Bajaj Allianz Group Personal Accident Insurance

Bajaj Allianz Group Personal Accident Insurance – Inclusions:

The policy provides coverage in the following cases:

• Death: This benefit is covered only when it is included by your employer in the personal accident insurance policy. The policyholder gets 100% of the sum assured that is mentioned in the policy wordings. The agreed sum assured is paid only when the insured encounters an accidental bodily injury that resulted in death within one year.
• Permanent Total Disability: This benefit is also available only when it is being opted for by your employer. Under this inclusion, 125% of the sum insured is paid to the policyholder in case of accidental bodily injury during the period of the policy that resulted in permanent partial disability within one year.
• Permanent Partial Disability: This benefit is available only when it is opted by your employer in group personal accident policy. Under this, an insured gets the compensation as shown in the below table in case he/she meets with an accidental bodily injury during the policy period that resulted in permanent partial disability within one year:

• Temporary Total Disability: This benefit is available only when it is opted for by your employer. If the insured gets bodily injury during the period of the policy that completely prevents him/her from getting back to his/her profession, then the policy makes weekly payments. The payment amount is lower than one percent 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: This benefit is available only if your organization has opted for it. If the company has accepted the claim under the following conditions:
    • For the death of the policyholder, then the company will pay for the actual cost of the transportation of the insured's remains from the place where he/she died to hospital, or burial ground, or cremation ground. The amount that the company pays towards this is limited to the lower of 2% and Rs. 5000/ of the sum assured mentioned under the schedule headings that are mentioned as – Wider, Comprehensive, and Basic.
  • Children’s Education Benefit: This benefit is available only if your organization has opted for it. If the company has accepted a claim under:
    • Death or Permanent Total Disability, then the company makes a one tie payment of Rs. 5000/ each for the cost of education of a maximum of two dependent children of the insured who are not more than 19 years on the date of an accident of policyholder.
  • Reimbursement of Hospital Expenses: This benefit is available only if your organization opts for it. If the company has accepted the claim under:
    • Death and Temporary Total Disability, then the company reimburses the cost of all the required medical treatment an insured had to opt for from a Doctor due to accidental bodily injury he/she met with. The payment is limited to the 40% of the claim value that the company has accepted or Rs. 5lakhs, whichever is lower.
  • Hospital Daily Allowance: This benefit is available only when your organization has opted for it. If the company has accepted the claim under:
    • Death or Temporary Total Disability, then the company pays Rs. 1000 for every completed calendar day that the insured has to hospitalized because of medical reasons due to the accidental bodily injury that he/she has encountered. However, the payment amount is limited to Rs. 30,000 during the period of the policy even if the insured has made more than one claim.

Bajaj Allianz Group Personal Accident Insurance – Exclusions:

The company does not pay for any event that happens due to or is caused by, or is linked with any of the following:

• Accidental Bodily Injury that the insured meets with:
  • Attempt to suicide, through suicide, illness, or self-inflicted injury.
  • While under the influence of drugs or alcohol.
  • Resulting from or arising as the insured commits any breach of law due to criminal intent.
  • While he/she was engaged in ballooning or aviation, when mounting into, traveling in, or dismounting from any duly licensed aircraft of standard type other than in the form of a passenger (paying the fare or otherwise) in any duly licensed standard type of airplane anywhere in the world.
  • When an insured participates as a co-driver, driver, or passenger of any motor vehicle during trail runs or motor racing.
  • As a result of any interventions or curative treatments that the policyholder has carried out or carry out on his/her body.
  • Arising due to the participation of the policyholder in any military, air force, or naval operations whether as a part of war games or military exercises with enemy whether domestic or foreign.
• 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 meets with any of the accidental bodily injuries that can result in a claim, then the insured or his/her family member has to follow the below mentioned steps to file a claim for group personal accident insurance policy:

• Policyholder/ insured or someone who is claiming on his/her behalf has to inform the company in writing instantly or within 14 days of the occurrence of the event.
• The policyholder must instantly consult the doctor and follow his/her advice and undergo the treatment that he/she suggests.
• The policyholder should take all the necessary steps to lessen his/her bodily injury.
• The policyholder must let the medical advisors of the company if the company asks for it, and as frequently as the company considers this to be compulsory.
• A policyholder or someone who is claiming on behalf of the policyholder should promptly provide the company all the documents and other information that the company has asked for the investigation of the claim or the company's obligation for making a payment towards it.
• In case of the death of the policyholder, the person who is claiming on his/her behalf has to inform the company in writing instantly and send the company a copy of the post-mortem report at least within 14 days.