case study of personal accident insurance

Real-life case studies on personal accident insurance

Real-life case studies can be a valuable tool in understanding the importance of personal accident insurance. These stories illustrate the impact that an unexpected accident can have on individuals and families, and the role that personal accident insurance can play in providing financial protection. Here are some real-life case studies that highlight the importance of personal accident insurance.

Case Study 1: John’s Story

John was a healthy and active 35-year-old man. One day, while playing basketball with his friends, he suffered a serious knee injury that required surgery and months of physical therapy. As a result, he was unable to work and had to rely on his savings to pay his bills. Fortunately, John had a personal accident insurance policy that provided coverage for temporary total disability. This coverage provided him with a percentage of his salary for the duration of his disability. Without this coverage, John would have faced significant financial hardship.

Case Study 2: Maria’s Story

Maria was a 45-year-old mother of two. One day, while driving her children to school, she was involved in a car accident that resulted in her death. Maria’s husband was devastated by the loss of his wife and the impact it would have on their family. However, he was relieved to discover that Maria had a personal accident insurance policy that provided coverage for accidental death. This policy provided him with a lump sum payout that helped him pay for the family’s expenses and allowed him to take time off work to grieve and care for his children.

Case Study 3: David’s Story

David was a 30-year-old construction worker. One day, while working on a job site, he fell from a scaffolding and suffered a spinal cord injury that left him permanently disabled. David’s personal accident insurance policy provided coverage for permanent disability, which provided him with a lump sum payout that helped him pay for his medical expenses and adapt his home to his new needs. This coverage allowed David to maintain his financial independence and quality of life despite his disability.

Case Study 4: Sarah’s Story

Sarah was a 50-year-old business owner. One day, while walking down the stairs in her office building, she slipped and fell, injuring her back. The injury was severe and required surgery, leaving Sarah unable to work for several months. Sarah’s personal accident insurance policy provided coverage for temporary total disability, which provided her with a percentage of her salary for the duration of her disability. This coverage allowed Sarah to pay her bills and maintain her business while she recovered from her injury.

These case studies illustrate the importance of personal accident insurance in providing financial protection in the event of an unexpected accident. Personal accident insurance policies can provide coverage for a range of benefits, including accidental death, permanent disability, temporary total disability, and medical expenses. The coverage amount and type, premiums, exclusions, duration of

coverage, and reputation and financial strength of the insurer are all factors to consider when choosing a personal accident insurance policy.

In conclusion, real-life case studies demonstrate the value of personal accident insurance in providing financial protection in the event of an unexpected accident. These stories highlight the impact that accidents can have on individuals and families and the role that personal accident insurance can play in providing peace of mind and security. When choosing a personal accident insurance policy, it’s important to consider the coverage amount and type, premiums, exclusions, duration of coverage, and reputation and financial strength of the insurer to ensure that you choose a policy that provides the necessary coverage for your needs and circumstances. If you are based in Dubai then hiring an effective insurance broker in Dubai  can definitely help in making this task easier for you.

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The Pros And Cons Of Personal Accident Insurance: Is It Worth It?

Accidents can happen at any time, and they can be costly to deal with. The costs associated with medical bills, rehabilitation, and time off work can quickly add up, leaving many people struggling to make ends meet.

Personal accident insurance is designed to help offset some of these costs. But is it worth it? In this article, we’ll take a closer look at the pros and cons of personal accident insurance to help you decide whether it’s the right choice for you.

What Is Personal Accident Insurance?

Financial protection, peace of mind, easy to obtain, limited coverage, duplication of coverage, is personal accident insurance worth it.

Personal accident insurance is an insurance policy that provides financial compensation in the event of an accident that results in injury or death. It is often sold as a standalone policy, but it can also be included as part of a broader insurance policy, such as a life insurance policy.

Personal accident insurance typically covers a range of accidents, including those that occur at home, at work, or while traveling. The policy may include coverage for medical expenses, disability payments, and accidental death benefits.

The Pros Of Personal Accident Insurance

One of the main benefits of personal accident insurance is that it provides financial protection in the event of an accident. The policy can help cover the costs of medical bills, rehabilitation, and time off work, which can be especially helpful if your accident leaves you unable to earn a living.

Having personal accident insurance can provide peace of mind, knowing that you and your family are protected in the event of an accident. Knowing that you have financial support in place can help you focus on recovery and getting back to your normal life.

Personal accident insurance is usually easy to obtain, with many insurance providers offering policies online or over the phone. The process of applying for and obtaining a policy is generally straightforward, with minimal paperwork or medical examinations required.

The Cons Of Personal Accident Insurance

One of the main drawbacks of personal accident insurance is that it provides limited coverage. The policy may only cover specific types of accidents, and there may be certain exclusions or limitations on the coverage provided. Additionally, the benefit amounts provided may be relatively low compared to other types of insurance.

Personal accident insurance can be expensive, particularly if you are looking for comprehensive coverage. The cost of the policy will depend on a range of factors, including your age, occupation, and health status. Additionally, if you have a pre-existing medical condition, you may find it difficult to obtain coverage at all.

If you already have an existing insurance policy, such as life insurance or health insurance, some of the coverage provided by personal accident insurance may overlap with your existing policies. This can make personal accident insurance redundant and may mean that you are paying for more insurance coverage than you need.

Whether personal accident insurance is worth it will depend on your individual circumstances and insurance needs. If you are at a higher risk of accidents due to your occupation or lifestyle, or if you do not have existing insurance coverage, personal accident insurance may be a worthwhile investment.

