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Does Health Insurance Policy cover auto accident injuries?

Team AckoMay 13, 2024

Insurance protects us from events that could potentially drain our financial resources. This allows us to lead a stress-free life. One such common unfortunate event is road accidents. And no road commuter is exempt from its threat.

As you may already know, health insurance covers most medical expenses. But does health insurance cover car accident injuries as well? To find out the answer to that question, read on!




What are accidental injuries?

As the name suggests, accidental injuries occur due to accidents. They are unforeseeable and sudden. Some accidental injuries can even lead to the loss of life and thus require swift treatment. Accidental injuries include injuries from a fall, getting burnt, drowning, road accidents, etc. The Ministry of Road Transport and Highways reported over 4.64 lakh road accidents in 2017. The report also stated that over 1.47 lakh people lost their lives as a result of these accidents.

Does a health insurance plan offer accident cover?

Many leading insurance providers offer accident cover as part of their base plan. But, this is not always the case. So make sure to check for required coverage before purchasing your health insurance plan. Also, go through the policy document to understand the limitations of the cover.

Usually, regular health insurance plans that offer accident cover, come with limitations. It is always advisable to have Personal Accident Insurance Cover along with your health insurance plan. This will save you the worry of managing medical expenses during emergencies.

How to File a Claim for an Accident Injury

If you get hurt in an accident, filing an insurance claim can help pay for medical bills and lost income. The first step is notifying your health insurance and auto insurance (if a car accident) about the injury. Provide details on how, when, and where it occurred. Keep records of doctor visits and save medical bills, as you'll need to submit those. Finally, complete any forms the insurance company provides to request payment formally. Although claims can seem intimidating, taking it step-by-step makes it very doable.

Shortcomings of a basic health insurance policy

As discussed above, a health insurance plan usually covers accidental injuries. But there are limitations to its coverage. Below are some of the shortcomings of a regular health insurance policy.

  • Not all health insurance providers offer coverage for accidental injuries. In such cases, one must purchase the Personal Accident add-on to increase the coverage of a basic health insurance plan.

  • Policies that offer accidental coverage by default, usually come with an upper limit. For example, a ceiling on coverage for the room rent, doctor’s fee, etc.

  • Some health insurance plans cover only hospitalisation expenses. The other expenses are borne by the insured.

The Role of Supplemental Insurance Policies 

Supplemental policies like accident or critical illness insurance can give extra support if you get injured. They pay cash benefits directly to you, regardless of what your health insurance covers. That money can help cover rent, groceries, and out-of-pocket medical fees while you recover. Such policies are optional but worth considering if you'd struggle financially if hurt in an accident. They give peace of mind.

The Importance of Disclosure and Accurate Information

It is vital to provide complete and accurate information when applying for and filing insurance claims. Insurance fraud drives up premium rates for all policyholders. If an insurer finds inaccurate or omitted information, later on, they may deny coverage altogether. Therefore, it is important to be upfront when first applying, even if it means higher initial premiums. Additionally, policyholders should proactively notify the insurance company and supply any updates if health conditions or other relevant status changes before filing a claim. 

Full transparency and disclosure protect all parties involved in the long run. It upholds the integrity of the policies while ensuring those paying for coverage can access the benefits they genuinely need. Overall, supplying insurers with the full picture is crucial for the ethical functioning of insurance systems.

Health Insurance Policy vs Personal Accident Insurance Policy

There are several differences between health insurance policy and Personal Accident Insurance policy. A health insurance policy covers a myriad of medical conditions, whereas a Personal Accident Insurance covers only medical expenses arising from accidents. Although some health insurance policies offer limited coverage for accidental injuries (as defined in the policy document), it is always advisable to either purchase a separate Personal Accident Insurance policy or add-on.

Coverage benefits of Personal Accident Insurance Policy

Under the personal accident policy, you can avail of the following benefits.

