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What are the Exclusions in a Group Personal Accident Insurance Policy?

May 28, 2024

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Group Personal Accident Insurance Policy

What are the Exclusions in a Group Personal Accident Insurance Policy?
Contents

A Group Personal Accident Insurance Policy, also known as GPA Insurance Policy, provides compensation to the Insured Employee or his family against Accidental Death or Disablement. An Accidental Death or Disablement has a long-lasting impact not only on the person but also on his/her family. A Group Personal Accident Insurance Policy offers protection to the employee and family members due to disablement or death due to an accident. As the name suggests, a Group Personal Accident Insurance Policy insures a group of people, usually employees of an organisation, under a single Insurance Policy. Usually, employers usually purchase a Group Personal Accident Insurance Policy for employees.

What does a Group Personal Accident Insurance Policy Cover?

A Group Personal Accident Insurance Policy provides the following coverages:

  1. Accidental Death: A Group Personal Accident Insurance Policy provides a lumpsum benefit of 100% of the Sum Insured to the nominee of the insured employee, if the insured employee dies due to an accident. The employer can also opt for 24*7 cover which means that the GPA Insurance Policy pays compensation even if the accidental death happens after office hours.
  2. Permanent Total Disability: A Group Personal Accident Insurance Policy for Employees pays the compensation to the Insured Employee as per the chosen Sum Insured if the employee suffers from Permanent Total Disability such as complete loss of sight or hearing or loss of both limbs due to an accident.
  3. Permanent Partial Disability: A Group Accidental Insurance Policy also covers the Insured Employee for Permanent Partial Disability such as loss of a hand or a foot or loss of sight in one eye. In case of a Permanent Partial Disablement resulting from an accident, the Group Personal Accident Insurance Company pays the employee a certain percentage, ranging from 1% of Sum Insured to 75% of Sum Insured, as compensation, depending on the type of disability.
  4. Temporary Total Disability/Weekly Benefits: In case of Temporary Total Disablement like a fracture or spinal cord injury resulting from an accident, the employee undergoes loss of wages as he will be unable to work for a temporary period of time. In such cases, a Group Personal Accident Insurance Policy for Employees pays a weekly payment to the employee which is equal to 1% of the Sum Insured, till the time his temporary disablement continues. The Compensation from a Group Accidental Insurance Policy insures the Policyholder and his family members from any loss of income due to accidents and thus protects the family from financial distress. While it is important to understand Group Personal Accident Insurance Coverage, it is also important to understand the exclusions in a Group Personal Accident Insurance Policy. Otherwise, ignoring exclusions in a Group Personal Accident Insurance might result in rejection of claims as well.

What is not covered in a Group Personal Accident Insurance Policy?

A Group Personal Accident Insurance Policy does not cover the following:

  1. Natural Death: A GPA Insurance Policy will not pay any claim arising out of a Natural Death due to any cause other than an accident.
  2. Death under the influence of drugs or alcohol: Any Accidental Death or Disability due to substance abuse like drugs, alcohol, intoxicants, etc will not be covered under the Group Accidental Insurance Policy.
  3. Death or Disability due to Self-Inflicted Injuries: Any Accidental Death or Disability arising out of suicide, attempted suicide, self-inflicted injuries is excluded under a Group Personal Accident Insurance Policy for Employees.
  4. Death or disability due to participation in Professional Sports, Bodily Contact Sports and Adventure Sports: A Group Personal Accident Insurance Policy will not pay any compensation for any claims of accidental death or disablement arising out of the Insured’s participation in Professional Sports, Bodily Contact Sports and Adventure Sports such as Skydiving, Parachuting, Bungee Jumping, Paragliding, Racing, Hunting, Equestrian Activities etc. However, this exclusion can be removed by getting such activities specifically covered with approval from the Group Personal Accident Insurance Company.
  5. Death or Disablement due to participation in illegal activities: Any Accidental Death or Disability arising out of participation in illegal activities, like riots, felonies, labour disturbances, strikes, public protests etc. is not covered under a GPA Insurance Policy.
  6. Injury Caused Due to Death or Childbirth: A GPA Policy does not cover any claims of accidental death or disablement arising out of pregnancy or childbirth.
  7. Death or disability due to participation in war: A Group Personal Accident Insurance Policy does not cover claims of Accidental Death or Disablement Death arising out of participation in Foreign Invasions, Warlike Operations, Chemical Attacks, Arrest, Confiscation, Mutiny, etc will not be covered under the policy.
  8. Death or Disability due to Sexually Transmitted Diseases: A Group Accident Policy will not cover any claims of Accidental Death or Disablement arising out of Sexually Transmitted Diseases like AIDS, HIV, or other STDs.
  9. Non-Accidental Medical Treatments: Any Surgical or medical treatments arising out of non-accidental causes are excluded under a Group Personal Accident Policy.

