Office package policies also have provision for personal accident cover for the insured. All provisions of personal accident cover offered in office package policy are similar to a standalone personal accident policy. Meaning, the following are covered:
- Death due to accident
- Permanent Total Disability
- Permanent Partial Disability
- Temporary total disability
- Hospitalization expenses incurred due to accident and any additional covers as selected by the insured
In the case of occurrence of any of the above, the insured or a person representing/claiming on behalf of the insured must proceed as follows:
- Inform the insurer in as soon as possible or at least within the prescribed time limit provided by the insurer; usually 15 days
- Undergo the consultation and treatment as advised by a qualified medical practitioner
- Take reasonable steps to lessen the consequences of any claim that may be made under this Policy
- As and when asked by the insurer, the insured must have himself/herself examined by Company’s medical advisors
- Provide all the documents and other information related to the accident to the insurer
- Provide post-mortem report in case of death claim
List of Documents for Claims
- Death Claims
- Personal Accident Claim Form signed by Nominee
- Copy of address proof (Ration card or electricity bill copy)
- Attested copy of:
- Death Certificate
- Burial Certificate (wherever applicable)
- Statement of Witness, if any lodged with police authorities
- FIR / Panchanama / Inquest Panchanama
- Post Mortem Report (only if conducted)
- Viscera report if any (Only if Post Mortem is conducted)
- Claim form with NEFT details & cancelled cheque duly signed by Insured
- Original Policy copy
- Permanent Partial /Total Disablement /Temporary Total Disability
- Duly Completed Personal Accident Claim Form signed by insured
- Attested copy of disability certificate from concerned government medical authority stating percentage of disability
- Attested copy of FIR
- Photograph of the claimant before and after injury supporting to disablement
- All X-Ray / Investigation reports and films supporting to disablement
- Claim form with NEFT details & cancelled cheque duly signed by Insured Original Policy copy
- Children’s Education Bonus
- Bonafide certificate from School/college or certificate from the educational institute
- Hospital Confinement Cover/ Medical Expenses Reimbursement/ Hospital Cash Daily Allowance
- First Consultation letter from the Doctor
- Duly completed claim form signed by the Claimant
- Hospital Discharge Card
- The hospital bill is giving detailed break up of all expense heads mentioned in the bill. Clear breakups must be mentioned for OT Charges, Doctor’s Consultation and visit charges, OT Consumables, transfusions, room rent, etc.
- Money receipt, duly signed with a revenue stamp
- All original laboratory and diagnostic test reports, e. X Ray, ECG, USG, MRI Scan, Hemogram, etc.
- Other documents as may be required by Bajaj Allianz to process the claim
J.S Associate had its office situated in Pune. The company had purchased office insurance to get financial coverage against losses or damages, like fire, earthquake, flood, theft, etc.; that could arise to disrupt their business. As a fire insurance policy, it also covered the office and equipments against fire losses or damages.
The company’s fire insurance policy also had a personal accident clause. It means, in case any of its employees meet with an accident or dies in an accident, the insurer will offer compensation to him/her or family.
Unfortunately, Rahul Sarai, working as an accountant in the company, slipped from the office stairs and got his back injured. His co-workers took him to a hospital where doctors examined and declared that his lower body got temporarily disabled due to shock.
As J.S Associate had a personal accident cover available under its fire insurance, the insurer came forward to cover all the expenses. The insurer covered not only medical expenses but also paid weekly disability benefits.
However, before settling the claim, the insurer asked for the complete account of the accident, doctor’s certificate to know the extent of disability along with the salary certificate of Rahul to decide the disability benefits.
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