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Insurance Article

Covered with accident insurance? Here's what you need to be careful of

December 30 2016
Personal Accident Insurance Exclusions

General exceptions and benefits you must know

Road accidents are at an all-time high in India. While every minute someone is injured due to an accident, an health insurance  coverage that takes care of accident related expenses becomes the need of the hour.

A personal accident insurance  plan protects you and your family from damage or loss to due accidents. The basic coverage depends from insurer to insurer, which includes:

  • Accidental Death: Nominee receives the entire sum insured.
  • Permanent Total Disablement: Depending on the extent of the disability as examined by a medical practitioner, a percentage of the sum insured (usually 100% of the sum insured) is given.
  • Accidental Hospitalization Reimbursement: This add-on saves you from hospitalization expenses provided you stay in the hospital for a minimum of 24 hours, within 7 days of the injury.
  • Accidental Hospital Daily Allowance: This add-on cover provides daily allowance for day-to-day expenses in case of loss of employment.

However, although the policy seems straight-forward, you must keep in mind the following:

Accident Definition

An accident is defined as a violent and unexpected force that causes damage. In case the event is not caused by external, visible and sudden means, your claim stands to be rejected.


An exclusion in the personal accident policy, self-injury signifies carrying out activities that intend to harm and damage the self. Thus, accidents resulting from suicide, attempted suicide, participation in criminal activities such as attempted felony, riot, non-compliance, or civil commotion are not covered in your policy.

Self-Harm also includes accidents arising out of being voluntarily intoxicated from the influence or abuse of alcohol, drugs, or other substances. In case of medicinal intoxication, you are not eligible to file a claim if you failed to produce prescription or take the medicine as prescribed.

Participation in potentially dangerous activities or adventure sports, especially if you are untrained is also not covered by most insurance providers. However, if you wish to cover these with insurance, ask your insurer to chalk out a customized plan for you.

Date of Accident

It has been observed that in case of accidents, be it minor or major, internal injuries slowly surface weeks post the accident. To ensure customer’s convenience weeks for even months after the accident, companies allow disability claims for a certain period after the accident date.

Thus, disablement due to the accident must occur within this specified period. Most companies will validate your claim if the permanent disability has occurred within 12 months of the accident.

Pre-existing Injuries

No claim for pre-existing injuries is permissible under your personal accident insurance. It is excluded irrespective of being treated or not, or for which medical consultation, diagnosis, or treatment has been carried out. Thus, even though further damage a pre-existing injury, which was not treated earlier, you cannot make a claim.

Other than the above-mentioned exclusions, other events that you cannot claim for are injuries pertaining to childbirth, pregnancy, infections, and diseases. You can cover the hospitalization expenses for these with a comprehensive health insurance policy and stay worry-free!

Check out your policy terms and conditions to understand the above exclusions in detail, including the details in fine print. This will help you check out what’s covered and what’s not, making it easier to choose a personal accident policy best suited for your needs.

ICICI Lombard also provides health insurance plans like Complete Health Insurance, Health Booster, Arogya Sanjeevani Policy, Corona Kavach Policy  which offers people with the much needed financial backup during any medical emergencies.

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