Claim Rejection Examples due to Exclusions in Group Personal Accident Insurance Policy

A Group Personal Accident Insurance Policy covers employees of ABC Pvt Ltd. One of the employees had an accident and lost his arm as a result of the accident. When raising an Insurance Claim under the Policy, the Claim was rejected as it was discovered that the injury was self-inflicted. This is an example of the claim being rejected due to the exclusions of the GPA Insurance Policy. Another employee was sent by the company for a work trip. In his free time, the employee went for Scuba Diving where he met with an accident which resulted in his death. The employee did not receive any compensation as the Group Personal Accident Insurance Coverage excluded any claims arising out of participation in adventure sports.

Compare and Buy Best Group Personal Accident Insurance Policy with Qian!

A Group Personal Accident Insurance Policy for Employees can be offered as part of an employee benefits package along with a Group Mediclaim Policy which helps boost employee productivity and retention. Employers need to compare Group Personal Accident Insurance Coverage amongst various insurers after which they can choose the best Group Personal Accident Insurance Policy depending on their budget and requirements. Also, apart from the basic coverages provided, certain Group Personal Accident Insurers also offer additional coverages for child education, hospitalisation expenses, ambulance charges etc. Check the details of the additional coverages provided before purchasing a Group Personal Accident Insurance Policy. Qian is a licensed Group Personal Accident Insurance Broker in India. We have tie-ups with the top Group Accident Insurance Companies and can provide the best coverages for your employees at competitive premiums which best suit the needs of your group. Our team will also assist employees with the complete Claims Process for Group Personal Accident Insurance Policy. If you have any queries about purchasing a Group Personal Accident Insurance Policy, we at Qian would be happy to assist. You can email us at insurance@qian.co.in or call us on 022-35134695. We would be glad to assist you.

  1. Group Personal Accident Insurance Policy For Employees
  2. Secure Employees against Accidental Death or Disabilities
  3. What is a Group Personal Accident Insurance Policy?
  4. What does a Group Personal Accident Insurance Policy cover?
  5. Accidental Death:
  6. Permanent Total Disability:
  7. Permanent Partial Disability:
  8. Temporary Total Disability:
  9. What are the additional Covers available in a Group Personal Accident Insurance Policy?
  10. Repatriation of Mortal Remains:
  11. Ambulance Charges
  12. Loss of Job Cover:
  13. Daily Cash Allowance:
  14. Accidental Hospitalisation Expenses:
  15. Treatment Outside India:
  16. Children’s Education Expenses:
  17. Prosthesis And Artificial Limbs:
  18. What are the Best Group Personal Accident Insurance Policies in India?
  19. What is the Sum Insured for a GPA Insurance Policy?
  20. How to Cancel a Group Personal Accident Insurance Policy?
  21. What are the major exclusions under a Group Personal Accident (GPA) policy?
  22. How to make a Claim under a Group Personal Accident Insurance Policy?
  23. Compare and Buy Group Personal Accident Insurance Policy with Qian!
  24. FAQS
  25. Testimonials

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