Insurance Plans September 17, 2020

Oriental Insurance Nagarik Suraksha policy offers a Personal Accident Cover including the reimbursement of Hospitalization Expenses as per the policy schedule to Indian citizens. It is the Oriental Insurance Company Ltd. total liability in respect of policy claim during the insurance period which shall not exceed the sum insured as specified under Section 1 (Personal Accident) in the policy and the sum insured under Section 2 (Hospitalisation). Read this page below to know what Oriental Nagarik Suraksha Policy covers and what it does not.

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Oriental Insurance Nagarik Suraksha Policy Coverage

The policy provides you protection under two sections, so we will know about each of the section’s coverage one after another.

Section 1 (Personal Accident)

This section covers several bodily injuries which are due to the direct or indirect cause of an accident. If the Insured person sustains any bodily injury during the policy period by an external, violent and visible means, the Oriental Insurance Company Ltd. will pay the insured, his/her nominee, or legal heir the sum insured. You can claim the policy for:-

  1. Accident
  2. Loss of Limbs
  3. Physical Separation
  4. Permanent Total Disablement
  5. Permanent Partial Disablement
  6. Injury series  

Situations When You Can Claim Oriental Insurance Nagrik Suraksha Policy Section 1

  1. If the injury happens within 12 calendar months and it is the sole and direct cause of the death of the insured, the Oriental Insurance Company Ltd. will pay the policy sum insured to the nominee or legal heir.
  2. If your injury within 12 calendar months is the cause of the total and irrecoverable loss of sight of both eyes, hands, or feet, or one hand, one foot, or one eye, the company will pay 100% of the sum insured.
  3. If the injury within 12 calendar months of its occurrence is the direct cause of the total and irrecoverable loss of sight of one eye, hand, foot, the company will pay 50% of the sum insured.
  4. If any such injury within 12 calendar months of its occurrence causes permanent, total and absolute disablement to the insured and he/she is unable to get any employment or occupation of any description, the sum insured which is specified in the schedule of Oriental Nagarik Suraksha Policy will be payable.
  5. If an injury within twelve calendar months causes total and irrecoverable loss of use or loss by physical separation due to a bodily injury incapacitating the insured up to 40% or more as assessed by the attending physician, the company will pay a percentage of the sum insured equal to the disability but in no case exceeding 100%  of the sum insured.

Section 2 (Hospitalization)

The Oriental Insurance Company Ltd. will give reimbursement for hospitalization expenses that arise due to an accident. This section of the Oriental Insurance Nagarik Suraksha Policy covers the insured if during the policy or renewal insured sustains any bodily injury from an accident. And as per the advice of the Physician, Medical Specialist, Medical Practitioner, or surgeon insured require hospitalization, the expenses for medical or surgical treatment at a nursing home or hospital is paid by the Oriental Insurance Company Ltd.

The company will reimburse such expenses as they are incurred in respect of such the insured person. The total liability of all claims must not exceed the sum insured as specified in the schedule of the policy, for 12 months. 

Oriental Insurance Nagarik Suraksha Policy Exclusions from Section 1 (P.A)

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

  1. More than one “Compensation” with respect to the same period of disablement which is due to an accident.
  2. Any claim under one of the sub-clauses
  3. More than one claim under section 1 during any one period of insurance where the liability in that period exceeds the sum insured as specified in the schedule of Oriental Nagarik Suraksha Policy.
  4. Injury whose direct cause is:
    1. Committing or attempting suicide
    2. Intentional self-injury
    3. Intoxicating liquor or drugs
  5. If the injury is caused due to whilst engaging in aviation or mounting, dismounting, or traveling in any private aircraft other than the passenger aircraft.
  6. Death or disablement  due to pregnancy or childbirth
  7. Death or disablement due to Venereal disease or insanity
  8. Illness which is directly or indirectly arising from HIV, or any HIV related illness including AIDS and any mutant derivative, or variation of HIV/AIDS.
  9. Breach of law due to a criminal intent

Oriental Insurance Nagarik Suraksha Policy Exclusions from Section 2 (Hospitalization)

As per the policy terms and conditions, Oriental is not liable to pay for the following:-

