Accidental Policy Benefits Clauses: Eye Opening Facts!
Alarming Road Accident Stats That Highlight the Need for Protection
In India, a road accident occurs every 3 minutes, and approximately 474 people lose their lives to road mishaps every single day. That adds up to nearly 1.73 lakh fatalities annually due to road accidents. In such a high-risk environment, understanding Accidental Policy Benefits becomes essential. These policies not only provide financial protection to individuals and their families but also offer crucial support during emergencies caused by unforeseen accidents.
In every 100 road accidents, approximately 3.6 people lose their lives — indicating a 3.6% fatality rate. This alarming statistic highlights the urgent need for proper protection through comprehensive personal accident insurance and the wide range of Accidental Policy Benefits available today.
What Are Accidental Policy Benefits and Why Do They Matter?
Now that we know the alarming numbers, fear is natural. It’s not just road accidents—major mishaps happen across India almost every day. So, isn’t it wise to secure ourselves with a comprehensive personal accident policy tailored to our needs? By adding suitable riders, we can maximize Accidental Policy Benefits, ensuring financial support and peace of mind during life’s unexpected emergencies.
However, one of the most important aspects is understanding the riders and their benefits—how they function, and what terms and conditions apply. This knowledge is essential to fully utilize your Accidental Policy Benefits and avoid surprises during a claim.
In this detailed article, you’ll get complete information about all the features, coverage options, and Accidental Policy Benefits included in a Personal Accident Policy.
List of Accidental Policy Benefits You Must Know About
- Accidental Death Cover (AD)
- Permanent Total Disablement(PTD)
- Permanent PartialDisablement(PPD)
- Temporary Total Disability/Disablement(TTD)
- Accidental In-patient Hospitalization Cover
- EMI Protect
- Broken Bone Benefits
- Loan Protect
- Coma Benefits
- Accidental medical Expenses
- Burn Benefits
- Adventurous Sports Cover
- Emergency Road/ Air Ambulance Cover
- Education Benefits for Kids
- Funeral Expenses
- Repatriation of Remains
- Orphan Benefits
- Modification Benefits (Residence and Vehicles)
- Compassionate Visits
- No Claims Bonus
Now we will explain the clauses of all these benefits in simple language
Accidental Death Cover (AD): If the insured person dies on the spot due to an accident, or passes away within 365 days from the date of the accident, the Accidental Policy Benefits include paying the full sum insured along with any earned bonus to the nominee or immediate legal heir.
Additionally, in cases like forced landing, stranding, sinking, or wrecking of a vehicle the insured was traveling in, the same benefits apply even if death occurs within 365 days of the incident. Once this benefit is paid, the policy will be terminated.
Permanent Total Disablement (PTD): If the policyholder suffers an accident that results in the permanent and complete disability of two major body parts, the Permanent Total Disablement clause comes into effect. Under this, the insured is entitled to receive the full sum insured, along with any No Claim Bonus (NCB) earned. This is one of the key Accidental Policy Benefits that ensures financial support during life-altering injuries.
But if both the limbs or any one limb is lost within 365 days (from the date of accident) then this claim will not be available.https://awarenessgyan.com/decoding-permanent-total-disablement/#Permanent_Exclusion_Clauses_in_Personal_Accident_Insurance
Permanent PartialDisablement(PPD)- If due to an accident, one main part of a person becomes completely disabled, then this condition is called permanent partial disability / disability and in this situation, claim will be received as per the table of (PPD) and the policy will continue and in this also the clause of within 365 days will be applicable. Decoding the Permanent Partial Disablement in Personal Accident Policy – Awareness Gyan
Temporary Total Disability/Disablement(TTD)-
Temporary Total Disability (TTD): If an accident causes the policyholder to become temporarily but completely disabled, the Accidental Policy Benefits include a weekly payout to compensate for income loss. Depending on the individual’s annual income and policy terms, this amount can go up to ₹50,000 per week. If the disability stems from the same accident, the benefit continues accordingly. Many insurers offer TTD coverage for up to 100 weeks, though this duration may vary by company.
I strongly recommend Temporary Total Disability (TTD) coverage for salaried individuals, especially those who don’t receive a salary during extended medical leave. In such cases, the situation qualifies as a loss of income, and the Accidental Policy Benefits help bridge the financial gap with regular weekly payouts. Importantly, your policy remains active even while you’re receiving these benefits, ensuring continued protection.
Accidental In-Patient Hospitalization Cover: If the insured person is admitted to the hospital (IPD) due to an accident, they are eligible for treatment coverage up to ₹1 lakh—depending on the insurance company and the selected plan. This benefit ensures that hospitalization expenses are taken care of, offering financial relief during emergencies. The Accidental Policy Benefits remain active, and the policy continues to stay in force throughout the treatment period.
