Oriental Insurance Company Limited
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Personal Accident Insurance Cover

FAQ

• What is Personal Accident Insurance ?
Personal Accident is an insurance cover wherein, in the event of the person sustaining bodily injuries resulting solely and directly from an accident caused by EXTERNAL, VIOLENT & VISIBLE means , resulting into death or disablement.
• What type of events are covered under Personal Accident Insurance ?
An accident may include events like:
  • Rail / Road / Air Accident.

  • Injury due to any collision/fall.

  • Injury due to Bursting of gas cylinder.

  • Snake-bite, Frost bite/Dog bite.

  • Burn Injury, Drowning, Poisoning etc.

These are only illustrative and not an exhaustive list of type of accidents.

• What is scope of cover & benefits available under Personal Accidental cover ?
Personal Accidental policy covers accidental death, loss of limbs, permanent total and partial disablement as selected and granted by the insurance companies based on the underwriting norms.
• Does this policy cover medical expenses incurred due to accident ?
Yes, on payment of additional premium, medical expenses reimbursement can be covered. These expenses are payable, in case, if the claim is admitted under the basic policy cover.
• What are the other types of covers available for covering accidental injuries ?
In addition to the Personal Accident Insurance cover the policies available are : Nagrik Suraksha Poicy, Janta Personal Accident Policy, Gramin Personal Accidental Policy , Student Package Policies for students, Bhagashree for Girl-children, Raj Rajeshwari for Women etc. Further as an ad-on cover Motor Vehicle Package Policy & Overseas Mediclaim Policy too offer personal accidental injuries cover.
• What is the age limits under personal accident cover ?
This Policy is available to persons between the age of 5 and 70 years (Male & Female). In case of Family Package covers, the age of children should be between 5 to 19 years. The age ceiling of 70 years can be relaxed in special conditions subject to suitable premium loading.
• Are there any territorial restrictions applicable to the policy ?
No, the coverage under this policy is WORLDWIDE however, claims, if any, will be paid in Indian currency only.
• What is the basis of arriving at the sum insured ?
Sum insured is based on various factors namely :
  1. income from gainful employment,

  2. type of occupation,

  3. age as on date of proposal,

  4. period of insurance

  5. Conditions prevailing at the place from where the proposal is made etc.

  6. As regards the non-earning spouse of the insured the sum insured in respect of such spouse shall not exceed 50% of the eligibility of the insured, subject to a limit of Rs.One Lakh under benefits available under Table III of the policy.

  7. Dependant children can be offered a sum insured not exceeding Rs.50000/- to cover death and disablement only. NO TEMPORARY DISABLEMENT COVER SHALL BE OFFERED.

• Are personal accidental policies are available for long term?
Generally Personal Accident policies are maximum for one year only. However, depending upon the requirement of the proposer it can be offered for a period which could even be lesser than 12 months.
• What is permanent total/partial and temporary disablement ?

(i) When an insured person sustains accidental injuries resulting in loss of limb and is certified by a medical specialist that the injury is of a permanent total or permanent partial nature, then only the insured shall deemed to be permanently totally/partially disabled.

(ii) Temporary total disablement arises when a person is not in a position to perform the duties that he performing immediately prior to the accident, which has to be certified by a medical professional.

These are general interpretation for easy understanding & not legal wording.

• What is the compensation available in the event of the insured sustaining TTD ?
In the event of an accidental injury resulting in temporary total disablement ( to be confirmed by the attending physician )the insured shall be entitled to a compensation @ 1% of sum insured per week subject to a maximum of 104 weeks. Such weekly compensation shall in no case exceed Rs.5,000/- per week.
• Can non-earning individual take Personal Accident Insurance cover ?
A non earning individual can have policies like Janta Personal Accident Policy , Gramin Personal Accident Policy.
• Is there any discount for getting family cover ?
Yes, depending upon the number of persons covered, family discount is granted.
• Can a cover be granted to a proposer where war and war like situation prevails ?
Under normal circumstances where war and or warlike situation prevails PA cover is not offered. However, on payment additional premium the same can be got covered.
• What is cumulative bonus ?
If the insured person does not prefer any claim in the expiring policy, he is entitled to 5% cumulative bonus for every such claim free year subject to maximum of 50% cumulative bonus that means the sum insured under the renewed policy will be increased by 5% every year without charging any additional premium.
• Is there any grace period for renewal of policy ?
There is no grace period for continuity of insurance cover and policy cover expires on the last day of policy period. In order to avail cumulative bonus benefits, the policy can be renewed within 90 days from the expiry of policy period.
• What is an Assignment ?
Assignment means that in the event of fatal accident of the insured person, the compensation is made to the assignee on the basis of his full and final discharge. In case the assignment is not made under Personal Accident Policy, the insurance company insist for SUCESSION CERTIFICATE from the Court for settlement of claim compensation, which is a time consuming, lengthy & cumbersome procedure.
• Is there any tax benefit under Personal Accident like covers?
There is NO TAX BENEFITS for the premium paid under these types of cover.
• What the insured has to do in the event of accident ?
IN THE EVENT OF ACCIDENTAL INJURIES
  • Immediate written notice should be given to the Insurance Company with all particulars.
  • Claim from duly completed alongwith the following documents should be submitted.
  • Medical Certificate about the nature and extent of accident resulting injuries.
  • Medical Examiner’s Report.
  • Details of treatment rendered by the attending Doctor/Hospital/Nursing home.
  • Certificate from the employer to the effect that the Insured was on leave during the period.
  • Fitness certificate.

IN THE EVENT OF ACCIDENTAL DEATH

The following documents are required to be submitted :
  • Post-mortem Report.
  • F.I.R./Police Report.
  • Punchnama
  • Departmental Inquiry, if any.
  • Report of Doctor/Hospital/Nursing Home.
  • Death Certificate.
Oriental Insurance Company Limited