THE NEW INDIA ASSURANCE COMPANY LIMITED
Registered & Head Office- 87, M.G. Road, Fort, Mumbai-400001

PERSONAL ACCIDENT POLICY (Individual)
WHEREAS the Insured named in the Schedule hereto had made or caused to be made to The New India Assurance Co. Ltd.
(hereinafter called the ‘Company’) a written proposal dated as stated in the Schedule hereto (warranting the truth of the
statements contained therein) which is the basis of this Contract and is deemed to be incorporated herein and has paid to the
Company the premium herein stated for the insurance specified hereinafter for the period stated in the Schedule or for any
further period for which the Company may accept payment for the renewal of this policy
NOW THIS POLICY WITNESSETH that subject to the terms, exclusions, definitions and conditions contained herein or
endorsed or otherwise expressed hereon the company will pay the Insured as hereinafter mentioned.
1. If at any time during the currency of this Policy, the Insured Person shall sustain any bodily injury resulting solely
and directly from accident caused by external, violent and visible means, then the Company shall pay to the insured
or his legal personal representative(s), as the case may be, the sum or sums hereinafter set forth, that is to say :
(a) If such injury shall within Twelve calendar months of its occurrence be the sole and direct cause of the death of the
Insured Person, the Capital Sum Insured (CSI) stated in the Schedule hereto.
(b) If such injury shall within Twelve calendar months of its occurrence be the sole and direct cause of the total and
Irrecoverable loss of
i) sight of both eyes or the actual loss by physical separation of two entire hands or two entire feet or one entire hand
and one entire foot, or of such loss of sight of one eye and such loss of one entire hand or one entire foot, the
Capital Sum Insured in the Schedule hereto.
ii) Use of two hands or two feet, or of one hand or one foot, or of such loss of sight of one eye and such loss of use of
one hand or one foot, the Capital Sum Insured stated in the Schedule hereto.
(c) If such injury shall within Twelve calendar months of its occurrence be the sole and direct cause of the total and
irrecoverable loss of
i ) the sight of one eye, or of the actual loss by physical separation of one entire hand or of one entire foot, fifty
percent (50%) of the Capital Sum Insured stated in the schedule hereto :
ii) total and irrecoverable loss of use of hand or a foot without physical separation, fifty percent (50%) of the Capital
Sum Insured stated in the Schedule hereto.
NOTE :For the purpose of Clause (b) and Clause (c) above, ‘physical separation’ of a hand means separation at or
above the wrist and of the foot at or above the ankle.
d) If such injury shall as a direct consequence thereof, immediately, permanently, totally and absolutely, disable the
Insured person from engaging in any employment or occupation of any description whatsoever, then lump a sum
equal to hundred percent (100%) of the Capital Sum Insured.
e) In such injury shall within twelve calendar months of its occurrence be the sole and direct cause of the total and/or
partial and irrecoverable loss of use or of the actual loss by physical separation of the following, then the
percentage of the capital Sum Insured as indicated below shall be payable. :
Percentage of Capital Sum Insured
I) Loss of toes - all 20
Ii)
Iii)
Iv)
v)
vi)
vii)
viii)
ix)
x)
Great - both phalanges
Great one phalanx
Other than great, if more than one toe lost for each
Loss of hearing - both ears
loss of hearing - one ear
loss of four fingers and thumb of one hand
Loss of four fingers
Loss of thumb - both phalanges
- one phalanx
Loss of index finger
- three phalanges or two phalanges or one phalanx
Loss of middle finger
- three phalanges or two phalanges or one phalanx
Loss of nine finger
- three phalanges or two phalanges or one phalanx
Loss of little finger
05
02
01
75
30
40
35
25
10
10
06
05
xi)
- three phalanges or two phalanges or one phalanx
Loss of metacarpals - first or second (additional)
or third, fourth or fifth (additional)
04
03
xii) Any other permanent partial disablement Percentage as assessed by the
panel doctor of the company
f) It such injury shall be the sole and direct cause of Temporary Total Disablement, then so long as the Insured Person
shall be totally disabled from engaging in any employment or occupation of any description whatsoever, a sum at
the rate of one percent (1%) of the capital Sum Insured, stated in the Schedule hereto, per week but in any case not
exceeding Rs. 3,000/- per week in all under all policies. Provided that the compensation payable under the
foregoing Sub-Clause (f) shall not be payable for more than 100 weeks in respect of any one injury calculated from
the date of commencement of disablement and in no case shall exceed the Capital Sum Insured.
