Group Personal Accident

 

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Under this policy the insured or his employees are granted pre-determined scales of benefits in the event of the Insured or his employees sustaining bodily injury or meeting with fatal accident or contracting certain specified diseases.

The Scheme was started in 1995 for the welfare of the State Government Employees. A group policy is issued for the employees on annual premium basis. Employees have to get deducted premium compulsorily from his salary of the month April paid May.

Such policy can be issued to other institutions on the rate decided by the GIF or decided by negotiation. The department is giving its services to Police Department, Electricity Department, KUMSs, Universities and others also. Premium is submitted through DD also, notification is published in Newspaper/s for the dates.

On an accidental death, the nominee of deceased employee is paid Rs. 2.00 lac and claim amount is also payable in injury cases as per the terms and conditions of the Policy.

To claim an amount employee or nominee has to submit claim form within specific time.

The benefits and compensations except death for the policy are


a) Loss of hearing:

Benefit/Compensation payable Rs.
i) Both ears 1 Lac
One ear 30 Thousand

b) Loss of thumb and finger of hand:

Benefit/Compensation payable Rs.
i) Loss of four fingers and thumb of one hand (All phalanges) 80 Thousand
ii) Loss of four fingers except thumb (All phalanges) 50 Thousand

c) Loss of thumb:

Benefit/Compensation payable Rs.
i) One thumb (both phalanges) 50 Thousand
ii) One thumb (One phalanx) 20 Thousand

d) Loss of Fingers except thumb:

Benefit/Compensation payable Rs.
i) Any finger (All phalanges) 12 Thousand
ii) Any finger (Two phalanges) 10 Thousand
iii) Any finger (One phalanx) 6 Thousand

e) Loss of toes of any leg:

Benefit/Compensation payable Rs.
i) Including great toe (All phalanges) 40 Thousand
ii) One great toe (Both phalanges) 10 Thousand
iii) One great toe (One phalanx) 4 Thousand
iv) Toes except great toe (Both phalanges) 2 Thousand (Per toe)
v) Toes except great toe (One phalanx) 1 Thousand (Per toe)

f) Loss due to burning:

Benefit/Compensation payable Rs.
i) 50% or more of entire body 1 Lac
ii) 40% or more but less than 50% of entire body 75 thousand
iii) 30% or more but less than 40% of entire body 50 Thousand

In the event of death of the insured person due to accident, as defined in the policy, outside his/her place of residing will get Rs. 2,000/- in addition to the amount payable for Transportation and cremation etc.


Exceptions

The General Insurance Fund shall not be liable under this policy for:

Payment of compensation in respect of Death, injury or Disablement of the Insured Person

  • (a) From intentional self-injury, suicide or attempted suicide,
  • (b) Whilst under the influence of intoxication liquor or drugs or any such substances whether directly or indirectly caused by or contributed to by it,
  • (c) whilst engaging in Aviation or Ballooning, or whilst mounting into, dismounting from or traveling in any balloon or aircraft other than as a passenger(fare paying or otherwise) in any duly licensed standard type of aircraft any where in the world,
  • (d) Directly or indirectly caused by any diseases or insanity,
  • (e) Arising or resulting from the Insured Person committing any breach or law with or without Criminal intent,
  • (f) If claim form received after six month of the accident/death
  • (g) If there are violations of Motor vehicle act 1989, (i) Absence of FIR, PMR, FR and other evidences in case of death due to biting of poisonous beings
  • (h) Absence of the FIR, FR, PMR in case of drowning.
  • (i) directly or indirectly connected with or traceable to War, Invasion, Act of foreign enemy, Hostilities (whether war be declared or not), Civil war, Rebellion, Revolution, Insurrection, Mutiny, Military or Usurped power, Seizure, Capture, Arrests, Restraint and Detainments of all kings, Princes, people of whatever nation condition or quality sever.
  • (j) Directly or indirectly caused by or contributed to by or arising from and ionising radiations or contamination by radioactivity any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose of this exception, combustion shall include any self-sustaining process of nuclear fission.

Pregnancy Exclusion Clause:

The Insurance under this policy shall not extend to cover death or disablement resulting directly or indirectly caused by, contributed to or aggravated or prolonged by child birth or pregnancy or in consequence thereof.


Surgical Exclusion Clause:

The Insurance under this policy shall not extend to cover death or disablement resulting directly or indirectly caused by, contributed to or aggravated or prolonged by any Surgical Operation.


Nominations

Persons who can be appointed nominee:-

  • (1) husband/wife, child/children, brother(s), sister(s), father or mother of the insured
  • (2) Other person if no relation mentioned in (1) above is alive at the time of making nomination.

Nomination of any other person if any relation as mention in (1) is alive shall be deemed to be null & void. However if any such relation except husband/wife is acquired after filing of nomination, the nomination shall not become invalid.


Payment of Claim in the absence of nomination:

In the absence of nomination, the claim amount will be paid in equal proportion to the following:-

  • (a) Wife or Husband, Sons and Unmarried daughters.
  • (b) In case of no such member as mentioned at (a) above are alive, to the widow daughters, brothers below the age of 18 years, Unmarried and widowed Sisters, Father or Mother.

In case no members amongst those mentioned at (1) & (2) above are alive, the claim amount shall be paid to the person producing the Succession Certificate of the Competent Court of Law.

Upon the happening of any event which may give rise to a claim under this policy, written notice with all particulars must be given to the GIF immediately. In case of death, written notice also for the death must, unless reasonable cause is shown, be given before internment/cremation and in any case, with one calendar month after the death and in the event of loss of sight or amputation of limbs written notice thereof must also be given within one calendar month after such loss of sight or amputation.

Proof satisfactory to the Fund should be furnished of all matters upon which a claim is based. Important documents which are required are

  • Death certificate
  • PMR
  • Treatment report
  • Fir & FR/challan
  • Panchnama
  • Naksha moka
  • Witness statement
  • MTI report
  • Original proposal form

These documents should be submitted within 2 months from the date of incident. All such documents/information must be submitted to the GIF latest by 6 month along with mentioning the reasons of delay otherwise claim to be closed as "No claim". No claim form would be entertained after 6 months.

No sum payable under this policy shall carry interest.