Personal Accident Insurance
Insuring the ability to earn, not the hospital bill
Personal Accident Insurance
A fixed-benefit policy paying an agreed amount if an accident kills you or leaves you disabled. It does not reimburse medical bills — it replaces the earning capacity an accident takes away.
Health insurance pays the hospital. Life insurance pays your family if you die. Neither answers the situation in between: you survive, you can no longer work, and the income stops while the expenses do not.
IRDAI requires every insurer to offer Saral Suraksha Bima, a standard personal accident product on a common wording — which makes this one of the easiest covers in the market to compare honestly.
What is personal accident insurance?
A fixed-benefit policy that pays an agreed amount if an accident kills you or leaves you disabled. It is not a medical policy — it does not reimburse bills. It replaces the earning capacity an accident takes away.
Health insurance pays the hospital. Life insurance pays your family if you die. Neither answers the situation in between: you survive, you are no longer able to work, and the income stops while the expenses do not.
In plain terms: it insures your ability to earn, which for most people under forty-five is their single largest asset.
What a personal accident policy actually does
- Pays the full sum insured on accidental death
- Pays the full sum insured on permanent total disablement
- Pays a scaled proportion for permanent partial disablement
- Pays a weekly benefit while a temporary disablement keeps you off work
Saral Suraksha Bima
IRDAI requires every general and health insurer to offer a standard personal accident product on a common, plain-language wording. It makes this the easiest cover in the market to compare honestly.
Accidental death benefit — 100%
The full sum insured is payable to the nominee if death results from an accident within the period stated in the policy.
Permanent total disablement — 100%
The full sum insured is payable where an accident results in permanent total disablement — for example total and irrecoverable loss of sight in both eyes, or loss of use of both limbs.
Permanent partial disablement — Scaled
A stated percentage of the sum insured according to a schedule of injuries, so a partial but permanent loss produces a proportionate payment rather than nothing.
Temporary total disablement — Weekly
A weekly benefit while you are certified totally unable to work, subject to a maximum number of weeks and a cap relative to your income.
Source: IRDAI standard personal accident product specification. Optional covers — hospitalisation expenses and an education grant for dependent children — are available on the standard product on stated terms.
What the policy actually pays
The value of a personal accident policy sits in the disablement sections rather than the death benefit, which is where people most often under-read it.
Accidental death
Payable to the nominee where death results from bodily injury caused by an accident. Because it is a fixed benefit, it pays in addition to any life insurance and any health insurance you hold.
Full sum insuredPermanent total disablement
Where the injury permanently and totally prevents you from earning. The schedule sets out what qualifies — typically loss of both eyes, both limbs, or one of each.
Full sum insuredPermanent partial disablement
A schedule assigns a percentage to each permanent injury — loss of a hand, a foot, an eye, hearing, a thumb. You receive that percentage of the sum insured.
A stated percentageTemporary total disablement
A weekly payment while you are certified unable to work at all, capped both by a maximum number of weeks and as a proportion of your income. This is the section that quietly matters most, because temporary disablement is by far the commonest outcome.
Weekly benefitThe scope of cover
- Any accident, anywhere. Cover applies worldwide and around the clock — at work, at home, on the road, on holiday. It is not confined to working hours or to India.
- Road traffic accidents. The largest single category of accidental injury and death in India, and the reason two-wheeler riders in particular should hold this cover.
- Accidents at work. Injury arising in the course of employment, whether or not any employer’s scheme also responds.
- Accidental drowning, burns and falls. Covered as accidental bodily injury on the same basis.
- Animal attack and snakebite. Covered where it results in bodily injury by accidental means.
- Transportation of remains. The cost of transporting mortal remains, payable in addition to the death benefit under most wordings, subject to a limit.
- Education grant. An additional benefit towards the education of dependent children on death or permanent total disablement, available as an optional cover.
- Hospitalisation expenses. An optional section reimbursing hospitalisation costs arising from the accident, subject to a percentage of the sum insured.
- Ambulance charges. Road ambulance costs following an accident, within a stated limit.
What is not covered
Suicide and self-inflicted injury
Including attempted suicide, whether or not the person was of sound mind.
Intoxication
Injury sustained while under the influence of alcohol or drugs not prescribed by a registered practitioner.
Breach of law
Injury sustained in the course of committing a criminal act, or while resisting arrest.
Adventure and hazardous sports
Mountaineering, racing, scuba diving, parachuting and similar activities, unless specifically covered.
War and nuclear risks
Including invasion, civil war, rebellion and radioactive contamination.
Illness and disease
The policy responds to accidents. Sickness, however sudden, is not an accident and belongs to a health or critical illness policy.
Pregnancy and childbirth
Including their consequences, unless arising from an accident.
Aviation other than as a fare-paying passenger
Flying other than as a passenger on a licensed commercial aircraft.
Mental illness and consequences of it
Excluded as a cause, though injury from an accident is covered regardless of any underlying condition.
How to size the cover
A personal accident sum insured should be built from your income, not chosen from a menu.
Start at ten to fifteen times annual income
A common working basis, on the reasoning that permanent disablement removes earning capacity for the rest of a working life and adds cost rather than removing it.
Add outstanding liabilities
Home loan, vehicle loan and any personal borrowing. Disablement does not pause an EMI.
Allow for care costs
Permanent disablement frequently means paid assistance, home modification and equipment, none of which health insurance covers.
Check the income cap on the weekly benefit
The temporary disablement benefit is capped as a proportion of your earnings. If you are self-employed, be ready to evidence income.
Take the hospitalisation option if health cover is thin
The optional hospitalisation section reimburses accident-related treatment costs. Useful where the health policy carries a high deductible or a modest sum insured.
Consider the education grant if you have young children
An additional lump sum towards school and college costs, payable on death or permanent total disablement.
Cover both earning partners
In a two-income household, the loss of either income is a material event. Cover is priced by occupation risk, not by gender.
Keep it alongside, not instead of, life and health cover
A personal accident policy answers only accidents. It complements life and health insurance; it substitutes for neither.
How to choose a policy
The checks that change the outcome, in the order they matter.
How a claim actually works
Most rejected claims fail on process rather than on cover. These five steps are the process.
Get medical attention and a record of it
The claim rests on a medical record establishing that the injury was caused by an accident. A first-treatment record from the hospital or attending doctor is the foundation of the file.
Report to the police where relevant
A road accident, an assault or a death will need a police report or first information report. Obtain it at the time.
Notify the insurer
Within the period stated in the policy, with the date, place and circumstances of the accident and the policy number.
Submit the claim form and evidence
Claim form, medical reports, hospital records, the police report where applicable, a disability certificate from a competent authority for a disablement claim, and income proof where a weekly benefit is claimed.
Assessment and settlement
Death and permanent total disablement claims are settled at the full sum insured. Partial disablement is settled against the schedule, usually after the condition has stabilised and been certified as permanent. Temporary disablement is paid weekly against medical certification.
Myths and facts
Terms you should know
Frequently asked questions
Other products in our suite
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