However, if you already have comprehensive insurance coverage and do not consider yourself at high risk of accidents, personal accident insurance may not be necessary.

Personal accident insurance can provide valuable financial protection in the event of an accident. However, it is important to weigh up the pros and cons and consider your individual circumstances before deciding whether it is worth investing in a policy. As with any insurance policy, it is important to read the terms and conditions carefully and shop around to find a policy that meets your needs at a price you can afford.

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Understanding Personal Accident Insurance: Coverage, Benefits, And Choosing The Right Plan

• August 3, 2023

Accidents are unexpected and unfortunate events that can occur in anyone’s life. They can lead to extensive medical expenses and serious financial burdens, whether you’re dealing with a minor injury or a more severe incident. 

The right insurance coverage can provide a safety net and peace of mind in these situations.

Personal accident insurance is a form of coverage that offers financial protection in the event of an accident. This article explores the available accident insurance plans, their benefits, and how to choose the right plan.  

What Is Personal Accident Insurance Coverage?

Accident insurance coverage is a specialized type of insurance designed to provide financial support and protection to individuals who suffer injuries or accidents. 

Unlike health insurance, which may cover a broad range of medical expenses, accident insurance focuses specifically on accidents and their associated costs. This form of coverage can supplement existing health insurance or stand alone as a separate policy.

Accidents can happen anytime and in various forms, such as slips and falls, sports-related injuries, car accidents, or other unforeseen mishaps. Regardless of the type of accident, the resulting medical bills and out-of-pocket expenses can quickly add up, leading to significant financial strain. 

Accident insurance policies typically offer a lump-sum payment or predetermined benefits to policyholders with qualifying injuries or accidents. The payout is usually based on the type of injury sustained and the extent of medical treatment required. 

This financial assistance can cover various expenses, such as medical bills, hospital stays, physical therapy, and even non-medical costs like transportation or childcare during recovery.

How Does It Work?

Accident insurance operates on a straightforward and transparent principle. When you purchase an accident insurance policy, you secure financial protection against unforeseen accidents or injuries.

When selecting insurance, you’ll explore different accident insurance policies and select one that aligns with your needs. Enhance Health , as a reputable source for insurance, can help you to compare options and choose the most suitable coverage for your needs.

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Once you’ve selected a policy, you must pay regular premium amounts to the insurance company. If you or a covered family member experiences an accident or sustains a qualifying injury, you can submit a claim.

During the claims process, you will likely be required to submit relevant documentation and medical records verifying the accident’s occurrence and nature. After the claim is approved, you will receive the payout per the agreed-upon amount.

Types Of Accident Insurance Coverage

The two main types of accident insurance are accident expense insurance and accidental death insurance. 

Accidental insurance refers to the payment you receive for injuries sustained in an accident. Death insurance is paid to your nominated beneficiaries in the case of your accidental death.

Accidental Expense Insurance 

Knowing when to use accident insurance coverage is essential to maximizing its benefits and protecting yourself from the financial burden of unexpected accidents.

It is designed to cover various accidental injuries, such as fractures, dislocations, burns, and concussions. If you or a covered family member sustains such injuries, accident insurance can help offset the medical expenses and other related costs that could make life even more difficult. 

Accidents often lead to emergency room visits, where immediate medical attention is necessary. Insurance can help cover the costs associated with emergency room care, including examinations, treatments, and medications. It can also help offset any rehabilitation you need post-treatment. 

Accidental Death Insurance

It’s important to review your accident insurance policy to understand its specific coverage, limitations, and exclusions. Additionally, be aware of any waiting periods that may apply before certain benefits become active.

The Benefits Of Accident Insurance Coverage

There are many benefits to having accident insurance. They include : 

• Financial Security : In the event of an accident, the policyholder receives a lump-sum payment or predetermined benefits. This can be used to cover medical expenses, hospitalization costs, and other related bills.
• Supplemental Coverag e: Working alongside other forms of insurance, accident insurance can fill gaps in coverage and provide additional support for out-of-pocket expenses. 
• Quick Processing: Accident insurance can be processed fairly quickly, providing immediate financial relief during a challenging time. 
• Available To All Ages: Accident insurance is available to people of all ages. This makes it an excellent option for individuals, families, and even seniors who want an extra layer of protection against accidents.
• Suits All Lifestyles : The coverage can also be tailored to suit individual needs and lifestyles. Policyholders can choose coverage levels that align with their specific requirements. 

How To Choose The Right Accident Insurance Coverage

To choose the right accident insurance, you will want to consider your specific needs, budget, and circumstances carefully. 

You should assess your personal risk factors and lifestyle. These factors include 

• daily activities
• any potential hazards you face regularly.

Next, you’ll need to seek out reputable insurance companies that offer accident insurance. Focus on companies with a proven track record that are regarded as reliable. 

When you’re looking at plans, make sure to carefully review the coverage details of each accident insurance policy you are considering. Check for any limitations, exclusions, or waiting periods that may apply.

If you’re unsure which accident insurance coverage to choose, consider seeking advice from insurance agents or advisors like our team at Enhance Health. Simply give us a call and we can help you find the right insurance policy for your needs. We guide you through all your options, helping you understand the fine print so that you can make an informed decision. 

The Cost Of Accident Insurance Coverage

The cost of accident insurance coverage can vary based on several factors:

The Type Of Policy

One significant factor is the type of policy you choose, which can influence the premium amount. Some monthly premiums are as low as $4 or as high as $50. 

