Coverage Under Accidental Insurance Policy

Definition 

Insurance works on the principle of Proximate Cause.  It is concerned with how the loss or damage actually occurred and whether it is a resultant of the cause of the injury. In the event of the Life Insured’s Accidental Death, if death is caused within 180 days of any bodily injury sustained directly and solely due to the same accident and while ADB (Accidental Death Benefit) Rider is still in force.

Let us understand through a live case: [Link]  

A person was going to the hospital on his bicycle, he was struck down by a stray-cow, due to which he fell down and suffered severe chest pain. He was then taken to a hospital, where first aid was given to him, and later on, he was referred to the heart specialist who gave medical aid. The condition became serious, the next day, he was referred to another heart specialist. Due to improper medical aid, he expired in the same Nursing Home.

Findings in the case:

• Wherein immediate cause of death has been referred to as "heart attack as per the version of doctor"
•  Against the duration of last illness, it was mentioned "four days" that means the insured was ill for four days after injuries caused
• Against the nature of the illness, it was mentioned "pain in the chest."
• The deceased first complain of being not in usually good health, "just soon after the accident"

Decision:

The insurance company was directed to pay the balance amount to the nominee of the deceased.

Now I hope this clause is well explained and will be wisely chosen while taking a policy.

 

Suggestion:

People either of a lower age group or people with excessive traveling related to their jobs should opt for this option. As in the lower age group, the chances of natural casualties are lower than the higher age group.