Accidental Death cover

A death due to an accident can cause severe emotional and financial stress to a family. In such a case the entire assured sum is paid to the nominee mentioned in the policy document. The cover offered for death is usually applicable only within a specific time frame. Unusually, a death that occurs up to approximately 180 days after the accident is covered.

Total Permanent Disability Cover

Injuries caused by an accident can be of varying magnitudes. Total permanent disability refers to accidental injuries resulting in permanent or lifelong impairment. For instance, loss of limbs, loss of eyesight, etc. In such cases, a specified insured amount is paid to the insured.

Permanent Partial Disability Cover

Permanent partial disabilities refer to accidental injuries resulting in permanent partial impairment. For instance, hearing loss, loss of an eye, loss of a limb, back injuries, etc. In such cases, a certain percentage of the sum insured is paid to the insured.

Temporary Total Disability

Temporary total disabilities refer to accidental injuries resulting in temporary total impairment. This could prevent the insured from working and earning a living. In such cases, the insurer will compensate for the loss of income by providing a weekly allowance.

Additional benefits

Some of the other benefits include the following.

  • Coverage of the ambulance costs of the insured as per the terms of the plan.

  • Reimbursement of transport charges to the hospital, of the immediate family, if covered by the policy.

  • Compensation for accidental broken bones and burns.

  • In accidental death cases, the dependent child’s education is covered to a specified limit as per the terms of the plan.

  • Coverage of repatriation costs of the mortal remains of the insured to their home or cremation ground.

If another party caused your accident, the legal process for injury compensation can get complicated. Insurers have whole teams managing liability and settlement details. Fortunately, you can hire a personal injury attorney to help navigate it all, communicate with insurers, and fight for maximum compensation. They understand the laws and procedures inside and out. Though they take a share of any settlement, having their expertise in your court is usually worth it in the long run.

To sum up

As the proverb goes, “A stitch in time, saves nine”. So too, purchasing health insurance and Personal Accident Insurance beforehand can save you from a ton of financial stress. Accidents are unpredictable and pose risks even to passengers. Investing in Personal Accident Insurance as soon as possible can prevent taking loans and burning through one’s savings during an emergency.

Frequently asked questions

Below are some of the commonly asked questions regarding health insurance and accident coverage.

Can I claim health insurance after getting into a car accident?


Yes, you can if your health insurer offers an accident cover as part of your base plan. But this is not always the case. Sometimes accidents are not covered in regular health insurance plans. In such cases, one has to purchase an accident cover as an add-on or as a separate policy.

Is Personal Accident Insurance and health insurance the same thing?


No, they are two separate plans. Personal Accident Insurance covers the cost of medical treatment arising out of an accident. Health insurance on the other hand caters to a host of medical conditions.

Does insurance pay for accidents?


Not all insurance plans cover accidents. Make sure to ask your insurance provider if your plan covers accidents before buying one. Also, make sure to buy a separate accident insurance policy. This will give you a more comprehensive accident cover.

How to find out if my insurance plan covers accidental injuries?


To find out if your plan includes accident cover, either ask your insurance provider or consider going through the terms and conditions of the policy document.

Why is being honest with my insurance so important?


Why is being honest with my insurance so important?

If your insurance company finds out you weren't completely upfront with them, they might not cover you when you need it most. Keeping things transparent from the get-go might mean a slightly higher premium upfront, but it also means you can relax, knowing you're fully covered.

Should I get a lawyer if my injury was someone else's fault?


Should I get a lawyer if my injury was someone else's fault?

Absolutely, especially if things start to look a bit complex. Personal injury attorneys are like navigators in the tricky world of insurance claims and legal battles. They take a piece of any settlement, but having an expert by your side usually pays off.

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Disclaimer: The content on this page is generic and shared only for informational and explanatory purposes. It is based on industry experience and several secondary sources on the internet; and is subject to changes. Please go through the applicable policy wordings for updated ACKO-centric content and before making any insurance-related decisions.

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