Oriental Insurance Personal Accident-Group

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 –

   Loss	Percentage of the Capital Sum Insured
   All toes	20%
   Both Great phalanges of toes	5%
   One Great phalanx of toe	2%
   >1 toe lost	1%
   Hearing (both ears)	50%
   Hearing (one ear)	15%
   4 fingers and one thumb of one hand	40%
   4 fingers of one hand	35%
   Thumb both phalanges	25%
   Thumb one phalanx	10%
   Index finger three phalanges	10%
   Index finger two phalanges	8%
   Index finger one phalanx	4%
   Middle finger three phalanges	6%
   Middle finger two phalanges	4%
   Middle finger one phalanx	2%
   Ring finger three phalanges	5%
   Ring finger two phalanges	4%
   Ring finger one phalanx	2%
   little finger three phalanges	4%
   little finger two phalanges	3%
   little finger one phalanx	2%
   Metacarpals first or second	3%
   Metacarpals third, fourth or fifth	2%
   Any other disablement	As 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)
   10	25
   25	50

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.