the insurer's comprehensive Personal Accident Policy — 24-hour, worldwide cover for accidental death, permanent total/partial disability, and temporary total disablement. Four coverage tables (A/B/C/D). Cumulative no-claim bonus up to 50%. Family package with 10% discount. Medical expenses extension available.
Personal Accident Insurance· External, Violent, Visible Means· Not Illness or Disease
The the insurer Personal Accident Policy provides financial compensation for bodily injury, disability, or death resulting solely and directly from an accident caused by external, violent, and visible means. It operates worldwide, 24 hours a day — covering accidents at work, on the road, at home, or anywhere in the world.
The most important PA scenario that life insurance cannot cover:
You are in a road accident. You survive — but you lose both your hands. You are permanently, totally disabled. You can never work again.
Life Insurance: Pays nothing (you're alive)
Health Insurance: Pays your hospital bills (₹5–₹10 lakh)
PA Policy (Table A/B/C): Pays 100% of your Capital Sum Insured as a lump sum — ₹25 lakh, ₹50 lakh, ₹1 crore — to replace your lifetime income.
This is why PA is not optional for any earning individual. It is the only insurance product that pays for living with a permanent disability.
An accident must satisfy all THREE conditions simultaneously:
Examples that qualify: Road accidents, falls, drowning, burns, industrial accidents, train accidents, animal bites, electrocution
Examples that do NOT qualify: Heart attack, stroke, cancer, diabetes complications — these are internal illness causes, not external accidents
Covers accidents anywhere in the world at any hour — road, workplace, home, travel. Your protection travels with you.
Not Location-Specific100% CSI lump sum paid for permanent total disability — life-changing financial support when you cannot work again.
Income ReplacementSI grows 5% every claim-free year, up to 50% extra — from ₹10L to ₹15L after 10 claim-free years, at no extra premium.
Auto SI GrowthCover your entire family (proposer + spouse + children) under one policy with a 10% premium discount.
Family ProtectionFrom ~₹45 per ₹1,000 SI for Class I occupations. A ₹25L PA policy can cost less than ₹1,500/year for an office worker.
Most Affordable CoverTable A pays 1% of SI per week (max ₹3,000/week) for up to 100 weeks if you are temporarily unable to work after an accident.
Table A OnlyCommute + workplace risks; Class I premium — most affordable PA cover
Highest road accident risk; Class II/III; essential daily income protection
Agricultural equipment accidents; JPA or IPA Class III for rural coverage
High-risk profession; Class III; scaffold, equipment, and fall accidents
Included in Class I; accidental injury during sports, travel, campus life
Class I; household accident cover — falls, burns, kitchen injuries all covered
Travel-heavy; disability without death cover protects business continuity
Professional athletes may be Class II/III depending on sport type and risk
Choose the Coverage Table That Matches Your Needs
Each table is a superset of the previous — you build up coverage from death-only (Table D) to fully comprehensive (Table A). Choose at policy inception. You cannot change table mid-year without re-applying.
Covers accidental death only — 100% CSI paid to nominee within 12 months of the accident.
Benefit (a) onlyTable D, PLUS permanent total disability (100% CSI) and 50% benefit for loss of one limb/eye.
Adds Benefits (b)(c)(d)Table C, PLUS permanent partial disablement (1–75% CSI) per body part schedule + no-claim bonus.
Adds Benefit (e) + NCBTable B, PLUS temporary total disablement — 1% SI/week (max ₹3,000/week) for up to 100 weeks.
