This insurance has been brought under a tariff regulation with effect with effect from 1.1.1977. The revised tariff became effective from 1st June, 1985.
The policy provides compensation in the event of the insured sustaining injuries, fatal or otherwise, resulting solely and directly from accident caused by external, violent and visible means.
Scope of Cover: If at any time during the currency of the policy the insured sustains any bodily injury resulting solely and directly from accident caused by external, violent and visible means, then the company undertakes to pay the insured or his legal nominee, as the case may be, following sums:
Within 12 calender months of its occurrence if such injury results in:
Death, the capital sum insured becomes payable. If death occurs away from residence of the insured, the company will reimburse expenses for transportation of the dead body to the place of residence subject to the limit of 2% of C.S.I. or Rs. 1000 whichever is less.
Loss of 2 limbs or 2 eyes or one limb and one eye, the capital sum insured becomes payable.
Loss of one limb or one eye, 50% of C.S.I. becomes payable.
Permanent Total Disablement (PTD) from injuries other than named above full capital cum insured becomes payable.
Permanent Partial Disablement (PPD) involving total and irrecoverable loss of use of parts of limbs, then applicable percentage of capital sum insured are payable as enumerated in the policy.
Temporary Total Disablement (TTD) then 1% of capital sum insured becomes payable per week for not more than 104 weeks but in any case not exceeding Rs. 3000 per week in all under all policies.
Territorial Limit : Cover is Worldwide
Conditions:
No compensation under more than one of the foregoing sub-clauses in respect of the same period of disablement will be payable.
No payment after a claim under sub-clauses (a), (b), (c) or (d) has been admitted and has become payable.
Any payment during the policy period exceeding the Capital sum insured, which is the company’s maximum liability.
Payment of weekly compensation under (f) above until the total amount shall have been ascertained and agreed.
Company has the right to get the Insured medically examined. In the event of accidental death post mortem report will be submitted by the claimant within 14 days of demand.
On payment for Permanent Total/Partial disablement claim, insured will have to submit original policy for the purpose of reduction of capital sum insured or cancellation of the policy as the case may be.
Exceptions
Self-injury, suicide or attempted suicide.
Whilst under the influence of alcoholic drinks or drugs.
Engaging in aviation activities other than travelling as a passenger (in a duly licensed standard type of aircraft) anywhere in the world.
Venereal disease or insanity.
Whilst committing any breach of law with criminal intent.
War amd allied perils.
Nuclear exclusion.
Pregnancy, childbirth or consequences thereof.
Classification of risks: The P.A. risks are divided into 2 classes as detailed below:
Normal: Persons other than those specified below under the “heavy” classification.
Heavy: Persons working in underground mines, explosives magazines, workers involved in electrical installation with high tension supply, jockey, circus personnel, racing on wheels or horseback, big game hunting, mountaineering, winter sports, sking, ice hockey, ballooning, polo and persons engaged in occupations of similar hazard. Cases of doubt regarding occupations not specified above may be referred to the Regional Committee for decision which will depend upon the merit of each case.