CLAIMS – PERSONAL ACCIDENT INSURANCE Prepared By: Megha Jain F10031 Ramya Rose F10045 Vijay D’Souza F10058

SUMMARY OF THE CASE Bank has taken a group PA insurance policy for all executives covering risks of ‘death only’ for a CSI of 25 lakhs Policy for ‘disablement’ for a CSI of 5 lakhs TTD cover is weekly of CSI subject to a maximum of 104 weeks Payment of claim can be made only under “one sub- clause or proviso”

SUMMARY OF THE CASE Mr. Mehra met with a road accident Hospitalized for 47 weeks and paid 2.75 lakhs towards hospital bills Confined in house for 5 weeks before resuming bank work Also got a PPD certificate for 45%

POSSIBLE CLAIMS THAT CAN BE MADE A higher amount of the below mentioned claims will be considered: 45% of CSI for PPD 1% of CSI for 52 weeks for TTD (47 weeks hospitalization + 5 weeks home)

CLAIM AMOUNT 45% of CSI = 0.45 * 5 = 2.25 lakhs 1% of CSI for 52 weeks = 0.01* 5 * 52 = 2.6 lakhs (Higher and so will be considered) Hospital bill amount = 2.75 lakhs (Not considered as not covered by policy) Total Claim amount = 2.6 lakhs

REASONS FOR SETTLING THIS AMOUNT As per the one sub clause, only one of the 6 contingencies specified in the PA policy will be covered. Here, Mr. Mehra can claim under PPD and TTD. Therefore, the higher of the two amounts will be considered.

DOCUMENTS REQUIRED FOR THE CLAIM Claim form Doctor’s certificate for TTD claim Disablement certificate for PPD claim FIR of accident Leave certificate from employer Hospital bills/records