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Universal Sompo's Personal Accident Policy provides you and your family mitigation against the financial consequences of unforeseeable accidents.

What does this Policy cover?

The Policy provides for defined benefits based on the nature of injury sustained, by the Insured Person in an accident during the Policy period.

Eligibility

  • The enrollment age under the Policy is from 5 years to 65 years. Fresh proposals for persons above 65 years till 75 years of age may be accepted with 20% loading on premium.
  • No fresh proposal beyond 75 years.
  • Proposer needs to be aged 18 years or above.
  • No maximum renewal age under the Policy

Coverage

The Policy provides for three different options as under:

  • Basic Cover - covers against Death only
  • Wider Cover - covers against Death, Permanent Total Disablement Permanent Partial Disablement
  • Comprehensive Cover - covers against Death, Permanent Total Disablement Permanent Partial Disablement Temporary Total Disablement

Compensation Benefit

The compensation benefits will depend upon the nature of injury and the Capital Sum Insured under the Policy.

For accidents resulting in Death or Permanent Total disablement, we will provide compensation equivalent to the full Capital Sum Insured.

For Permanent Partial Disablement the compensation will depend on the nature of injury and corresponding percentage of Capital Sum Insured as detailed in the 'Table of Benefit' under the Policy document or as per the medical advices of our appointed Medical Practioner.

In respect of Temporary Total Disablement, we will provide compensation at 1% of Capital Sum Insured or Rs 5000/- whichever is less per week for a maximum period of 104 weeks.

Additional benefits under the Policy

In addition to the Compensation benefit stated above, we also undertake to provide compensation in respect of the following:

Transportation Cost for carriage of dead body to Home including funeral charges. 1% of Capital Sum Insured or 2,500/- (Two thousand five hundred) whichever is lower.
Cost of Clothing damaged in the Accident as described above and liability for disablement is admitted by Us. Actual expenses subject to maximum of Rs 1000/
Ambulance charges for transportation of Insured person to Hospital following Accident subject to maximum of Rs 1000/
Education Fund In the event of death, permanent total disablement i.e. 1 2 of Table of Benefit of Insured Person, We will approve compensation towards Education Fund for dependent children as below -5% (Five percent) of C.S.I Subject to a maximum of Rs. 15000/-
Loss of Employment In the event of accident leading to loss of employment as a consequence of Permanent Total Disability as per the table of benefits. 2% of CSI subject to a maximum of Rs 25000/-

Optional Extension available under the Comprehensive Cover Policy

The Policy can be extended to cover the following by payment of additional Premium

Medical Expenses Extension: Cover the medical expenses reasonably and necessarily incurred by you towards medical expenses as a result an accident resulting in the bodily injury, death or disablement. The compensation under this extension is restricted to 40% of Personal Accident Claim or actual medical expenses whichever is less.

Hospital Confinement Allowance: Daily allowance of Rs 500/- per day to a maximum of 30 days if you or any of the insured person (s) is hospitalised as a result of an accident resulting in the bodily injury, death or disablement.

Terms OF Renewal:

  • This Policy shall ordinarily be renewable for lifetime except on grounds of fraud, moral hazard or misrepresentation or non-cooperation by You
  • The Renewal of the Policy sought by You shall not be denied arbitrarily. If denied, We shall provide You with cogent reasons for such denial of Renewal.
  • We shall not deny the Renewal of the Policy on the ground that You had made a claim or claims in the previous or earlier years, except for Death or Permanent Total Disablement claims where the Policy terminates following payment of the benefit covered
  • No loading on premium shall be applied on Your individual claims experience basis
  • The premium of the Policy may be revised subject to approval from Insurance Regulatory Development Authority

Three Months’ Notice:

We shall give You notice in the event We may decide to revise, modify or withdraw the product. Such notice shall be given to You at least three months prior the date when such modification or revision or withdrawal comes into effect. We shall adhere to the following:

  • In case of modification or revision, the notice given to You shall detail the reasons for such revision or modification, in particular the reason for an increase in premium (if any) and the quantum of such increase.
  • The product shall be withdrawn only after due approval from the Insurance Regulatory and Development Authority. However, if You do not respond to Our intimation in case of such withdrawal, the Policy shall be withdrawn on the renewal date and We shall provide You with an option to migrate to a substitute product offered by Us.

