Personal Accident and All Sickness Insurance – Policy
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Transcript of Personal Accident and All Sickness Insurance – Policy
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Personal Accident and AllPersonal Accident and AllSickness InsuranceSickness Insurance
Policy FormPolicy Form
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Types of PolicyTypes of Policy
Types of PolicyTypes of Policy Annual / Short PeriodAnnual / Short Period
Policies.Policies.
P. A PolicyP. A Policy Compensation for accidentalCompensation for accidentalinjury (Granted in conjunction with otherinjury (Granted in conjunction with otherpoliciespolicies Death Benefits under householdDeath Benefits under householdpolicy)policy) Benefit policy.Benefit policy.
Sickness InsuranceSickness Insurance Compensation forCompensation forSicknessSickness -- Benefit policy.Benefit policy.
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Types of PolicyTypes of Policy
Indemnity Contract & Benefit PolicyIndemnity Contract & Benefit Policy ::
Contract of Indemnity (Fin.Contract of Indemnity (Fin.
Compensation)Compensation) -- ((PA policy )PA policy )-- EmployerEmployerpay full wages to employee duringpay full wages to employee during
disablement & Insure this Liability.disablement & Insure this Liability.
Benefit PolicyBenefit Policy Payment of specifiedPayment of specifiedsums on the happening of certain events.sums on the happening of certain events.
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Types of PolicyTypes of Policy
Various Combinations of benefitsVarious Combinations of benefits ::
Accident only policyAccident only policy Injuries ByInjuries By
Accident, Individual policy & Group Policy,Accident, Individual policy & Group Policy,Accidents & All SicknessAccidents & All Sickness Injuries byInjuries byAccident & Disablement by Illness,Accident & Disablement by Illness,
Injuries in Specified CircumstancesInjuries in Specified Circumstances Journey by Air or During a Holiday.Journey by Air or During a Holiday.
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Form of the policyForm of the policy
Annual ContractsAnnual Contracts 12 Months,12 Months,
Renewable Policies at the Option of theRenewable Policies at the Option of the
Insurers,Insurers, Wording & Principal Clauses vary withWording & Principal Clauses vary with
Insurers,Insurers,
Single form (Individual & Group Policy).Single form (Individual & Group Policy).
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Form of the policyForm of the policy
Constituent Parts of the PolicyConstituent Parts of the Policy ::
Recital Clause or Preamble,Recital Clause or Preamble,
Operative Clause,Operative Clause, Exceptions,Exceptions,
Attestations Clause,Attestations Clause,
Schedule,Schedule, Conditions.Conditions.
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Form of the policyForm of the policy
Recital Clause or PreambleRecital Clause or Preamble ::
Parties of the Contract,Parties of the Contract,
Proposal form,Proposal form, Declaration as the basis of the contract &Declaration as the basis of the contract &
to the premium.to the premium.
Read in Conjunction with Schedule.Read in Conjunction with Schedule.
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Form of the policyForm of the policy
Operative Clause :Operative Clause :
Claims Payment (during insured period)Claims Payment (during insured period)
Exceptions, Conditions.Exceptions, Conditions. Read in Conjunction with Schedule.Read in Conjunction with Schedule.
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Form of the policyForm of the policy
Important Phrases & WordsImportant Phrases & Words DifferDiffer
between insurers :between insurers :
Bodily InjuryBodily Injury Diseases caused byDiseases caused byaccident.accident.
Solely & Directly (Proximate Cause)Solely & Directly (Proximate Cause)
Bodily Injury.Bodily Injury.AccidentAccident -- Unexpected, Unintentional &Unexpected, Unintentional &
not designed Events.not designed Events.
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Form of the policyForm of the policy
Outward (Accident caused byOutward (Accident caused byexisting Physical defectsexisting Physical defects -- NotNot
covered)covered) Heart attack due to BrokenHeart attack due to Brokenlegs.legs.
Violent & VisibleViolent & Visible Bodily Injury byBodily Injury byaccident.accident.
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Form of the policyForm of the policy
Exceptions (Depends Upon Insurer)Exceptions (Depends Upon Insurer) ::
Alcohol / Drugs / Insanity / Suicide / ChildAlcohol / Drugs / Insanity / Suicide / Child
birth / Pregnancy / Under 15 years / Abovebirth / Pregnancy / Under 15 years / Above
70 years / Civil war / War.70 years / Civil war / War.
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Form of the policyForm of the policy
Schedule & Benefits :Schedule & Benefits :
DeathDeath
Permanent DisablementPermanent Disablement Loss of eyeLoss of eyeor Limb (Above wrist / ankle),or Limb (Above wrist / ankle),
Permanent Total disablementPermanent Total disablement FootFoot
baller :baller :From gainful employment of any kindFrom gainful employment of any kind nono
compensation .compensation .
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Form of the policyForm of the policy
Insured Person's usual occupation &Insured Person's usual occupation &
Any other occupation for which the insuredAny other occupation for which the insured
is fitted by knowledge & Trainingis fitted by knowledge & Training Partner disabled (No compensation).Partner disabled (No compensation).
Insured person usual occupationInsured person usual occupation Compensation Payable.Compensation Payable.
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Form of the policyForm of the policy
Lump Sum / Annuity Payment, (InsurerLump Sum / Annuity Payment, (Insurer
may pay weekly benefits to reduce Hardshipmay pay weekly benefits to reduce Hardship
of Insuredof Insured until total liability is calculated).until total liability is calculated).
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Form of the policyForm of the policy
Permanent Partial DisablementPermanent Partial Disablement NotNotsevere. Small %age of Payment.severe. Small %age of Payment.
Temporary DisablementTemporary Disablement -- TemporaryTemporarytotal & temporary partial disablement fromtotal & temporary partial disablement fromusual occupation.usual occupation.
Medical ExpensesMedical Expenses Scale ofScale ofCompensation (According to the FatalCompensation (According to the Fatalaccident benefits).accident benefits).
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Form of the policyForm of the policy
Deferment of BenefitDeferment of Benefit PremiumPremium
discount.discount.
Usual ConditionsUsual Conditions :: Claims Procedures,Claims Procedures,
Change in riskChange in risk Notify the Insurer,Notify the Insurer,
AdjustmentAdjustment Premium & RenewalPremium & Renewaladjustments,adjustments,
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Form of the policyForm of the policy
CancellationCancellation 7 days notice to the insured7 days notice to the insuredat the insured's last known address,at the insured's last known address,
AssignmentAssignment Subject Matter can't beSubject Matter can't beassigned,assigned,
Observance of TermsObservance of Terms Insured PersonInsured Person(Clear the Insured Person).(Clear the Insured Person).
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Form of the policyForm of the policy
All Sickness :All Sickness :
Rapid Expansion Market,Rapid Expansion Market,
Weekly benefits without any CapitalWeekly benefits without any Capitalsum (May Arrange),sum (May Arrange),
Application of Excess than Franchise,Application of Excess than Franchise,
Waiting periodWaiting period 7 days,7 days,
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The EndThe End