For the purpose of benefits applicable, Table D will cover of above Benefit (a) only, Table C will cover of above Benefit (a)
to (d), Table B will cover of above Benefit (a) to (e) and Table A will cover of above Benefit (a) to (f). The applicable
benefits with CSI for the same as more specifically described in the shedule will be considered for any liability under the
Policy.
SPECIAL FREE BENEFITS
1) CARRIAGE OF DEAD BODY :
It is hereby agreed that in the event of the death of the Insured Person due to accident, as defined in the Policy, outside
his/her residence, the Company shall pay, in addition to the amounts payable under Sub-Clause (a), for transportation of
Insured Person’s Dead body to the place of residence, a lump sum of 2% of Capital Sum Insured or Rs. 2,500/-, whichever
is less.
2) EDUCATION GRANT :
In the event of death or permanent total disablement of the Insured due to an accident as defined, the Policy shall pay
as education grant for the dependent children as below :
(a) If the Insured Person has one dependent child below the age of 25 years, an amount equal to
10% of the CSI subject to a maximum of Rs. 5,000/-.
(b) If the Insured Person has more than one dependent child below the age of 25 years, an amount equal to 10% of CSI
subject to maximum of Rs. 10,000/-
The payment as above will be made alongwith the CSI to the same person/s who is/are entitled to receive CSI.
Provided that if there be any other subsisting personal accident insurance/s covering the Insured Person then the total
benefits under this regulation, under all such policies, shall be limited to a maximum of Rs. 5,000/- in case there is one
dependent child and Rs. 10,000/- in case there is more than one dependent child. The amount so payable shall be borne by
all the policies in proportion to the original sum insured.
EXCEPTIONS
PROVIDED ALWAYS THAT :
The Company shall not be liable under this Policy for :
1. Compensation under more than one of the foregoing Sub-Clauses in respect of the same period of disablement.
2. Any other payment after a claim under one of the Sub-Clauses (a), (b) or (d) has been admitted and become
payable. This would not apply to payments made under medical expenses extension, education grant and expenses
for carriage of dead body.
3. Any payment, in case of more than one claim under the Policy, during any one period of insurance by which the
maximum liability of the Company in that period would exceed the sum payable under sub-clauses (a) of this
Policy. This would not apply to payments made under medical expenses extension, education grant and expenses
for carriage of dead body.
4. Payment of weekly compensation until the total amount shall have been ascertained and agreed.
5. Payment of compensation in respect of Death, Injury or Disablement of the Insured (a) from intentional self-injury,
suicide, (b) whilst under the influence of intoxicating liquor or drugs (c) whilst engaging in Aviation or Ballooning
whilst mounting into, dismounting from or traveling in any balloon or aircraft other than as a passenger (fare
paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world, (d) directly or indirectly
caused by venereal disease/s, AIDS or insanity, (e) arising or resulting from the insured committing any breach of
law with criminal intent.
‘Standard type of Aircraft’ means any aircraft duly licensed by appropriate authority to carry passengers (for hire or
otherwise) irrespective of whether such an aircraft is privately owned OR chartered OR operated by a regular
airline OR whether such an aircraft has a single engine or multi-engine.
6. Payment of compensation in respect of Death, Injury or Disablement of the Insured person due to or arising out of
or directly or indirectly connected with or traceable to : War, Invasion, Act of foreign enemy, Hostilities (whether
war be declared or not), Civil War, Rebellion, Revolution, Insurrection, Mutiny, Military or Usurped Power
Seizure, Capture, Arrests, Restraints and Detainment by all kings, princes and people of whatsoever nation,
condition or quality.
7. Payment of Compensation in respect of death of, or bodily injury or any disease of illness to the Insured Person.
(a) directly or indirectly caused by or contributed to by or arising from ionizing radiations or contamination by
radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. For the purpose
of this exception, combustion shall include any self-sustaining process of nuclear fission.
