Group Personal Accident

Group personal accident insurance plans cover multiple types of disabilities. The disabilities caused by accidents are classified under the following three sections for determining compensation:

  1. Permanent Total Disablement (PTD)
  2. Permanent Partial Disablement (PPD)
  3. Temporary Total Disablement (TTD)

Permanent total disablement refers to the permanent loss of functionality of one or two limbs. For example, severed arms or feet from the body, loss of eyesight or hearing without recourse.

Permanent Partial Disablement refers to the partial loss of functionality in one or more limbs without chance of recovery or treatment.

Read More: What is group personal accident insurance?

In both the cases, the disability must last for more than 365 days to be considered permanent by the insurer. If disability lasts for less than this period, it’ll be considered under the third category, “Temporary Total Disablement or TTD.”

The insurer pays a weekly benefit in case of TTD, instead of a one-time lumpsum amount.

Since the disablement is considered for a limited time, the insurer may apply a limit on the maximum period for which the benefit is payable. This limit depends on the percentage of sum insured (S.I.) payable with each installment. Point to note here is that insurer will pay only up to the maximum S.I. Under the plan.

Case: 1

As a senior accountant, Radha Sharma was working in K.J Jewellers from the last ten years. When her retirement was a few years away, the destiny played its game.

One day, when she was coming back from office, her car collided with a truck coming from the other side. The impact of the collision was so severe that the truck driver died on the spot and Radha suffered grave injuries. Some passersby took her to a hospital where the doctor operated on her immediately. Though her life was saved, doctors had to amputate her right hand and both legs.

All her medical expenses were covered under group personal accident insurance policy offered by K.J Jewellers. As she became permanently total disabled, the insurer not only covered medical expenses incurred on the treatment of Radha but also paid a lump-sum amount (on the basis of her salary) to deal with the loss of income. As she also lost her earning ability, the lump sum amount helped in dealing with expenses other than medical, like a household, EMIs, etc.

Case: 2

It was the fateful day of December in 2015 when Ram Sharan’s hand gloves caught between the machine while working in the clothing mill in Gujarat. His co-workers took him to a hospital, where the doctors had to cut a portion of his right thumb which got severely damaged in the accident.

Doctors kept him under observation and discharged after a week.

Here Ram Saran’s employer was offering him a group personal accident insurance policy. Considering the case as permanent partial disability, the insurer agreed to cover medical expenses and also paid a lump sum amount to Ram as per his salary. His partial disability was permanent which affected his earning capacity, and he had to find a new job as per his current state.

The insurer’s lump sum amount took care of expenses other than medical, like a household, EMI, etc.

Case: 3

Vijay Saran was travelling to Pune on an official trip when his car braking system failed and hit the stationary mini truck. As Vijay’s car had airbags, they got opened as soon as the car hit the truck. Thankfully, these airbags saved his life, however, he sustained some injuries and was being taken to a nearby hospital by passersby.

Read More: How the claim is processed under group personal accident insurance?

Though doctors declared him out of danger, he was in shock and lost sensation in both his hands and feet. As per doctors attending him, “Due to the accident, Vijay is under shock and due to which, movement in some of its body parts are restricted. His condition will improve with time and eventually he will start working normally as he would have before the accident.”

In this case, Vijay’s employer was covering him under a group personal accident insurance policy. Though he was disabled, it was temporary, and therefore, instead of paying the lump-sum amount, the insurer paid weekly benefits as per sum insured for six months. The insurer asked for his salary certificate to decide the amount to be paid to Vijay as weekly compensation.

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