Personal Accident Insurance - Insurers Sunny Days

The Personal Accident Insurance under the Insurance Act, 1972, India, says that the risk insured is the bodily injury resulting solely and directly from accident caused by violent external and visible means.

When one of the employees understood the whole concept behind this Insurance Act in such depth, that he decided to avail the Insurance. He walked in the HR department, which handles Insurance as part of its Legal procedures, with what seemed a fractured right hand, only to know he’s suffered from shoulder dislocation. He not only was entitled to receive ‘Medical Allowance’, he also hoped to get back the hospital bill expenses in getting the bandaged arm resting on a sling.

Now when we make claims for the Insurance, we are supposed to state the reason behind the injury and what exactly is the injury. Seemed like the employee was all so keen for the Insurance that he didn’t realize he would have to back up with a reason. It took him nearly 10 minutes to tell it’s a shoulder dislocation, which happened when he lifted his arm upwards. That stirred the curiosity of the Insurer, who made a loud thought, stating how anyone could dislocate by mere lifting the arm. The employee had to be coaxed and cajoled really hard, so that he coughed up the real reason. With frequent gulps he confessed 20 minutes later, that, he lifted his arm in a swift and sharp movement to hit his daughter who had just disobeyed him. And it’s then he felt a sting in the arm.

That left the insurer to contemplate whether he could state such a reason, and whether the Insurance people would pass the bills of medical expenses? The employee looked really keen and hopeful, but the HR Department had to politely tell him, that he be settled with the ‘Medical Allowance’.

This makes a need felt to explain the kind of injuries and causes acceptable be listed under the Personal Accident Insurance Act, alike those in the Partial/Permanent Disablement clauses under Workmen’s Compensation Act. But owing to the multiplicity of how accidents can happen, and what ways an injury may show up; this surely looks like a tedious task. Maybe what the HR Departments can do is come up with select categories of the nature and seriousness of the injury, and how much claim can the employer make on behalf of the employee, slot/category wise; instead of specifying the many a times embarrassing moments of truth.

To facilitate such needs, we have 3 kinds of Forms that a doctor fills, which specifies what kind of injury the person has, how long will it take to cure and what genre/category does it belong to signifying the percentage of gravity. Based on these forms that are submitted to the Insurance companies, the claims are calculated using percentage, period of healing which may in general cases amount to anything between Rs. 3 lakhs – Rs. 5 lakhs. What should be kept in mind is that the amount isn’t constitutional, but largely depends on Company policies.

Imagine another case of Personal Accident whereby due to the menace of stray cattle on the roads, a fight between two buffalo’s resulted one buffalo being pushed and horned to the center of the road. The force was so strong that the cattle lost balance and collapsed on a passerby employee who was trying to evade collision with the cattle. The employee received severe injuries, and developed respiratory problems. Now stating such a reason to the Insurance guys is definitely embarrassing! How about clubbing it under the genre – road accident.