Group Personal Accident

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A group personal accident policy covers the employees of the organization against disability or death while in the service period. Most organizations secure their employees with this policy as employees form a vital part of any business. What does Pregnancy Exclusion Clause in a Group Personal Accident Policy?

A group personal accident policy can be customized according to the group size, whether the group is large or small. This policy covers any disability or death arising due to causes like accidental death, permanent or partial disability, weekly benefit, and accident medical expenses reimbursement. However, this policy does not cover pregnancy-related issues.

What it does not cover?

A group personal accident policy has a pregnancy exclusion cause embedded in it. Any female employee of a firm having a group personal accident policy doesn’t receive benefits in case of pregnancy-related claims.

A female employee may suffer from death during her pregnancy, or she can suffer from any injury or disablement caused due to pregnancy or childbirth. According to the pregnancy exclusion clause, the insurer or the insurance company will not cover any such losses caused due to death, injury, or disablement of the female employee. The cause of death, injury, or disablement may be directly or indirectly related to pregnancy.

Any injury or disablement caused due to aggravated or prolonged childbirth is also excluded from the group personal accident policy.

Case Study:

Richa, a 30-year-old female was working in an IT firm in Delhi. She was a devoted employee of the firm and had climbed her ladder upwards in the organization with a five-year experience in website designing.

Since employees are the main assets, the management of the IT firm had secured all its employees with the help of a group personal accident policy. Thus, Richa also had a group personal accident policy provided to her by the employer.

While Richa was pregnant, she still managed to attend office and complete her duties. One day, due to the pain in their stomach rushed her to the hospital. During that time, she was in her second trimester of pregnancy. Upon hospitalization, the hospital conducted all the necessary tests. The reports came the next day and stated the cause of the pain that Richa suffered. Reports found that her progesterone levels were quite below the normal requirements and she showed hemoglobin deficiency. The slight pain that she was suffering in her stomach was due to this hormonal deficiency which had caused the uterine wall to swell. Admitted her for five days for the required treatment and discharged her on the sixth day.

Read More: How is the Claim Processed Under Group Personal Accident Insurance?

Once Richa was fine, she claimed to get the reimbursements of her hospital and medical-related bills based on the group personal accident insurance policy provided to her by her IT firm.

When the insurers investigated the matter, they found Richa hospitalized due to the injury caused to her uterine wall. The cause of the injury was a hormonal imbalance. So, the insurers refused her claim.

The group personal accident policy had the pregnancy exclusion clause in it. This clause stated that Richa would not get any benefit from the policy in the event of death. Or injury or disablement caused due to pregnancy or childbirth. Since Richa suffered a uterine wall injury due to her pregnancy-related issue, the insurers rejected her claim.

If Richa had suffered from any accidents or disability due to factors other than pregnancy and childbirth, the insurers would have settled her claim. But since the group personal accident policy does not provide any benefits for the pregnancy-related issues and has a pregnancy exclusion clause embedded in it, Richa was unable to settle her claim.