Personal accident insurance can be a lifesaver, especially when covering unexpected medical expenses. This step-by-step guide will walk you through the process of reimbursement medical claims under your personal accident insurance policy, ensuring you’re prepared if an accident occurs.
What is personal accident insurance?
It is a type of insurance that offers financial support for accidents, injuries, disability, or accidental death. It provides payment up to the Sum Insured for covering accidental death, fractures, road ambulance cover, burns, permanent total and partial disabilities, etc.
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The most significant advantage of having personal accident insurance or the best health insurance plan is financial protection from accidents and injuries. Additionally, it offers lifetime security for family members in unfortunate times of accident, disability, and death.
What are the two types of personal accident policy?
There are two types of personal accident policy, namely-
- Individual Personal Accident Plan: This plan covers medical emergencies resulting from an individual’s accidental death or disability.
- Group Personal Accident Plan: Employers offer this policy to employees, covering injuries, accidental death, and disability. Policy details vary based on coverage, group size, and plan type.
What is covered in a personal accident insurance policy?
A personal accident insurance plan can be comprehensive, just like the best health insurance plans, which offer the insured several policy benefits and add-ons. Generally, a personal accident insurance plan offers the following benefits.
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- Accidental death cover: In case of accidental death, the policy ensures a one-time payout to your beneficiaries or nominees.
- Medical expenses: Offer hospitalisation and medical treatment coverage after an accident.
- Disability benefits: Provides financial support for permanent or temporary disability due to an accident.
- No pre-policy medical checkups: Most plans do not need pre-policy clinical tests.
- Flexible sum insured options: You may choose various sum-insured choices to match your needs.
- Emergency assistance: Road ambulance cover and transportation expenses to the hospital.
Five steps to get a reimbursement claim
A seamless reimbursement claim process is crucial. Below are the reimbursement claim steps that most personal accident insurance and the best health insurance plans follow-
Step 1: Notify your insurance provider
Report the occurrence to your insurance company immediately after the accident. It is essential to submit your reimbursement medical claim as soon as possible after an accident. Insurance companies often have time limits for submitting claims, so notify them by phone, website, or email.
Step 2: Submit your claim form
Fill out the claim form with all the information, such as how the accident occurred, your injuries, and what medical treatments are required. Required supporting documents include medical records, bills, a police report (if applicable), pictures of the area of the accident, and witness statements.
Step 3: Get the approval letter from the claim management team
Contact your agent and seek approval from the claim management team. You can go for cashless care if you are in a network hospital with your insurance company. Otherwise, you need to go for the reimbursement claim process.
Step 4: Respond to queries
The claim management team may raise a few questions regarding the incident and the claim filed. To advance the process, give appropriate answers to those questions.
Step 5: Acceptance or rejection of claim
If your claim is rejected, the claim management team will contact you and share the reasons for rejection as soon as possible. On the other hand, you would get the amount reimbursed subject to your policy terms and conditions.
Documents required to file a claim
Here is the list of the documents that must be submitted to file a reimbursement claim in a personal accident and the best health insurance plans:
- Completed claim form
- Photocopy of the insurance policy
- Medical certificates and bills
- Indoor case papers
- Discharge summary (for inpatient claims)
- FIR or police report – if there has been an accident
- Report on cause of death (in cases where the claimant dies)
- Identity proof of the claimant
- Information on bank accounts to facilitate the process of claim settlement
Wrapping up
Accidents can happen anywhere, anytime and to anyone. The best health insurance plans and a personal accident insurance policy relieve you from financial burden during accidents, disability, fractures, and other severe injuries. Common mistakes in the reimbursement medical process include submitting incomplete documents or failing to include all medical receipts. Ensure you double-check everything before submission to avoid unnecessary delays.
Disclaimer: The information above is just for reference. Please read the T&C of the policy thoroughly. Also, refer to the IRDAI guidelines for tax exemption conditions.
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