A comprehensive accident insurance policy covering a wide range of accidents and injuries may have a higher premium than a policy with more limited coverage.

Coverage Amount

The coverage amount you select will also impact the cost. Policies with higher coverage limits typically come with higher premiums. This is because the insurance company would have to pay out a larger sum in the event of a claim.

Another crucial factor in determining the cost of accident insurance is age. Generally, younger individuals are going to pay lower premiums as they are perceived to be at a lower risk of experiencing accidents.

Occupation 

Occupation and lifestyle also play a role in premium calculations. Individuals in hazardous occupations or engaging in extreme sports may be considered riskier to insure, leading to higher premiums.

How To File A Claim For Accident Insurance Coverage

• When the accident happens, notify your insurance company or the designated claims department. Many insurance companies have a 24/7 claims helpline to assist you at any time.
• Prepare all relevant information related to the accident, such as the incident’s date, time, and location. Provide details about how the accident occurred and any involved parties.
• If you sought medical treatment following the accident, gather all medical records, bills, and receipts related to the treatment. These documents will help substantiate your claim.
• Your insurance company will provide you with a claim form. Complete it accurately and thoroughly, including all required details about the accident and your injuries.
• You’ll next need to add supporting documents like medical reports, hospital invoices, and more. 
• Once you have completed the claim forms and collected the supporting documents, submit them to your insurance company. 
• The claim will be evaluated and, if approved, paid out. 

Common Exclusions Of Accident Insurance Coverage 

While accident insurance provides valuable financial protection for various types of accidents and injuries, it’s essential to be aware of common exclusions. These are situations or circumstances that your policy does not cover. Some common exclusions include: 

• Injuries or conditions before the policy’s effective date. 
• Intentional self-inflicted injuries are also not covered.
• Accidents under the influence of alcohol or drugs.
• Injuries sustained while engaged in criminal activities. 
• Some high-risk activities are also not included in basic policies, for example, racing, extreme sports, and professional athletics. 

Tips For Maximizing Accident Insurance Coverage Benefits

Accident insurance coverage offers valuable financial protection, and maximizing its benefits can be beneficial during unforeseen accidents.

• Familiarize yourself with the coverage details and exclusions of your accident insurance policy.
• Keep your insurance company updated with accurate and current information, such as contact details and beneficiaries.
• Report any accidents to your insurance company right away.
• In the event of an accident, seek medical attention as soon as possible. 
• Opt for healthcare providers that offer direct billing to your insurance company when possible.
• Cooperate fully with the claims adjuster during the claims process.

Personal accident insurance coverage is a vital safeguard against the unexpected financial burdens that accidents can bring. It provides individuals and their families with the peace of mind that comes from knowing they have a safety net to protect them during challenging times. 

By understanding the key aspects of accident insurance, including its coverage, benefits, and exclusions, you can make an informed decision to select the right policy that meets your specific needs.

If you’re not sure how to go about this process, get in touch with us at Enhance Health . We can guide you through a wide range of policies from reputable insurance companies and provide expert advice to help you make the right decision.

At Enhance Health, our mission is to empower individuals to protect themselves and their families through comprehensive and suitable insurance coverage.

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How Personal Accident Insurance Works: Coverage, Purpose, Claiming Process, and Who Should Buy It?

Accidents are unpredictable and can result in unforeseen medical expenses and financial strain. To protect against such uncertainties, personal accident insurance offers a safety net for individuals and their families. In this blog, we will delve into how personal accident insurance works, its coverage, and who should consider getting it.

What is Personal Accident Insurance?

Personal accident insurance is a specialized type of insurance that provides financial compensation in the event of an accident resulting in bodily injury, disability, or death. Unlike health insurance , which covers medical expenses related to illnesses and general medical treatments, personal accident insurance focuses specifically on accidents. The policyholder pays regular premiums, and in the event of an accident, the insurer provides a lump sum benefit or weekly payouts depending on the extent of the injury or disability.

What is the Coverage of Personal Accident Insurance?

• Accidental Death Benefit : In the unfortunate event of the insured’s death due to an accident, the policy’s beneficiaries receive a lump sum payout.
• Permanent Total Disability : If an accident causes permanent and total disability, the policyholder is entitled to a lump sum payment.
• Permanent Partial Disability : In cases where the insured sustains a permanent partial disability, such as the loss of a limb or eyesight, a percentage of the sum insured is paid out.
• Temporary Total Disability : If the accident results in temporary total disability, the policy provides weekly or monthly payouts during the recovery period.
• Medical Expenses Reimbursement : Personal accident insurance may cover medical expenses incurred due to the accident, including hospitalization, ambulance fees, and other necessary treatments.

What is the Purpose of Personal Accident Insurance?

The purpose of personal accident insurance is to provide financial protection and support to individuals and their families in the event of accidents resulting in bodily injury, disability, or death. This specialized insurance offers coverage for accidental death, permanent and partial disabilities, temporary disabilities, and medical expenses incurred due to an accident. By offering a lump sum benefit or regular payouts, personal accident insurance ensures that policyholders and their loved ones are shielded from the financial burden caused by unexpected accidents, providing peace of mind and security during challenging times.

What is Excluded in Personal Accident Insurance?

