FAQs - Group Accident Guard

Q. What is an accident?

A. Any unforeseen/unfortunate event that happens unexpectedly and unintentionally typically which results in damage and injury.

Q. What is Personal Accidental Policy?

A. PA Policy is a comprehensive cover which can secure you after any unforeseen event/accident. It is a remedy, which can prepare you in advance to mitigate any sort of losses arising from an accident.

Q. Who can be covered under Personal Accidental Policy?

A. All individual customers of India Post Payments Bank and Department of Post

Q. How Policy can be obtained?

A. Customers to get in touch with GDS/IPPB Branches, product is readily available on MATM App in just few clicks.

Q. What is not covered in the product/exclusions?

A. 1. Accidental Bodily Injury that the Insured Person(s) meet with
a) Through suicide, attempted suicide or self-inflicted injury or illness.
b) While under the influence of liquor or drugs.
c) Arising or resulting from the insured person (s) committing any breach of law with criminal intent
d) Whilst engaging in aviation or ballooning, whilst mounting into, dismounting from or traveling in any duly licenses standard type of aircraft other than as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world.
e) Whilst participating as the driver, co-driver or passenger of a motor vehicle during motor racing or trail runs.
f) As a result of any curative treatments or interventions that the Insured Person(s) carry out or have carried out on his/her body.
g) Arising out of the participation of the Insured Person(s) in any naval, military or air force operations whether in the form of military exercises or war games or actual engagement with the enemy, whether foreign or domestic.
2. The Insured Person(s) ‘consequential losses of any kind or their actual or alleged legal liability.
3. Venereal or Sexually transmitted diseases
4. HIV (Human Immunodeficiency Virus) and/or any HIV related illness including. AIDS (Acquired Immune Deficiency Syndrome) and/or mutant derivatives or variations thereof however caused.
5. Pregnancy, resulting childbirth, miscarriage, abortion, or complications arising out of any of these.
6. War (whether declared or not), civil war, invasion, act of foreign enemies, rebellion, revolution, insurrection, mutiny, military or usurped power, seizure, capture, arrest, restraint or detainment, confiscation or nationalisation or requisition of or damage by or under the order of any government or public local authority.
7. Nuclear energy, radiation.

Q. How to Intimate claims/Claim procedure?

A. Cashless Claims Procedure:

Applicable only for Accidental Hospitalization Expenses Optional Cover Cashless treatment is only available at Network Hospitals. In order to avail of cashless treatment, the following procedure must be followed by You:

a. Prior to taking treatment and/or incurring Medical Expenses for any Accidental Injury, at a Network Hospital, the Insured Person must call Us and request pre-authorization by way of the written form which the Company will provide. Waiver of this condition shall be considered in case of emergency hospitalisation arising out of accidental bodily injury.

b. After considering the Insured’s request and after obtaining any further information or documentation the Company have sought, the Company may if satisfied send to the Insured Person or the Network Hospital, an authorization letter. The authorization letter, the ID card issued to the Insured along with this Policy and any other information or documentation that the Company have specified must be produced to the Network Hospital identified in the pre-authorization letter at the time of Insured’s admission to the same.

c. If the procedure above is followed, the Insured Person will not be required to directly pay for the Medical Expenses raised out of Accidental Bodily Injury, in the Network Hospital that the Company is liable to indemnify under Accidental Hospitalization Expenses Section and the original bills and evidence of treatment in respect of the same shall be left with the Network Hospital. Pre-authorization does not guarantee that all costs and expenses will be covered. We reserve the right to review each claim for Medical Expenses and accordingly coverage will be determined according to the terms and conditions of this Policy. Insured Person shall, in any event, be required to settle all other expenses directly.

Reimbursement Claim Procedure

If you meet with any Accidental Bodily Injury that may result in a claim, then as a condition precedent to our liability:

a. You or someone claiming on your behalf must inform us in writing immediately and in any event within 30 days from the date of the accident and submit all documents to us within 30 days from the date of intimation.

b. You must immediately consult a Doctor and follow the advice and treatment that he recommends.

c. You must take reasonable steps to lessen the consequence of Bodily injury.

d. You should allow examination by our medical advisors if we ask for this.

e. You or someone claiming on your behalf must promptly give us documentation and other information we ask for to investigate the claim or our obligation to make payment for it.

f. In case of your death, someone claiming on your behalf must inform us in writing immediately and send us a copy of the post mortem report (if conducted) within 30 days.

*Note: Waiver of conditions (a) and (f) may be considered in extreme cases of hardship where it is proved to Our satisfaction that under the circumstances in which the Insured Person was placed, it was not possible for the Insured Person or any other person claiming on his/her behalf to give notice or file claim within the prescribed time limit.

Q. What are the documents required for Claim?

A. Below are the Standard Claim Documents

1. Death Cover

a) Duly Completed Personal Accident Claim Form signed by Nominee.
b) Copy of address proof.
c) Attested copy of Death Certificate.
d) Burial Certificate (wherever applicable).
e) Attested copy of Statement of Witness, if any lodged with police authorities.
f) Attested copy of FIR / Panchanama/ Inquest Panchanama.
g) Attested copy of Post Mortem Report (only if conducted).
h) Attested copy of Viscera report if any (Only if Post Mortem is conducted).
i) Claim form with NEFT details.

2. Permanent Total Disablement Cover/Permanent Partial Disablement

a) Duly Completed Personal Accident Claim Form signed by insured.
b) Attested copy of disability certificate from Civil Surgeon of Government.
c) Hospital stating percentage of disability.
d) Attested copy of FIR.
e) All X-Ray / Investigation reports and films supporting to disablement.
f) Claim form with NEFT details.

Grievance Redressal -

In case of any grievance, the Insured Person may contact:

Toll free Number: 1800-102-5858, 1800-209-5858

Email Address: Bagichelp@bajajallianz.co.in