Adds Benefit (f) — TTD| Benefit | Table D | Table C | Table B | Table A |
|---|---|---|---|---|
| (a) Accidental Death — 100% CSI | ✔ | ✔ | ✔ | ✔ |
| (b) PTD — Loss of both eyes/limbs — 100% CSI | ✘ | ✔ | ✔ | ✔ |
| (c) Loss of one eye/hand/foot — 50% CSI | ✘ | ✔ | ✔ | ✔ |
| (d) General PTD (any occupation) — 100% CSI | ✘ | ✔ | ✔ | ✔ |
| (e) Permanent Partial Disablement — 1–75% CSI | ✘ | ✘ | ✔ | ✔ |
| No-Claim Bonus — 5%/year (max 50%) | ✘ | ✔ | ✔ | ✔ |
| (f) Temporary Total Disablement — 1%/week, max ₹3,000 | ✘ | ✘ | ✘ | ✔ |
| Free: Education fund + Carriage of dead body | ✘ | ✔ | ✔ | ✔ |
| Medical Expenses Extension (optional) | ✔ | ✔ | ✔ | ✔ |
| Premium Level | Lowest | Low | Medium | Highest (Recommended) |
Detailed Benefit Schedule
If accidental injury is the sole and direct cause of death within 12 calendar months of the accident — 100% of Capital Sum Insured (CSI) is paid to the nominee or legal heirs. Covers all road accidents, industrial accidents, drowning, falls, burns, and any other accidental death by external, violent, visible means.
Example: Fatal road accident on NH48 — death in hospital 3 days later. Nominee receives 100% CSI.
Physical separation or total, irrecoverable loss of use of specified body parts — within 12 calendar months of the accident:
If the accident immediately, permanently, totally, and absolutely disables the insured from engaging in ANY employment or occupation of any description whatsoever — 100% CSI lump sum.
This is the "any occupation" PTD — broader than Benefit (b) which requires specific limb/eye loss. Assessed by Company's Panel Doctor.
Loss of specific body part within 12 calendar months — pays a percentage of CSI per the schedule. Note: Only ONE sub-clause can be claimed per accident. Enter your CSI below to see ₹ values:
| Body Part / Injury | % of CSI | ₹ Amount |
|---|
If accidental injury is the sole and direct cause of total disability preventing engagement in ANY employment:
→ 1% of CSI per week· Maximum ₹3,000/week· Maximum 100 weeks or until CSI exhausted
Example: Fracture of both legs — unable to work for 18 weeks. Weekly payment calculated below:
Transportation expenses to carry the deceased insured from the place of accident to the place of residence. Payable IN ADDITION to the death benefit. Available when death occurs outside the insured's residence.
On death or permanent total disablement of the insured — for dependent children below age 23 (age at date of accident). Paid along with the CSI settlement. NOT available under Table D.
CSI increases by 5% for every claim-free renewal — up to a maximum 50% addition. No premium increase for this CSI growth. Available under Tables A, B, C. NOT available for Table D (death-only).
Premium Based on Your Occupation Risk Class
Lawyers, Doctors (clinics), Dentists, Office Executives, Clerks, Salesmen, Teachers, Accountants, Architects, Bankers, Bureaucrats, Administrative staff, Housewives, Students
Builders, Contractors, On-site Engineers, Car Drivers, Mechanics, Veterinary Doctors — supervisory role with some field exposure; NOT machine operators or manual workers
Taxi/Auto/Truck Drivers, Heavy Vehicle Drivers, Industrial Workers, Construction Workers, Electricians, Farmers, Filling Station Attendants, Labourers — skilled/semi-skilled using machinery
Proposer + lawful spouse + dependent children can be covered under a single PA policy with a 10% discount on the total premium. Maximum 5 dependants. Education fund payable on death/PTD of any covered family member.
Optional Extension + Janata PA Reference
Available for individual and group PA policies. Reimburses hospitalisation and medical expenses for treatment of an accident for which a PA claim is made and admitted.
Janata PA is designed for India's unorganised sector — daily wage workers, rural labourers, agricultural workers, and any individual regardless of occupation who needs basic accident protection at a minimal premium. ₹60/year for ₹1 lakh cover (₹15 × 4). Call 022 4302 0000 to understand which product is right for you.
