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.