Personal accident insurance typically includes specific exclusions, which are scenarios and circumstances not covered by the policy. Common exclusions may involve:

• Pre-existing Conditions : Injuries or disabilities that existed before the policy’s inception are usually excluded from coverage.
• Self-Inflicted Injuries : Injuries sustained intentionally by the policyholder, such as attempted suicide, are generally not covered.
• War and Terrorism : Personal accident insurance often excludes injuries resulting from acts of war, civil unrest, and acts of terrorism.
• Hazardous Activities : Engaging in high-risk activities, such as skydiving or extreme sports, may lead to exclusions in case of accidents related to these activities.
• Intoxication : Injuries caused while under the influence of alcohol or drugs may not be covered.
• Professional Sports : Personal accident insurance may not extend coverage to injuries sustained while participating in professional sports or as a professional athlete.

It is crucial to thoroughly review your policy documents to understand the specific exclusions of your personal accident insurance policy.

How Do I Claim a Personal Accident Policy?

To claim a personal accident insurance policy, follow these general steps:

• Notify the Insurer : Contact your insurance provider as soon as possible after the accident to inform them about the incident and initiate the claims process. Many insurers have a specified time frame within which claims should be filed.
• Gather Documentation : Prepare all necessary documents, including the policy documents, a filled claim form, a copy of the FIR (in case of an accident), medical reports, hospital bills, and any other relevant evidence supporting your claim.
• Submit the Claim : Submit the completed claim form along with the required documents to the insurance company . You can typically submit the claim online, through email, or in person at the insurer’s office.
• Await Assessment : The insurer will review your claim and assess the eligibility for coverage based on the policy terms and the provided documentation. This may involve verification and investigation.
• Receive Payout : If your claim is approved, the insurer will disburse the agreed-upon benefit, which could be a lump sum payment or regular payouts, depending on the policy terms.
• Follow Up : Stay in touch with the insurer to monitor the progress of your claim. If there are any delays or issues, follow up with the insurance company’s customer service team for clarification and updates.

The specific process for claiming a personal accident insurance policy may vary depending on the insurance provider and the policy terms. It’s essential to thoroughly read and understand your policy documents and contact the insurance company for specific guidance on the claims process.

Who Should Get Personal Accident Insurance?

Personal accident insurance is suitable for a wide range of individuals due to its comprehensive coverage and affordable premiums. The following groups can significantly benefit from this insurance:

• Breadwinners : Individuals who are the primary earners for their families should consider personal accident insurance to ensure their loved ones are financially protected in case of an accident.
• Professionals and Workers : Occupations with higher risks of accidents, such as construction workers, delivery drivers, and athletes, can benefit from the added protection of personal accident insurance.
• Students : Young individuals, including students, are exposed to various risks in their daily lives. Having personal accident insurance provides them with financial security if an accident occurs.
• Retirees : Seniors can also benefit from personal accident insurance, as it can offer financial support for medical expenses or lost income if an accident affects their retirement plans.
• Travelers : Individuals who frequently travel for work or leisure can find personal accident insurance valuable, especially when venturing to unfamiliar or potentially risky destinations.

Personal accident insurance is a valuable safety net that provides financial support in the aftermath of an accident. It covers a wide range of scenarios, including accidental death, disability, and medical expenses. Anyone can benefit from this insurance, but it holds particular importance for breadwinners, workers in high-risk professions, students, retirees, and frequent travelers. By investing in personal accident insurance, individuals can have peace of mind, knowing that they and their families are protected from the financial burden that may arise from unexpected accidents. As with any insurance decision, it’s essential to compare policies, understand the terms and conditions, and consult with insurance experts to find the best coverage that suits individual needs and budget.

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Accident & Health Insurance

What Is Accident Insurance and How Does It Work? 

Your health – and the health of your family – is priceless. But recovering your health, especially when unexpected injuries occur, can come at a surprisingly high cost. An unforeseen medical bill can significantly set you and your family back financially.

In fact, one survey found that less than 50% of U.S. adults have three months’ worth of savings for an emergency expense — such as an unexpected trip to the hospital. 1  One way you can better prepare for accidents or injuries is with accident insurance. 

For a monthly premium, accident insurance can provide funds to help you pay for unexpected expenses after an accidental injury like a fracture or concussion. A medical plan may leave you with extra costs to cover that an accident insurance plan can help pay. Whatever you need while recovering from an accident or injury, whether that’s another form of transport to get to work or help covering rent while you’re out of work, a payment from accident insurance can help.

How does accident insurance typically work?

When a covered event happens, you submit a claim. Next, a claims professional reviews it and, if approved, a payment is sent directly to you to use as you see fit.

In the event of a policyholder’s accidental death, the benefit will be paid out to the designated beneficiary.

Why might accident insurance be a good idea?

No one knows when an accident may occur, which is why anyone may benefit from accident insurance. It could also be especially beneficial if:

• You and your family lead an active lifestyle that may increase the risk of accidents.
• You don’t receive paid time off, sick days, or workers’ compensation and wouldn’t earn a paycheck while out of work due to an accident.

What does accident insurance generally cover?

An accident insurance policy may help cover costs resulting from:

• Medical services and treatments
• Hospitalization
• Accidental death
• Dismemberment, loss, and paralysis

Your coverage will depend on your specific policy. For a complete list of what’s covered, check with your employer’s benefits administrator if you obtain coverage through work.

Is accident insurance worth it?

Expenses can add up quickly after an accident. For example, treatment for a broken leg can cost up to $7,500. 2   If you haven’t met your deductible or out-of-pocket maximum, you could be left paying a large portion of that expense.