(b) directly or indirectly caused by or contributed to by or arising from nuclear weapon material. Provided also that the
due observance and fulfillment of the terms and conditions of this Policy (which conditions and all endorsements
hereon are to be read as part of this Policy) shall so far as they relate to any thing to be done by the insured be a
condition precedent to any liability of the Company under this Policy.
8. Pregnancy Exclusion Clause : The Insurance under this Policy shall not extend to cover death or disablement
resulting directly or indirectly caused by, contributed to or aggravated or prolonged by child-birth or from
pregnancy or in consequence thereof.
CUMULATIVE BONUS
Compensation payable under clauses (a), (b), (c) and (d) of the Policy viz. death, loss of limb(s) or sight and Permanent
Total Disablement arising out of accidental injuries shall be increased by 5% thereof in respect of each completed year
during which the Policy shall have been in force, prior to the occurrence of an accident for which capital sum becomes
payable but amount of such increase shall not exceed 50% of the Capital Sum Insured stated in the Schedule herein. This
Cumulative Bonus is applicable to CSI which is renewed continuously.
This clause shall not in any way alter the annual character of the Insurance nor the right of the Company to decline to renew
or to cancel this Policy as hereinafter provided.
The earned Cumulative Bonus will not be lost if the Policy is renewed within 30 days after its expiry.
CONDITIONS
1. Upon the happening of any event which may give rise to a claim under this Policy, written notice with full particulars must
be given to the Company immediately. In case of death, written notice also for the death must, unless reasonable cause is
shown, be so given before internment, cremation and. In any case, within one calendar month after the death, and in the
event of loss of sight or amputation of limbs, written notice thereof must also be given within one calendar month after such
loss of sight of amputation.
2. Proof satisfactory to the Company shall be furnished of all matters upon which a claim is based. Any Medical or other agent
of the Company shall be allowed to examine the insured person on the occasion of any alleged injury or disablement when
and so often as the same may reasonably be required on behalf of the company and in the event of death, to make a postmortem
examination of the body of the insured. Such evidence as the Company may from time to time require shall be
furnished and a post-mortem examination report, if necessary, be furnished within the space of fourteen days after demand
in writing and in the event of a claim in respect of loss of sight the Insured shall undergo at the insured’s expense such
operation or treatment as the Company may reasonably deem desirable. Provided that all sums payable hereunder shall be
payable.
i) In case of death or permanent total disablement only after deleting by an endorsement the name of the insured person in
respect of whom such sum shall become payable without any refund of premium.
ii) In case of Permanent Partial Disablement (PPD) only after reduction by an endorsement of CSI by the amount admissible
under the claim in respect of the Insured Person and
iii) In case of Temporary Total Disablement (TTD) upon termination of such disablement.
No sum payable under this policy shall carry interest.
3. The Company shall not be liable to make any payment under this policy in respect of any claim if such claim be in any
manner fraudulent or supported or supported by any fraudulent statement or device, whether by the insured or by any person
on behalf of the insured.
4. (a)The insured shall give immediate notice to the company of any change in the business or occupation of the insured person.
(b)The insured shall, on tendering any premium for the renewal of this Policy, give notice in writing to the company of any
disease, physical defect or infirmity with which he has become affected since the payment of last preceding premium.
5. This Policy may be renewed by mutual consent every year and in such event the renewal premium shall be paid to the
Company on or before the date of expiry of the Policy or of the subsequent renewal thereof. The Company shall not,
however, be bound to give notice that such renewal premium is due.
6. The Company may at any time, by notice in writing, determine this Policy provided that the Company shall in that case
return to the insured the then last paid premium less a prorata part thereof for the portion of the current insurance period
which shall have expired. Such notice shall be deemed sufficiently given if posted and addressed to the insured at the
address last registered in the Company’s books and shall be deemed to have been received by the insured at the time when
the same would be delivered in the ordinary course of post. OR the policy may be canceled at any time by the insured by a
notice in writing under a certificate of posting or a Regd. A. D. Such notice shall be deemed to be effective from the date of
despatch of the same by the insured. PROVIDED no claim has arisen under the within mentioned Policy prior to the
despatch of such notice by the insured to the company, the insured would be entitled to the return of premium less premium
at company’s short period rates for the period the policy has been in force.
