Importance of Reading the Fine Print in Your Personal Accident Insurance Policy

In the event of an accident, a health insurance   plan can cover the hospitalisation expenses. However, what if the accident leads to disability or death of the individual? In such cases, a personal accident insurance policy can cover these events. However, it is important to understand the scope of an accident insurance policy coverage, the related terms, and what is excluded. You can know about these things by reading the policy fine print. This article will explain the importance of reading the personal accident insurance policy fine print.

What is a personal accident policy, and what does it cover?

A personal accident cover compensates an individual in the event of death, disability, or injuries caused due to an accident. An accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means. A personal accident insurance policy  usually covers the following:

1) Death

If the individual dies due to an accident, the specified sum insured will be paid.

2) Disability

If the accident results in permanent total disability, the sum insured as specified will be paid. The permanent total disability will be classified as one of the following:

a) Total and irrecoverable loss of sight of both eyes

b) Total and permanent loss of use of both hands or both feet

c) Total and permanent loss of use of one hand and one foot

d) Total and irrecoverable loss of sight of one eye and loss of a limb

e) Total and irrecoverable loss of hearing of both ears and loss of one limb/loss of sight of one eye

f) Total and irrecoverable loss of hearing of both ears and loss of speech

g) Total and irrecoverable loss of speech and loss of one limb/loss of sight of one eye

If the accident results in permanent partial disability, the sum insured as specified will be paid. The permanent partial disability will be classified as one of the following:

a) Total and irrecoverable loss of sight of one eye

b) Loss of one hand or one foot

c) Loss of all toes - any one foot, or loss of toe great - any one foot

d) Loss of toes other than great, if more than one toe lost, each

e) Total and irrecoverable loss of hearing in both ears or one ear

f) Total and irrecoverable loss of speech

g) Loss of four fingers and thumb of one hand, or loss of four fingers

h) Loss of thumb – both phalanges, or loss of thumb – one phalanx

i) Loss of index finger: one phalanx, or two phalanges or three phalanges

j) Loss of middle/ring/little finger: one phalanx, or two phalanges or three phalanges

If the accident results in temporary total disability, the sum insured as specified will be paid.

3) Hospitalisation expenses

If the accident results in hospitalisation, the accident insurance policy will cover the expenses as per the limits specified in the policy.

4) Loss of income

Due to the accident, if the individual loses the ability to earn income, the policy will compensate for the income loss as per the policy terms.

5) Funeral expenses

If the accident results in the insured’s death, the policy will make a specified one-time payment for the funeral/cremation. The amount may be based on the sum insured.

6) Child’s education

If the accident results in the insured’s death, the accident policy will make a specified onetime payment, to be used for the child’s education.

Note: The above features vary across accident insurance covers  of various companies as follows:

a) Some policies may provide all the above features in the base plan,

b) Some policies may provide some features across variants of the plan,

c) Some policies may provide some features as optional, or

d) Some policies may not provide some features

Reading the policy fine print

The above section shows how insurance companies may offer variants of the same plan and optional features. The accident insurance   plan variant, the optional features that you have chosen, and the terms and conditions related to them are all detailed in the policy document. To acquaint yourself with them, read the policy fine print.

There may be certain limits to the amount payable for certain features. These limits may be a percentage of the sum insured or a specified amount. All these details are specified in the policy fine print. With regard to certain features, there may be some limitations, and the overall policy may have some exclusions. All these details are also mentioned in the policy fine print. Hence, once you receive the policy document, you should spend some quality time going through all the details to acquaint yourself with what is covered in the policy, the limits (if any), and the exclusions.

ManipalCigna Accident Shield

In the personal accident policy category, ManipalCigna offers the ManipalCigna Accident Shield ,  Policy, an a highly customizable personal accident plan that offers range of sum insured up to ₹25 crores in case of Death, Disabilities, and Debt. This is a first of its kind offering that offers claim benefit of up to 200% of sum insured, for Accidental Death and Permanent Total Disablement. advanced personal accident plan. It provides comprehensive coverage for accidental death, permanent total disability (PTD), and permanent partial disablement (PPD), as per the plan opted. You can choose the sum insured in the Rs. 5 lakhs to Rs. 25 crores range based on your needs.

The plan is offered in 3 variants (Classic, Plus, and Pro) along with the following base and optional covers.

Base covers

The base covers under the plan include the following:

a) Accidental death:

In case of accidental death, 100% of the sum insured is paid. All three variants offer this benefit.

b) Permanent Total Disablement (PTD):

  If the accident results in PTD, 100% of the sum insured is paid. The benefit is offered under Plus and Pro variants.

c) Permanent Partial Disablement (PPD):

 If the accident results in PPD, a fixed percentage of the sum insured, up to 100%, will be paid as per the nature of the disability. The benefit is offered under the Pro variant.

d) Funeral expenses:

 A onetime payment will be made towards funeral or cremation expenses, if the claim gets accepted under accidental death. The amount paid will be as follows: Rs. 50,000 for a sum insured up to Rs. 50 lakhs, and Rs. 1 lakh for a sum insured above Rs. 50 lakhs.

e) Repatriation of mortal remains: 

Reimbursement of up to 2% of the sum insured, subject to a maximum of Rs. 5 lakhs, will be made, if the claim gets accepted under accidental death.

Optional covers

Some of the optional covers under the plan include the following:

a) Temporary Total Disablement (TTD):

The benefit is paid weekly, for a maximum of 100 weeks as per the applicable limits, for the duration of TTD.

b) Burns benefit: 

10% to 100% of the sum insured is paid, depending on the degree of burns caused by the accidental burns.

c) Child welfare benefit:

 In case of accidental death of the insured person, the following payouts will be given for the benefit of the dependent child. 10% of the sum insured, subject to a maximum of Rs. 20 lakhs, will be paid as education benefit. 20% of the sum insured, subject to a maximum of Rs. 40 lakhs, will be paid as orphan benefit. If there is a surviving parent, the orphan benefit will not be paid.

d) Loss of employment:

 If the insured person suffers PTD or PPD, and loses employment, a onetime payout will be made. The amount will be the sum insured opted for under this cover or the amount totalling up to 3 months’ base net income, whichever is lower.

e) EMI shield:

 If the insured person suffers an accident leading to accidental death, PTD, or PPD, a payout will be made. The amount will be the sum insured opted for under this benefit or a total of 3 EMIs due, whichever is lower.

f) Accidental hospitalisation: 

If the accident leads to hospitalisation, coverage will be provided for the actual expenses incurred, up to the chosen sum insured under accidental hospitalisation.

Reading the fine print is important    

Buying a personal accident insurance   policy is a must as it serves a specific purpose. While a life insurance policy covers death, a health insurance policy covers hospitalisation expenses. However, an accident can lead to disability, loss of employment, etc., which can be covered with a personal accident insurance policy. An accident policy also provides many other benefits, which may be subject to specific terms and conditions. You can make the best use of your policy when you the policy only when you understand what it covers and excludes, along with the related terms and conditions. These details will be mentioned in the  You will understand these details only when you read the fine print of your personal accident insurance policy .