Accident Shield

A. Endorsement Wordings

In consideration of payment of additional premium, it is hereby agreed and declared that this
Policy extends to pay compensation as per the following scale for Bodily Injury and/or death
sustained by any occupant other than the paid driver, attendant or cleaner whilst mounting
into, dismounting from or traveling in the Insured Vehicle and caused by violent, Accidental,
external and visible means which independently of any other cause shall within three
calendar months of the occurrence of such injury result in:

S. No. Nature of Injury Scale of Compensation

1 Death 100% of specified Sum Insured
Loss of two limbs or sight of both eyes
2 125% of specified Sum Insured
or one limb and sight of one eye
3 Loss of one limb or sight of one eye 50% of specified Sum Insured
Permanent Total Disablement from
4 125% of specified Sum Insured
injuries other than named above

B. Conditions (Applicable Only for this add on cover)

1. Claims made by You against Us under ‘Accident Shield’ are subject to the conditions set forth
under the Motor Insurance Policy
2. In case of transfer of ownership of the Insured Vehicle, the cover under ‘Accident Shield’ shall
expire.
3. Free Look Period (Applicable only in case of New Policy)

You have a period of 15 days from the date of receipt of the policy document to review the
terms and conditions of this Policy. If You have any objections to any of the terms and
conditions, You have the option of cancelling the Policy stating the reasons for cancellation.
If you have not made any claim during the Free look period, you shall be entitled to refund of
premium subject to,
i. a deduction of the expenses incurred by Us on Your medical examination, stamp
duty charges and if the risk has not commenced
ii. If the risk has commenced the stamp duty charges, medical examination charges
& proportionate risk premium for period on cover would be deducted.
iii. Where only a part of risk has commenced, such proportionate risk premium
commensurate with the risk covered during such period.
4. Renewal & Cancellation

i. Under normal circumstances, lifetime renewal benefit is available under the cover
except on the grounds of fraud, misrepresentation or moral hazard.
ii. In case of Our own renewal, a grace period of 30 days is permissible for annual
premium policies and the Policy will be considered as continuous. However, any
accident/ injury contracted during the break period will be not be admissible under
the policy.
iii. We may cancel this insurance by giving You at least 15 days written notice, and if
no claim has been made then We shall refund a pro-rata premium for the
unexpired Policy Period. Under normal circumstances, Policy will not be cancelled
except for reasons of mis-representation, fraud, non-disclosure of material facts or
Your non-cooperation. You may cancel this insurance by giving Us at least 15 days
written notice, and if no claim has been made then We shall refund premium on
short term rates for the unexpired Policy Period as per the rates detailed below.
Period on Risk % of Annual Rate Refunded
1 month 75%
3 months 50%
6 months 25%
12 months Nil

5. Portability Conditions

i. Retail Policies: As per the Portability Guidelines issued by IRDA, applicable benefits
shall be passed on to insured persons who were holding similar retail health
insurance policies of other non-life insurers. The pre-policy medical examination
requirements and provisions for such cases shall remain similar to non-portable
cases.
ii. Group Policies: As per the Portability Guidelines issued by IRDA, applicable benefits
shall be passed on to insured persons who were insured under Our Group Personal
Accident Policy and are availing Our Personal Accident Policy. However, such benefits
shall be applicable only in the event of discontinuation/ non-renewal of the Group
Personal Accident Policy (applicable for both employer-employee relationships and
non-employer-employee relationships) and/or the particular insured person leaving
the group on account of resignation/ retirement (applicable for employer-employee
relationships) or termination of relationship with the Group Administrator
(applicable for non-employer-employee relationships). The pre-policy medical
examination requirements and provisions for such cases shall remain similar to non-
portable cases.