Read four other reasons why accident insurance might be worth it for you.

Other supplemental insurance

Life is full of the unexpected. And sometimes, that can put a strain on your family and your wallet. Fortunately, supplemental insurance plans can help cover some costs so you can focus on healing.

Hospital indemnity

While accident insurance may be good for covering a quick trip to the emergency room, hospital indemnity insurance is another option that can help cover costs if you need a longer stay or frequent visits, like accident-related inpatient rehabilitation. You submit a claim and, if approved, receive a check directly.

Critical illness

Similar to the way accident insurance works, critical illness insurance is designed to help you pay for out-of-pocket expenses related to covered illnesses — which may include strokes, cancer, and organ transplants. This supplemental policy may provide a lump-sum payment that you can use when expenses arise.

Disability and absence services

If a covered disability happens and you’re unable to earn your paycheck at work, short-term and long-term disability insurance — as well as paid family and medical leave — can help support you financially. You may be able to receive weekly payments for three months to a year, depending on your policy.

Deciding on accident insurance plans

When it comes to choosing an accident insurance plan, here are a few questions to ask to make sure you’re getting the right coverage for you:

• What is and isn’t covered by the plan?
• How do you receive payouts (i.e. one payment or multiple payments)?

Related Reads

Get information about metlife accident insurance.

 1 “Bankrate’s 2023 annual emergency savings report,” Bankrate, 2023 

2 “Why health insurance is important,” HealthCare.gov

This article is intended to provide general information about insurance. It does not describe any MetLife product or feature.

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What is a personal accident insurance policy: who needs it and why.

This article explains the pros and cons of a Personal Accident Insurance policy and makes a case for getting one to safeguard your financial goals.

📚 Topics covered:

What is personal accident insurance, temporary partial/total disability (tpd/ttd), permanent partial disability (ppd), permanent total disability (ptd), accidental death, what is an accident, should you consider a term insurance policy with a pa rider, how is a pa cover different from a pa cover in vehicle insurance, how much pa cover should you get, are there alternatives to a pa cover, how to get a cover, is it worth it.

The purpose of the personal accident (PA) insurance policy is to provide a replacement for your income if you have an accident and cannot work after that. Unlike term insurance, where claims are paid on death, a PA cover is applicable when one of the following is the result of an accident :

• accidental death
• temporary or permanent partial disability
• temporary or permanent total disability

What are the main features of a PA policy?

General insurance companies, just like health insurance policies, sell PA policies. The premium depends on the sum insured (SI) and profession and not too much on the age. The policies are renewable yearly; usually, 2-3 year premiums are offered at a discount. 18% GST is applicable on the premium.

The purpose of the PA policy is for such cases where due to an accident , you do not die but are unable to work. The onus is on the insured person to conclusively prove if the disability due to the accident is preventing you from earning your living.

In all cases, you need to be able to prove that the injury is preventing you from doing your day job. In each case, the amount paid out will depend on the policy terms. From least to most severe, the benefits are, using some representative cases, from one of the policy term documents on the Insurance Regulatory and Development Authority of India (IRDAI) site:

These injuries will heal with time, like fractures or paralysis that may get cured. However, these cases offer the lowest payout, around 1% of the SI per week, until recovery or small lump sum amounts. In most cases, TTD/TPD will not be meaningfully covered.

Temporary loss of limb(s), paralysis or sense organs (eye/ear), uniplegia (paralysis of a single limb) etc., fall under this category. The payout may be 25-100% of the SI.

The payout may be 100% of the SI since cases like a total loss of limb(s), sense organ(s) or paralysis are covered here.

The insurance company will generally pay out 100-200% of the sum insured.

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We have put accident in italics in the previous paragraphs since the definition is fundamental in buying a PA policy. As per multiple PA policy documents on the IRDAI website, an accident is defined as:

An accident is a sudden, unforeseen and involuntary event caused by external, visible and violent means - Source: IRDAI site

The following examples could lead to claim rejection if they strictly do not follow the definition of an accident:

• sudden: planned activities like acrobatics, water sports or similar acts may get excluded
• unforeseen: it is not unforeseen that if you walk on the road, a car may hit you. So a vehicle hitting you is admissible if and only if you were walking where it is legally allowed to walk, like on a pavement
• visible: you were crossing the road in the middle of the night on a zebra crossing, and a car hit you and escaped. The insurer will ask for witnesses for the incident
• violent: slipping inside the house may not be an accident since the insurer could argue that it is not violent

In many cases, you may need an FIR and medical examiner’s report or autopsy report to support the claim process.

Riders make the claim process complicated since you need to prove the cause of death as well. This may cause issues in claim processing by giving the insurance company more to investigate. It is, therefore, better to take a stand-alone PA policy instead of a term insurance rider.

Related: Understanding Insurance Requirements for Home Loans in India: What's Mandatory and What's Optional?

PA cover in vehicle insurance protects the owner of the vehicle, as long as they have valid driving license. The policy is set at 15 lakhs by IRDAI (since 2018) and covers permanent total disability and accidental death. PA cover is mandatory if you are driving your own car.

There are two cases here:

• if you already have a general PA cover:skip the PA cover with vehicle
• if you don’t already have a general PA cover: taking PA cover with vehicle is mandatory if you have a driving license

However, this particular PA cover does not cover cases where you have an accident apart from driving your car.

Also read How much EMI do I have to pay for my home loan?

