

In the event of accidental death of the insured, the nominee or the family members get 100 per cent compensation from the insurance company. Generally, there are two kinds of accidental insurance policies Individual accident and group accident policies. As the name suggests, an Individual Accident Policy provides cover to an individual in case of any accidental damage. It provides covers for accidental death, partial disability (loss of limbs or sight), or other permanent disabilities due to an accident. Group Accident Insurance is provided by employers to their employees. However, as these are basic plans they offer limited benefits compared to an individual plan.

General inclusions in personal accident insurance policies are accidental death, permanent total or partial disability, accidental dismemberment, medical expenses, hospitalization charges (with minimum 24 hours of hospitalization), child education support, life support benefit, burns, broken bones, and daily allowance.

Major Exclusions in Personal Accident insurance policy

The date of accident plays an important role while making a claim. Especially, internal injuries arising out of an accident, be it minor or major, surface slowly. Sometimes, they even take weeks and months, due to which most of the insurers allow to claim for disability up to a certain period from the date of the accident. Companies generally validate a claim if the disability has occurred within 12 months of the accident.

Some of the major exclusions include suicide, self-injuries, natural death, pre-existing disability, childbirth or pregnancy, non-allopathic treatments, the influence of intoxicants, and suffering from any mental disorders. Also, committing a criminal act or being involved in war activities, or participating in the naval, military, air force, and adventurous sports activities are also among the major exclusions.

Among the prime exclusion, self-harm and pre-existing injuries are commonly misunderstood. If the policyholder inflicts or tries to inflict himself, it is an act of self-injury, and will not be covered by the policy. Any activity that signifies intend to harm and damage the self is excluded. Hence, accidents resulting from attempted suicide or suicide, committing or participating in criminal activities including riots, non-compliance, or civil commotion, are not covered under the policy.

Any accident arising out of voluntary intoxication is also excluded from the policy. However, if you are under medicinal intoxication, you will be eligible to file a claim if you can produce a prescription. No claim is paid for pre-existing injuries under a personal accident policy. Irrespective of you being treated or not, it is excluded from the policy cover.

Personal accident plans also do not cover for adventure sports, such as skydiving, mountaineering, hang gliding, bungee jumping, scuba diving, trekking or parasailing, which have become increasingly popular among vacationers, are not covered under this policy.

These activities are perceived to have a higher level of inherent danger, because of which they are excluded from the policy. However, companies like HDFC Ergo, Bajaj Allianz General Insurance, Bharti Axa General Insurance, and GoDigit provide cover for adventure sports. These insurers have policies that provide cover for such activities both as a specific adventure sports policy or as an add-on to the base policy.