What Is Covered In Group Personal Accident Insurance?

Introduction

A group personal accident insurance is an insurance policy that provides comprehensive cover to employees of an organization in the event of their death or permanent disability due to an accident. By safeguarding the interests of the employer and the employee, the policy is an absolute must-have to prevent businesses from incurring losses due to an unforeseen disruption.

To get a detailed understanding of what falls within the scope of the policy, let us look at what GPA insurance covers.

What Does a Group Personal Accident Insurance Cover?

Essentially, a GPA cover is applicable to accidental death or disability. The beneficiary is the employee and not his family members in extension. The family members are entitled to compensation in the unfortunate event of the employee’s demise. The scope of the cover depends on the plan selected by the employer.

The following list enumerates the coverage offered in a group personal accident insurance policy:

1. Accidental Death

The policy schedule explicitly states the meaning of accident for the purpose of ensuring unambiguity. The accident should be sudden, unanticipated, unintended, and due to a visible external event. As per this definition, natural death or death or disablement resulting from self-harm, life-threatening addictions, hazardous activities, and accidents under the influence of intoxicants are not covered under this insurance policy.

The insurer pays a lump sum amount if the insured succumbs to death after meeting with an accident. Generally, 100% of the sum insured is paid by the insurance companies, in this case, to the nominee(s) of the deceased employee.

2. Permanent Total Disability

When an accident leads to complete and irreparable damage, which deems the employee incapable of engaging himself in any possible occupation, it falls within the scope of permanent total disability. The disability should be such that it continues for at least a year and the compensation, in this case, depends on the degree of loss and incapability. Usually, 100% compensation is allowed if the employee loses both his eyes or both limbs.

3. Permanent Partial Disability

Under permanent partial disability, the accident that leads to a partial impairment to the body parts or sensory organs of the employee is covered. The period for which the disability continues should be a minimum of one year for the claim to become applicable. Based on the incapability and loss suffered, a predefined percentage of the sum insured is paid. The percentage of compensation ranges from 2% to 50% generally, and these are assessed by a medical practitioner appointed by the insurance company.

4. Weekly Compensation

When the accident deems the employee incapable of occupation for a temporary period, compensation is paid to the employee on a weekly basis during the period of his or her disability. The maximum time limit, however, is 104 weeks. Although the percentage can vary from one insurance company to another, it is generally kept at 1% of the capital sum insured.

5. Ambulance Cost

A GPA policy also provides for the reimbursement of the ambulance charges borne to move the person from the site of the accident to the hospital. This amount varies from one insurance company to another. A predefined percentage of the capital sum insured (CSI) is paid to the insured following the accident.

6. Medical Expenses

The medical expenses incurred by the insured, including the hospitalization charges post-accident, are reimbursed by the insurance company. A fixed percentage of the CSI or the actual medical expenses, whichever is lower, is paid as compensation for the accidental injury. The expenses, in this case, should be necessary and reasonable.

7. Mortal Remains Expenses

Under this cover, the expenses incurred in the transportation of the last remains of the deceased employee from the place of accident to the hospital, residence or the funeral grounds are reimbursed. Some companies bear the funeral expenses as well subject to a specified sum or as a fixed percentage of the CSI, whichever is lower.

8. Education Expenses

The education benefit under the GPA insurance policy allows for the compensation of education expenses for the dependent children of the employee in the case of his or her death or permanent disability post his or her accident. Generally, the company pays a fixed sum or a predefined percentage of the CSI for up to two dependent children of the insured.

For instance, if the amount of compensation is 25,000, if there is one dependent child, the entire amount will go toward the education of that single dependent child. In the case of two dependent children, this sum gets divided between the two. If the accident results in the employee’s death, the sum is due to his legal heir or nominee(s).

9. Lifestyle Changes

An accident might render the insured permanently disabled. In view of this, the lifestyle changes cover allows for compensation toward house alteration and vehicle modification to make these accessible to the disabled. It is an additional cover; therefore, not all insurance companies may offer this.

10. Broken Bones

An accident might lead to permanent impairments, making the insured unfit for occupation. Such a situation leads to exertion, both physical and monetary. This cover allows for a lumpsum amount in case of a fracture. An imaging examination report, such as an X-ray, along with certification of a medical practitioner, is required for claim settlement.

Conclusion

A group personal accident insurance policy, besides providing financial security to the employees, also helps strengthen their faith and loyalty toward the organization. Employees who feel a sense of belonging are motivated to work more efficiently, leading to increased productivity. Similarly, a group health insurance policy, too, helps achieve this objective because a healthy workforce exudes positive energy and enthusiasm.

At Plum, employers can now opt for customized plans that best suit the needs of their organization. A GPA insurance policy with Plum comes with 24*7 WhatsApp support, and you also can choose a group term life insurance for added benefits.