A factor important in underwriting; this term refers to the chance of the insurer’s business not lapsing or being replaced by another insurer’s coverage.

An accident is essentially unexpected, not intended or designed. Certain voluntary acts which results in bodily injury are included, as for example, where a person in order to escape from a building jumps from an upper window and is injured by his fall.Fortuitous occurrence caused by external visible and violent means is considered as an accident. Any person meeting with accident has to suffer (the consequences of the accident) and the result of an accident may widely vary from simple injury to death.Question often arise whether events like suicide, murder, frostbite, snakebite, animal bite, insecticide, drowning etc., can be regarded as accidents. Applying the various tests, it can be stated that while suicide and murder or homicide following grave provocation are not accidents, homicide or murder without provocation, frostbite, snakebite, animal bite, insecticide and drowning are accidents.Death due to Malaria after a mosquito bite too is termed as an accidental death as is rightly pronounced by Hon’ble National Commission in case of National Insc Co v/s Mousmi Bhattacherjee (RP 1270/2016). The Commission pronounced that an accident is something that happens unexpectedly and not planned in advance and causes injury. Thus, no one can predict about the mosquito bite and it can happen anywhere and anytime like an accident. It has already been a settled law that snake-bite, dog-bite, frost-bite are also accidents. As such death of the insured person due to Malaria after a mosquito bite is termed as accidental death.

To construe an accidental death and or disablement or injury in a Personal Accident Insurance there must be an outside agency or cause involved in occurring accident. It excludes accidents caused purely by existing physical defects, e.g., a broken leg resulting from a heart attack would not come within the scope of the policy.

Personal Accident insurance covers death or disablement to the insured person arising out of accident. It is a benefit policy meaning hereby that a fixed compensation is paid to the insured or named assignee for death or disablement arising out of an accident, caused by external violent and visible means. The Policy provides for compensation in the event of (i) loss of limbs (iii) permanent total disablement (iv) permanent partial disablement and (v) temporary total disablement due to accident which may occur at any time and whilst anywhere in the world including whilst travelling by car, boat, train or any other mode of conveyance or whilst flying as a passenger in any aircraft operating over regular schedule routes by any transport Company.1. Personal Accident Insurance, Individual : Personal accident Policy issued to any individual in his individual capacity.
No

Contingency

Percentage of capital sum insured payable as compensation

A

Death

100% of the Capital Sum Insured

B

Loss of two limbs or both eyes or one limb and one eye

100% of the Capital Sum Insured

C

Loss of one limb or one eye

50% of the Capital Sum Insured

D

Permanent total disablement other than the above

100% of the Capital Sum Insured

E

Permanent partial disablement

Percentage as shown in the table in the Policy

F

Temporary total disablement

Weekly compensation at 1% of the capital sum insured subject to a maximum of 104 weeks. The amount of weekly payment is restricted to an amount decided by each insurer whatever be the capital sum insured. This limit applies to all personal accident policies help by the insured.

Note 1. The Benefits A to E are known as capital benefits and benefit F as weekly benefits.

Note 2. It is not necessary that all benefits stated above are covered.

Note 3. Insurers design their policies in with different combinations of the benefits above.

2. Personal Accident Insurance, Family Package Cover :

Family package cover may be granted on the following pattern :

1. Earning member (person insured) and Spouse, if earning

CSI to be decided in line with their respective monthly earnings.

2. Spouse, if not earning

Usually 50% of CSI of the principal member subject to a maximum of stated sum under various tables.

3. Dependent children

Usually 25% of the CSI of the principal member subject to a maximum of stated sum under various tables.

4. Dependent Parents or blood relatives i.e., dependent brother/s – sister/s

Usually 25% of the CSI of the principal member subject to a maximum of stated sum under various tables.

5. For children and dependent parents/blood relatives the cover shall be limited to death and Permanent Disablement i.e., Table II Benefit. Rate of premium applicable to table II shall be charged.

6. Premium payable for husband and wife will be on the total sum insured for Husband and wife at Table III rates. The benefits will be as per Table III.

7. Insurers usually allow discount for insured’s opting for a Family package policy.

3. Personal Accident Insurance, Individual Policy : Free Extra Benefits : The Policy allows certain additional benefits free of charge basically to encourage individuals to go in for a cover and to renew the same promptly when due.