7. The Company shall not be bound to take notice or be affected by any notice of any trust, charge, lien, assignment or other
dealing with or relating to this Policy but the receipt of the insured or his legal personal representatives shall in all cases be
an effective discharge to the Company.
8. If any dispute or difference shall arise to the quantum to be paid under the policy liability being otherwise admitted such
difference shall independently all other questions be referred to the decision of a sole arbitrator to be appointed in writing by
the parties to of if they cannot agree upon a single arbitrator within 30 days of any party invoking arbitration the same shall
be referred to a panel of three arbitrators, comprising of two arbitrators, one to be appointed by each of the parties to the
dispute/difference and the third arbitrator to be appointed by such two arbitrators and arbitration shall be conducted under
and in accordance with the provisions of the Arbitration and Conciliation Act, 1996.
It is clearly agreed and understood that no difference or dispute shall be referable to arbitration as herein before provided, if
the Company has disputed or not accepted liability under or in respect of this policy.
It is hereby expressly stipulated and declared that it shall be a condition precedent to any right of action or suit upon this
Policy that award by such arbitrator/arbitrators of the amount of the loss or damage shall be first obtained.
It is also hereby further expressly agreed and declared that if the Company shall disclaim liability to the insured for any
claim hereunder and such claim shall not within 12 calendar months from the date of such disclaimer have been made the
subject matter of a suit in a court of Law, the claim shall for all purposes be deemed to have been abandoned and shall not
thereafter e recoverable hereunder.
ENDORSEMENT TO COVER MEDICAL EXPENSES APPLICABLE UPON THE PAYMENT OF EXTRA
PREMIUM & SPECIFIC COVERAGE AS SHOWN IN THE POLICY SCHEDULE
In consideration of the payment of an additional premium as shown in the policy schedule it is hereby agreed and declared
that notwithstanding anything in the within written policy contained to the contrary, this insurance is extended to cover the
medical expenses necessarily incurred and expended in connection with any accident as specified in the Policy, for which a
claim is made by the Insured and admitted by the Company.
The Company shall reimburse to the Insured an amount upto but not exceeding forty percent of the compensation paid in
settlement of a valid claim under this Policy or 10% of the relevant sum insured whichever is less. Further, it is a condition
precedent to the payment of such medical expenses that the medical attendant’s detailed account shall be submitted to and is
approved by the Company.
PROVIDED ALWAYS THAT :
1. This insurance shall not apply, in so far as it applies to a female to expenses incurred in respect of any condition arising
from or traceable to any disease of the organs of generation, malignant disease of mammary gland, pregnancy
childbirth, abortion or miscarriage or any complications and/or sequels arising from the foregoing, unless otherwise
provided hereafter.
2. The Company shall not be liable to make any payment under this Policy in respect of :-
i) Disease, Injury, Death or Disablement directly or indirectly due to War, Invasion, Act of Foreign Enemy Hostilities or
Warlike Operations (whether war be declared to nor) or Civil Commotion or Rebellion Military, Naval or Air Service
or Breach of Law of Hunting, steeple-chasing, Revolution, Insurrection, Mutiny, engaging in aviation other than a
passenger (fare paying or otherwise) in any licensed Standard Type of Aircraft.
ii) Circumcision or Strictures or Vaccination or Innoculation or change of life or beauty treatment of any description or
dental or eye treatment or Intentional self injury or insanity or dissipation or Nervous Breakdown (which expression
shall cover also general debility “run down” conditions and General “overhaul”) or Venereal Disease or intemperance
or the use of intoxicating drugs or liquors or any diseases, injury, death or disablement directly or indirectly due to any
one or more of them.
Subject otherwise to the terms, exceptions, conditions and limitations of this Policy.
N.B.- IN THE EVENT OF DISHONOUR OF PREMIUM CHEQUE THE POLICY AUTOMATICALLY STANDS CANCELLED AS FROM INCEPTION.