The claim process for a group personal accident insurance is mentioned below

Steps to follow in case of a death claim

  1. Assignee named under the policy should immediately notify the policy issuing office.
  2. Submit the claim form along with the death certificate, post-mortem report, police report and original copy of the policy.

Documents Required

  • Claim Form,
  • Photo ID,
  • Death Certificate,
  • Post-Mortem Report,
  • Police Report,
  • HR Letter, and
  • Salary Slip.

Steps to follow in case of an injury claim

  1. Notify the policy issuing office immediately.
  2. Submit Police report, if any.
  3. Submit claim form along with a medical certificate certifying the disablement.
  4. In case the medical expenses extension has been taken in the policy plan, then the prescription along with bills are to be submitted.

Documents Required

  • Claim Form,
  • Photo ID,
  • HR Letter,
  • Salary Slip and
  • Disablement Certificate from a competent authority (medical practitioner approved by the insurer, or empaneled with the insurer).

Claims can be rejected if the documentation is incorrect, or the claim involves and excluded condition. To know what is excluded in group personal accident policies, see What is not covered under group Personal accident insurance?

To know about the additional benefits which can be claimed under a group personal accident policy, see What are the additional benefits available in the Group Personal Accident insurance?

Case on Claim Processing in Group Personal Accident Policy

Disability Claim

Two employees of AB Media Pvt. Ltd. went on a business event to Radisson Blu Plaza Hotel in New Delhi. They were returning after the event in the wee hours of the day and met with a serious accident.

One of the employees was severely injured and was battling for his life. He did survive but unfortunately at the cost of one of his limb (left hand from the wrist) which left him permanently impaired.

Read more: What is covered under Group Personal Accident Insurance?

Luckily, AB Media Pvt. Ltd. had a personal accident group insurance plan for their employees which helped the accident victim financially. The first thing the employer did was notify the police and filed a report.

In the meanwhile, after the operation, the medical officer issued a certificate of disablement. The employee was asked to submit required documents along with the claim form.

Upon sending the documents provided by the employer and medical professionals, the disabled employee received the reimbursements for his medical bills and compensation for the loss of his hand from the insurer.

Death Claim Rejection

Subros Constructions Ltd. had sent one of the teams on a group outing to a hill region of Kashmir. The region had faced heavy snow falls recently, which stopped before the outing schedule and the group expected to face a pleasant weather.

However, during the five-day outing schedule, it started snowing heavily while the members were out on trekking. They found themselves stuck at a high altitude and in bad weather condition.

Though, the group members stayed together and were able to ward off a major incident. The place they were camping at for the season, came under an avalanche on the last day.

Due to poor conditions and delayed rescue two members of the group could not be saved and perished to the weather.

The death certificates were issued, and FIR lodged at local police station, however, no copies were taken by the group organisers or the members.

The family members were issued death certificates and condolences by Subros Ltd. copies of which they submitted to the group insurer for the claim under personal accident policy.

The insurer rejected the claim citing insufficient documentation, as the family could not submit the FIR copy, death certificate and post mortem report filed in the FIR, as the employer or the trip organiser failed to collect these certificates from the place of the accident.

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