Personal Accident and All Sickness Insurance – Policy

8/3/2019 Personal Accident and All Sickness Insurance Policy

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Personal Accident and AllPersonal Accident and AllSickness InsuranceSickness Insurance

Policy FormPolicy Form


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Types of PolicyTypes of Policy

Types of PolicyTypes of Policy Annual / Short PeriodAnnual / Short Period

Policies.Policies.

P. A PolicyP. A Policy Compensation for accidentalCompensation for accidentalinjury (Granted in conjunction with otherinjury (Granted in conjunction with otherpoliciespolicies Death Benefits under householdDeath Benefits under householdpolicy)policy) Benefit policy.Benefit policy.

Sickness InsuranceSickness Insurance Compensation forCompensation forSicknessSickness -- Benefit policy.Benefit policy.


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Indemnity Contract & Benefit PolicyIndemnity Contract & Benefit Policy ::

Contract of Indemnity (Fin.Contract of Indemnity (Fin.

Compensation)Compensation) -- ((PA policy )PA policy )-- EmployerEmployerpay full wages to employee duringpay full wages to employee during

disablement & Insure this Liability.disablement & Insure this Liability.

Benefit PolicyBenefit Policy Payment of specifiedPayment of specifiedsums on the happening of certain events.sums on the happening of certain events.


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Various Combinations of benefitsVarious Combinations of benefits ::

Accident only policyAccident only policy Injuries ByInjuries By

Accident, Individual policy & Group Policy,Accident, Individual policy & Group Policy,Accidents & All SicknessAccidents & All Sickness Injuries byInjuries byAccident & Disablement by Illness,Accident & Disablement by Illness,

Injuries in Specified CircumstancesInjuries in Specified Circumstances Journey by Air or During a Holiday.Journey by Air or During a Holiday.


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Form of the policyForm of the policy

Annual ContractsAnnual Contracts 12 Months,12 Months,

Renewable Policies at the Option of theRenewable Policies at the Option of the

Insurers,Insurers, Wording & Principal Clauses vary withWording & Principal Clauses vary with

Insurers,Insurers,

Single form (Individual & Group Policy).Single form (Individual & Group Policy).


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Constituent Parts of the PolicyConstituent Parts of the Policy ::

Recital Clause or Preamble,Recital Clause or Preamble,

Operative Clause,Operative Clause, Exceptions,Exceptions,

Attestations Clause,Attestations Clause,

Schedule,Schedule, Conditions.Conditions.


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Recital Clause or PreambleRecital Clause or Preamble ::

Parties of the Contract,Parties of the Contract,

Proposal form,Proposal form, Declaration as the basis of the contract &Declaration as the basis of the contract &

to the premium.to the premium.

Read in Conjunction with Schedule.Read in Conjunction with Schedule.


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Operative Clause :Operative Clause :

Claims Payment (during insured period)Claims Payment (during insured period)

Exceptions, Conditions.Exceptions, Conditions. Read in Conjunction with Schedule.Read in Conjunction with Schedule.


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Important Phrases & WordsImportant Phrases & Words DifferDiffer

between insurers :between insurers :

Bodily InjuryBodily Injury Diseases caused byDiseases caused byaccident.accident.

Solely & Directly (Proximate Cause)Solely & Directly (Proximate Cause)

Bodily Injury.Bodily Injury.AccidentAccident -- Unexpected, Unintentional &Unexpected, Unintentional &

not designed Events.not designed Events.


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Outward (Accident caused byOutward (Accident caused byexisting Physical defectsexisting Physical defects -- NotNot

covered)covered) Heart attack due to BrokenHeart attack due to Brokenlegs.legs.

Violent & VisibleViolent & Visible Bodily Injury byBodily Injury byaccident.accident.


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Exceptions (Depends Upon Insurer)Exceptions (Depends Upon Insurer) ::

Alcohol / Drugs / Insanity / Suicide / ChildAlcohol / Drugs / Insanity / Suicide / Child

birth / Pregnancy / Under 15 years / Abovebirth / Pregnancy / Under 15 years / Above

70 years / Civil war / War.70 years / Civil war / War.


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Schedule & Benefits :Schedule & Benefits :

DeathDeath

Permanent DisablementPermanent Disablement Loss of eyeLoss of eyeor Limb (Above wrist / ankle),or Limb (Above wrist / ankle),

Permanent Total disablementPermanent Total disablement FootFoot

baller :baller :From gainful employment of any kindFrom gainful employment of any kind nono

compensation .compensation .


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Insured Person's usual occupation &Insured Person's usual occupation &

Any other occupation for which the insuredAny other occupation for which the insured

is fitted by knowledge & Trainingis fitted by knowledge & Training Partner disabled (No compensation).Partner disabled (No compensation).

Insured person usual occupationInsured person usual occupation Compensation Payable.Compensation Payable.


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Lump Sum / Annuity Payment, (InsurerLump Sum / Annuity Payment, (Insurer

may pay weekly benefits to reduce Hardshipmay pay weekly benefits to reduce Hardship

of Insuredof Insured until total liability is calculated).until total liability is calculated).


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Permanent Partial DisablementPermanent Partial Disablement NotNotsevere. Small %age of Payment.severe. Small %age of Payment.

Temporary DisablementTemporary Disablement -- TemporaryTemporarytotal & temporary partial disablement fromtotal & temporary partial disablement fromusual occupation.usual occupation.

Medical ExpensesMedical Expenses Scale ofScale ofCompensation (According to the FatalCompensation (According to the Fatalaccident benefits).accident benefits).


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Deferment of BenefitDeferment of Benefit PremiumPremium

discount.discount.

Usual ConditionsUsual Conditions :: Claims Procedures,Claims Procedures,

Change in riskChange in risk Notify the Insurer,Notify the Insurer,

AdjustmentAdjustment Premium & RenewalPremium & Renewaladjustments,adjustments,


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CancellationCancellation 7 days notice to the insured7 days notice to the insuredat the insured's last known address,at the insured's last known address,

AssignmentAssignment Subject Matter can't beSubject Matter can't beassigned,assigned,

Observance of TermsObservance of Terms Insured PersonInsured Person(Clear the Insured Person).(Clear the Insured Person).


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All Sickness :All Sickness :

Rapid Expansion Market,Rapid Expansion Market,

Weekly benefits without any CapitalWeekly benefits without any Capitalsum (May Arrange),sum (May Arrange),

Application of Excess than Franchise,Application of Excess than Franchise,

Waiting periodWaiting period 7 days,7 days,


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The EndThe End

Documents

Personal Accident and All Sickness Insurance – Policy