Personal accident insurance allows the insurer to get a fixed amount in case of an accident. A group personal accident insurance can help an organization to ensure the safety of its employees. Know how is claim processed under Group Personal Accident Insurance?
How to claim a Group Personal Accident Insurance
In case of an accident, the insurer must follow these steps to get the claim under Group Personal Accident Insurance. The process differs a bit in the case of death claims and injury claims.
Steps to follow in case of a death claim
- Notify the policy issuing office immediately. The Assignee of the policy should do this.
- Submit the claim form along with the death certificate, post-mortem report, police report, and original copy of the policy.
- 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
- Notify the policy issuing office immediately.
- Submit a Police report, if any.
- Give claim form along with a medical certificate certifying the disablement.
- Submit the prescription along with bills in case the policy plan has medical expenses extension.
- 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).
If the documentation is incorrect, or the claim involves an excluded condition then the insurer may reject the claim. 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?
Two employees of AB Media Pvt. Ltd. went on a business event at a hotel in New Delhi. They were returning after the event in the wee hours of the day and met with a serious accident.
The accident injured one of the employees severely. He was battling for his life. He did survive but unfortunately at the cost of one of his limbs (left hand from the wrist) which left him permanently impaired.
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.
Meanwhile, after the operation, the medical officer issued a certificate of disablement. The employee had to submit the 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 snowfalls recently, which stopped before the outing schedule, and the group expected to face pleasant weather.
However, during the five-day outing schedule, it started snowing heavily while the members were out trekking. They found themselves stuck at a high altitude and in bad weather conditions.
The group members stayed together and were able to ward off a major incident. However, 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 the local police station, however, no copies were taken by the group organizers or the members.
Subros Ltd. sent the family members death certificates and condolences. The group insurer submitted copies of the death certificates for the claim under the 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. The employer or the trip organizer had failed to collect these certificates from the place of the accident. This led to an unsuccessful claim.