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    Personal accident insurance is a policy that can provide you with financial protection against uncertainties such as accidental death, injuries, and partial or total disability resulting from an accident. In case of the policyholder’s unfortunate death, a lump sum amount is paid to the nominee. In this article, let us understand everything about personal accident insurance, including its types, benefits, and exclusions....Read More

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    Rohit Ghosh

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    Rohit Ghosh has authored and reviewed several informative articles on Life and Term Insurance during his experience working with top Life Insurance brands. During his experience in the Life Insurance sector he has been responsible for formulation of several integrated marketing communication strategies. In his current role with Max Life Insurance he is responsible for website content and experience enhancement

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    Bhaskar Sinha

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    8+ years of experience in Life Insurance with expertise in Developing Life and Health Products, Digital Sales, Conducting effective trainings and Key Account Management.

    What is Personal Accident Insurance

    A personal accident insurance policy provides protection against death, permanent total or partial disability, and temporary disability in case of an accident. In case of death or permanent disability, the insurer pays a sum insured, and the policy terminates thereafter.

    While in the case of partial disability, only a percentage of the sum insured is paid depending on the severity of disablement, whereas a weekly compensation is provided in case of temporary total disability. The personal accident insurance policy is renewable if the accident results in permanent partial disability or temporary total disability.

    The personal accident insurance policy can be seen as an income protection plan where your profession and income determine your maximum cover and premium rates. Generally, you can get a maximum cover that is 10 times your annual income, and the premium rates usually depend on your profession.

    What is Personal Accident Insurance
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    What is Covered Under Personal Accident Insurance?

    Both life insurance and health insurance products cover for specific eventualities and provide coverage to mitigate the financial implications of the eventuality. At the same time, personal accident insurance offers additional coverage for a wider range of possible accidents. It can provide coverage for loss of limbs or disabilities caused due to an accident at the workplace or while travelling, etc. This insurance policy can help you create a financially stable environment against any possible eventuality.

    Let us look at some of the key things covered[1] under the personal accident insurance policy: -

    what-covered-personal-accident-insurance.png

    1. Accidental Death Cover

    An emergency such as an accident can be both financially and emotionally distressing for the policyholder’s family members. In case the policyholder suffers fatal injuries or dies due to the accident, the entire sum insured is paid to the nominee as mentioned in the policy document.

    2. Permanent Total Disability Cover :

    If the accident results in permanent disability or lifelong impairment such as loss of limbs, then a pre-determined sum insured is paid to the policyholder depending on the severity.

    3. Permanent Partial Disability Cover

    Under the personal accident insurance policy, a certain percentage (up to 100%) of the sum insured is paid to the insured in case of bodily injuries resulting in permanent partial disability.

    4. Temporary Total Disability Cover

    If the policyholder meets temporary total disability and gets bedridden, the insurer provides a weekly allowance as compensation for the loss of income. The insured can even use this claim amount to pay thei

    Types of Accident Insurance Policy

    The personal accident insurance policy can be divided into two categories. Let us briefly talk about both types: -

    Individual Personal Accident Insurance


    This is the more common type of personal accident insurance policy, where the insured opts to cover themselves against uninvited accidents. The accidental damage cover includes accidental death, loss of sight or limbs, or other permanent disabilities resulting from the accident.

    Group Personal Accident Insurance


    This type of personal accident insurance policy applies to a group of people who have something in common—be it employment type or location. Employers generally take these to provide coverage to their employees. Depending on the group size, the insurance company may provide discounts on the premium.

    It is a good value-added advantage for small organizations as this policy is available at a low cost. However, this is only a basic plan and offers limited benefits compared to the individual plan.

    Benefits of Buying a Personal Accident Insurance

    Personal accident insurance is a useful policy to get financial assistance for yourself and your family in the event of an accident. This policy provides comprehensive coverage for accidental death or disabilities. Here are some of the benefits[1] provided under this policy: -

    benefits-personal-accident-insurance.png

    1. Dismemberment Cover

    Most personal accident insurance policies offer the benefit pay-outs for the dismemberment of any kind occurring due to an accident. The insurers have pre-determined percentages and ratios in which the benefit is paid to the policyholder.

    2. Coverage for Burns

    This is an optional extra coverage under the personal accident insurance policy. And this additional insurance covers the possible dismemberment or death due to burns. The cost of treatment is reimbursed to the insured after hospitalization.

    3. Reimbursement of Hospitalization Expenses

    The insurance company reimburses all or part of the expenses incurred at the hospital. All the medical expenses, room rent charges, doctor’s consultation fees, medical tests, etc., are considered for reimbursement.

    4. Daily Allowance

    Some insurance companies provide daily cash allowance for the expenses arising due to hospitalization. This allowance to meet the unexpected hospital expenses can be given for up to 30 or 45 days of hospitalization.

