Group Insurance 621 views February 11, 2021

Oriental Insurance Personal Accident-Group is for a group of members where they’ll be financially insured against the outcome of an accident such as death, total and irrecoverable loss of a body part. The claim will be admissible only if the insured person sustains any bodily injury only and directly from an accident caused by external, violent and visible means. To know furthermore about the Oriental Insurance Personal Accident-Group coverage and exclusion, read the page below.

Coverages Under Oriental Insurance Personal Accident-Group

You can provide your employees insurance against the following with the Oriental Insurance Personal Accident-Group plan –

  1. If an accident injury becomes the only cause of the insured member’s death within 12 months from the date of its occurrence, the insurance company shall pay the capital sum insured to the nominee as mentioned in the policy bond.
  2. When an injury caused due to an accident leads to total and irrecoverable loss of sight (both eyes), separation of hands or feet (both hand and feet), one hand and one foot, loss of sight of one eye, one entire hand or one entire foot, usage of both the hands or feet, loss of use of one hand and one foot, or loss of sight of one eye and loss of use of one foot or one hand within 12 months of its occurrence, the capital sum insured will be payable.
  3. In case the accident injury within 12 months of its occurrence causes total and irrecoverable loss of one eye, separation of one hand or one foot, loss of use of one hand or one foot, 50% of the capital sum insured will be payable.
  4. If an accident causes immediate permanent total and absolute disablement to the insured, and now he/she won’t be able to engage in employment or any other occupation, 100% of the capital sum insured will be payable in a lump sum.
  5. An accident that causes total and partial irrecoverable loss, the following percentage of the capital sum insured will be payable –
    LossPercentage of the Capital Sum Insured
    All toes20%
    Both Great phalanges of toes5%
    One Great phalanx of toe2%
    >1 toe lost1%
    Hearing (both ears)50%
    Hearing (one ear)15%
    4 fingers and one thumb of one hand40%
    4 fingers of one hand35%
    Thumb both phalanges25%
    Thumb one phalanx10%
    Index finger three phalanges10%
    Index finger two phalanges8%
    Index finger one phalanx4%
    Middle finger three phalanges6%
    Middle finger two phalanges4%
    Middle finger one phalanx2%
    Ring finger three phalanges5%
    Ring finger two phalanges4%
    Ring finger one phalanx2%
    little finger three phalanges4%
    little finger two phalanges3%
    little finger one phalanx2%
    Metacarpals first or second3%
    Metacarpals third, fourth or fifth2%
    Any other disablementAs assessed by the attending doctor
  6. Temporary total disablement, if caused to the insured member due to an accident during the policy term, 1% of the capital sum assured shall be payable per week to compensate the employment and occupation loss. This benefit should not be more than INR 20,000 per week or 25% of the monthly income of the insured, whichever is less. And its benefit shall be applicable up to 100 weeks only.
  7. Oriental Insurance shall also pay for the carriage of body and funeral expenses in case of death of the insured member. This benefit is limited to 2% of the capital sum insured or INR 2,500, whichever is less.
  8. Loss of employment in case of total disablement, the company will pay 1% of the capital sum insured or INR 1,500, whichever is less.
  9. The Oriental Insurance Personal Accident-Group will also cover accident medical expenses on additional premium payment such as-
    Additional Premium (% of the valid admissible claim amount)Claim Amount for Medical Expenses (% of the valid admissible claim amount)

Note – Medical expenses coverage shall be subject to the policy terms and conditions.

Exclusions from Oriental Insurance Personal Accident-Group

You won’t get coverage in case of the following –

  1. No benefit shall be payable if more than one of the A, B, C, D except for E is ongoing in the same period of disablement. 
  2. No claim payment is made further if a claim has already been admitted and paid for any one of the A, B, C and D. 
  3. If an insured member requests for claim more than once in a policy year, and by which the maximum liability of the company exceeds as specified in section A above, the company will not pay any further during such period.
  4. Weekly compensation will not be paid until the total amount is ascertained and agreed
  5. The benefit of Death, Injury or Disablement isn’t admissible if they arise from intentional self-injury, suicide or attempted suicide
  6. Participation in aviation or ballooning
  7. Venereal disease or insanity
  8. Breach of law with criminal intent
  9. War, Invasion, an act of the foreign enemy, hostilities, civil war, rebellion, revolution, insurrection, mutiny, military/usurped power, seizure, capture, arrests, restraints and detainment 
  10. Ionizing radiations or contamination from any nuclear fuel or nuclear waste 
  11. Nuclear weapons material
  12. Pregnancy and its consequence thereof

Note – A, B, C, D and E refer to the points mentioned under the heading for coverage.

Oriental Insurance Personal Accident-Group Provisions

  1. All sums shall be payable under this policy in case of death, permanent total disablement, permanent partial disablement and temporary total disablement. 
  2. The company will not pay under the policy if any claim is proved to be fraudulent or supported by any fraudulent statement or device.
  3. The company needs to be informed if any of the insured member’s business or occupation changes. 
  4. Send a written notice to the company if you are affected by any disease, physical defect or infirmity since the payment of the last preceding premium.
  5. This policy shall be renewed by mutual consent only
  6. The insurance company may terminate this policy and return the last paid premium anytime by giving you notice. 
  7. The insured can also cancel this policy anytime by writing a notice under a certificate of posting or a Regd. A. D.

People Also Read