The PA cover protects you in multiple ways

• protect your day-to-day expense flow
• protect the investments that go into goals
• account for increased expenses due to long-term medical care. This may be offset, to a degree, by lowering expenses on travel and entertainment

The Arthgyaan goal-based investing calculator accounts for the first two options: monthly expenses and investments in SIP form. The calculator will show you the total insurance cover for both term, and as a result personal accident, in the same field.

A health insurance policy is not the replacement for Personal accident coverage. A health plan covers planned and unplanned medical expenses where you are eventually expected to recover. PA covers income loss due to an accident which causes a disability.

Similarly, having only a term insurance policy does not help since the accident does not necessarily kill you. Instead, it will prevent you from earning income, making it impossible to reach your financial goals.

A third-party vehicle insurance cover, for example, if you are injured when a car hits you on the road, is for the car’s driver’s benefit and not for you.

The only alternative to a personal accident cover is having enough wealth to be unaffected if your income stops today. Astute readers will notice that this is the exact same definition of being Financially Independent: What is the quickest way to reach FIRE?

The biggest challenge at this point is finding policies with sufficient coverage. There are too many policies with coverage of a few lakhs than those with coverage of multiple crores. The higher coverage out there is a policy of 2 crores capped at 12x of your annual gross income. However, this amount may not be enough depending on your goals.

This link is the official IRDAI page with all currently available insurance policies: click here . From the same page, you can get the updated list from Products Offered > Health Insurers for the current year.

The page has the policy documents for all active policies in the market. You should look for individual (i.e. non-Group) policies and shortlist the ones where you are okay with the terms and conditions. In parallel, from the insurance company website, you can get a plan quote. You should be able to buy the policy online in most cases from your shortlist.

Given the definition of accident, onerous claim process and lack of high-value policies, it is natural to believe that a PA policy is not worth the hassle.

There are some significant upsides as well, though:

• this is the only policy that covers permanent disability that may happen due to no fault of yours
• the policy is decently cheap (1cr coverage is available for around ₹10,000/year or less)
• unlike health premiums that increase with age, there are not many dependencies on the age of the insured

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This post titled What is a Personal Accident Insurance policy: who needs it and why? first appeared on 31 Jul 2022 at https://arthgyaan.com

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...the factory gate, Medical and Personal Accident Policy, Group Personal Accident Policy, Insurance, Catering bills, Personal Accident Insurance, Category bills. Personal Accident ...Medical and Person, Accident Policy, Group Personal Accident Policy, Insurance, Personal Accident Policy, Personal Vehicle Services, Landscaping of factory garden, Catering bills were valid and le...

..., the ‘ personal accident coverage’ will not be applicable as the coverage under the policy after payment of additional premium cannot be extended to the driver who is not the third party...premium of Rs. 50/- was paid to cover personal accident coverage for owner driver as well as limited liability coverage for the employees respectively. Therefore, in terms of personal accident coverage.... Gola, learned counsel also could not point out any clause from the policy that the Indian Motor Tariff would be applicable in respect of the liability of personal accident coverage for the owner and...

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...course of the order observed that indemnification extended to personal accident of the owner-cum-driver was limited to the extent of Rs 2,00,000. The finding of the High Court on this question is as...established by the claimant respondents that the premium was paid for the personal accident the insurance company is liable to pay the said compensation, even though it is limited to Rs 2,00,000 to the...directing the appellant insurer to pay the compensation determined by the Tribunal. Since the indemnification extended to personal accident of the deceased is limited to Rs 2,00,000 under the contract of...

...:Smt Lalitha Devi Patel, wife of the complainant had obtained a Janata Personal Accident Policy for a sum of Rs 5 lakhs in August 1998, for which a premium was paid and accepted and the...policy was issued. The insured died on account of an accident by way of falling into a well and drowning. FIR was lodged, autopsy was performed and the appellant was informed. Various documents were...though there may have been some information given which has no relation with the actual state of affairs, yet the factum of the accident resulting in death and policy was not in dispute and, therefore...

...owner. An owner of a vehicle can only claim provided a personal accident insurance has been taken out. In this case there is no such insurance.11. We, therefore, see no...in his own jeep. Around 6.30 a.m the jeep met with an accident . In the accident , the appellant as well as the other passengers received injuries. A number of claim petitions came to be filed. The...appellant also filed a claim petition.5. The Motor Accidents Claims Tribunal (MACT) held the driver of the jeep responsible for the accident . In all the claim petitions filed...

...a claim with the respondent insurance company which was repudiated on the ground that the deceased had not taken the ' Personal Accident Cover'. Aggrieved by this, petitioner filed the complaint...the District Forum has been set aside. It was held that the petitioner had not taken the ' Personal Accident Cover' and pay the premium for the same. As the deceased had not paid the premium for... personal accident cover, petitioner was not entitled to receive any compensation for the death of the deceased. Counsel for the petitioner by referring GR-36 of Indian Motor Tariff contends that taking of...

...premium is towards damage to the vehicle and not for injury to the person of the owner. An owner of a vehicle can only claim provided a personal accident insurance has been taken out. In this case...Vehicles Act and Rules the owner is not entitled to get any compensation if he drives the vehicle and falls in an accident — as the insurance policy is a third party in nature. The contract between the...insured and the insurer is that if any accident occurred out of the use of motor vehicle then only third party is entitled to get compensation. The insurer and the insured is the first and second party and...