Policy Term

The Policy shall be issued for a period of 12 months from date of commencement of Policy

Fixing of Sum Insured under the Policy

Death only cover --- 10 times the yearly Income Wider Cover --- 05 times the yearly Income Comprehensive Cover --- 05 times the yearly Income (Rs 500,000/- max)

Substitute Product

In case We may decide to withdraw this product under which this Policy is issued to You or where the children have attended maximum eligibility age under the Policy, if covered, We shall provide You with an option to buy a similar substitute accident insurance Policy from Us.

Sum Insured Enhancement

Sum Insured can be enhanced only upon renewal, subject to Our underwriter‟s approval.

Cancellation

We may cancel this Policy by sending 15 days notice in writing by recorded delivery to You at Your last known address. You will then be entitled to a pro-rata refund of premium for the un-expired period of this Policy from the date of cancellation, which We are liable to pay on demand.You may cancel this Policy by sending a written notice to Us. Retention premium for the period we were on risk will be calculated based on following short period table and the balance will be refunded to You subject to the condition that no claim has been preferred on Us:

Period Of Risk Rate of premium to be charged
Upto 1 month 25% of annual premium
Upto 3 months 50% of annual premium
Upto 6 months 75% of annual premium
Above 6 months 100% of annual premium

Nomination

The Policy has provision of nomination, in absence of Your declaring Nomination at the time of proposal, then all benefits accrued under the Policy if any, shall be given to Your legal heir/ dependants.

Free Look Period

1. The Policy shall have a free look period. The free look period shall be applicable at the inception of the Policy and:

  • You will be allowed a period of at least 15 days from the date of receipt of the Policy to review the terms and conditions of the Policy and to return the same if not acceptable

2. If You have not made any claim during the Free Look period, You shall be entitled to

  • A refund of the premium paid less any expenses incurred by Us on Your medical examination and the stamp duty charges or;
  • Where the risk has already commenced and the option of return of the Policy is exercised by You, a deduction towards the proportionate risk premium for period on cover or;
  • Where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period.

Premium details:

The premium under the Policy shall be payable in single installment

Nature of Cover Category- Normal Heavy Very Heavy
Basic 0.40% 0.60% 0.90%
Wider 0.85% 1.25% 1.95%
Comprehensive 1.40% 2.00% Not to be covered

Rating for Add-on Covers:

a) Medical Expenses Extension: The additional Premium for this extension is 25% of the base PA premium.

b) Hospital Confinement Allowance: The additional premium for this extension is Rs 300/- per person.

Rating for Add-on Covers:

For Renewal policies for persons above 65 years of age, a 10% loading shall be applicable. We will inform You about the applicable risk loading through a counter offer letter. You have to revert to Us with consent and additional premium (if any) within 15 days of issuance of such counter letter. In case, You neither accept the counter letter from Us nor revert to Us within 15 days, We shall cancel Your application and refund the premium within next 7 days.

Please note:We shall issue Policy only after getting Your consent

Other Rating Guidelines:

A) Family package discount: More than 3 family Members 10.00% More than 4 family Members 12.50% More than 5 family Members 15.00% NB: Family means Proposer, spouse, dependent children and dependent parents.

B) Loyalty Discount:

Loyalty discount on the premium in respect of individual and family package cover at the following rate shall be allowed in case the Policy is renewed with Us within 7 days after the expiry of the Policy:

1st year 05%

2nd year 10%

3rd year 15%

Claims Procedure

A) Upon happening of any Accident and/or Injury which may give rise to a claim under this Policy

  • You shall give us a notice to our call centre immediately and also intimate in writing to our Policy issuing office. In case of death, written notice also of death must, unless reasonable cause is shown, be given before internment/ cremation and in any case, within 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.
  • All certificates, information and evidence from the attending Medical Practitioner shall be provided by You.

