Personal Accident Claim Process

Personal accident (PA) insurance pays out for death, permanent disability, temporary disability, or hospitalisation caused by an accident. The policy is simple in concept but the claim process requires you to match your documentation precisely to the benefit being claimed. Here is how to navigate it.

Identify Which Benefit You Are Claiming

PA policies typically offer four benefits:

• Accidental death — 100% of sum insured to nominee
• Permanent total disability (PTD) — 100% of sum insured (e.g., loss of both limbs or eyesight)
• Permanent partial disability (PPD) — a percentage of sum insured as per the policy table (e.g., loss of one thumb = 20%)
• Temporary total disability (TTD) — weekly or daily benefit for the period you cannot work

Read your policy schedule to confirm which benefits apply and their limits.

Documents for an Accidental Death Claim

• Death certificate from municipal authority
• Post-mortem report
• FIR / panchanama
• Nominee''s KYC and NEFT details
• Original policy document

Documents for Disability Claims

• Disability certificate from a government or empanelled doctor confirming the nature and percentage of disability
• Hospital discharge summary and surgical notes
• FIR or MLC report confirming accidental cause
• Employer''s certificate confirming loss of income (for TTD claims)
• Completed claim form

Filing Timeline

Intimate the insurer within 30 days of the accident (or within the window stated in your policy). For death claims, the same 30-day intimation rule applies. IRDAI requires settlement within 30 days of a complete document submission, and within 90 days if investigation is initiated.

Pitfalls in PA Claims

• Not lodging an FIR — especially critical if the accident involved a third party, vehicle, or occupational hazard.
• Claiming disability without a government-certified disability certificate — the insurer will insist on one.
• Assuming a self-inflicted injury or injury under influence of alcohol is covered — these are standard exclusions.
• Forgetting that a PA policy does not cover illness — only accidents qualify.

If the Insurer Disputes the Disability Percentage

If the insurer assesses a lower disability percentage than you believe is correct, obtain an independent medical assessment and challenge via the Grievance Redressal Officer. The IRDAI Ombudsman can also adjudicate disability percentage disputes.

Conclusion

Matching your documents to the specific benefit type is the key to a smooth PA claim. If you are uncertain whether your injury qualifies as PTD or PPD, or if the insurer has offered a lower percentage than expected, explore your options with an informed advisor at TruePolicy before accepting the settlement.