... accident by examining a Doctor. In view of the fact that the respondent/claimant has not proved the factum of disablement, he is not entitled for Personal Accident Coverage. In other words, it is...contended that the respondent/claimant is not entitled for any compensation even under the Personal Accident Coverage as he has not examined the Doctor before the Tribunal and now, he cannot take a...different stand with reference to his entitlement under the Personal Accident Coverage.11. The compensation under the Personal Accident Coverage is provided only in respect of the injuries specified...

... Personal Accident Cover benefit covered by the policy, without considering the terms and conditions stipulated in the policy. The benefit of Personal Accident Cover is available only in respect of...certain injuries specified in the terms and conditions of the policy and not otherwise. The claimant in the present case did not suffer any injury of the nature specified in the Personal Accident Cover and...therefore, the award of Rs. 2 lakhs to the claimant under the Personal Accident Cover is also unsustainable. 4. It is further contended that when the claim petition...

...of a vehicle can only claim provided a personal accident insurance has been taken out. In this case there is no such insurance.’ ”10. In...control resulting in the accident .3. The appellant herein, having been issued notice, resisted the claim, inter alia, contending that although the owner of the vehicle...deposited an extra amount of Rs 50 covering his personal insurance, the same would not cover the case of the pillion rider and in any event, the owner of the vehicle is not a third party within the meaning...

...compensation under the personal accident policy of insurance? If so, what shall be the quantum and from whom?6. As far as the personal accident policy is concerned, the Tribunal relied on certain...judgments. The Tribunal considered the personal accident policy marked as Ex.R2 and relied on the judgment in the case of Bajaj Alliance General Insurance Company Limited, Vs. C.Ramesh, reported in...2013(1) TN MAC 325. In the personal accident policy, the maximum compensation shall not exceed the amount mentioned in the policy. Therefore, the...

...163-A of the Motor Vehicles Act, 1988 (hereinafter called the Act) has been held to be not maintainable, yet he has been awarded compensation to the tune of 1,00,000/- under the personal accident cover...wrongly awarded the compensation to the tune of 1,00,000/- under the personal accident cover. He contended that the compensation under personal accident cover can only be granted to the registered..., he was not entitled for compensation under personal accident cover. To support his contentions, he relied upon cases Sushila and others Vs. Sh. Pankaj Mahajan and another 2013...

... Heard counsel appearing on both sides. The claim was allowed by the District Forum with reference to the personal accident benefit, but it was set aside in appeal by the State...to personal accident benefit while the deceased insured drove a vehicle not owned by him which resulted in accident and death of the insured. Our attention has been drawn to the insurance policy and..., more particularly, to the schedule of premium relating to personal accident cover which reads as under:- "Compulsory personal accident to owner driver amount one lac...

...entitled for personal accident cover but the same cannot be granted to person who had borrowed the vehicle. The issue is settled, the borrowed would step into the shoes of the owner. Therefore, the...deceased is entitled to the amount under personal accident cover. 4. The next contention of the Insurance Company is that the said amount would not carry any interest...since the claimant had not submitted any application under personal accident cover. If an application is filed under personal accident cover, then the Insurance Company is bound to pay the same. When...

...the deceased steps into the shoes of the owner of the vehicle (first respondent) and the Appellants who are his dependants are entitled for compensation under the personal accident coverage given under...borrowed the vehicle from the owner steps into the shoes of the owner (first respondent) and hence the Appellants are entitled for personal accident coverage under the insurance policy (Ex.R1...). 5. Per contra, Mr. D. Bhaskaran, learned counsel for the second respondent submitted that it is settled law that for availing compensation under the personal accident policy...

...the amount of personal accident benefit before the respondent No.1 within one month from today. 3. In view of the statement made at bar, it is directed that...benefit of the amount of personal accident benefit as per Rule and policy in question. 5. Permission, as sought for, is granted. The present appeal stands disposed of as withdrawn.... Appellants are at liberty to avail alternate recourse available under the policy in question to claim the amount of personal accident benefit. 6. Registry is directed to refund...

...bearing No.CC/05/17 claiming Rs.2 lac under personal accident benefit policy. According to complainants, husband of complainant No.1 & father of Complainant No.2, Mr.Ashok Borkar was owner and...risk. The Opponent Insurance Company had also issued a compulsory Personal Accident Benefit to the owner/driver for which extra premium of Rs.100/- was charged in the policy. On 8/11/2004, vehicle of...driving and dashing with the vehicle of the deceased. Complainant lodged claim but it was repudiated on the ground that Insurance Company is not liable to pay any claim under the personal accident benefit...

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Case Example: Hit and Run Accident Personal Injury Claim

Charles R. Gueli, Esq.

Licensed Attorney

Charles is a practicing attorney with over 20 years of experience in personal injury law. He was recently selected as a SuperLawyer by Thomson Reuters, an exclusive honor awarded to the top 5% of attorneys.

Follow along with a hit and run car accident victim from the collision to compensation. Learn about auto insurance claims after a hit and run.

The hit and run collision, side-impact accident injuries, liability for hit and run accidents, damages and claim negotiations, important points about hit and run claims.

Here we unpack a fictional case study drawn from the fact patterns in actual hit and run car accident cases.

Our study deals with a side-impact collision that left the victim injured and helpless as the other driver sped away from the scene.

We’ll discuss how the crash occurred, liability, injuries, negotiations, and the final claim resolution.

We wrap up with a list of important points you should know about hit and run car accident claims .

The accident occurred at a 4-way intersection in a residential neighborhood outside of a medium-sized city. The day was clear, and the roads were dry. It was still early in the morning, so commuter traffic was light.

