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ACCIDENTACCIDENT CARE. Facts and Figures about Road Accidents- Ill-planned motorization kills one person every six minutes on Indias roads. Road accidents.

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Presentation on theme: "ACCIDENTACCIDENT CARE. Facts and Figures about Road Accidents- Ill-planned motorization kills one person every six minutes on Indias roads. Road accidents."— Presentation transcript:

1 ACCIDENTACCIDENT CARE

2 Facts and Figures about Road Accidents- Ill-planned motorization kills one person every six minutes on Indias roads. Road accidents in cost India about 3 per cent of its GDP. During , 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 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.

3 ACCIDENT ?

4 Definition of Accident Means a sudden, unforeseen, uncontrollable and unexpected physical event to the insured person caused by external, violent and visible means.

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11 Accident Means Not only Road/Rail or Travel accidents but also includes : Accidental Fall Electric Shock Snake Bite Drowning in Water Murder

12 Covers Covers Accidental Death Disablement

13 Age 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.

14 Table of Benefits Table IDeath Cover Only Table IIDeath + Permanent Total Disablement (PTD) + Permanent Partial Disablement (PPD) Table IIIDeath + Permanent Total Disablement (PTD) + Permanent Partial Disablement (PPD) + Temporary Total Disablement (TTD)

15 Table 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

16 Table II : Accidental Death + 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

17 Table II : Percentage of compensation Payable BenefitsBenefits 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%

18 Table II : Percentage of Compensation Payable (contd.) BenefitsBenefits 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% 50%

19 Table II : Percentage of Compensation Payable (contd.) BENEFITSPercentage 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 Table II : Percentage of Compensation Payable (contd.) BENEFITSPercentage 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 Percentage as assessed by the panel Doctor of the Company

21 Table III Accidental Death+PTD+PPD+TTD Death Cover - As per Table I Death+PTD+PPD Cover- As per Table II TTD Cover Weekly 1% of the Sum Insured not exceeding Rs per week

22 Capital Sum Insured 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)

23 Capital Sum Insured Maximum Limit 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

24 Risk Groups Risk Group IPersons engaged primarily in administrative functions Risk Group IIPersons engaged in manual work other than what is specifically provided under Group III Risk Group IIIPersons working in explosives industry, mine and / or magazine workers, high tension supply, horse racing including jockeys, athletes and occupations of similar hazard.

25 Premium Rating COVERAGE / RISK GROUP GROUP 1GROUP 2GROUP 3 Table I Table II Table III Note: Rate provided is Per Mille i.e., Per Thousand

26 Additional Benefits Educational Grant – Rs.5000 per Child below 18 years maximum Rs 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)

27 Medical Expenses Extension 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.

28 Cumulative Bonus Applicable for Death and PTD cover only. 5 % increase in Capital Sum Insured for every claim free year. Maximum 50 %.

29 Transfer 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.

30 Major Exclusions Any 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.

31 Claims 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 Coroners Report/Police Inquest Report

32 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 Employers Certificate for the period of absence from duty (for TTD Claims)

33 Thank You


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