Permanent Exclusion Clauses in Personal Accident Insurance: Key Insights for Policyholders

It is often seen that when a person takes an insurance policy, he compares certain parameters very carefully such as premium, benefits and features, in fact, the insurance company but there are many clauses in the insurance policy in which an insurance claim is not given, which is called “Permanent Exclusion”

There are many clauses in the Personal Accident Policy also, if any one of these clauses comes under the notice of the insurance company, in that situation the insurance company does not give the claim, which the company itself has already mentioned on its official website.

But this check has to be done by policyholders, insurance advisors and sales representatives so that the dignity and eco-system of the insurance industry move in a positive way

This article explained the all-permanent exclusion where an insurance company denies the claim of a Personal Accident Policy

List of Permanent Exclusions

Pre-Existing Medical Reasons-

If the insured person has any pre-existing disease or medical condition and meets with an accident, then the insurance is not covered.

Payout of Total Sum Insured-

If the same insurance company has paid the entire sum insured in a policy, then the company is not liable for any other accidental claim

Self-Injury or Suicide-

If any injury is caused while committing suicide or attempting suicide, i.e. in case of self-injury, the insurance company will not pay the claim

Mental Illness-

If any accident happens due to any mental condition, then even in that case the insurance company will not give the claim

Conflict of Interest of Medical Practitioner and Policyholder-

If the policyholder and the medical practitioner who has issued any certification related to the claim are present at the same place, then even in that situation the insurance company will not pay the insurance claim

War and Foreign Attack-

Any occurrence resulting from or linked to foreign invasion, actions by foreign adversaries, hostilities, or military operations (regardless of whether a state of war has been declared or not, including duties performed in the armed forces of any nation during wartime or peacetime), involvement in any naval, military, or air force activities, civil conflict, public defence, rebellion, revolution, insurrection, or actions taken by military or usurped authority.

STD or Venereal Disease

Any occurrence that is directly or indirectly linked to or caused by a venereal disease or a sexually transmitted infection

Congenital Anomaly / Congenital Anomaly

Congenital anomalies, which may be classified as either internal or external, refer to inherent diseases or defects that arise from such conditions

Bacterial Infections

Bacterial infections (except pyogenic infection which occurs through a cut or wound due to Accident).

Medical or Surgical Procedure for Non-Accident Treatment

Any medical treatment that is not related to accidental injury is also not covered

Virus Infections

Any event that is directly or indirectly associated with or caused by the human T-cell lymphotropic virus type III, also known as the lymphadenopathy-associated virus, including its variants or mutations, as well as AIDS, irrespective of its connection to HIV, AIDS-related complex syndrome (ARCS), and any injuries resulting from or related to HIV.

Wrong Profession or Change of Profession

Non-disclosure of the correct occupational profession, any alteration in profession following the Inception Date that leads to an increased risk under the Policy must be accepted and endorsed by the insurance company on the Policy Schedule; otherwise, it will not be covered.

Any Abuse (Drung & Alcohol) & Rule Break and

The insurance company will not provide coverage for any incident that occurs as a result of the Insured Person engaging in unlawful activities or being involved in an actual or attempted felony, riot, crime, Misconduct or civil disturbance with criminal intent. Any occurrence that results from or is attributable to the use, misuse, or repercussions stemming from the abuse of any substance, intoxicant, drug, alcohol, or hallucinogen.

Any Pregnancy-Related Medical Issue

Any occurrence that is directly or indirectly caused, exacerbated, or extended by childbirth or pregnancy, or any related consequence, including ectopic pregnancy, unless it specifically results from an accident

Flying Activity

Any occurrence resulting from the Insured Person’s involvement in any aerial activity, except being a legitimate, fare-paying passenger on a certified civil airline operating on established routes and adhering to a predetermined schedule

Adventurous Activity / Sports

Individuals covered by insurance while participating in speed contests or any form of racing (excluding foot races), as well as activities such as bungee jumping, parasailing, ballooning, parachuting, skydiving, paragliding, hang gliding, mountain or rock climbing that require the use of guides or ropes, potholing, abseiling, deep-sea diving with hard helmets and breathing apparatus, polo, and snow and ice sports, provided these activities involve training for or participation in competitions or professional sports.

Defence Services

Any individual involved in military, naval, or air force operations will face permanent exclusions.

Hazardous Work

Employment in subterranean mining, tunnelling operations, the use of explosives, high-voltage electrical installations, roles as jockeys or circus performers, or participation in hazardous occupations or professions

Chemical or Biological

Any occurrence resulting from or attributable to ionizing radiation or contamination due to radioactivity from any form of nuclear fuel, whether explosive or hazardous, or arising from any other cause or event that concurrently or sequentially contributes to the loss, claim, or expenses associated with nuclear waste generated from the combustion of nuclear fuel, as well as from nuclear, chemical, or biological attacks.

Insect bite

Any injury or accident due to snakebite shall be a permanent exclusion

Any Other

Any other will be defined as per the insurance company from time to time.

Disclaimer: All the information in this article is for Educational Purposes, where the purpose is to be aware of financial literacy of personal finance topics. In addition, any medical or healthcare terms are purely used for Insurance Awareness wherever these terms are necessary, this article does not advise any medical treatment, for any medical or healthcare please get in touch with Experts only.