    5. Education Grants

    Depending on the insurer, the policyholder may or may not be eligible for the education grants pay-out. An additional amount to be used for tuition fee payment for the dependent children is paid out to the policyholder. This is a common benefit provided by many insurance companies.

    6. Reimbursement of Transportation Expenses

    Under the personal accident insurance policy, some insurance companies also provide coverage for the cost of transportation of the mortal remains of the insured person.

    Life vs Health vs Personal Accident Insurance

    Life and health insurance products offer protection against specific financial eventualities, while personal accident insurance offers wider coverage for possible accidents. Here is a brief comparison of these three types of insurance policies: -

    Term Life InsuranceHealth Insurance PlanPersonal Accident Insurance

    A term life cover[2] provides protection against the financial burden on the policyholder’s dependents in case the insured passes away.

    Health insurance[3] plans provide financial aid during medical emergencies to mitigate the expenses incurred.

    Personal accident insurance provides coverage for burns, loss of limbs, broken bones, disabilities, etc., resulting from an accident.

    The death benefit is paid out on death. It is paid on maturity if you have opted for it.The benefit is paid after the hospitalization process. It includes the ambulance charges, pre-and post-hospitalization charges, etc.This policy pays out the benefits on death, permanent partial or total disability, and temporary total disability.
    You should buy this policy if you are the sole breadwinner of the family.This plan should be taken by people who are prone to health conditions, etc.This is the right plan for individuals who may be hospitalized due to their dangerous nature of work.

    What is Covered Under Personal Accident Insurance?

    Exclusions refer to the provisions under an insurance policy that restricts coverage due to certain conditions. It includes the things that are not covered under the plan. The personal accident insurance policy also has some exclusions. They may vary with the insurer, as the comprehensive list of exclusions is only communicated to the policyholder.

    Here is a general list of exclusions[1] under the personal accident insurance policy: -

    benefitsHealth-imgfamilySecureMobile-img

    1. Intentional Injury

    An emergency such as an accident can be both financially and emotionally distressing for the policyholder’s family members. In case the policyholder suffers fatal injuries or dies due to the accident, the entire sum insured is paid to the nominee as mentioned in the policy document.

    2. Injuries from Civil or Foreign Wars

    If the accident results in permanent disability or lifelong impairment such as loss of limbs, then a pre-determined sum insured is paid to the policyholder depending on the severity.

    3. Injuries Due to Consumption of Alcohol or Drugs

    Under the personal accident insurance policy, a certain percentage (up to 100%) of the sum insured is paid to the insured in case of bodily injuries resulting in permanent partial disability.

    4. Accidents Due to Riding a two-Wheeler over 150cc

    The claim for a personal accident insurance policy will be rejected if the accident is determined to have been caused while the policyholder was riding a two-wheeler with an engine capacity of more than 150cc.

    5. HIV/AIDS/STDs

    If it is found out that the accident leading to death or disability is caused because the policyholder suffers from an STD, the claim will not be honoured.

    6. Injuries Due to Involvement in Violent Public Disturbances

    The involvement of policyholders in any kind of public disturbance, protest, riot, strike, demonstration, etc., can cause the personal accident insurance claim rejection.

    7. Injuries on Duty with Military/ Paramilitary/ Police Force

    Injuries caused due to policyholder’s duty with the military, paramilitary, or police force are also not covered under the personal accident insurance policy.

    8. Injuries from Unsafe Sports

    If the injuries are caused due to participation in unsafe sports such as mountaineering, rafting, bungee jumping etc., the claim will be denied.

    9. Pre-existing Illnesses

    If the accident occurs as a result of a pre-existing medical condition or a worsening illness, the policyholder will not receive the claim benefits.

    10. Claim Arising Out of Pregnancy/Childbirth

    The claim arising from pregnancy or childbirth-related issues will not be covered under the personal accident insurance policy.

    Who is Eligible?

    Here are the eligibility criteria for the personal accident insurance policy: -

    • Individuals between 18 to 65 years of age are eligible for the personal accident insurance policy.
    • You can buy this policy for any family member(s).

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    FAQ's

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    Yes, you can purchase multiple personal accident insurance policies. It is totally legal in India. With multiple insurance policies, you can haveextra protection from future eventualities. You can get the total of all the policies as per the terms and conditions of the insurance company.

    The policyholder can claim the personal accident insurance policy by following these steps: -

    • Gather information at the accident scene
    • Obtain witnesses
    • Inform the details of the accident as soon as possible
    • Keep all the medical bills

    In case of the unfortunate accidental death of the policyholder, the family receives the sum insured under the policy. This helps compensate for the family expenses, such as the children’s education.

    To file a claim for the personal accident insurance policy, you should inform the insurer about the accident as soon as possible. This can also be done on the official website of the insurance company.

