Group accident insurance plans are group policies that cover accidental contingencies. Insured members of the group are protected by a master policy that pays lump-sum benefits if they suffer a covered contingency.
These are the main instances covered by group personal accident plans:
- Accidental Death: 100% of the sum insured is paid in a lump sum.
- Accidental Total and Permanent Disablement: 100% of the sum insured is paid in a lump sum.
- Accidental Partial and Permanent Disablement: A specific portion of the sum insured is paid in a lump sum depending on the disability suffered.
Besides these coverage benefits, there are other coverage benefits too that group plans offer. Such features might be offered as inbuilt benefits or as optional ones. Common examples include the following –
|Temporary total disablement||A weekly benefit is paid, up to a maximum number of weeks, if an insured is disabled, but it is a temporary impairment.|
|Ambulance costs||The cost of the ambulance is covered up to a limit if accidents result in hospitalisation.|
|Medical cover||The medical costs incurred are covered if accidents result in hospitalisation.|
|Repatriation of remains||In the case of accidental death, the cost of transporting the body back to the residence of the insured member is covered, up to a limit.|
|Funeral expenses||The cost of arranging the funeral is covered, up to a specific limit, if the insured member dies in an accident.|
Most of the coverage benefits are contingent on accidental death. That is why the technical definition of such a death should be known. So, let’s understand what accidental death exactly means in the context of the group personal accident policy.
What is accidental death in group accident insurance?
According to a group personal accident plan, accidental death is caused by an accident. On the other hand, an accident is considered a sudden, involuntary, and unforeseen event that is caused by external, violent, and visible factors.
In this definition, the following words hold importance –
- Sudden: it means that the event should not be planned but unexpected and immediate.
- Involuntary: it means that the incident is not under the control of any individual or entity.
- Unforeseen: it means that the event is unplanned and unexpected.
The terms relating to the cause of the accident can be understood as follows –
- External – something that is due to outside forces and not due to a condition in the individual’s body or mind.
- Violent – an event that includes violence that causes death.
- Visible – the incident is visible to the human eye.
Examples of accidental death
Accidental death is not limited to road accidents. It can happen for many reasons. Some of the common examples of accidental deaths include the following –
- Suffering a road accident, either in the insured member’s car or one in which another vehicle is involved
- Dying in a road accident when the insured member was on foot and another vehicle caused the death
- Death caused by falling down the stairs
- Dying in a plane crash
- Dying in a train wreck
- Falling off the roof, balcony, window, etc. accidentally and dying
The following instances of death are not considered accidental death:
- Death resulting from participation in adventure sports
- Death resulting from participation in a hazardous act
- A death resulting from defence activities, i.e. when the insured member is in the military and dies in the line of duty. Policemen who die in the line of duty are also not covered by accidental death insurance
- Death when participating in a criminal act
- Accidental death under the influence of alcohol, drugs or any other intoxicating substances
- Death due to war, invasion, revolution, resurrection, civil unrest, etc.
In each of the aforementioned instances, coverage is not available because an accidental death is a distinct possibility. Though the accident might be sudden and violent, it is predictable. Since an unforeseen accident is not relevant in this case, the death cannot be considered accidental. The claim is rejected in such cases.
So, for a death to be termed as accidental death covered under the scope of the group accident insurance policy, all the relevant terms explained earlier should be fulfilled. If any term is not fulfilled, the death would not be covered under the scope of the policy, and the claim would get rejected.
Group accident plans have streamlined the claims process by opting for the digital mode. Members of the insured can apply for a digital health ID Card online to facilitate their claims processing. However, a police FIR is required in the cases of accidental deaths. So, the nominee of the insured member should file a police FIR and submit a copy to the insurance company for claim settlements. Moreover, the nominee should also intimate the insurer when the member dies so that the claim process can begin.
A group accident insurance plan pays a lump sum benefit to the nominee of the deceased member if the member dies in an accident as defined under the policy terms and conditions. Thus, make sure your members understand what “accidental death” means in group personal accident insurance terminology so they can know when their claims will be accepted.