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Which Contingency Is Not Covered Under Personal Accident Insurance?

The article details exclusions under personal accident insurance, such as pre-existing conditions, mental health-related accidents, hazardous sports, and illegal activities. It highlights situations where coverage is denied avoiding future disputes.

  • 05 May 2025
  • 3 min read
  • 34 views

Personal accident insurance provides coverage for unexpected accidents and can offer peace of mind to those who worry about the financial consequences of an injury or death. However, not all accidents or incidents get covered under personal accident insurance. It is important to understand what contingencies are excluded from the policy to avoid any surprises in the event of an unfortunate occurrence.

What is personal accident insurance?

Personal accident insurance is a type of health insurance policy that provides financial protection against injuries, disabilities or death caused by accidents. Unlike regular health insurance, which covers hospitalisation expenses due to illness, personal accident insurance specifically addresses accidental injuries and their consequences. This policy is beneficial for individuals with high-risk jobs, frequent travellers and those seeking additional financial security.

What is covered under personal accident insurance (PAI)?

A personal accident insurance policy typically covers the following:

Accidental Death Benefit:

  • The nominee receives a lump sum amount if the insured person passes away due to an accident.
  • Permanent Total Disability:
  • If the insured suffers from total disability (e.g., loss of both limbs, eyesight or complete paralysis), a lump sum compensation is provided.
  • Permanent Partial Disability:
  • Compensation is given for partial disabilities such as loss of fingers, toes or hearing in one ear due to an accident.
  • Temporary Total Disability:
  • If the insured is temporarily disabled due to an accident and unable to work, weekly compensation is provided for loss of income.
  1. Medical Expenses Coverage:
  • Some policies cover medical expenses related to accidental injuries, including hospitalisation, surgery and treatment costs.
  • Education Benefit for Dependents:
  • If the policyholder dies or becomes permanently disabled, some insurers provide financial assistance for their children's education.
  • Transportation and Funeral Expenses:
  • Some policies cover the cost of transporting the insured’s mortal remains and funeral expenses in case of accidental death.

List of exclusions in personal accident insurance (PAI)

Despite its broad coverage, personal accident insurance policies come with several exclusions. Below are some contingencies that are not covered under PAI:

  • If the policyholder has a pre-existing medical issue before buying the policy, any accident related to that condition does not get covered under the plan. To get coverage for these you would need to buy a health insurance plan and go through the necessary waiting period.
  • If the policyholder is injured while participating in an activity that is unapproved or not covered under the policy or if he/she participates in any activity without the insurance company’s prior approval, the insurer will not provide any financial assistance.
  • Personal accident insurance does not cover injuries or death resulting from mental illness or emotional distress. That means if a policyholder suffers from depression, anxiety, or any other mental health condition and meets with an accident, the insurer will not provide any financial assistance.
  • Injuries sustained while participating in hazardous sports or activities such as bungee jumping, mountaineering, or skydiving do not get covered under personal accident insurance.
  • If the policyholder is involved in an incident classified as an act of war or terrorism, the insurance company will not provide any compensation for the resulting injuries or death.
  • Personal accident insurance does not cover any injuries that are self-inflicted, intentional, or caused by a policyholder’s negligence. This includes injuries resulting from the policyholder’s participation in illegal activities, such as drug abuse or alcoholism.
  • Personal accident insurance typically excludes coverage for injuries sustained while flying a private aircraft. That is because a private aircraft carries a higher risk of accidents due to the lack of safety regulations and oversight.

It is important to have clarity when it comes to understanding which contingency does not get covered under personal accident insurance. If you have any questions about your policy, be sure to contact your insurance provider for clarification and clear your doubts.

Conclusion

While personal accident insurance offers extensive coverage against accidental injuries, it is essential to understand the exclusions to avoid claim rejections. Policyholders should thoroughly review their health insurance policy terms, be aware of the exclusions and choose additional riders if necessary to enhance their coverage. Being well-informed ensures better financial planning and peace of mind in times of unexpected contingencies.



Disclaimer: The information provided in this blog is for educational and informational purposes only. It is not intended as a substitute for professional advice, diagnosis or treatment. Please consult a certified medical and/or nutrition professional for any questions. Relying on any information provided in this blog is solely at your own risk, and ICICI Lombard is not responsible for any effects or consequences resulting from the use of the information shared.

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