How To Claim Personal Accident Insurance plan?

No one can predict accidents beforehand. However, certain precautions can prevent financial loss related to such an unpredictable event. Personal accident insurance is one such policy that guarantees financial security in case of disablement, death, or injury caused by an accident. However, many people find it difficult to file a claim in such a case. 

In this blog, we have discussed the different types of claims, the documents necessary for the process, and the steps required for filing a claim. We have also listed a few tips on how to prevent claim rejection.

Types of Claims Under Personal Accident Insurance

Different claims can be filed for Personal Accident Insurance based on the incident, such as:

• Accidental Death Claim: The nominee can file for this claim if the death of the policyholder was caused by an accident. In such a case, the death benefit or the entire lump sum amount is forwarded to the nominee.
• Permanent Total Disability Claim: If during the accident the policyholder suffers permanent disability or loss of limbs, sight, etc., i.e., total impairment for a lifetime, then a certain portion of the sum insured is provided to the policyholder. The percentage of the sum insured amount can vary from insurer to insurer.
• Permanent Partial Disability Cover: If the policyholder suffers partial but permanent disability during an accident, he/she is eligible for a certain percentage of the sum assured. Keep in mind that the percentage of the sum assured is different for several insurance companies.
• Temporary Total Disability Claim: If there is a temporary total disability from an accident that results in being bedridden, the policyholder shall receive a monthly/weekly allowance as compensation for the financial loss. The policyholder can use the received benefit for household expenses or EMI pending payments.
• Medical Expenses: In case of an accident, the plan even covers your medical expenses, i.e., hospitalization costs, surgeries, treatment costs, and rehabilitation expenses.

Documents Required for Personal Accident Health Insurance Claim Process

The following documents must be submitted to the insurance companies to file a personal accident health insurance claim.

• The claim form must be properly filled and signed
• Death Certificate (if death caused due to an accident)
• Attach Post-mortem report
• Identity proof documents
• Disability Certificate
• Medical certificates, reports, and bills
• Submit FIR and investigation report
• A discharge summary must be submitted if hospitalized

Steps to Claim a Personal Accident Insurance Plan

The following steps will help you file a claim for a personal accident health insurance plan during emergencies:

Step 1: Notify Your Insurance Provider

First and foremost, contact your insurer via helpline number or email. Notify them about the accident within 24 hours of hospitalization or directly from the accident spot. Avoid delay in getting the right treatment and medication in case of injury or disablement.

Step 2: Submit Your Claim form

Request the claim form from the insurer and fill in the required details. Ensure the claim form is properly filled and signed by the policyholder or nominee before submission. Once it is done, submit the form to the insurance company or TPA.

Step 3: Submit Your Policy Documents

Submit the above-listed documents for the claim process along with other documents like policy card, policy purchase receipts, and premium receipts for quick verification.

Step 4: Scrutiny by Insurer

Once the insurer receives your claim request, he will conduct scrutiny to verify the case and understand the claim's authenticity. The team will go through the submitted documents and claim requests.

Step 5: Medical Examination

In some cases, the policyholder is even asked for a medical examination to determine the severity of the injuries.

Step 6: Claim Settlement

After reviewing the claim's authenticity if the insurance company feels satisfied with the documents provided and reports, the claim will be approved. However, if there is missing information, the claim may get rejected, and a rejection letter will be sent to your mail.

Claim Rejection: Common Reasons and How to Avoid Them

Some of the common reasons for claims being rejected by insurance providers are listed below. Further, we have mentioned a few ways to avoid such issues.

• Policy Exclusions: Certain cases or treatments are not covered under different policies referred to as exclusions. Each policy is different and may have certain limitations or exclusions. If you claim for accidental injury or damage from any of the excluded clauses, your claim will be rejected. Hence, make sure to review your exclusions properly.
• Incomplete information: If you provide incomplete or false information while filing a claim related to the accident, the insurer may reject your filed claim. Hence, ensure all the paperwork and documentation is properly attached. Also, you are not missing out on any facts related to the accident.
• Delay in Medical Treatment: A few policies even get rejected because no immediate medical action or treatment was taken by the claimant for the injury.
• Pre-existing Injuries: The insurer has the full right to deny your claim if pre-existing conditions were not disclosed at the time of purchase. Hence, try to provide complete and accurate details about your health and lifestyle to the insurer when buying the policy.
• Lack of Proof: If there is no evidence to support the connection between your injury and the accident, the insurer can deny your claim request due to lack of proof.

How Long Does It Take to Settle a Personal Accident Insurance Claim?

The process of claim settlement can vary from insurer to insurer. Generally, it takes 15 to 30 days to settle a personal accident insurance claim. But, if it is a permanent disability or death case due to an accident, it can take up to 60 days to process the claim. It is best to follow up with your insurer and track your claim status.

What To Do If Your Claim is Rejected?

Your claim for accident insurance coverage can be denied due to various reasons. But still, you have the option to appeal again. Use the following methods or channels to reach out to the insurer and appeal in case the claim gets rejected:

• Review the Rejection Letter and Appeal: When rejecting a claim, the insurer sends an email clearly highlighting the cause for the claim rejection. Review the letter, and if it seems unfair, file an appeal with the right documentation supporting your case.
• Contact the Insurance Provider: You can directly visit the nearby branch office and directly communicate with the claims department. You can ask for the reason and clarify the issue from your end. If any document is missing, re-submit your claim request with proper documentation,
• Consult an Ombudsman: The policyholder also has the option to reach out to an insurance ombudsman, in case there is no solution to their request or concern.

Customer Care Details In Case of Any Query for Claims

If a customer has any queries related to the Personal Accident Health Insurance Claim Process, they can use any of the following channels to directly coordinate and communicate with the InsuranceDekho team:

• Make a request to the support team via email at support@insurancedekho.com. It will take a minimum of 24-48 hours for the support team to review your request or query and respond with an appropriate solution.
• You can even reach out directly to the support representatives using helpline number 755 1196 989.

FAQs

Ques 1: Do personal accident insurance plans offer global coverage?

Ans: Yes, most insurance plans include worldwide coverage in their comprehensive plan benefits. Hence, review your policy inclusions before making a purchase.

Ques 2: Can I apply for a personal accident plan without having to do a medical test?

Ans: Yes, you can purchase a personal accident plan without going through any medical test. But, at the time of claim, you must run a medical test and submit the reports along with other essential documents.

Ques 3: Is it possible to cancel your accident plan between the policy period and the demand for premium back?

Ans: Certain insurance policies include a free-look period. Under this 15-day period (from the day of commencement), the policyholder has the option to cancel and get back their premium. Also, no claims can be made during this period.

Ques 4: Is Purchasing Personal Accident Insurance Worth It?

Ans: No matter whether you work in a high-risk occupation or as a homemaker, it is highly beneficial to purchase personal accident insurance. The plan offers financial support to the policyholder and family in case of accident-related expenses or death.

Ques 5: What circumstances are taken into account for determining permanent total disability?

Ans: The loss of one hand, one foot, or the total loss of both eyes, hands, and feet are a few examples of permanent total disability.