Group Personal Accident

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There are different types of disabilities that are covered under a Group personal accident insurance. 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 permanent loss of functionality. For example, if there is loss of both the legs and the arms or there is blindness in both the eyes. A disability becomes permanent only when it lasts for more than 365 days. A disability may include loss of arms or feet, loss of eyesight, or hearing without recourse.

Permanent Partial Disablement refers to the partial loss of functionality without the chance of recovery or treatment. For example, if one leg or eye is damaged and cannot be repaired within 1 year. In this case, the insurer pays a weekly benefit instead of a one-time lump-sum amount.

Read More: What is group personal accident insurance?

The insurer may apply a limit on the maximum period for which the insurer will receive the benefit. This limit depends on the percentage of the sum insured (S.I.) payable with each instalment. The insurer will pay only up to the maximum S.I. under the plan. The examples below illustrate different types of disabilities covered under a Group Personal Accident Plan?

Group Personal Accident Plan: Case 1

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

One day, when she was coming back from the 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 doctors operated on her immediately. To save her life, the doctors amputated her right hand and both legs.

The group personal accident insurance policy offered by K.J Jewellers covered all her medical expenses. As she became permanently totally disabled, the insurer along with covering the medical expenses paid a lump-sum amount (on the basis of her salary). This helped her to deal with the loss of income. As she also lost her earning ability, the lump sum amount helped in dealing with costs such as expenses and EMI’s.

Group Personal Accident Plan: 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. It was severely damaged in the accident.

Doctors kept him under observation and discharged him after a week.

Ram Saran’s employer had covered him in a group personal accident insurance policy. Considering the case as a 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 provided much-needed relief to the family.

Group Personal Accident Plan: Case 3

Vijay Saran was traveling to Pune on an official trip when his car brakes failed and hit a stationary mini truck. As Vijay’s car had airbags, they opened as soon as the car hit the truck. Thankfully, these airbags saved his life, however, he sustained some injuries. The passersby took him to a nearby hospital.

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 the doctors attending him, “Due to the accident, Vijay is under shock because of which, some of his body parts are not moving fully. 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. In this case, Vijay’s employer was covering him under a group personal accident insurance policy. Since his disability was temporary the insurer paid weekly benefits instead of a lump-sum amount. The weekly benefit was on the basis of the sum insured for six months. The insurer asked for his salary certificate to decide the amount to be paid to Vijay as weekly compensation.