Health Insurance 1463 views September 9, 2020

Oriental Personal Accident Policy

Meeting accidents on the road can be damaging both physically and financially. On the physical side, accidents can lead to physical disability or even a death. Financially speaking, you will need to pay a huge sum for the treatment that will happen after the accident. But a Oriental Personal Accident Policy can help you deal with accidents better, at least financially. This policy provides compensation to the insured or nominee from an accident caused by violent, visible and external means. If you want to get secured financially from accidents, know about the Oriental Personal Accident Policy on this page below. The page will highlight the expenses covered in the policy and the ones that are excluded. So, read on!

Oriental Personal Accident Policy Coverages

If you sustain any bodily injury from an accident during the policy period, Oriental Insurance Company shall pay to the insured or his/her legal personal representative. Check out the pointers below to know when you can claim the Oriental Personal Accident Policy.

    1. If such bodily injury causes the death of the insured, the Capital Sum Insured as stated in the policy will be offered to the nominee or legal heir of the insured.
    2. Injury within twelve calendar months which is the sole and direct cause of total and irrecoverable loss of sight of both eyes, one eye, separation of two entire hands, separation of two entire feet, separation of one entire hand and one entire foot. The ‘physical separation’ of the hand or foot means separation at or above the wrist and of the foot at or above the ankle respectively. Following is the Percentage of Capital Sum Insured
Injury CauseCapital Sum Insured
Loss of all toes 20%
Both Great phalanges5%
One Great phalanx2%
More than one toe lost each1%
Loss of hearing both ears50%
Loss of hearing one ear15%
Loss of 4 fingers and thumb in one hand only40%
Loss of four fingers35%
Loss of thumb both phalanges25%
Loss of thumb-One Phalanx10%
Loss of index finger- three phalanges10%
Loss of index finger - two phalanges8%
Loss of index finger- one phalanx4%
Loss of middle finger- three phalanges6%
Loss of middle finger - two phalanges4%
Loss of middle finger- one phalanx2%
Loss of ring finger- three phalanges5%
Loss of ring finger - two phalanges4%
Loss of ring finger- one phalanx2%
Loss of little finger- three phalanges4%
Loss of little finger - two phalanges3%
Loss of little finger- one phalanx2%
Loss of metacarpals 3%
Loss of metacarpals--third, fourth or fifth(additional)2%
Any other permanent-Partial disablementAs assessed by the doctor or medical practitioner
  1. Injury whose direct consequence causes immediate, permanent, total and absolute disable the Insured from engaging in any employment or occupation of any description.
  2. If the injury is the sole and direct cause of Temporary Total Disablement and makes the insured disabled from engaging in any employment or occupation of any description, the insurance company shall pay the sum at the rate of 1% of the Capital Sum Insured, stated in the schedule is payable per week. But the maximum benefit won’t exceed INR 20,000 per week under all policies. The compensation payable under the foregoing sub-clause is not available for more than 100 weeks. The duration is calculated in respect of any one injury calculated from the date of commencement of disablement. The amount payable won’t exceed the capital sum insured in any case.
  3. In the event of the death of the insured person due to accident, the company shall reimburse expenses incurred for transportation of the insured’s dead body to the place of residence, subject to a maximum of 2% of the capital sum insured or INR 2,500, whichever is less. The cover should also be given for funeral expenses.
  4. The policy shall also provide compensation towards the Education Fund for the dependent children in the event of Permanent Total Disablement or death due to accident.
    • In case the insured person has one child below 23 years, 10% of the Capital Sum Insured will be given.
    • In the case of more than one child below 23 years, 10% of the Capital Sum Insured will be given

    Note: The policy payment as above is made along with the Capital Sum Insured of the person who is entitled to receive it. The benefit under this extension is available based on the original Capital Sum Insured only and not on the insured cumulative bonus. The age limit of 23 years is applicable from the date of the accident and not the date of policy commencement. If there are any other subsisting Personal Accident Insurance in the name of the insured, the total payable amount is limited to a maximum of INR 5,000 in the case of one dependent child and INR 10,000 in case of more than one dependent child. The insurance company will pay the application amount in proportion to the original sum insured.

  5. Compensation for loss of employment due to total disablement can be 1% of the capital sum insured or INR 15,000, whichever is less

Exclusions from Oriental Personal Accident Policy

The Oriental Insurance Company Ltd. is not liable to pay for the following:

  1. Compensation under more than one sub-clauses that is death of the insured, total and Irrecoverable loss of one or two eyes and one or two limbs, disablement due to which the insured can’t work, except for total and Irrecoverable loss by physical separation in respect of the same period of disablement.
  2. Any other payment after a claim under any one sub-clauses becomes payable
  3.  When any payment, in case of more than one claim under the Policy, during any one period of insurance increases the maximum liability of the company beyond the sum payable under the sub-clause relating to the death of the insured.
  4. Weekly compensation until the total amount is ascertained and agreed by the company
  5. Payment of compensation for Death, Injury or Disablement
    • Intentional self-injury
    • Suicide or attempted suicide
    • Influence of intoxicating liquor or drugs
    • Aviation, ballooning, mounting, or dismounting
    • Directly or indirectly caused by veneral diseases or insanity
    • Breach of law aided by criminal intent
  6. Payment of compensation in respect of the Death, Injury or Disablement to the insured due to:
    • War
    • Invasion
    • Act of foreign enemy
    • Hostilities where the war is declared or not
    • Civil War
    • Rebellion
    • Revolution
    • Insurrection
    • Mutiny
    • Military or Usurped Power
    • Seizure, Capture
    • Arrests
    • Restraints
    • And detainment of all kings, princes and people
  7. Payment of Compensation in respect of death of, or bodily injury or any disease or illness of the insured from:
    • Direct or indirectly caused by ionizing radiations or contamination by radioactive nuclear fuel
    • Direct or indirect cause of nuclear weapon material
  8. Pregnancy exclusion clause: The policy may not cover death or disablement due to the direct or indirect cause of child-birth or any pregnancy consequences.

Free Look Period

Oriental Personal Accident Policy offers a free look period where the insured will be allowed for at least 15 days from the date of receipt to review the terms and conditions and to return the same if it is not acceptable. If you do not make any claim during the free look period, you are entitled to the following benefits.

  1. A refund of the paid premium less the expenses incurred during medical examination and stamp duty charges
  2. If the risk has already commenced and you have returned the policy, a deduction is provided towards the proportionate risk premium for the period on cover
  3. Where only a part of the risk is commenced, the risk premium commensurates with the risk covered during the free look period

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