HomeHow to make a claim-personal accident insurance

How to make a claim-personal accident insurance

Personal Accident Claims

  • Immediate notification to the insurer.
  • In case of accidental death, the capital sum is paid to the legal nominee/assignee of the insured. If the insured fails to provide the name of the nominee, succession certificate from a court of law is necessary

Accident hospitalization: Following document to be submitted for processing the claim

  • Duly filled & Signed claim form
  • Medical Report
  • Original Discharge summary
  • Original Discharge Bill
  • Advance payment receipts
  • Other Medical bills & Lab Bill with seal & signature from the hospital
  • Lab reports/ X-Ray/ Scan if any
  • Bank details of Insured- Bank Passbook front Page/ Cancelled cheque leaf if name printed on the cheque.
  • Copy of Adharcard
  • Copy of MLC/FIR if any

*All the claim documents should be submitted to the insurance company within 14 days of discharge from the Hospital

Permanent Partial Disablement (PPD) due to accident: Following documents to be submitted for processing the claim

  • Duly filled and Signed Claim form
  • Medical report
  • Doctor certificate of disability
  • Photograph of the injured with reflecting disablement, Medical bills with prescriptions/ treatment.
  • Discharge summary
  • Discharge Bill
  • All other Medical Bills, Lab bills, lab reports, X-Ray, Scan reports [ All Original Papers with seal & signature of hospital]
  • Bank Details- Bank passbook front page/ Cancelled cheque leaf if name printed on the cheque.
  • Copy of Adharcard

Accidental Death: Following documents required for processing a claim

  • Duly Filled and Signed Claim Form
  • Attested Copy of FIR/ Medico Legal Certificate.
  • Attested copy of PM (Post-mortem) report
  • Attested copy Death certificate
  • Death summary
  • Report of attending doctor either as a separate document or on the reverse of claim form if provision is made thereof  if any
  • Investigation reports like laboratory test, X-rays and reports essential for confirmation of the injury  if any
  • KYC document s of Deceased –Adhar card/Election ID
  • KYC documents of Nominee- (Self attested copy of PAN Card/ Form 60, Address proof and Bank details- Bank Passbook front page/ Cancelled cheque if name Printed
  • Paper cuttings if any

Weekly Benefit Claims

  • Claim form
  • Attending Doctor’s Report
  • Disability Certificate from the Doctor, if any
  • Investigation /Lab reports (x-rays &reports etc.)
  • Original Admission/discharge card, if hospitalized
  • Employers Leave Certificate, with grade/designation
  • Details of salary-Latest Salary Certificate.
  • Fitness Certificate

Some of the major exclusions include suicide, self-injuries, natural death, pre-existing disability, childbirth or pregnancy, non-allopathic treatments, the influence of intoxicants, and suffering from any mental disorders. Also, committing a criminal act or being involved in war activities, or participating in the naval, military, air force, and adventurous sports activities are also among the major exclusions

Among the prime exclusion, self-harm and pre-existing injuries are commonly misunderstood. If the policyholder inflicts or tries to inflict himself, it is an act of self-injury, and will not be covered by the policy. Any activity that signifies intend to harm and damage the self is excluded. Hence, accidents resulting from attempted suicide or suicide, committing or participating in criminal activities including riots, non-compliance, or civil commotion, are not covered under the policy.

Any accident arising out of voluntary intoxication is also excluded from the policy. However, if you are under medicinal intoxication, you will be eligible to file a claim if you can produce a prescription. No claim is paid for pre-existing injuries under a personal accident policy. Irrespective of you being treated or not, it is excluded from the policy cover

Personal accident plans also do not cover for adventure sports, such as skydiving, mountaineering, hang gliding, bungee jumping, scuba diving, trekking or parasailing, which have become increasingly popular among vacationers, are not covered under this policy.