    Yes, anyone can buy a personal accident insurance policy by submitting the required documents to the insurance company.

    A personal accident insurance policy can help cover the treatment expenses arising from an accident. The policyholder can avail compensation in case of any permanent or partial disability.

    The death, injury, disability caused due to the following factors are not covered in the personal accident insurance policy: -

    • Natural death
    • Pre-existing conditions
    • Childbirth or pregnancy
    • Suicide or self-inflicted injuries
    • Participating in war, riot, etc.
    • Participating in an unsafe sports activity

    A personal accident insurance policy is specifically designed to offer financial protection against injuries, permanent disability, or death resulting due to an accident. Moreover, substantial compensation is provided in case of accidents when travelling.

    ARN NO: PCP/PAI/200223

    Sources:

    www.irdai.gov.in/ADMINCMS/cms/Uploadedfiles/107.%20Ind%20Personal%20Accident_UniversalSompo.pdf

    www.policyholder.gov.in/whatlifeinsurancetobuy.aspx

    www.irdai.gov.in/ADMINCMS/cms/Uploadedfiles/RTI_FAQ/FAQs%20on%20Health%20Insurance%20Regulations20201106.pdf

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      Option to double your insurance cover, basis underwriting, at the time of your need by increasing your sum assured up to an additional 100% of base sum assured, chosen at inception

      ^^*^^Free look period conditions:

      The policyholder has a period of 30 days from the date of receipt of the policy document, to review the terms and conditions of the Policy, where if the policyholder disagrees to any of those terms or conditions, he / she has the option to return the Policy stating the reasons for his objections. The policyholder shall be entitled to a refund of the premiums paid, subject only to deduction of a proportionate risk premium for the period of cover and the expenses incurred by the company on medical examination of the lives insured and stamp duty charges.

      ^Individual Death Claims Paid Ratio as per IRDAI Annual Report FY 2021-2022

      8https://www.moneycontrol.com/news/business/economy/buy-term-insurance-now-as-rates-may-rise-from-april-1-4930921.html

      2Total premium will be charged at the time of the policy issuance (subject to underwriting’s decision).

      3The guaranteed benefits are available with selected life insurance plans & are applicable if all due premiums are paid

      4Tax benefits as per prevailing tax laws, subject to change

      Terms and conditions for availing 5% employee discount:

      <Due to system constraints, employee is requested to select 5 Lakh and above income which can be changed to actual amount on the information page.

      1 The 5% employee discount will be refunded to you once your policy is issued. Submit your documents for getting your policy issued and get 5% employee discount

      9

      The percentage savings is for a regular pay Max Life Smart Secure Plus Plan ( A Non Linked Non Participating Individual Pure Risk Premium Life Insurance Plan, UIN - 104N118V05)– Life Option for 1 cr life cover for a 35 year old, non-smoker male for a policy term of 40 years vs a 10 year policy term with the same details’

      ~*Standard premium for 24-year old healthy male, non-smoker, 25 years policy term,25 year premium payment term (exclusive of GST) for Max Life Smart Secure Plus Plan (UIN:104N118V05)

      **Healthy non-smoking male, 24 years, 2 cr cover,25 years policy term,25 year premium payment term, exclusive pf GST for Max Life Smart Secure Plus Plan (UIN:104N118V05)

      ~~Healthy non-smoking male, 24 years, 1 cr cover,25 years policy term,25 year premium payment term, exclusive pf GST for Max Life Smart Secure Plus Plan (UIN:104N118V05)

      Max Life Smart Wealth Plan| A Non-Linked, Non-Participating, Individual Life Insurance Savings Plan| @Rs.9,68,800/- as lump sum at the end of 15 years, for 35 years old healthy male.

      ARN - ARN/Web/01/21042021

      Past performance of the investment funds do not indicate the future performance of the same. Investors in the Scheme are not being offered any guaranteed / assured returns.The premiums & funds are subject to certain charges related to the fund or to the premium paid.

      The premium shall be adjusted on the due date even if it has been received in advance.

      For Total Installment Premium -**Total Installment Premium is the Premium payable as per premium paying frequency chosen, it excludes GST and applicable taxes, cesses or levies, if any; and includes loadings for modal premiums, Underwriting Extra Premium and Rider Premiums if any.

      For Return of Premium -~The Return of Premium Option is available on payment of Additional Premium. Premium does not include amount paid for riders and is excluding taxes, cesses and levies. Upon Policyholder's selection of Return of Premium variant this product shall be a Non-Linked Non-Participating Individual Life Insurance Savings Plan.

