Personal Accident

Personal Accident Insurance is a protection and your financial support to face any unexpected accident.

Coverage

  1. This policy covers the risk of Death, Permanent Disability, Treatment and/or Medical Expenses which are directly caused by an accident, namely an incident or event that contains elements of violence, both physical and chemical, which comes suddenly, unwanted or planned. from the outside, visible, directly to the Insured which immediately results in bodily injury whose nature and location can be determined by Medical Science, including:
  • Poisoning due to inhalation of toxic gases or vapors, unless the Insured intentionally uses narcotics or other substances with known bad effects, including the use of illegal drugs,
  • Contracted a virus or disease germ as a result of the Insured accidentally falling into water or some other liquid substance,
  • Suffocate or drown
  1.  This policy covers the risk of Death, Permanent Disability, Treatment and/or Medical Expenses caused by:
  • The entry of viruses or germs into the wound suffered as a result of an accident guaranteed by the policy.
  • Complications or worsening of the disease caused by an accident covered by the policy during the treatment or treatment carried out by a doctor.

Compensation

1. Death (Coverage A). Coverage A will be provided in the event that the Insured:

  • Dies within 12 (twelve) months of the accident, or
  • Lost and not found within at least 60 days from the occurrence of the accident as a direct result of an accident covered by the policy.

2. Permanent Disability (Coverage B). Coverage B will be provided in the event that the Insured suffers permanent disability as a direct result of an accident covered by the policy, which consists of:


a. Overall permanent disability Overall Permanent Disability includes:

    • Loss of vision in both eyes, or
    • Loss or dysfunction of both arms, or
    • Loss or dysfunction of both legs, or
    • Loss or malfunction of: vision of one eye and one arm; vision of one eye and one leg; or one leg and one arm. It can also be interpreted as Total Permanent Disability, in the case of insanity or total paralysis suffered by the Insured as a direct result of an accident covered by the policy. This Permanent Disability must occur within 12 (twelve) months from the occurrence of the accident.


b. Partial permanent disabilities.Permanent Partial Disabilities are partial loss or non-functioning of the limbs. This right to compensation applies after the doctor determines the condition of the permanent disability suffered. If the Insured has received compensation in the case of Permanent Disability, then due to the same accident the Insured dies, the right to compensation in the event of Death will be given after deducting the amount of Permanent Disability compensation that has been paid. If the Permanent Disability compensation that has been paid is greater than the Death benefit, the Insured is not entitled to Death compensation.

3. Costs Of Treatment Or Treatment (Coverage C). Coverage C will be provided in the event of payment for reimbursement of the costs of care and or treatment carried out in an effort to heal or recover from illness or injury suffered by the Insured as a direct result of an accident covered by the policy. The right to this reimbursement is given in accordance with the costs incurred by the Insured but does not exceed the Sum Insured stated in the Summary of Insurance.

Compensation Amount

  1. Death: Compensation of 100% (one hundred percent) of the Sum Insured for Collateral A will be paid to the Policy Holder or the Heirs whose names are listed in the Schedule of Insurance.
  2. Permanent Disability:
  • Permanent Disabled Entire. 100% (one hundred percent) of the Sum Insured for Guarantee B will be paid to the Insured.
  • Partial Permanent Disability. The compensation will be paid to the Insured based on the percentage table of the Sum Insured for Coverage B, as follows:

Under the condition:

  • The total percentage of all permanent disabilities suffered during the coverage period does not exceed 100% of the Sum Insured for Coverage B.
  • For left-handed people the meaning of the word “right” is read as “left” and vice versa.
  • In the event of a loss of part of one of the items mentioned in the table above, the amount of compensation will be given proportionally (according to a comparison) in a percentage number that is smaller than the percentage scale associated with the missing part.
  • In the event of loss or non-functioning of more than one finger, the compensation provided for it does not exceed what has been determined for the loss of a hand from the wrist.
  • In the event of malfunction of the limb listed in the table, compensation is given if the non-functioning of the limb reaches 50% (fifty percent) or more based on the Certificate of the Doctor performing the treatment.

3.Cost of Treatment Or Treatment.

This guarantee is paid to the Insured based on the original receipt issued by the doctor who performed the treatment or treatment. The amount of reimbursement during the period of coverage is a maximum of the Sum Insured. Guarantee C. This guarantee does not apply to receipts issued by alternative medicine.

Exclusions

The risks that are not covered are if the accident occurs because of the insured or the policyholder, among others:

  1. In a state of war, invasion (whether war is declared or not);
  2. Suicide/attempted suicide, self-injury on purpose;
  3. The insured is under the influence of alcohol/drugs;
  4. Pregnancy / Miscarriage / Other related complications;
  5. Illness/illness, AIDS;
  6. Participation in dangerous sports;
  7. Terrorism and Sabotage;
  8. Duties in the Military/Police Service;
  9. Cost of Treatment or Alternative Medicine;
  10. The influence of nuclear or other radioactive material.

Pricing Factor

Mengingat risiko yang dijamin adalah kemungkinan terjadinya kecelakaan pada tertanggung, sedangkan faktor ini didominasi oleh kegiatan tertanggung, besar kecilnya premi dipengaruhi oleh pekerjaan tertanggung. Ada 4 (empat) kelompok pekerja, yaitu:

Class A:

People whose main job is in the office or often stay in the office.

Class B:

People from class A who often work outside or are housewives.

Class C:

People whose work requires tools or means to support activities such as drivers, field officers, dentists.

Class D:

People whose jobs are high risk such as miners, divers.

Minimum Data Requirement

  1. Details of those proposed to be insured i.e. name, occupation, date of birth, height and Weight, sex, cover period, benefit period
  2. Loss History

Claim Procedure

In the event of an accident which may result in a claim for reimbursement, the Insured must submit the following supporting documents:

  1. The claim submission report form follows the chronology of the accident that occurred.
  2. Original policy or photocopy
  3. Photocopy of Identity Card (KTP).
  4. In the event that the Insured dies:
  • Certificate regarding the results of the post-mortem (Visum et Repertum).
  • Photocopy of death certificate from the Lurah or local police.
  • Statements of witnesses
  1. In the event that the Insured is lost
  • A certificate regarding the accident and termination of the search from the competent authority
  • A statement from the heirs will return the compensation if the Insured is found alive again
  1. In the event that the Insured suffers permanent disability
  • Certificate of examination (Visum) from the doctor who carried out the treatment or treatment
  • Statements of witnesses
  1. Original receipts from doctors, hospitals, laboratories, pharmacies, in the event the Insured is undergoing treatment or treatment. If the original receipt is used to obtain reimbursement from mandatory insurance, the Insured must submit a photocopy of the receipt which has been legalized by the mandatory insurance company.
  2. Other relevant, reasonable and appropriate documents requested by the Insurer in connection with the settlement of claims