PERSONAL ACCIDENT

INSURANCE
●Purpose of the policy is to pay
fixed compensation in case of death
or bodily injury to insured
due to accident
●Accident means any external,violent

physical and unforseen incident

causing death or disability
●Customers..Any person aged between

5 to 70 years and who is hale and

healthy
Basic Coverage
1.Death due to accident 100% CS
2.Loss of any two limbs
i.e.eyes,legs,hands 100% CS
3.Loss of any one limb
eye,leg,hand 5
4.Permanent Total
Disability accidental 100% CS
5.Permanent partial %shown
disability
6.TTD.1%CSI per week upto 100 wks
Explanation of certain terms
●Permanent partial disability means

loss of fingers,toes or loss of hearing

capacity etc
●CSI means Capital Sum Insured or

the amount insured against the benefit

of the insured person
●In any case the maximum liability of

the company will not exceed CSI

●TTD benefit is restricted to 1% CSI

per week upto max 5000/-per week

maximum 100 weeks
Additional benefits under the policy with
out additional premium
●Transportation charges for carriage

of dead body from place of accident

to residence of insured ..2%CSI upto
maximum Rs.2500/-
●Children Education fund..For insureds

dependant children below 25 years age

10%CSI upto maximum 5000/-per children
(upto 2 children only)
Benefits with additional premium
Medical expenses extension
With this extension, medical expenses
following accidents get reimbursed
and two options are available
By paying 20% extra premium
medical expenses with following thumb
rule get covered.
Lowest of :
10% of SI insured,
50% of admissible claim amount,
actual expenses incurred,
Cumulative bonus benefit

If no claim is made during policy period

an additional compensation of 5% CSI
will add to the insured in the subsequent
year,this enhanced limit applicable only
for death,PTD and PPD covers.The benefit
will accrue upto maximum 10 claim free
continuous renewal or 50% of CSI
CB is lost, if policy not renewed continously
Sum Insured and Table of Benefits
Maxmiu
Table I Death only 60 times monthly
income
Table 2 Death,PTD 60 times monthly
income
Table 3 Death,PTD,60 times monthly
PPD income of insu
Table 4 Death,PTD 24 times monthly
PPD,TTD income of insur
Note..For non earning spouse SI restricted
to 50% of CSI of insured max1lac
For dependant children 25% max 0.50lac
●Premium based on occupation and
table of benefit opted
●Risk classified into 3 groups based

on occupation viz
Group-1..non hazardous occupations
doctors,lawyers,accounts,architects,
consulting engineers,teachers,bankers
persons in administrative functions,
etc
Group-2..hazardous occupation like
builders,contractors,superintending
engineers,veterinary doctors,paid
Risk group 2 contd
Paid drivers of motor cars and light
motor vehicles.
Besides,all persons in manual labour
like cash carrying employees,garage
and motor mechanics,machine opera
tors,truck/lorry/heavy vehicle drivers
professional athletes and sportsmen,
wood working machinists etc
Risk group-3
Persons engaged in underground mines,
explosives,magazines,workers in
electrical installation,jockeys,circus
personnel,person engaged in activities
like racing on wheels or horseback,
big game hunting,mountaineering,
winter sports,skiing,ice hockey,ballooning,
hand gliding,river rafting,polo and
similar activities
Premium tariff guide rates in Rs.per mille
Risk I Risk 2 R

Table I 0.45 0.60 0.90

Table 2 0.65 0.90 1.3
Table 3 1.00 1.25 1.75
Table 4 1.50 2.00 3.00

Note..Tariff has been withdrawn however

tariff rates serve as guide rates
Loading/discount
●Family discount of 5%off the premium

wherever spouse covered and 10%

when more than one family member
covered
●Indian person going to foreign places

on civilian duties can be given war

risk cover by loading 50% on premium
during peace period and 150% during
times of apprehensive period.
NOTE PA cover is worldwide and
duration of cover is annual
Exclusions
●Intentional self injury,suicide

●Under alcohol,drug effect

●Aviation,ballooning

●Breach of law with criminal intent

●From service in armed forces

●Resulting from childbirth or pregnancy

●Natural death

●War and nuclear exclusion

Policy conditions
●All notices in writing only,in death before

before internment, for disability claims

immediate notice and in any case not
exceeding 30 days from date of accident
●Company doctor has right to examine

●Post mortem report in death cases

●Claim payments do not carry interest

●Fraudulent claims not payable

●In case of change of occupation immediate

intimation to insurers
Note..this is not exhaustive but main points
Group Personal Accident
Customer.. Groups which have a
common relationship among the
persons to be insured and a central
point for administration of the insurance
scheme eg.
●Employer employee relationships

including dependants of the employee

●Pre identified groups/segments where

premium is paid by the State/Central

Government
●Members of registered cooperative
society
●Members of registered service clubs

●Holders of credit card of banks

●Holders of deposit certificates issued

by banks
●Shareholders of banks/public limited

companies etc.
Salient features of Group PA
●Group size discount is the attraction

●For discount,minimum group size 101

●Deletion and addition allowed

●SI either single or various for group

members can be selected

●Medical extension option available

●War risk extension also available

●Cover can be taken either ON DUTY

@75% of standard premium

●Can avail OFF DUTY cover @50%
standard premium
●Standard policy coverage is worldwide

365 days
●Cumulative bonus and children

education grant not available

●Carriage of dead body free cover is

there
●Based on three years claim experience

discounts/loading are imposed

Group size discount chart
Group(no.of person covered) Discount
101 to 1000
1001 to 10000
10001 to 50000 10
50001 to 100000 15
100001 to 200000
200001 to 500000
500001 to 1000000
Details required in proposal form
●Serial number

●Employee number/membership no.

●Name of the insured person

●Designation and age

●Monthly income

●Any existing deformities or sickness

●Sum insured (tablewise bifurcation)

●Premium

●Service tax

●Nominees name,age,relationship