Jennifer was driving her new compact sedan to work. She was traveling her usual route to work when she came to a 4-way intersection. She came to a complete and legal stop at the stop sign. There was one car behind Jennifer’s when she stopped.

After looking both ways, Jennifer went ahead through the intersection. Without warning, a large, white pickup truck barreled through the intersection without stopping and T-boned her on the passenger side of her small car.

The impact pushed her car across the street and into a light pole. Both vehicles came to a skidding stop. However, the white pickup truck immediately fled the scene.

The driver of the car that was behind Jennifer pulled over to the curb, called 911, and got out to see if she could help. Due to the sound of the collision, several residents of the neighborhood came outside to see what happened.

Within minutes an ambulance, fire truck, and the police were on the scene.

Side impact collisions often cause secondary crashes, as when Jennifer’s car smashed into a light pole after the initial impact from the pickup truck.

T-bone crashes are fast and violent, often causing devastating injuries to occupants of the car that gets broadsided. Spinal cord injuries , broken bones, and brain trauma are not uncommon.

Despite the airbags that deployed during the crash, Jennifer was in and out of consciousness when emergency responders cut her out of the mangled car.

After carefully immobilizing Jennifer’s head and neck on a backboard, the paramedics transported her to the nearest trauma center .

At the hospital, Jennifer was evaluated and rushed into surgery for repair of internal injuries, including a ruptured spleen . She also suffered a concussion, a broken nose, whiplash, and multiple scrapes and bruises.

Jennifer had multiple medical appointments for treatment and follow-up for a full six months after the crash.

Although she knew she was lucky to be alive and able to walk, Jennifer required mental health treatment to cope with her fear of car travel, nightmares, and general anxiety following the accident .

Jennifer was out of work for the first three months of her recovery. She was medically cleared to ease back into her desk job as a travel agent, working part-time hours for another three months.

Jennifer was observing the rules of the road and had come to a complete stop at the intersection. When she lawfully drove forward, she was struck by the truck that fled the scene.

The driver behind Jennifer at the stop sign saw everything and willingly provided a witness statement to the police. Police officers are trained in accident investigation and fault analysis.

Based on witness statements and evidence from the scene , the police concluded Jennifer did not contribute to the cause of the collision. The driver of the white pickup truck was at-fault for the crash.

Every state has traffic laws that are violated in hit and run car accidents.

Drivers who cause injury to others by violating the traffic laws are liable, meaning financially responsible, for the injury victims’ losses.

In this hit and run accident, the driver of the pickup could be cited for:

• Failure to yield the right of way
• Failure to come to a complete stop at the intersection
• Felony hit and run (raised to a felony because Jennifer was injured)

Because the driver left the scene and no one was able to get a look at the truck’s license plate, the police were unable to name the at-fault driver.

In an effort to find the at-fault driver, the police broadcasted a descriptions of the pickup truck, and the type of front-end damage to look for, to state and local police departments.

Jennifer was left with a wrecked car and bodily injury damages after the hit and run collision.

Bodily injury damages include:

• Ambulance expenses
• Medical bills
• Mental health treatment bills
• Out-of-pocket medical expenses
• Transportation costs to medical appointments
• Pain and suffering

Unfortunately, the police were not able to track down the driver of the pickup. Therefore, there was no other insurance company against which to submit a personal injury claim.

Jennifer turned to her own insurance company to submit her damages claim under her uninsured motorist coverage . She also had collision coverage she could use for her wrecked car.

Jennifer carried uninsured motorist coverage limits of $100,000 per person for bodily injury and $50,000 for property damage.

Most states require auto policies to include uninsured motorist coverage to protect policyholders in the event of an accident caused by someone without insurance, or in this case, someone who can’t be located.

The company quickly settled the property damage claim for Jennifer’s car for the fair market value of her vehicle.

Injury Compensation

Jennifer had $40,000 in medical expenses, $3,000 in out-of-pocket expenses, and $9,000 in lost wages. Her attorney filed an insurance claim on her behalf, demanding the full $100,000 of underinsured motorist coverage in compensation for Jennifer’s hard costs and pain and suffering.

Jennifer’s attorney handled all the settlement negotiations with her insurance company, emphasizing the severity of her injuries and the emotional distress she suffered from the violent crash.

After a few rounds of negotiations, Jennifer’s bodily injury claim was settled for $95,000.

• If you’re hit by an uninsured or unknown driver, you can turn to your own insurance company for claims under your uninsured motorist coverage.
• In no-fault insurance states , you and your passengers will be covered by your Personal Injury Protection (PIP) coverage.
• Carry enough uninsured motorist coverage to adequately protect you and your family. If you only purchase the bare minimum of coverage, that’s all there is to fall back on if you’re badly injured by an uninsured or unknown driver.
• If the at-fault driver is located later, your insurance company has a right of subrogation , meaning they can go after the at-fault driver to recover the money they paid on your behalf.
• Severe injury claims should be handled by an experienced personal injury attorney, even if you are dealing with your own insurance company. The adjuster’s job is to minimize payouts, including payouts to policyholders.
• If you are an injured passenger in a car that’s hit by an uninsured or unknown driver, you can file an injury claim with your driver’s insurance company.
• Fleeing the scene of an accident is a crime. If you are injured by a hit and run driver, you may be eligible for benefits through your state’s Crime Victim Compensation Fund. For example, Texas provides hit-and-run Crime Victim Compensation benefits .

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