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Personal Accident

A benefit on death or disablement caused by an accident, paid on the event rather than against bills.

Also calledIndividual Personal Accident · PA Policy

File/Claims library/Health, life and accident/Injury and accident

First thing, todayReport it at once and get the injury recorded by a doctor on the day, because the link between the accident and the disablement is what the claim turns on.

Three deadlines
  • Tell the insurer now, not after the assessment.
  • The statutory notice to whoever the law requires, within the time it sets.
  • Every document within the time the insurer asks for it.
A site where a ladder has fallen, a hard hat left on the ground
A site where a ladder has fallen, a hard hat left on the ground. An illustration.

When you would claim

  • Accidental death
  • Permanent total or partial disablement after an accident
  • Temporary total disablement, where the policy pays weekly
  • Fractures or burns, where the policy carries a benefit table

What insurers most often rely on

  • Disablement said to be from illness rather than from the accident
  • The percentage of disablement assessed lower than the claim
  • Accident while under the influence, or during an excluded activity
  • No medical record from the day, so the link is argued about
  • Late intimation, where the policy sets a short notice period

Most are answered by the treating doctor in a paragraph, once somebody asks for the right paragraph.

The documents

ask the hospital on the day

9 items. A hospital will hand you most of them on the day if you ask at the desk, and take three weeks over them if you ask in a month. Ask on the day.

  • Claim form and the policy schedule
  • FIR or the police report, where the accident was on the road
  • First medical record from the day of the accident
  • Disability certificate from the competent medical authority
  • Photographs and X-ray or scan reports supporting the injury
  • Employer's leave record, on a temporary disablement claim
  • Cancelled cheque and bank details in the insured's name, for the NEFT payment
  • Details of any other insurance covering the same accident
  • The benefit claimed, read against the capital sum insured and the disablement table in the policy
Admission to dischargeThree dates and the gap between them is most of what a health insurer queries. Note the hour of the emergency admission too: several wordings count in hours, not days.

Next

Employee Injury Claim: What to Do First, and what it shares with this

Open the employee injury playbook. The first hours are about treatment and the record of it, and the commonest way this claim is lost is a private settlement reached before the insurer was told.

Call 92514 56334

Read the benefit table

This pays a benefit, not a loss. The capital sum insured and the policy's own table decide the figure, and no amount of receipts moves it. What is worth reading before a claim is which events are on that table and what each is worth.

Filed under: Health, life and accident · Injury and accident

Claims that sit next to this one

the same person, a different trigger

Health Insurance

the hospital bill itself

Critical Illness

illness rather than accident

Group Personal Accident

the same cover, bought by an employer

Somebody hurt at work and the paperwork already behind? Report a loss or call 92514 56334.