Why Personal Accident Insurance is Not a Replacement for Health or Life Insurance
Many people assume they're fully covered with a health policy and a life policy. Personal Accident insurance fills a critical gap that neither of those covers — the financial impact of accidental disability and lost income while you're still alive.
| Feature | Personal Accident Policy | Health Insurance | Life Insurance |
|---|---|---|---|
| Accidental Death | ✅ 100% Sum Insured to nominee | ❌ Not covered | ✅ Covered (but only death) |
| Permanent Total Disability | ✅ 100% Sum Insured | ❌ Not covered | ❌ Not typically covered |
| Permanent Partial Disability | ✅ % of Sum Insured as per table | ❌ Not covered | ❌ Not covered |
| Temporary Total Disability | ✅ Weekly income for up to 100 weeks | ❌ Not covered | ❌ Not covered |
| Loss of Income Replacement | ✅ Yes — via TTD benefit | ❌ Not covered | ❌ Not covered |
| Hospitalisation Treatment | ✅ As add-on (up to 40% of claim) | ✅ Core benefit | ❌ Not covered |
| Natural Death / Illness | ❌ Not covered | ✅ Covered (hospitalisation) | ✅ Covered |
| Medical Tests Required | ✅ Not required | ⚠️ Sometimes required | ✅ Usually required |
| Payout Type | Lump sum + weekly benefit | Reimbursement / cashless | Lump sum to nominee |
| Multiple Policies Allowed | ✅ Can hold multiple PA policies | ⚠️ Coordination of benefits | ✅ Can hold multiple |
Personal Accident insurance does something your health policy and life policy simply cannot — it replaces the income you lose when an accident leaves you temporarily or permanently unable to work, while you're still alive and your family still depends on you. At a premium of just a few hundred rupees a year for significant cover, it's one of the most cost-effective additions to any insurance portfolio.
Standard Permanent Partial Disability (PPD) Scale — Personal Accident Policy
If an accident results in loss or permanent loss of use of a specific body part, the policy pays a defined percentage of your Sum Insured. This is a standard scale applied across personal accident policies in India.
| Body Part Lost | % of Sum Insured |
|---|---|
| Arm at the shoulder joint | 70% |
| Arm above the elbow joint | 65% |
| Arm below the elbow joint | 60% |
| Hand at the wrist | 55% |
| Leg above mid-thigh | 70% |
| Leg up to mid-thigh | 60% |
| Leg below the knee | 50% |
| Leg up to mid-calf | 45% |
| Foot at the ankle | 40% |
| Body Part Lost | % of Sum Insured |
|---|---|
| A thumb | 20% |
| Index finger | 10% |
| Any other finger | 5% |
| Large toe | 5% |
| Any other toe | 2% |
| One eye | 50% |
| Hearing — one ear | 30% |
| Hearing — both ears | 75% |
| Sense of smell | 10% |
| Sense of taste | 5% |
Beyond Death and Disability — Benefits You May Not Know About
A comprehensive Personal Accident Policy does much more than pay a lump sum on death or disability. Here are the important additional benefits that give this cover its real value.
Covers the cost of transporting you to hospital by ambulance (including air ambulance in some variants) immediately following an accident. Ensures you get to care without worrying about cost.
Available as Add-OnIf the insured parent dies or suffers PTD, a one-time education grant is paid for up to 2 dependent children (up to age 19) to ensure their schooling continues despite the family's financial setback.
Included in Most PlansExpenses for transporting the deceased from the place of accident back to their home are covered — up to 2% of the Sum Insured or ₹2,500, whichever is less — relieving the family of an immediate practical burden.
Standard InclusionOn a PTD claim, an additional amount is paid to help modify your home or vehicle to accommodate the disability — for example, wheelchair ramps, modified controls, or accessibility modifications.
Up to 1% of Sum InsuredA daily cash allowance (e.g. ₹1,000 per day, up to 30 days) is paid if you're hospitalised as a direct result of an accident — covering incidental expenses beyond the main medical bills.
