A group personal accident insurance plan is an employee welfare scheme that covers a group of employees against the risk of unforeseen incidents like accidents. In this article, we’ll give a quick guide for filing the claim under Group Personal Accidental Insurance Policy.
A slip or fall might cause major fractures or injuries which can affect the working of an employee. The risk of road accidents is increasing day by day. Hence an employer should provide the benefit of group personal accident insurance to employees to cover the medical cost of accidents.
Buying an employee accident policy shows the genuine concern of the employer toward the well-being of employees. Primarily because this policy covers unexpected expenses that arise due to accidents. A group personal accident insurance policy is an apt protection plan for employees if it fosters a smooth claim settlement process. Here is a quick reference guide for a smooth claim settlement under Group Personal Accident Insurance Policy.
You should keep the following factors in consideration while filing a claim:
Types of events covered:
A group of personal accident insurance
covers different types of claims. These include claims arising out of accidental death, permanent total disability, permanent partial disability, and temporary total disability due to an event of an accident.
Additionally, the policy covers any kind of road, rail, or air accident, injury due to a fall or slip, or due to the bursting of the gas cylinder, snakebite or dog bite, burn injury, etc. Hence, before filing the claim, you should make sure that any such injury should be resulting from an accident.
However, any kind of exclusion mentioned in the terms of the policy is not covered under the policy. One should not file the claim against –
- Natural Death
- Self Inflicted Injuries
- Intoxication
- HIV related injury
- Damage from war or terrorism
- Injury from adventure sport
- Pregnancy complications
- Intoxication
- Participation in criminal activity
The above-mentioned are the standard exclusions of group personal accident insurance policies.
Claim intimation:
One should immediately intimate the insurer about the incident. The intimation TAT usually is 3 months. However, it is the responsibility of the insurer to provide the intimation within a week after the incident occurred. Accordingly, employee details, employee code and policy number, date, and cause of a loss should be provided to the insurer. Furthermore, timely claim intimation increases the probability of timely and smooth claim settlement.
Documents required to file a claim:
Complete and accurate documentation should be provided by the insured at the time of the claim. So, to file a claim, you need the following standard documents:
- Duly filled and signed the claim form
- Filled attending physician’s statement or doctor’s prescription
- All Original bills
- Original Report
- Copy of Photo ID
- Address ID for Employee and Nominee
- A canceled cheque of the employee/nominee with his pre-printed name on it
- Copy of FIR/MLC (if registered)/Panchnama.
You need to submit the following documents in case of temporary total disability:
- Copy of medical documents supporting the accidental injury and treatment taken
- Investigations reports, and X-ray films supporting the accidental injury. Post-operative
- Leave records with the seal and signature of the authorized signatory.
- Medical fitness certificate by treating doctor.
To sum up, in case of permanent partial or total disability, you need to submit the following documents:
- Disability certificate.
- Investigations reports, and X-ray films supporting the accidental injury. Post-operative (films if any).
Read About: What are the different types of Disabilities covered under a Group Personal Accident Plan?
However, in case of accidental death, you need to submit the following documents:
- Copies of death summary, treatment papers, and investigation reports.
- A copy of the death certificate.
- Postmortem/autopsy report copy.
- Copy of the final police investigation report.
Claim settlement:
Claims get settled on a reimbursement basis be it accidental injury, permanent total, or partial disability. Hospitalization expenses are also settled in the same way. However, there are sub-limits applied to various coverage. Hence, an insured will get compensation and medical cost coverage based on the pre-specified sub-limits.
Complete claim documentation plays a pivotal role in a smooth claim settlement. You can prevent the rejection of the claim by following the claim settlement process. However, you should submit all the documents timely. Intimation of the claim should be done immediately. Additionally, in case of hospitalization, an e-mail should be sent to the insurer within 24 hours of hospitalization.
Also Read: Tips to buy best group personal accident insurance policy
Conclusion
You can take the help of insurance experts while buying a group personal accident plan for employees. So they would negotiate better in terms of benefits and costs.
Therefore, SecureNow can help you in getting the best group personal accident insurance policy.