Cumulative Bonus : 5% per renewal subject to a maximum 50% of CSI. The benefit is not lost if renewal takes place within 30 days of expiry of earlier Policy.Education Fund : 10% of CSI is payable subject to maximum Rs. 5,000 where there is one dependent child land Rs. 10,000 where more dependent children are involved.Carriage of Dead Body : 2% of CSI subject to maximum of Rs. 2,500 is payable for carriage of dead body to the residence of insured, this will include funeral expenses.4. Personal Accident Insurance Policy : Optional Additional Benefits :

Medical Expenses Benefit : Policy can be extended on payment of additional premium to cover medical expenses incurred by an insured in connection with the accidental bodily injury. These benefits are in addition to other benefits under the policies. It is not necessary that personal has to be hospitalized.War risks : War risk cover can be granted to Indian personnel/experts working in foreign countries on civilian duties at the additional premium applicable differently during peace time, normal period, abnormal/apprehensive period etc.5. Personal Accident Insurance, Group Policy :

Personal Accident Insurance, Group Policy : Type A : Covering employees of a firm/Company/association/club (i.e. with employer-employee relationship). These are further divided into two types (i) named employees, and (ii) unnamed employees.

Personal Accident Insurance, Group Policy : Type B : Covering members of an institution, society, association, club (i.e., with no employer-employee relationship)-(i) group where members could be named and identified (ii) Others.

In respect of unnamed employees under type. A above it shall be left to the discretion of the employer to declare the number of employees in each classification based on authentic record maintained by his various offices. In case the employer is unable to give class-wise information, all the employees shall be treated as normal risk excluding those who can be classified under heavy risk and their number shall be declared.

With regard to group of unnamed person under type B above, where it is neither possible to categorize individual risk nor to classify a group of people under any one classification, the group may be insured as ‘normal’ risk with the proviso that all members of the group must be included in the Policy. If only selected members of such a group want to insure themselves they must declare their occupations when this will become named group, and the risk classified as pre provisions. Where an unnamed group having no employer-employee relationship consists of persons belonging to a particular trade, occupation or profession the classification shall be as applicable to that particular trade or occupation or profile.

Personal Accident Insurance, Group Policy : On Duty Covers : If personal accident cover is required only for the restricted hours of duty (and not for all the 24 hours of the day and night) a reduced premium equivalent to 75% of the appropriate premium can be charged. The restricted cover is intended for employees only under policies taken out by employer for accident to employees arising out of and in the course of employment only.

Personal Accident Insurance, Group Policy : Off Duty Covers : If Group Personal Accident cover is required only for he restricted hours, when the insured employee is not at work and/or not on official duty, the required premium 50% of the appropriate premium shall be charged.

Personal Accident Insurance, Group Policy Excluding Death Benefits : It is possible to issue Group Personal Accident Policies excluding the death benefit, subject to the following conditions:

A Group life policy covering death benefit for the same group of persons is in existence.Group P A Policy covers a group of 100 persons and above. Where a Group Policy is issued subject of course to condition (01) above a discount of 50% from the premium applicable to death cover may be allowed from the total premium payable.Personal Accident Insurance, Group Policy With Double Benefits : In certain tailor made policies benefits are incorporated which provides for payment of double the compensation payable for death and/or loss of limbs or eyes, in the event of bodily injury resulting from an accident to the lift, train, tram, omnibus or other licensed vehicle in which the insured at the time of injuries traveling as an ordinary passenger or in the event of injury sustained as a direct result of the insured being lawfully within a burning building.

Personal Accident Insurance, Group Policy : Linkage of Capital Sum Insured with the earnings of the Insured Person :

Capital sum insured to be fixed in relation to Insured person’s earnings from gainful employment maximum up to 120 times of the personal monthly income in case of Table I cover and 60 times in case of Table II and Table III Covers.

Personal Accident Insurance, Group Policy : Tailor made Group Personal Accident Insurance Policy : Insurers usually draft tailor-made schemes to suit the requirements of institutional clients in respect of groups consisting of more than certain minimum number of persons., say 500 and abovePersonal Accident Insurance, Group Policy : Group Discounts : If the number of insured persons in a group exceeds 25 then the group discount shall be allowed as per provisions.

6. Personal Accident, Gramin Accident Insurance : The cheapest Personal Accident Insurance Policy for person between the age group of 10 to 70 years can be issue at an annual premium of Rs. 5/- per person covering death, loss of use of two eyes or two limbs or one eye and one limb, permanent total disablement due to accident for Rs. 10,000/- and loss of use of one eye or one limb due to accident for Rs. 5,000/- Group policies can also be issued in which case no claim discount could also be allowed.

