accidentaccident care. facts and figures about road accidents- ill-planned motorization kills one...
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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