EMI Protect – In case of loss of income due to an accident, this option entitles policy holders to pay a maximum of 3 EMIs (this may vary from insurer to insurer and plan to plan) and the policy will continue even in this situation.
Broken Bone Benefits – If the Insured Person sustains broken bones of the nature as specified in the table below, solely and directly due to an Accident that occurs during the Policy Period. Some sub-limits are also applicable in some optional covers of Personal Accident Policy which also includes the features of Broken Bone. In which there is some pre-defined % that is based on the sum insured of the Broken Bone and not on the base sum insured of the policy, these benefits are defined by the table. https://awarenessgyan.com/broken-bone-in-personal-accident-policy/
Loan Protect- Policyholders can also protect their loans with this option, but nowadays, lenders provide this option separately along with the loan.
Coma Benefit: Among the essential Accidental Policy Benefits, this cover offers financial assistance if the policyholder falls into a coma due to an accident. To qualify, the coma must last for a minimum duration defined by the insurer — for instance, Birla’s Active Secure requires 96 hours, whereas Tata’s plan mandates 30 days of continuous coma. The lump-sum payout is determined as per the insurer’s guidelines and can be a crucial relief in such life-threatening situations.
Accidental Medical Expenses (OPD): In cases where an accident leads to outpatient treatment (OPD) but does not require hospitalization (IPD), the policyholder can still claim expenses under the Accidental Medical Expenses benefit. The OPD coverage limit is defined by the specific insurance plan. This is a valuable part of Accidental Policy Benefits, ensuring even minor injuries and treatments are covered without requiring hospital admission.
Burn Benefits- In this option, if the policyholder is burnt due to an accident, then a claim is made as per the Burn Benefits table. If this claim is different from the base sum insured. https://awarenessgyan.com/understanding-the-benefits-of-burn-feasures-in-personal-accident-policies/
Adventurous Sports Cover: If a policyholder opts for this rider, they can be protected while participating in adventure sports like trekking, paragliding, or scuba diving. However, it is mandatory to inform the insurance company in advance, and the activity must be conducted through a government-approved academy with a certified trainer. This cover extends your Accidental Policy Benefits to high-risk activities, offering added security for thrill-seekers under specific conditions.
Emergency Road/Air Ambulance Cover: If the insured person sustains a serious injury directly caused by an accident and requires hospitalization, this cover helps with the cost of emergency transportation by road or air ambulance. It is separate from the basic sum insured and varies depending on the insurer and the selected plan. However, this benefit typically does not cover transportation from home to hospital. As part of extended Accidental Policy Benefits, it ensures swift access to advanced medical care during critical situations.
Education Benefits for Kids: Some insurance companies offer educational support for children as part of the Accidental Policy Benefits. This benefit is applicable only in the event of accidental death or permanent total disability of the policyholder. It is provided separately from the basic sum insured and may be a fixed amount (e.g., ₹10 lakhs) or a percentage of the basic sum insured, depending on the insurer’s terms. This ensures your child’s education continues without financial stress during difficult times.
This will be payable only for 2 dependent children who are up to 25 years of age and The Dependent Child shall not have any independent source of income and must be pursuing an educational course as a full-time student at an Accredited educational institute.
Funeral Expenses- This option is different from the basis sum insured, in which in case of accidental death, some specific cover is given for the actions of the policyholder, such as Rs 25,000 or Rs 50,000, this varies from insurer to insurer.
Repatriation of Remains- The repatriation of remains involves the procedure of returning the body of a deceased individual to their native country for the purposes of burial or cremation.In this option a beyond defined coverage amount is given to the family of the policyholder in lump sum
Orphan Benefits- Orphan benefits claim In case of accidental death of the policyholder, including death of his spouse, one of whom should be the insured person and dependent children up to the age of 25 years, if the children are below 18 years, the money for orphan benefits will go to the legal guardians of the children.
From all this information, it seems that there will be a lot of legal formalities, which a normal policyholder is not aware of.
Modification Benefits (Residence and Vehicles): As part of extended Accidental Policy Benefits, if a policyholder suffers from permanent total disability due to an accident, some insurance companies provide a separate allowance to help modify their home and vehicle for better accessibility. This amount is independent of the basic sum insured and is specifically meant to support the insured person in adapting their living and travel conditions to their new needs.
Compassionate Visits- It covers the travel expenses for a family member or a close relative when they are hospitalized in a location distant from their home or regular address. It’s pre-defined amount in policy for domestic and International Travel.The benefits of Compassionate Visits option are Accidental Death, Accidental Permanent Disability and Accidental Total Partial Disability.
No Claims Bonus: One of the valuable Accidental Policy Benefits is the No Claims Bonus (NCB). If the policyholder doesn’t make any claims during the policy term and renews the policy within the grace period, many insurance companies offer a bonus in the form of a pre-defined percentage increase in the sum insured. This percentage varies depending on the insurer and the chosen plan, rewarding safe and claim-free years.
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