Group personal accident insurance policy

The key benefit of GPA insurance policy is that it provides compensation in the event of death or disability of an insured employee directly due to accident

October 15, 2012 2:48 IST | India Infoline News Service

Mr Ajay Gupta—a middle-income working employee—was careless about his finances. He was working in a well-reputed organisation for more than five years. Apart from his daily expenses, he also had to meet the financial requirements of his family. Being tied-up with work, Mr Gupta never knew what benefits his employer / company was offering to the employees. He only knew that a certain amount of his income was deducted for group personal accident (GPA) insurance. He never bothered to know what GPA is and what benefits it offers.

Unfortunately, Mr Gupta met with an accident and lost his hand. Mr Gupta had to stay at home for some days for medical treatment. He wouldn’t join his company immediately. During his stay at home, Mr Gupta used all his savings to meet his daily expenses and medical treatment charges. After two months, Mr Gupta recovered fully and joined his company back. At the work place, he discussed about his ‘loss of income’ due to his permanent disablement and wished he had an insurance cover.

Mr Gupta already had a permanent total disablement cover—under GPA—offered by his company. But he never enquired about it. Under GPA insurance, Mr Gupta was eligible to get permanent total disablement benefit. But due to his ignorance, he had to use his personal savings. Most of us behave like Mr Gupta. We are hardly aware of the benefits our company / employer provides us under different schemes—one such scheme is group personal accident insurance policy. Let’s try to know more about GPA policy to avoid ourselves from being in a situation which Mr Gupta had to go through.

The key benefit of GPA insurance policy is that it provides compensation in the event of death or disability of an insured employee directly due to accident. This policy is basically designed to offer some sort of compensation to the insured person who suffers bodily injury solely as a result of an accident which is external, violent and visible. Hence death or injury due to any illness or disease is not covered by the policy.

The policy operates worldwide and is a 24 hours cover. Different covers are available ranging from a restricted cover of death only; to a comprehensive cover covering death, permanent disablements and temporary total disablements. GPA insurance covers accidental death, loss of limbs, permanent total and partial disablement as selected and granted by the insurance companies based on the underwriting norms. The major exclusions under GPA includes pre-existing conditions, natural death, suicide, illegal act, dangerous sports, pregnancy or anything related to childbirth.

Group policies are given by firm, company, associations, etc, to their employees. The group policy is eligible for group discount based on the size of the group. The group discount is slab-wise and increases with the size of the group. The following is a specimen table of benefits on the basic of sum insured of Rs. 1 lakh which sum insured is selected for the purpose of illustration.

Know what group personal accident covers

Sr. no. Contingency Amount of compensation payable
A. Death Rs. 1 lakh (100% of capital sum insured)
B. Loss of 2 limbs, both eyes or 1 limb & 1 eye Rs. 1 lakh (100% of capital sum insured)
C. Loss of 1 limb or 1 eye Rs. 50,000 (50% of capital sum insured)
D. Permanent total disablement other than the above (e.g. Paralysis due to an accident) 100% of capital sum insured
E. Permanent partial disablement (e.g. loss of a finger) % as shown in the table in the policy
F. Temporary total disablement Weekly payment of Rs. 1,000 (1% of capital SI) subject to maximum 100 weeks.

The benefits (A.), (B.), (C.), (D.) & (E.) above are referred to as capital benefits and benefit (F.) as weekly benefit. Remember, it is not necessary that all benefits mentioned above are to be covered. On underwriting consideration or at the request of the insured, policies may be issued covering all benefits or benefits (A.) to (C.) or (A.) to (E.) or only benefit (A.). Employees need to refer to the policy wordings for the complete cover, exclusions and terms and conditions of the policy.

Some policies may cover additional benefits like expenses for ambulance charges, loss of employment; expenses for carriage of dead body of insured (death due to accident only) to place of residence—subject to limits. In case death or permanent total disablement (PTD) of the insured person, the policy provides for education fund for dependent child in addition to capital sum insured.

Documents required for settlement of claims (accidental death)

  • Duly signed claim form
  • Death certificate
  • FIR (final police report)
  • Post mortem report
  • Affidavit from the legal heirs of the deceased (in case nomination has not been filed by deceased)
  • Copy of certificate of insurance signed & attested by authorised official

Documents required for settlement of claims (PTD)

  • Duly signed claim form
  • Medical certificate
  • Leave of absence certificate from employer
  • Copy of original certificate of insurance signed & attested by authorised official
  • In case of accidental death, the sum insured is provided to the nominee as mentioned in the policy document, whereas in PTD sum insured is paid to the person insured.

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