Group Personal Accident Policy

Coverage:
In event of any bodily injury sustained due to accident the policy seeks to compensate the policyholder as per terms/conditions of the policy. Aggregate benefits under the policy are limited to capital sum insured.

Age:
Persons of 5 to 70 years can be covered under the policy. Persons over 70 years up to 80 years are coverable with loading of premium in case of renewal.

Risk Group:
For purpose of premium the persons are divided in 3 groups.
I. High
II. Medium
III. Normal on basis of occupation of person insured

Coverage:
1. Death
2. Permanent Total Disability (PTD)
3. Permanent Partial Disability (PPD)
4. Temporary Total Disability (TTD) with weekly benefit
5. Medical Extension

IMPORTANT POINTS TO REMEMBER WHILE BUYING THE POLICY

Can cover upto five times of annual CTC

Sum insured taken on salary basis allows to take sum insured maximum upto five time of annual CTC.

Any Addition and deletion of employee should be reported to the insurance company.

Details of additions and deletions of employees should be shared to insurance company and get the confirmation of coverage in the form of endorsement.

In case of un-named policy, client should ensure that number of employee should not exceed the number of employees in the policy.

In case of un-named policy, client should ensure that number of employee should not exceed the number of employees in the policy.

Key Documents at The Time Of Claims

General Claim
Intimation Format

Immediate Action Client
Should Take

Indicative General Documents
for Settlement of Claims

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FAQ's

PREMIUM

COVERAGES

CLAIMS

OTHERS

How is premium determined under GPA policy?

The premium of the policy depends on occupation and capital sum insured. Professional mountaineers, pilots, miners are charged higher premium rate than people with low risk jobs such as bankers, professors, IT professionals or persons engaged in administrative duties.
Do I get a premium refund for employees who leave the organization?

Yes, addition and deletion of lives is done on pro-rata basis. So, if an employee leaves the organization then the period of insurance for which he is not covered is refunded back to the policy holder.
How does claim history impact the premium paid at the time of renewal?

Claim history reveals the risk exposure of the client and therefore, it is a consideration for arriving art premium proposed by insurance company.
Do I get Tax benefit on the premium paid?

Unlike health or life insurance, which provides you with a tax benefit for the annual premium paid, Group Personal Accident plan don’t have any tax benefit for the insured.

What is the period of coverage under Group personal Insurance policy?

GPA policies are generally issued for a period of 12 months.
Which benefits does the policy cover for the employees?

A Group Personal Accident Policy would cover accidental death, permanent partial disability, permanent total disability and temporary total disability. Some policies can also provide additional coverage features like ambulance charges, transportation of mortal remains, loss of employment due to permanent total disability, education fund for dependent children, coverage for broken bones, etc.
Can family members be covered under this policy?

No, only employees of the Organization can be covered. Unlike, Group Health Insurance Policy, this is not a family floater.
Is death due to any reason covered under the policy?

No, only accidental death is covered under the policy.
Child Education allowance is covered in all claims?

Child education benefit is available only to employees who have admissible claim under accidental death or permanent total disability only. Child education benefit is not available under any other type of disability.

What would be the claim amount the insured dies naturally?

This policy doesn’t cover such perils. The claim under this policy will only trigger once there is an accident.
What is the maximum claim amount payable under the policy?

For, Accidental Death and PTD, 100% of sum insured is payable. For Permanent partial disablement, % of sum insured defined in the policy basis the diagnosis made by the treating doctor. For temporary total disablement, amount payable is limited to the sub-limits specified in the policy.
Is cashless facility available under group personal accident policies?

Most of the insurance companies provide only re-imbursement benefit in group personal accident policies. However, a few like ICICI Lombard can provide cashless facility also, on payment of additional premium.
Is there any limit to the number of claims that can be made under the policy in 1 year?

No, there is no limit to the number of claims under the policy.
What is maximum accumulation limit?

It means the maximum amount payable by the Company in respect of any one Accident, irrespective of the number of Insured Persons involved in such Accident. In the event that an Accident occurs which results in insurable losses under this Policy and the Accumulation Limit is exceeded, the Accumulation Limit amount will be distributed on a proportional basis to all Insured Persons, taking into account the maximum Sums Insured per Benefit and per Insured Person.

Why GPA Insurance needed?

As per Global Status Report on Road Safety 2013, one person dies every 4 minutes due to a road accident in India. Working class, passengers using any conveyance are susceptible to injuries due to accident. Persons living in posh houses are also not 100% safe and are prone to injury by negligence or accident. PA Policy assumed lot of importance due to such uncertainties of life.
Is tax benefit available from GPA policy?

No
Does an employer need GPA policy, when it already has a GMC Policy?

Yes. The risks covered in two policies are different. GMC policy covers medical costs, particularly hospitalization. Personal accident covers accidental death and disablement.
Will the insured get the Sum Assured in case of a loss of employment due to an accident?

The full Sum Assured is not paid in case of loss of employment due to an accident. Only a percentage of the Sum Assured subject to a maximum limit is paid to the insured. Moreover, such a payment of a proportion of the Sum Assured is an additional benefit which is not available universally with all types of group personal accident plans.
Will the group members require a pre-policy medical test?

The plan covers death or disability due to accidents which are uncertain and are not related to any member’s health conditions. Thus, there is no requirement of pre-policy medical tests when members are enrolled in the group personal accident plan.
Do i get the tax benefit for the premium paid under group personal accident plans?

An employer can claim the premiums paid under the plan as a business expense and claim tax deduction on such expense under section 37.
What are minimum number of lives that can be covered in Group personal accident policy?

25 is the minimum no of lives that can be covered. However, some insurance companies cover groups as small as 10 lives.
what is the difference between named policy and un-named policy?

As the name suggests, named policy is one in which the names of the employees enrolled under the policy is specified at the time of issuing the policy, whereas, in an unnamed policy, no names are given, only count of lives covered is provided.

Claim Case Study - 1

Situation

In a GPA policy of a fast growing IT company, there are frequent joining of the employees due to which the employees do not get the coverage from day one.

Challenge

The insurance company had rejected the claim on the grounds of non coverage of such employees.

Solution

We were able to convey to the Insurance company that the CD deposit so maintained takes care of such exigencies and claims were paid accordingly.

Advisory/Conclusion

Complete reconciliation of data was done to ensure all the existing members are covered. Monthly details of addition and deletion of members was comprehensively done for future.

Claim Case Study - 2

Situation

A business man died due to snake bite

Challenge

the claim was rejected on the ground that animal bite is by specific mention not covered under the policy

Solution

the case was presented to Insurance company that animal bites within the definition of accident --Sudden , violent and external . Animal bite comes within the purview of the difinition of an accident, later on it was accepted by the Insurer.

Advisory/Conclusion

One should structure the policy in such a way that Animal Bite is not specifically excluded from the policy.

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