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ACCIDENT CARE. Facts and Figures about Road Accidents-. Ill-planned motorization kills one person every six minutes on India’s roads. Road accidents in 1999-2000 cost India about 3 per cent of its GDP.
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Facts and Figures about Road Accidents- • Ill-planned motorization kills one person every six minutes on India’s roads. • Road accidents in 1999-2000 cost India about 3 per cent of its GDP. • During 1970-2005, registered motor vehicles increased 50 times, but road networks grew less than three times. • Accidents increased fourfold; injuries and fatalities also shot up more than six times. • In 2005, there were 439,255 road accidents – 1,205 accidents daily – which killed about 95,000 people; injuring more than 465,282. • The Pioneer has reported that the number of fatalities on Indian roads in 2006-07 increased to 1,05,749 • The Navbharat Times has reported that in the Annual Press Conference of Delhi Police, it was revealed that 8,270 road accidents were recorded in 2007, in which 2,050 persons died.
ACCIDENT ?
Definition of Accident Means a sudden, unforeseen, uncontrollable and unexpected physical event to the insured person caused by external, violent and visible means.
Accident Means Not only Road/Rail or Travel accidents but also includes : • Accidental Fall • Electric Shock • Snake Bite • Drowning in Water • Murder
Covers • Accidental Death • Disablement
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 • 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 • 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 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 • 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)
Capital Sum Insured Maximum Limit • Earning Member – Sum Insured can be given up to 100% of the eligibility • In respect of cover for spouse (non–earning), the sum insured shall be 50% of the sum insured of the earning member , subject to a maximum of Rs.7,50,000/- (cover shall be restricted to Table II benefits only) • In respect of cover for dependent children, the sum insured shall be 25% of the sum insured of the earning member, subject to a maximum of Rs.5,00,000/- ( cover to be restricted to table II benefits only ) • Family Discount – 10% on Basic Premium
Premium Rating Note: Rate provided is “Per Mille” i.e., Per Thousand
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)
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.
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 • 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 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 • 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.) 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)
