Personal Accident Insurance


1.    Personal Accident Insurance (Individual) Policy:
Cover: Death or bodily injury resulting solely and directly from accident which is caused by external violent and visible means. The payable claim is the sum set forth in respect of any of the insured persons for the contingencies as under

Item

Description of Benefits

Compensation payable % of the Capital Sum Insured

a

Death only

100

b

Loss of sight of two eyes or loss of use of two hands or feet or loss of use of one hand and one foot or loss of sight of one eye and loss of use of one hand or foot.

100

c

Loss of sight of one eye or loss of use of one hand or one foot

50

d

Permanent total disablement from injuries other than named as above

100

e

Permanent Partial Disability

% as per policy

f

Temporary Total Disablement

Up to 104 weeks maximum weekly benefits not exceeding Rs. 5000

Above Coverage is classified into 4 Tables of Benefit I, IA, II & III:
Table of Benefits:
I (Death only- a above),
IA (Death & PTD i.e. a, b, c and d above),
II (Death, PTD & PPD i.e. a, b, c, d and e above) and
III (Death, PTD, PPD & TTD i.e. a to f above)
TTD is the Weekly Benefit/compensation (stated in f) which is 1% OF CSI MAX RS. 5000/- Per Week Up to Max 104 Weeks.


Eligibility- AGE 5 TO 70 years


Additional Benefits-
1.    Cumulative Bonus 5% Per Year Max 50%-, Sum Insured under items A, B, C, and D above will be increased by 5% on each claim free renewal of the policy up to maximum limit of 50%.
Note: Cumulative Bonus will be lost if the policy is not renewed within 30 days after its expiry with this company.
2. Education fund: for two children up to age 23 years and per child Rs. 5000/- for two Rs. 10,000/--
3. Transportation of Body 2% OF CSI Max Rs. 1000/-
The following extra benefits may be covered on payment of additional premium: Reimbursement of Medical Expenses incurred following an accident up to 40% of the valid claim payable under item (a) to (f) above or 10% of the Capital Sum Insured for Personal Accident Cover, whichever is less.


Classification of Occupational Risks:


Normal Risks: Bureaucrats, doctors, lawyers, accountants, architects, bankers, insurance, administration, consultant, teacher, clerical jobs and similar occupation.


Medium: builders, contractors, engineers in supervisory jobs, veterinary surgeon, paid drivers and people are engaged in similar nature of job, manual labour, police personnel , cash carrying employees, motor mechanics, machine operators, athletics , sportsman and people engaged in wood working.


Heavy Risks: Persons working in underground mines, explosives, magazines, workers involved in electrical installations with high tension supply, circus personnel, persons engaged in activities like racing on wheels or horseback, big game hunting, mountaineering, winter-sports, skiing, ice hockey, polo and persons engaged in occupation of similar hazard and police/CRPF personnel engaged similar type of hazardous jobs.


Note: For classification of occupation risks not specified above, a reference should be made to the Office.
Premium Rates:


The following are the annual rates applicable to proposals from persons (both male and female upto70 years.

Table of benefits

Covers

Rate for normal risks

medium Risks Rate for

Rate for Heavy Risks

I

a

0.40 per mille

0.60 per mille

0.90 per mille

I(A)

a to d

0.45 per mille

0.65 per mille

1.50 per mille

II

a to e

0.90 per mille

1.25 per mille

1.90 per mille

III

a to f

1.5 per mille

2.00 per mille

3.00 per mille

1. Any combination other than those shown above is to be referred to DO.
2. Person aged 71 to 75 years 10% premium be loaded above 75 years to 80 years 20% premium beyond 80 years premium loading to be decided on case to case basis (cover is restricted to table I only). Policy can be renewed throughout the life time.
3. For reimbursement of Medical expenses benefits the rates of premium are to be loaded by 20%
4. Cover for restricted duty hours 75% premium of the above.
5. Family discount 5%
6. Minimum premium per policy-Rs. 30/- (net).


Capital Sum Insured (C.S.I.):
1. Table I & IA: 5 to 6 times of gainful employment annual income (income from interest, house/property rent, share and debentures not to be considered).
2. Table II: 4 to 5 times of gainful employment annual income (income from interest, house/property rent, share and debentures not to be considered).
3. Table III: 2.5 to 3 times of annual income maximum Rs. 5 lacs
4. One can take policy combination of all the tables; however, total sum insured should not exceed to 6 times of annual income.
5. Family package Sum Insured- Earning member 100% CSI, Spouse (non-earning) 50% of CSI maximum Rs. 2, 00,000/- & dependent children 25% of CSI, max Rs. 50,000/-


Major Exclusions Claim under more than one of the sub clauses of cover, weekly compensation until total amount is ascertained, intentional self-injury, drug/alcohol abuse, venereal disease or insanity, pregnancy, engaged in aviation works, breach of law, war & radioactivity.

 

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