      For Riders -#Applicable Rider available on the payment of Additional Premium is Max Life Critical Illness and Disability Rider | Non-Linked Non-Participating Individual Pure Risk Premium Health Insurance Rider |UIN: 104B033V01 . Critical Illness and Disability Rider variant opted is Platinum Plus which covers 64 critical Illnesses. The rider cover will only be paid in scenarios where customer is diagnosed with listed 64 critical illnesses or total and permanent disability. Rider will terminate after major critical illness claim is paid to the policyholder. In case customer requests for cancellation of rider only, the solution as a whole will be cancelled and not just the individual rider.

      For Additional Benefits -##On Payment of Additional Premium. The accident cover will only be paid in scenarios where death occurs due to accident.

      *~Disclaimer | Max Life Smart Secure Plus Plan. A non-linked non-participating individual pure risk premium life insurance plan |Benefit available with special exit value -Total premium paid inclusive of any extra premium but exclusive of all applicable taxes, cesses or levies & modal extra. The premium calculated as per Standard premium for 30 year old healthy male, non-smoker, 40 years policy term, 40 years premium payment term (exclusive of GST) for Max Life Smart Secure Plus Plan.

      6

      Applicable for Titanium variant of Max Life Smart Fixed-return Digital plan (Premium payment of 5 years and Policy term of 10 years) and a healthy male of 18 years paying Rs. 20,000/- per month (exclusive of all applicable taxes) with 7.50% return. Life Insurance is available with this product.

      ##

      Policy continuance benefit is not available with lifelong wealth variant. **The accrued income will be accumulated on an annual basis at the prevailing reverse repo rate (publish on RBI’s website).

      #

      With “Save the date”, you can choose to take your annual income to any special date in a year.

      ***Available with early wealth variant. Income benefit will be paid as per selected plan terms.

      ~

      Accidental death benefit is available in call variants except for Single premium variant. Life insurance coverage is available in this product.

      #~

      Term Insurance plan bought online directly from Max Life Insurance has no commissions involved.

      ~1

      Max Life Smart Secure Plus Plan, A non-linked non-participating Individual Pure Risk Premium Life Insurance Plan| Standard Premium for 30 year old healthy male, non-smoker, 40 years policy term, 40 year premium payment term (exclusive of GST) for Max Life Smart Secure Plus Plan| ~1 Conditions for special exit value: Option to receive all premiums paid back, at a specified point in the term of the policy (free of cost). Available when Return of premium variant is not chosen. No additional premium to be paid. Option to receive all premiums back (exclusive of GST). Flexibility of exiting the plan early. Special Exit Value cover applicable till age 68 & above (of your age). T&C Apply.

      6

      Applicable for Titanium variant of Max Life Smart Fixed-return Digital plan (Premium payment of 5 years and Policy term of 10 years) and a healthy male of 18 years paying Rs. 20,000/- per month (exclusive of all applicable taxes) with 7.50% return. Life Insurance is available with this product.

      **

      Max Life Critical illness and Disability (UIN- 104B033V01) available as a rider on payment of additional premium. 64 critical illnesses covered in platinum and platinum plus variant on payment.

      *

      Available on Payment of Additional Premium. The accident cover will only be paid in scenarios where death occurs due to accident.

      7

      Available with Max Life Smart Wealth Plan (UIN: 104N116V08)

      8

      Available with Max Life Smart Fixed-return Digital Plan (UIN:104N123V03). The guaranteed benefits are available with selected life insurance plans & are applicable if all due premiums are paid.

      **Disclaimer: Standard premium for 24-year old healthy male, non-smoker, 25 years policy term,25 year premium payment term (exclusive of GST) for Max Life Smart Secure Plus Plan (UIN:104N118V05) with a life cover of Rs. 50 lakh.

      **Disclaimer: Standard premium for 24-year old healthy male, non-smoker, 25 years policy term,25 year premium payment term (exclusive of GST) for Max Life Smart Secure Plus Plan (UIN:104N118V05) with a life cover of Rs. 75 lakh.

      **Disclaimer: Standard premium for 24-year old healthy male, non-smoker, 25 years policy term,25 year premium payment term (exclusive of GST) for Max Life Smart Secure Plus Plan (UIN:104N118V05) with a life cover of Rs. 1.5 Cr.

      **Disclaimer: Standard premium for 24-year old healthy male, non-smoker, 25 years policy term,25 year premium payment term (exclusive of GST) for Max Life Smart Secure Plus Plan (UIN:104N118V05) with a life cover of Rs. 2 Cr.

      **Disclaimer: Standard premium for 24-year old healthy male, non-smoker, 25 years policy term,25 year premium payment term (exclusive of GST) for Max Life Smart Secure Plus Plan (UIN:104N118V05) with a life cover of Rs. 5 Cr.

      **Our Life insurance policies cover COVID-19 life claims under life insurance claims, are subject to applicable terms and conditions of the policy contract and extant regulatory framework.