  1. Any conditions which are in existence at the time of proposal, any pre-existing condition whose symptoms existed before the effective date of the policy, whether you know that pre-existing condition or not.
  2. Any complications arising from the pre-existing condition
  3. Circumcision unless it is necessary for the treatment of the injury
  4. Vaccination
  5. Inoculation
  6. Change of life
  7. Cosmetic or Aesthetic treatment of any description
  8. Plastic surgery unless it is necessary for the treatment of the injury
  9. Expenses of spectacles, contact lens, or hearing aids
  10. Convalescence
  11. General debility
  12. Run-down condition or rest cure
  13. Congenital external disease or defects or anomalies
  14. Sterility
  15. Venereal disease
  16. Intentional self-injury and use of intoxicating drugs or alcohol
  17. Treatment related to Human T-Cell lymphotropic virus types III (IITB-III), Lymphadenopathy Associated Virus (LAV), Mutants Derivative, VariationDeficiency Syndrome, or any syndrome or condition of a similar kind referred to as AIDS.
  18. Diagnostic, X-Ray, or laboratory expenses unless it is related to the treatment of your injury 
  19. Outpatient or first aid 
  20. Expenses which do not arise out of Hospitalization
  21. Vitamin and tonic unless prescribed by the attending Physician
  22. Naturopathy
  23. Magnetic or Yoga therapy treatment
  24. Dental treatment 
  25. Surgery of any kind unless it requires hospitalization
  26. Pre-hospitalization and Post-hospitalization medical treatment
  27. Treatment arising from pregnancy, childbirth including cesarean

Major Exclusions from Oriental Insurance Nagarik Suraksha Policy  

Oriental Insurance Nagarik Suraksha Policy is designed to provide financial security to the individual or his/her family at the time of medical emergency which arises due to an accident. But as per the policy conditions, there are some exclusions from Oriental Nagarik Suraksha Policy which the company isn’t liable to pay. Have a look at them in the below pointers.

  1. War Risk: If any bodily injury is a consequence of direct or indirect cause of war, invasion, an act of a foreign enemy, hostilities, (Whether war be declared or riot) civil war, rebellion, revolution, insurrection, military or usurped power, confiscations nationalization, civil commotion or loot, or pillage in connection herewith
  2. Confiscation: Bodily injury to the insured due to confiscation, requisition, or destruction by order of any government, public, or the local authority
  3. Nuclear Risk: Consequential loss, legal liability, or any bodily injury due to direct or indirect effect arising from:
    1. Ionizing radiation
    2. Contamination by radioactivity from any nuclear fuel 
    3. Contamination by radioactivity from any nuclear waste 
    4. Contamination by radioactivity from the combustion of nuclear fuel
    5. The radioactive toxic
    6. Explosive or any kind of hazardous properties of a nuclear assembly or nuclear component 
  4. Consequential loss of any kind or description

Additional Benefits of Oriental Insurance Nagarik Suraksha Policy

Apart from the above-mentioned coverage, the policy provides several other benefits to the policyholder like:-

Cumulative Bonus

You can get a payable compensation under the Oriental Insurance Nagarik Suraksha Policy for a claim-free period of 12 months. Under this cumulative bonus, the Oriental Insurance Company’s liability under section 2 reimbursement section is increased by 5% for each claim-free period. The maximum amount of such an increase is not more than 20% of the sum insured as specified in the schedule of Oriental Nagarik Suraksha Policy. However, the Cumulative Bonus will be lost if you don’t renew the policy within 30 days of its expiry. The cumulative bonus applies to individual policyholders only.

Carriage & Funeral Expenses

In the event of death, the expenses which are incurred in the carriage of the insured dead body from his/her residence, a funeral charge of a maximum of 2% is reimbursed from the sum insured by the company as specified in the policy schedule. The funeral expenses reimbursed by the company will be INR 2,500 or less.

Education Funding

The insurance company will provide compensation towards education for the dependent children in addition to the sum insured as specified in the schedule under section 1 (PA) of Oriental Insurance Nagarik Suraksha Policy. In this, if the insured is expired in an accident, the nominee will be entitled to receive the compensation as shown below:-

  1. If the Insured Person has one dependent child below the age of 23 years on the date of the accident, the claim will be 10% of the original sum insured as specified in section 1 of the Oriental Insurance Nagarik Suraksha Policy, subject to a maximum of INR 5,000
  2. If the Insured person has more than one dependent child below the age of 23 years on the date of the accident, the claim will be 10% of the original sum insured as specified in section 1 of the Oriental Insurance Nagarik Suraksha Policy, subject to maximum INR 10,000.

The benefit is available under the Individual Oriental Insurance Nagarik Suraksha Policy Section 1 (P.A) policy only.

Unemployment Benefits

In case you lose your job due to the permanent total disablement, a 1% of the original sum insured as specified in the schedule of Oriental Insurance Nagarik Suraksha policy section 1 (PA) becomes payable to the insured in addition to his/her sum insured.

Oriental Insurance Nagarik Suraksha Free Look Period (Only for Individual Plan)

The insurance company provides you with a free look period during which you can return the policy if not satisfied with the terms and conditions. The insured will be allowed at least 15 days from the date of receipt to review the terms and conditions of the Oriental Nagarik Suraksha policy.

