Bajaj Allianz Group Personal Accident Insurance - Inclusions:
The policy provides coverage in the following cases:
- Death Benefit: This coverage applies if your employer includes it in the personal accident insurance policy. The policy ensures that 100% of the sum insured, as specified in the policy terms, is paid to the nominee. This benefit is provided only if the insured suffers an accidental bodily injury leading to death within one year of the accident.
- Permanent Total Disability (PTD): This benefit is available if chosen by your employer. In the event of an accidental injury during the policy period that causes permanent total disability within one year, 125% of the sum insured is paid to the policyholder as compensation.
- Permanent Partial Disability (PPD): This coverage is offered only if your employer opts for it under the group personal accident policy. In cases of accidental bodily injury sustained during the policy period that results in permanent partial disability within one year, compensation is provided as per the policy's predefined table of benefits.
| Permanent Partial Disability Table |
| An arm at the joint of the shoulder |
70% |
A leg up to mid-calf |
45% |
| An arm that is above the elbow joint |
65% |
A foot at the ankle |
40% |
| An arm beneath the elbow joint |
60% |
A large toe |
5% |
| A hand at the wrist |
55% |
Any other toe |
2% |
| A thumb |
20% |
An eye |
50% |
| An index finger |
10% |
Hearing of one ear |
30% |
| Any other finger |
5% |
Hearing of both the eyes |
75% |
| A leg that is above mid-thigh |
70% |
Sense of smell |
10% |
| A leg up to mid-thigh |
60% |
Sense of taste |
5% |
| A leg up to beneath the knee |
50% |
- Temporary Total Disability: This benefit is available only when it is opted for by your employer. If the insured gets bodily injury during the policy period that completely prevents him/her from returning to his/her profession, then the policy makes weekly payments. The payment amount is lower than one per cent of the sum assured and Rs. 5000, with the following conditions:
- The company makes the first payment only when the insured satisfies the company that the Accidental Bodily Injury has fully prevented the insured from engaging in his/her work/occupation.
- The company will stop making payments when it gets satisfied that the policyholder can be back to his/her occupation/ work again. Or when the company has made payments for a maximum period of 100 weeks from the date of the accident, whichever is earlier.
Additional Insurance:
- Transportation Benefit: This benefit is applicable only if it has been included by your organisation. In the event of the policyholder's death, the insurer will cover the actual cost of transporting the insured's remains to a hospital, burial site, or crematorium. The reimbursement is limited to the lesser of 2% of the sum insured or ₹5,000, as per the policy's coverage under the Basic, Comprehensive, or Wider sections.
- Children's Education Benefit: If selected by your organisation, this benefit provides educational support for dependent children. In the case of the policyholder's death or permanent total disability, a one-time payment of ₹5,000 per child is made for up to two dependent children, provided they are under 19 years of age at the time of the accident.
- Reimbursement of Hospital Expenses: This benefit is available only if your organisation has chosen it. It reimburses the cost of necessary medical treatment due to an accidental bodily injury. In cases of death or temporary total disability, the insurer reimburses up to 40% of the approved claim amount or ₹5 lakh, whichever is lower.
- Hospital Daily Allowance: If opted for by your organisation, this benefit provides ₹1,000 per completed day of hospitalisation due to an accidental injury. In case of death or temporary total disability, the total payout is capped at ₹30,000 during the policy period, regardless of multiple claims.
Bajaj Allianz Group Personal Accident Insurance - Exclusions:
The company will not provide coverage for any event arising from, caused by, or associated with any of the following:
- Accidental Bodily Injury that the insured meets with:
- Attempted suicide, suicide, illness, or self-inflicted injury.
- While under the influence of drugs or alcohol.
- Arising from or occurring as a result of a breach of law committed with criminal intent.
- While engaging in ballooning or aviation activities, including mounting, traveling in, or dismounting from a licensed aircraft, except as a fare-paying passenger in a licensed standard type of airplane.
- When an insured participates as a co-driver, driver, or passenger of any motor vehicle during trail runs or motor racing.
- As a consequence of medical interventions or curative treatments undertaken by the insured.
- Arising from involvement in military, air force, or naval operations, whether during war games or military exercises, involving domestic or foreign forces.
- The policyholder's consequential losses of any type or their alleged legal or actual liability.
- Sexually transmitted or venereal disease.
- Human Immunodeficiency Virus (HIV) and or any illness related to HIV, including Acquire Immune Deficiency Syndrome (AIDS) or/ and mutual variations or derivatives thereof however caused.
- A pregnancy that results in miscarriage, childbirth, abortion, or other complications that arise because of any of these.
- Civil war, war (whether it is declared or not), the act of a foreign enemy, invasion, detainment, rebellion, insurrection, military, mutiny, usurped power, capture, seizure, arrest, detainment, restraint, confiscation, nationalization, or requisition of, under the order of any government, or damage by any public or local authority.
- Radiation or nuclear energy.
Claim Process
If an insured sustains accidental bodily injuries that may lead to a claim, the insured or their representative must follow these steps to file a claim under the Group Personal Accident Insurance policy:
- Notify the Insurance Provider: The insured or their representative must inform the company in writing immediately or within 14 days of the incident.
- Seek Medical Attention: The insured must consult a doctor promptly, follow their advice and undergo any recommended treatment.
- Minimise Further Injury: The insured should take all reasonable steps to mitigate the impact of the injury.
- Cooperate with Medical Examinations: The insured must allow the company's medical advisors to examine them, as requested, and as often as deemed necessary.
- Submit Required Documentation: The insured or their representative must promptly provide all necessary documents and information requested by the company to process the claim or establish liability.
In Case of Death: In the event of the insured's death, the claimant must notify the company in writing immediately and submit a copy of the post-mortem report within 14 days.
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