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Presentation on ACCIDENT CARE. ACCIDENT. ?. Accident Means. Not only Road/Rail or Travel accidents but also includes Accidental Fall Electric Shock Snake Bite Drowning in Water. Covers. Accidental Death Disablement. Age Limits.

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Presentation Transcript
presentation on accident care
Presentation on

ACCIDENT CARE

accident means
Accident Means

Not only Road/Rail or Travel accidents but also includes

  • Accidental Fall
  • Electric Shock
  • Snake Bite
  • Drowning in Water
covers
Covers
  • Accidental Death
  • Disablement
age limits
Age Limits
  • Available for Persons aged between 18 years and 70 years.
  • Children from 3 years can be covered under family package when atleast any one of the parents are covered.
table i accidental death
Table I : Accidental Death
  • Covers Death of the Insured Person
  • Death occurring within 12 Months from the date of Accident
  • Compensation payable is 100% of Capital Sum Insured
table ii accidental death ptd ppd
Table II : Accidental Death + PTD + PPD
  • Death Cover - As per Table I
  • Disablement cover
  • The disablement should occur within 12 Calendar months from the date of the Accident
  • The disablement is confirmed and claimed for, prior to the expiry of a period of 60 days since occurrence of the disablement
table iii accidental death ptd ppd ttd
Table IIIAccidental Death+PTD+PPD+TTD
  • Death Cover - As per Table I
  • Death+PTD+PPD Cover- As per Table II
  • TTD Cover
  • Weekly compensation @ 1% of the Sum Insured not exceeding Rs. 5000 per week
capital sum insured maximum limit
Capital Sum Insured Maximum Limit
  • TABLE I - 75 Times of monthly income
  • TABLE II - 60 Times of monthly income
  • TABLE III - 24 Times of monthly income

(Table III cover can be given only with the approval of Corporate Office)

premium rating
Premium Rating

Note: Rate provided is “Per Mille” i.e., Per Thousand

additional benefits
Additional Benefits
  • Educational Grant – Rs.5000 per Child below 18 years maximum Rs.10000
  • Transportation of Mortal Remains – Rs.3000 if Accident outside the place of Residence
  • Travel Expenses for Relative – Actual TravelExpenses, maximum of Rs.1000 (Relative means spouse, children, parents, siblings or in-laws)
group discount
Group Discount

Group Discount Applicable to Accident Care (Group) Policies

medical expenses extension
Medical Expenses Extension
  • ADDITIONAL PREMIUM - 10%
  • COVERAGE

25% of valid claim under P.A. or the Actual Medical Expenses incurred because of Accident, which ever is less subject to a maximum of 10% of Capital Sum Insured.

restricted cover
Restricted Cover
  • On-duty cover : @75% of Applicable Premium
  • Off-duty Cover : @50% of Applicable Premium
cumulative bonus
Cumulative Bonus
  • Applicable for Death and PTD cover only.
  • 5 % increase in Capital Sum Insured for every claim free year.
  • Maximum 50 %.
transfer of policy
Transfer of Policy

Documents required for granting Cumulative Bonus

(a) Renewal Notice with Cumulative Bonus details

  • Cumulative Bonus as shown in the Renewal Notice is given

(b) No Renewal Notice or Renewal Notice without Cumulative Bonus details

  • Cumulative Bonus as shown in the Previous Policy is given
  • If a declaration stating No Claim under the expiring policy is obtained from the insured, eligible Cumulative Bonus will be given

Note: To obtain the above mentioned benefits there should be a

continuous renewal without break.

major exclusions
Major Exclusions

Any Claim,

  • In Respect of Pre Existing Conditions.
  • If the Insured acts against the advice of the Physician.
  • Whilst under the influence of intoxicating liquor or drugs.
  • Arising out of mental diseases, suicide or attempted suicide, self inflicted injuries or sexually transmitted conditions, anxiety, etc.
  • Due to participation in hazardous sport / activities.
  • By persons who are physically and mentally challenged unless specifically agreed and endorsed in the policy.

Note: For a detailed list kindly refer the policy conditions.

claims procedure
Claims Procedure

Document to be submitted in case of Death Claims

  • Completed Claim form
  • Death certificate, Panchanama
  • FIR, wherever applicable
  • Postmortem report
  • In the absence of assignment, Legal Heir ship Certificate/Succession Certificate / Will duly probated
  • Original Policy, if issued for Individual
  • Coroner’s Report/Police Inquest Report
claims procedure contd
Claims Procedure (Contd.)

Document to be submitted in case of Disablement Claims

  • Original Policy
  • Disability Certificate from the attending Doctor confirming the %age of disability.
  • Photo of the person indicating the disability.
  • Completed claim form
  • FIR, Wherever applicable
  • Employer’s Certificate for the period of absence from duty (for TTD Claims)
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