If the insured doesn’t make any claim during the free look period, the insured will be entitled to the following benefits:-

  1. A refund of the paid premium less any expenses incurred during the medical examination and the stamp duty charges
  2. Where the risk is already commenced and the option of policy return is exercised, a deduction equal to the proportionate risk premium is applied for the period on cover
  3. Where only a part of the risk is commenced, the deduction is proportionate to the risk covered during the free look period.

Claim Procedure for Oriental Insurance Nagarik Suraksha Policy

To cover your accidental loss, you can claim under this policy with a written notice consisting of full particulars and submit it to the issuing office immediately. However, a reasonable cause will be furnished if the insured person or his representative doesn’t notify the company of the accident immediately. The clarification for delay notification should be submitted within 7 days from the date of accidental injury.

For reimbursement of the claim, you should submit the original bills, receipts and other documents to the company. If all the proofs are satisfactory to the company, they will furnish all matters upon which a claim is based.

A medical practitioner or an authorized official of the company will be allowed to examine the insured in the case of any alleged injury which requires hospitalization. For the final claim, you need to submit the hospital bills, Cash memos, FIR- if any, claim form along with the list of documents as mentioned in the claim form to Oriental’s issuing office within 14 days of discharge.

Terms & Conditions of Oriental Insurance Nagarik Suraksha Policy 

Before you proceed to buy the Oriental Nagarik Suraksha Policy, you should take a look at the company’s terms and conditions as mentioned below:-

  1. The insurance cover is for Indian citizens only
  2. People from the age group of 5 to 70 years are covered under the Oriental Nagarik Suraksha Policy family package
  3. People from the age group of 18 to 70 years are covered under Oriental Nagarik Suraksha Policy Individual or Group Cover. 
  4. Individual policy terms range between 1 to 4 years
  5. Group policy terms range upto 12 months
  6. The policy comes with a minimum sum insured of INR 1 lakh and a maximum of INR 5 lakh
  7. An enhancement of minimum sum insured in multiples of INR 25,000 is allowed up to INR 5,00,000
  8. Every notice or communication should be made in writing at the official address of the company’s issuing office. 
  9. In the event of a claim, if any other person or property not relating or belonging to the insured is involved in the complaint that is lodged in the police station, a report is to be sent to the police station as soon as possible.
  10. All the insured persons must take all reasonable precautions for safety and soundness to prevent aggravation of injury to minimizing claims.
  11. In the event of misrepresentation, misdescription or concealment of any material facts, this policy will be void and the paid premium will be forfeited.
  12. You must inform the company of any information change, like the change of address, as soon as possible
  13. The premium is paid in advance
  14. No receipt for premium is valid if it is not signed by a duly authorized company official
  15. No waiver of any terms, provisions, conditions and endorsement of the policy is valid unless it is made in writing and signed by the company’s authorized official.
  16. The insurance company is not liable to make any payment under this policy in respect of any claim if such claim remains fraudulent in any manner, supported by any fraudulent statement or device, by the insured or any other person on behalf of the insured.
  17. The insurer is not liable to pay or contribute more than its rateable proportion of any such expenses which are the same as in existence to any other Insurance/scheme other than the Oriental Nagarik Suraksha Policy. It applies to section 2 (Hospitalization) only.
  18. The policy is renewed by mutual consent of the insurance company and the Insured. The company is not bound to give notice for renewal and at any time cancel the policy by sending a 30-day notice to the insured. For cancellation, the company shall refund a pro-rata premium for the unexpired period of the policy to the insured. The company remains liable for any mishap which might have arisen before the cancellation. Check out the table below to know the risk rate premium for Oriental Nagarik Suraksha Policy.
  19. The company may deny your policy renewal on the grounds of fraud, moral hazard, or non-cooperation
  20. If there remains any difference to any amount payable to the insured (liability being otherwise admitted), it shall be referred independently of all other questions to the decision of Arbitrator (s) to be appointed as per the appropriate statutory provisions in force in India at the time of reference
  21. If the Company shall disclaim liability under any claim and such claim shall not have been made a subject matter of suit in a Court of Law within 12 months from the date of disclaimer, the claim shall be deemed to have been abandoned for all purposes and shall not thereafter be recoverable as per the policy 
  22. Oriental will not be liable for any interest on any sum paid or payable under Oriental Nagarik Suraksha policy
  23. Disputes under the Oriental Nagarik Suraksha policy are subject to Indian Courts of competent jurisdiction and the laws of the Republic of India that will govern the validity, construction, interpretation and effect of this policy.
  24. In the event of a claim in respect of hospitalization due to an accident on foreign land, the reimbursement of hospital expenses will be at the rate of exchange as applicable on the date of the accident. However, such a payable claim amount is in Indian Currency and limited to the policy Sum Insured as specified in the schedule.

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