Group Personal Accident Insurance

What is Covered

Accident insurance covers bodily injuries resulting directly from an accident caused by external, violent, and visible means, which end in death or permanent
or temporary disablement.

• Accidental death

• Permanent total disability

• Permanent partial disability

• Weekly Benefit (Loss of Pay/Income)

Add-On Covers and Riders

• Accidental Medical Expenses (Inpatient) Reimbursement

• Accidental Medical Expenses (Outpatient) Reimbursement

• Child Education Allowance

• Repatriation of mortal remains

• Repatriation of mortal remains

• Mobility Modification allowance

• Emergency family travel expenses.

• Broken bones

• Ambulance charges

What is not covered?

• Pre-existing conditions

• Suicide or self-injury

• Participation in sports or adventurous activities

• Illegal/Criminal Act.

• Natural death

• Non-allopathic treatments

• An injury caused by the influence of drugs/alcohol

• Pregnancy/childbirth

• Occupational diseases

• An injury caused by radioactivity

• Military Service or operations

• War/nuclear unrest

Who can buy the GPA Policy?

• This policy can be offered as an employee benefit by employers.

• The bank can offer coverage to its account holders, shareholders, etc.

• Members of cooperative societies can be covered by these policies

• NGOs or other social welfare organizations/associations can also have this policy

Group Personal Accident Insurance Vs Employee Compensation (Act) Policy

• The coverage provided by both policies is similar in case of death or disability. The GPA cover does not have limitations on work-related accidents, and you can choose higher sums assured, but you will not be covered for unlimited liability as with WC.

• GPA is a Benefit policy, whereas WC is a Legal Liability Policy.

• Workman’s Compensation policy can be enhanced by a Group Personal Accident Insurance policy so that employees receive extra benefits over and above that provided by WC. The GPA policy is a benefit policy and cannot replace a workers’ compensation policy.

• GPA provides coverage for accidents occurring 24 hours a day worldwide, whereas the Workmen’s Compensation Policy covers only accidents occurring while on duty.

• The GPA Policy also allows you to choose the benefit limit per employee or member based on your needs. A Workmen’s Compensation Policy defines only the maximum and minimum compensation in accordance with the WC Act.

• GPA policies can be issued on an unnamed or named basis, while Workmen’s Compensation policies can only be issued on an unnamed basis.

Claim Procedure and Documentation

• In the event of an accident, the insurance company must be notified

• A claim is filed, and the insurance company provides a checklist of required documents.

In the case of disability claims

• Claim form

• Proof of identity

• Employer’s incident report (cause of the accident).

• Leave certificate from the employer

• Certificate of salary or other income documentation.

• Doctor’s certificate of treatment.

• Related Medical Papers, Reports, and Final bills.

• Police FIR/ MLC (if done)

• A disability certificate signed by an attending doctor or civil surgeon

• The treating doctor or civil surgeon must provide a fitness certificate.

Additional Requirement (in case of death)

• Death certificate

• Post-mortem report

• Notarized affidavit or succession certificate (payment to the nominee)