ACCIDENT CARE

Facts and Figures about Road Facts and Figures about Road Accidents-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.

ACCIDENTACCIDENT

?

Definition of AccidentDefinition of Accident

Means a sudden, unforeseen, uncontrollable and unexpected physical event to the insured person caused by external, violent and visible means.

Accident MeansAccident Means

Not only Road/Rail or Travel accidents but also includes :

Accidental FallElectric ShockSnake BiteDrowning in WaterMurder

CoversCovers

Accidental Death

Disablement

Age LimitsAge 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 of BenefitsTable of BenefitsTable I Death Cover Only

Table II Death

+

Permanent Total Disablement (PTD)

+

Permanent Partial Disablement (PPD)

Table III Death

+

Permanent Total Disablement (PTD)

+

Permanent Partial Disablement (PPD)

+

Temporary Total Disablement (TTD)

Table I : Accidental DeathTable 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 + Table II : Accidental Death + PTD + PPD 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 II : Percentage of Table II : Percentage of compensation compensation Payable Payable

Benefits Benefits Percentage of Sum Insured

1. Death

2. Permanent Total Disablement

Total and irrevocable loss of

a. Sight of both eyes

b. Physical separation of two entire hands

c. Physical separation of two entire foot

d. One entire hand and one entire foot

e. Sight of one eye and loss of one hand

f. Sight of one eye and loss of one entire foot

100%

100%

100%

100%

100%

100%

100%

100%

Table II : Percentage of Table II : Percentage of Compensation Payable (contd.)Compensation Payable (contd.)

Benefits Benefits Percentage of Sum Insured

g. Use of two hands

h. Use of two foot

i. Use of one hand and one foot

j. Sight of one eye and use of one hand

k. Sight of one eye and use of one foot

l. Sight of one eye

m. Physical separation of one entire hand

n. Physical separation of one entire foot

o. Use of one hand without physical separation

p. Use of one foot without physical separation

100%

100%

100%

100%

100%

50%

50%

50%

50%

50%

Table II : Percentage of Table II : Percentage of Compensation Payable (contd.)Compensation Payable (contd.)BENEFITS Percentage of Sum Insured

Loss of toes – all

Great - both phalanges

Great - one phalanx

Other than Great, if more than

One toe lost – for each toe

Loss of hearing - both ears

Loss of hearing - one ear

Loss of four fingers and thumbs of One hand

Loss of four fingers

Loss of thumb - both phalanges

- One phalanx

Loss of index finger - three phalanges

- Two phalanges

- One Phalanx

20

5

2

1

75

30

40

35

25

10

10

8

4

Table II : Percentage of Compensation Payable (contd.)

BENEFITS Percentage of Sum Insured

Loss of middle finger - Three phalanges

- Two phalanges

- One phalanx

Loss of ring finger - Three phalanges

- Two phalange

- One phalanx

Loss of little finger - three phalanges

- Two phalanges

- One phalanx

Loss of metacarpals - first or second (Additional)

Third, fourth or Fifth (Additional)

Any other permanent partial disablement

6

4

2

5

4

2

4

3

2

3

2

Percentage as assessed by the panel Doctor of the Company

Table IIITable III Accidental Death+PTD+PPD+TTDAccidental 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 InsuredCapital Sum Insured Maximum Limit 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 Capital Sum Insured Maximum LimitLimit

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

Risk GroupsRisk GroupsRisk Group I Persons engaged primarily in

administrative functions

Risk Group II Persons engaged in manual work other than what is specifically provided under Group III

Risk Group III Persons working in explosives industry, mine and / or magazine workers, high tension supply, horse racing including jockeys, athletes and occupations of similar hazard.

Premium RatingPremium Rating

COVERAGE / RISK GROUP

GROUP 1 GROUP 2 GROUP 3

Table I 0.45 0.60 0.80

Table II 0.80 1.30 1.75

Table III 1.25 1.75 2.00

Note: Rate provided is “Per Mille” i.e., Per Thousand

Additional BenefitsAdditional 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 Travel Expenses, maximum of Rs.1000 (Relative means spouse, children, parents, siblings or in-laws)

Medical Expenses Medical Expenses ExtensionExtension 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 BonusCumulative Bonus

Applicable for Death and PTD

cover only.

5 % increase in Capital Sum Insured for every claim free year.

Maximum 50 %.

Transfer of PolicyTransfer 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 ExclusionsMajor ExclusionsAny 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 ProcedureClaims 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.)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)

Thank You