7. Personal Accident, Janata Personal Accident Insurance : A specially devised personal accident Insurance Policy for lower income group of 10 to 70 years. The Policy covers death, loss of use of limbs, permanent total disablement due to accident. The sum insured i.e., the amount of indemnity is Rs. 25,000/- to Rs. 1,00,000/- and the rate of premium is Rs. 15/- for a sum insured of Rs. 25,000/-. The sum insured shall be increased in multiples of Rs. 25,000/- and premium is charged accordingly. Group discount and no claim discounts are allowable for Group policies. The Policy covers accidental death, loss of use of two limbs, sight in both eyes, one eye and one limb or permanent total disablement in which case 100% of the sum insured is payable. In case of total and irrecoverable loss of use of one limb/sight of one eye 50% of the sum insured is payable. Policy can also be issued for a longer period up to 5 years with appropriate increase in premium payable at the inception of the policy. Group Janata Personal Accident Policy can also be issued when the norms for groups are the same as a regular Personal Accident Group Insurance Policy. Here, the distinction is that the policy can be issued for a longer period of 3 to 5 years.

8. Personal Accident Insurance for Visitors in Bank Premises : The personal accident policy benefits payable to visitors in bank premises. The Policy would be issued to the bank, the benefits payable under the Policy shall reach he beneficiary through the concerned bank.

9. Personal Accident for School Going Children : Groups of students in schools recognized by State Government or Central board can take this Insurance. Sum insured is stipulated moderately per student. Along with the students the teachers and other staff members also can be covered at the same rate. Benefit provided is against death, loss of two limbs, two eyes or one limb and one eye, permanent total disablement and permanent partial disablement. Age limit for students is 3 to 19 year. The cover is operative for 24 hours and is not restricted to school hours only. The school authorities will have to collect the premium and remit it to the Insurers. The Scheme can be suitably modified to cover College/University/Technical Education Institutions.

10. Personal Accident-Air Travel Flight Coupons : To cover accidents in air travel. Bodily injury resulting in death or disablement by accident is covered: (a) whilst travelling in airlines vehicles from booking office to airport. (b) whilst in the airport for the purpose of travel. (c) whilst mounting into the aircraft, (d) whilst travelling in the aircraft as a fare-paying passenger on any scheduled route, (e) whilst travelling in vehicle from airport to booking office. The cover may be (i) for specific flight(s) only for which flat premium is charged based on sum insured and duration of flight/s, and (ii) The cover may be issued for a certain specific period of time and the company will be at risk in respect of all the flights undertaken by the insured within that period. A deposit premium equivalent to number of flights likely to be undertaken is collected. At the end of the policy insured has to declare all the flights actually undertaken for adjustment of premium. The declaration policies can also be given to companies in respect of their employees who travel by air frequently.

11. Personal Accident-Group Cover for Rickshaw Pullers : The Policy covers death and PTD risks in addition to limited hospitalization cover including pre and post hospitalization not exceeding 15 days each covering hospitalization arising from accident or in respect of varicose veins and piles only excluding domiciliary hospitalization. The Insurance can be provided to Rickshaw Pullers in the age group of 16 to 65 years through a State Govt. Authority or Bank or any other financial institution.

12. Personal Accident Insurance Policy with Medical Expenses arising out of Road Accident (Traffic Accident only) : A short period cover usually issued to Persons including their families for undertaking travel within the geographical scope mentioned. The Policy besides personal accident benefits also cover Medical expenses incurred consequent upon road accidents. Medical expenses can be a per cent age of the basic sum insured or up to a maximum limit.

13. Personal Accident Social Security Scheme : This was a Social Security Scheme formulated and sponsored by Government of India and was being implemented by then GIC through its subsidiary companies. The scheme provided for payment of compensation amount of Rs. 3,000 to the family whose earning member died due to an accident. The term ‘accident’ included drowning, snakebite, food poisoning, fall from a tree, killing by armed criminals or wild animals, lightning. The compensation under the scheme was payable, if the earning member was between the age of 18 to 60 years and the income of the family from all the sources was less than Rs. 7,200 per annum. The undernoted were eligible for the benefit under the scheme-surviving husband/wife, if not living, surviving dependent children, if not living, dependent parents, if not living, dependent unmarried brother/sister.
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A type of insurance which provides for the payment of specified sums in the event that the insured suffers some bodily injury as a result of an accident.