The below-mentioned causes of injury or death are not covered or included under a group personal accident insurance:
- Additional payment for a claim after it has been paid
- Any pre-existing condition and disability or accident arising out of it
- Consequential loss of any kind and legal liability
- Curative treatments or interventions
- 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
- Death or injury while engaged in an adventure sport or hazardous activity
- Death or injury while under the influence of intoxicating liquor or drugs
- HIV and or related illness
- Natural Death
- Participation in any naval, military or air force operations
- Payment of compensation in respect of Death or injury because of attempting suicide
- Pregnancy including childbirth, miscarriage, abortion, or complication arising there from
- Venereal or Sexually transmitted diseases
To know more about the usefulness of group personal accident cover see What is Covered under Group Personal Accident Insurance?
Case on Exclusions in Group Personal Accident Insurance
Employees of AC Pvt. Ltd. are covered under a group personal accident insurance policy. One of the employees, Kirti Shukla met with an accident while driving and got severely injured. During his 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 bear all recovery and treatment expenses on her own now.
Another employee, Srishti Duggal, had been pregnant, and while commuting one evening in the official cab, suffered 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 for an adventure trip and while riding horses in one of the activities, one of them got injured and had to be hospitalized for neck sprain and other internal injuries.
Their claim to the firm’s personal accident insurance was rejected citing the exclusions in the policy.
Read More: Why Group Personal Accident Insurance?
Explaining Other Conditions
Insurer is liable to pay the claim only once for one incident. There cannot be another payment made for the same accident/loss to the insured. However, if you have two personal accident policies, a group, and an individual policy, you may claim accidental death benefit from both policies.
A preexisting disability/health condition may aggravate a loss in case of accidents. For example, a person with bad eyesight is more likely to meet with an accident at night, and if such person avoids taking sufficient precaution while going out at night, the accident may not be covered by the insurer.
Personal accident policy does not cover third party liability or injury. Therefore, if the insured meets with an accident in a vehicle and the vehicle has damaged a third-party property, that damage will not be covered by the personal accident insurance.
All other exclusions can be clearly understood, since all these activities increase the chance of accidents multifold, and thus present a much higher risk than our normal day to day life.