B) On receipt of intimation from You regarding a claim under the Policy, we are entitled to carry out examination and ascertain details and in the event of death get the post-mortem examination done in respect of deceased person.

C) The steps for lodging the claim shall be as under:

  • Notify Us immediately on occurrence of a claim and in any case within 7 days giving full description of the medical treatment undertaken and the cause.
  • Submit the completed and signed claim form, provide all the relevant documents as mentioned below in support of Your claim not later than 30 days from the date of intimation.

D) Following documents shall be required in the event of a claim.

For Death Claim

  • Duly filled up claim form
  • Death Certificate
  • Original FIR
  • Original Panchnama
  • Post mortem report

For Permanent Total disablement/Permanent Partial Disablement

  • Duly filled up claim form
  • Original FIR
  • Panchnama
  • Hospitalization Report
  • Hospital discharge card
  • Original Certificate from Doctor of Govt. Hospital stating the degree of disability

For Temporary Total Disablement

  • Duly filled up claim form
  • Original FIR
  • Panchnama
  • Hospitalization Report
  • Hospital discharge card
  • Original Certificate from Doctor of Govt. Hospital stating the degree of disability
  • Termination letter for claim under “Loss of Employment”

We shall settle claim(s), including its rejection, within thirty days of the receipt of the last necessary claim document.

Wherever details pertaining to happening of claim are conveyed by You to Us after reasonable period, You shall provide the reasons of such delay to Us and We may on analysis of reasons provided by You, may condone the delay in intimation of claim or delay in providing the required information/documents to Us.

E) Position after claim:

The maximum liability of the Company for each of the benefit opted is limited to its Sum Insured as reflected in the Schedule of the Policy and if a claim is made for more than one of the covered benefits resulting from any Accident, only one benefit amount which is the largest among the admissible benefits, will be paid. Regardless of one or more claim during the Policy period, the maximum amount payable towards any admissible benefit covered shall be restricted to Sum Insured for the Death/Permanent total disability benefit as reflected in the Schedule of the Policy.

F) Claim Payment:

All admissible claims under this Policy shall be paid by Us within 7 working days from date of acceptance of such a claim. In case of delay in the payment, We shall be liable to pay interest at a rate which is 2% above bank rate prevalent at the beginning of the financial year in which claim is reviewed by Us.

Claim Disclaimer

In the unfortunate event of any medical contingency resulting into a claim on this Policy, please intimate the mishap IMMEDIATELY to Our Call Centre at Toll Free Numbers: 1800-200-5142, Chargeable Numbers: 022 – 39635200, Fax Toll Free Numbers: 1800-200-9134. email at This email address is being protected from spambots. You need JavaScript enabled to view it.. Please note that no delay should be allowed to occur in notifying a claim on the Policy as the same may prejudice liability.

TPA:

The Policy shall be directly serviced by Us. Please get in touch with Our Company‟s representative for complete details. For all Your service requests e-mail Us at This email address is being protected from spambots. You need JavaScript enabled to view it.

Statutory Warning

No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate of the whole part of the commission payable or any rebate of the premium shown on the Policy nor shall any person taking out or renewing or continuing a Policy accept any rebate, except such rebates as may be allowed in accordance with the published prospectuses or tables of the Insurer. Any person making default in complying with the provisions of this section shall be punishable with fine which may extend to Ten Lakh Rupees

Please note:

The prospectus contains only an indication of cover offered, for complete details on terms, conditions, coverages and exclusions please get in touch with Us or Our agent and read Policy wordings carefully before concluding a sale. Insurance is a subject matter of solicitation. Universal Sompo General Insurance Co. Ltd., Express IT Park, Plot No EL 94, T.T.C. Industrial Area, M.I.D.C., Mahape, Navi Mumbai-400710, Toll Free Numbers: 1-800-224030 (For MTNL/BSNL users) or 1-800-1024030

Note: The above are only the salient features of the Policy , for complete terms and conditions please refer to Policy Wordings


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