What Is Not Covered Under Group Personal Accident Insurance?
The below-mentioned causes of injury or death are not covered under a group personal accident insurance:
- Natural Death
- Death or injury while under the influence of intoxicating liquor or drugs
- Death or injury while engaged in an adventure sport or hazardous activity
- Any pre-existing condition and disability or accident arising out of it
- Consequential loss of any kind and legal liability
- Damages due to war, civil war, invasion, act of foreign enemies, revolution, insurrection, mutiny, seizure, capture, arrest, restraint or detainment, confiscation, nationalization, or restitution by or under the order of any government or public authority
- Payment of compensation in respect of death or injury because of attempting suicide
- Pregnancy including childbirth, miscarriage, abortion, or complication arising therefrom
- Venereal or Sexually transmitted diseases
- Curative treatments or interventions
It is possible to modify these exclusions by paying an additional premium.
Case on Exclusions in Group Personal Accident Insurance
A group personal accident insurance policy covers employees of AC Pvt. Ltd. One of the employees, Kirti Shukla had an accident while driving and got several injuries. During her treatment at the emergency ward, the doctors found out that she was under the influence of alcohol at the time of the accident.
The insurer rejected the claim citing the more than normal alcohol content in Kirti’s blood report. Kirti must now bear all recovery and treatment expenses on her own.
Another employee, Srishti Duggal, who was pregnant, while commuting one evening in the official cab, suffered a miscarriage. Her family blamed the company for it and forced her to file a claim with the employer, who in turn approached the insurer.
The insurer rejected the claim as it is one of the exclusions under the policy.
Similarly, five employees of Jumbo Works Pvt. Ltd. went on an adventure trip. One of them suffered an injury while riding horses in one of the activities. He went to the hospital for a neck sprain and other internal injuries. The insurer rejected his claim to the firm’s personal accident insurance, citing policy exclusions as the reason.
Read More: Why Group Personal Accident Insurance?
Explaining Other Conditions
The insurer is liable to pay the claim only once for one incident. The insurer cannot receive another payment for the same accident/loss. However, if you have two personal accident policies, a group, and an individual policy, you may claim accidental death benefit from both policies.
A pre-existing disability/health condition is likely to aggravate a loss in case of accidents. For example, a person with bad eyesight is more likely to meet with an accident at night. If such a person avoids taking sufficient precautions while going out at night, the insurer may not cover the accident.
A personal accident policy does not cover third-party liability or injury. Therefore, if an accident occurs in a vehicle and the vehicle damages a third-party property, the insured will not get a claim through personal accident insurance.
All other exclusions can be clearly understood. All these activities increase the chance of accidents multi-fold and thus present a much higher risk than our normal day-to-day life.