Available as Add-OnIf a death, PTD, PPD or TTD claim is admitted, the policy also reimburses actual accident-related medical expenses — up to 40% of the claim amount or actual bills, whichever is less.
Available as Add-OnFor every claim-free year, your Sum Insured automatically increases by 5% at no extra cost — up to a maximum of 50% above your original cover. Your policy grows with you without a premium increase.
Standard BenefitCover your spouse and dependent children under the same policy and receive a 10% discount on the total premium. One policy, one renewal date, comprehensive family protection.
Family DiscountChoosing the Right Cover Amount for Your Situation
The sum insured under a Personal Accident Policy is directly linked to your income — because the policy is designed to replace financial loss, not create a windfall. Here's how it works.
| Category | Maximum Sum Insured Allowed | Income Proof Required? |
|---|---|---|
| Earning individual (employed/self-employed) | Up to 72 months' income from gainful employment | Required for Sum Insured above ₹25 lakh (3 salary slips / Form 16 / IT return) |
| Non-working spouse | Up to 50% of earning spouse's sum insured, max ₹1,00,000 | Not required (tied to earning spouse's policy) |
| Dependent children | Up to 25% of earning parent's sum insured, max ₹50,000 | Not required |
| Students | Fixed sum as per applicable scheme (Vidyarthi, Students Safety, etc.) | Not required |
What PA Does NOT Cover
PA policy's operative clause is triggered only by bodily injury from external, violent, visible means. Natural death (heart attack, stroke, cancer), death from disease, and disability from chronic conditions are NOT within the scope of PA at all — they don't meet the "accident" definition. These require life insurance and health insurance, not PA.
Injuries arising from racing (all types), mountaineering (except trekking), extreme sports, sky-diving, bungee jumping, hand gliding, river rafting competitions, polo, winter sports, skiing, and similar hazardous recreational activities are excluded. Standard trekking is generally covered; extreme mountaineering at altitude is not.
Only ONE sub-clause benefit payable per accident event. Once Death, PTD (b), or General PTD (d) is paid — no further claims under those sub-clauses for that insured person.
Any injury, disablement, or death that is deliberately self-caused — including suicide and attempted suicide — is completely excluded.
Any accident occurring while the insured is under the influence of intoxicating liquor or drugs (other than prescribed medication) is excluded.
Injury while engaging in aviation, ballooning, or travelling in aircraft other than as a fare-paying or non-fare-paying passenger in a duly licensed standard type aircraft. Commercial airline passenger = COVERED. Pilot, sky-diver, glider = excluded.
Death or disablement directly or indirectly caused by venereal diseases, HIV/AIDS, or related conditions is excluded.
Mental disorders or injury arising from insanity or mental illness is not covered under the PA policy operative clause.
Any injury or death arising from the insured committing a breach of law with criminal intent is excluded from all benefits.
War (declared or undeclared), invasion, civil war, rebellion, revolution, insurrection, mutiny, military operations — all excluded.
Ionising radiation, radioactive contamination, nuclear fuel, nuclear weapons — all excluded from PA coverage.
Under the medical expenses extension: death or disablement from pregnancy, childbirth, miscarriage, or complications thereof — excluded for female policyholders.
After a claim under Benefit (a) death or Benefit (d) PTD is admitted, no further PA claims of the same type are payable for that insured person.
TTD (weekly) payments are not made until the total amount has been ascertained and agreed — no advance weekly payment before final assessment.
How to File a Personal Accident Claim
Written notice must be given to the insurer IMMEDIATELY after any accident.
For DEATH claims: notice must be given BEFORE internment or cremation, and in any case within ONE CALENDAR MONTH of death. For loss of sight or amputation: within one calendar month of the event.
Late notification can be used to repudiate the claim. Call 022 4302 0000 immediately after any accident that may give rise to a PA claim.
