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A Step-By-Step Guide To Make A Personal Accident Insurance Claim

The IRDAI (Insurance Regulatory and Development Authority of India) has defined the concept of personal accident insurance as a health-benefit scheme that pays a pre-determined assured sum in the event of disability or death caused due to accidents. In a time when over 150 people die on the Indian roads daily, such insurance policy covers a person against partial or total disability and death in cases of accidents.

To know how to make claims and benefit from such insurance policies as the insured, it is vital to have an in-depth idea about the terms and features of such policies in the first place.

How do such insurance policies function?

Usually, if the insured individual faces permanent disability or death, this health insurance policy pays the entire sum assured and terminates the same thereafter. In cases of partial disability, the insurer pays a percentage of the insured sum depending on the severity of the policyholder’s disablement.

As this insurance coverage is viewed as an income-protection plan, the policyholder’s income and profession are taken under account. These are assessed to determine the maximum coverage one will be assigned with, and the premium amount is set accordingly. Typically, you can avail a maximum coverage sum that is 10 times of your annual income. The premium is set as per your profession – the riskier it is, more expensive your policy premiums will be.

You can consider availing a perosnal accident insurance to cover your life’s unforeseen events.

How to claim your accident insurance?

You can file claims against personal accident health insurance by following this step-by-step guide – 

  1. Inform your insurance company when an accident occurs – before or after the policyholder is admitted at a hospital. The policy/reference number must be provided to your insurance company to register the claim.
  2. The insurer needs to be informed during hospitalisation of the policyholder to avail a hospital cash cover. Along with it, the nature of the injury and all the documents covering diagnosis, treatment and billing must be appropriately maintained. Note that insurers may provide cashless assistance only in case of healthcare centres within their hospital network. 
  3. The representative of the insurance company will then verify with the hospital regarding the details of the customer. After the verification of the claim and the necessary documents are collected, the processing is initiated.
  4. Most insurers also demand an FIR from the police station that has jurisdiction over that area where the accident occurred.

In cases of the demise of the policyholder, the beneficiary needs to submit the holder’s death certificate mentioning the cause of his/her death. A medical certificate is required in case of permanent disability. For temporary disability, an insurer is also required to furnish the certificate of absence of work from his/her. This is because a personal accident insurance policy often is supposed to provide a supplement income as any form of disability will refrain you from working.

Benefits of a personal accident insurance policy

Accidents are uncertain, thus, having a personal accident policy can help you –

  • Stay secure financially

You can cover your financial liability occurring from personal accidents. This way, you do not require breaking your savings to pay for the medical expenses. You can use a personal accident health insurance claim instead. You can enjoy reimbursement up to 40% of your claim amount and pay it for medical bills.

  • Receive allowance for hospital confinement

As your regular wage is disturbed in the event of an accident, you will receive a daily allowance of Rs. 1000 for up to 30 days of hospitalisation.

  • High-disability compensation

In cases of total disability, you can get up to 125% of the sum assured as compensation. Besides, you also get a bonus of 10-15% for each claim-free year.

With this information, you now have an idea what a personal accident insurance cover is and how to claim it. Refer to insurance policies which provide the most comprehensive set of coverage terms.