The policy permits compensation under only ONE of the benefit sub-clauses (a)–(f) for any single accident or period of disablement. Once a claim is admitted and paid under Benefit (a) Death, (b) PTD, or (d) General PTD — no further claims under those same sub-clauses are payable for that insured person. Medical expenses and carriage of dead body are payable additionally where applicable.
Written notice to the insurer immediately after any accident. Death claims: notify before cremation or within 1 month. Loss of sight/amputation: within 1 month. Call Probitas on 022 4302 0000 for claims guidance.
For road accidents, criminal violence, and deaths — FIR with police + Medico-Legal Case (MLC) number from hospital where first treatment given. Essential for death and serious injury claims.
the insurer may appoint a Medical Officer to examine the injured insured. For disability claims: Panel Doctor assesses the disability percentage. Post-mortem report required for death claims (within 14 days of demand). Submit to the insurer examination when requested.
Claim form + Policy + FIR + MLC + Hospital records + Doctor's certificate + Photographs of injuries. Death: additionally — Death Certificate + Post-Mortem report + Legal heir certificate + Nominee ID. Disability: employer certificate for TTD. Medical expenses: original bills + prescriptions.
In-house assessor or IRDAI-licensed surveyor reviews the claim. Panel Doctor assesses PPD percentage. For TTD: total amount must be ascertained before weekly payments begin. Disputed quantum: referred to sole arbitrator (or 3-member panel if no agreement within 30 days).
Death/PTD/PPD: lump sum to insured or nominee. TTD: weekly payments (up to 100 weeks). Med. expenses: reimbursement after account approval. After death/PTD: insured's name deleted by endorsement (no premium refund). IRDAI TAT: 30 days from complete documents.
PA in Action — Three Illustrative Claim Scenarios
| Parameter | Scenario 1: Road Accident Death | Scenario 2: Factory Accident PPD | Scenario 3: Fracture + TTD |
|---|---|---|---|
| Person | Rajesh Kumar, 42 yrs, Office Executive | Suresh Mahajan, 35 yrs, Factory Worker (Occ. Class III) | Priya Sharma, 28 yrs, Banker (Occ. Class I) |
| Table / CSI | Table A· CSI ₹25,00,000 | Table B· CSI ₹10,00,000 | Table A· CSI ₹15,00,000 |
| Accident | Fatal road accident on NH48 — death 12 hours later in hospital | Machine accident — severe injury to right hand (thumb + index finger crushed) | Slip on office stairs — both legs fractured — completely unable to work 18 weeks |
| Main Benefit | Benefit (a): Accidental Death → 100% CSI = ₹25,00,000 | Benefit (e): PPD — Panel Doctor assesses combined hand injury as 35% → ₹3,50,000 | Benefit (f): TTD — 1% × ₹15L = ₹15,000/wk; capped at ₹3,000/wk; 18 weeks × ₹3,000 = ₹54,000 |
| Free Benefits | Carriage of dead body: ₹2,500 (min of 2% and ₹2,500); Education fund (2 children below 23): ₹10,000 | NCB resets to 0 for next year (claim year) | Medical expenses extension (if opted): min(10% × ₹15L, 40% × ₹54K) = min(₹1.5L, ₹21,600) = ₹21,600 |
| Total Paid | ₹25,00,000 + ₹2,500 + ₹10,000 = ₹25,12,500 | ₹3,50,000 (CSI reduced by this amount) | ₹54,000 TTD + ₹21,600 med exp = ₹75,600 |
| What Life Insurance would have paid | Same ₹25L (life insurance also covers accidental death) | ₹0 — Life insurance pays nothing for disability | ₹0 — Life insurance pays nothing for temporary disability |
* Illustrative only. Actual claims subject to policy terms, Panel Doctor assessment, and complete documentation. PPD % is assessed by Company's Panel Doctor based on actual injury. TTD not paid until amount ascertained and agreed.
Common Questions
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