6. Revision/ Modification of the Cover:

 There is a possibility of revision/ modification of terms, conditions, coverages and/or
premiums of this cover at any time in future, with appropriate approval from IRDA. In such
an event of revision/modification of the product, intimation shall be set out to all the existing
insured members at least 3 months prior to the date of such revision/modification comes into
the effect

7. Withdrawal of Cover

There is a possibility of withdrawal of this cover at any time in future, with appropriate
approval from IRDA, as We reserve Our right to so with a intimation of 3 months to all the
existing insured members. In such an event of withdrawal of this cover, at the time of Your
seeking renewal of this cover, You can choose, among Our available similar and closely similar
Health insurance products. Upon Your so choosing Our new product, You will be charged the
Premium as per Our Underwriting Policy for such chosen new product, as approved by IRDA.
Provided however, if You do not respond to Our intimation regarding the withdrawal of the
cover/ product under which this Policy is issued, then this cover shall be withdrawn and shall
not be available to You for renewal on the renewal date and accordingly upon Your seeking
renewal of this Policy, You shall have to take a Policy under available new products of Us
subject to Your paying the Premium as per Our underwriting policy for such available new
product chosen by You and also subject to Portability condition

8. Sum Insured Enhancement:

i. The Insured member can apply for enhancement of Sum Insured at the time of
renewal. You can apply for enhancement of Sum Insured by submitting a fresh proposal
form to the company.
ii. The acceptance of enhancement of Sum Insured would be at the discretion of the
company, based on the health condition of the insured members & claim history of the
policy.

C. Exclusions

We will not be liable to indemnify You for the following events:

1. Where the Own Damage Claim made by You against Us under the Motor
Insurance Policy is not payable
2. Accidental Bodily Injury that You or other members covered under ‘Accident Shield’
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 committing any breach of law with
criminal intent
d) Whilst participating as the driver, co-driver or passenger of a motor vehicle
during motor racing or trial runs
 3. 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

D. Claims Process

1) Making a claim
If You/other persons covered under ‘Accident Shield’ 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 behalf must inform Us in writing immediately and in any
event within 14 days
b. You/other persons covered under ‘Accident Shield’ must immediately consult a
Doctor/ Medical Practitioner and follow the advice and treatment that he
recommends
c. You/other persons covered under ‘Accident Shield’ must take reasonable steps to
lessen the consequences of Bodily injury.
d. You/other persons covered under ‘Accident Shield’ must have Yourself examined by
Our medical advisors if We ask for this.
e. You or some one claiming on behalf must promptly give Us documentation and other
information We ask for to verify the claim or Our obligation to make payment for it.
f. In the event of death, someone on deceased’s behalf must inform Us in writing
immediately and send Us a copy of the post- mortem report ( if performed) within
30 days
g. Following documents should be submitted to the Company for processing of Claims:
In case of Claim related to Loss of limb or sight of eye and PTD:

i. Duly Completed Claim Form

ii. Intimation given by You/ Your Representative, regarding the Insured Vehicle
meeting with an accident
iii. Attested Disability certificate from a concerned government medical
authority confirming the extent and nature of disability;
iv. Attested copy FIR
v. Photograph of the claimant before and after injury supporting to
disablement
vi. Investigation Reports like Laboratory test, X-rays and reports essential of
confirmation of the Injury;
vii. Policy Copy
viii. NEFT details & cancelled cheque

In case of Death Claim:

i. Duly Completed Claim Form

 ii. Intimation given by You/ Your Representative, regarding the Insured Vehicle
meeting with an accident
iii. Attested copy of death certificate
iv. Burial Certificate (wherever applicable).
v. Attested copy of Statement of Witness, if any lodged with police authorities.
vi. Attested copy of FIR / Final Police report.
vii. Attested copy of Post Mortem Report (if performed)
viii. Attested copy of Viscera report if any(Only if Post Mortem is conducted).
ix. Photo identity proof , address proof (Ration Card or Electricity Bill copy)
x. Policy Copy
xi. NEFT details & cancelled cheque

h. On receipt of all the documents and on being satisfied with regard to the admissibility
of the claim as per policy terms and conditions, We shall offer within a period of 30
days a settlement of the claim to You. Upon acceptance of an offer of settlement by
You, the payment of the amount due shall be made within 7 days from the date of
acceptance of the offer by You. In the cases of delay in the payment, We will be liable
to pay interest at a rate which is 2% above the bank rate prevalent at the beginning
of the financial year in which the claim is reviewed by it.
i. If We, for any reasons decides to reject the claim under the policy, the reasons
regarding the rejection shall be communicated to You in writing within 30 days of
the receipt of documents.

Note: Waiver of conditions (a) and (f) may be considered in extreme cases where it is proved
to Our satisfaction that under the circumstances in which the You/other persons covered
under ‘Accident Shield’ were placed it was not possible for You or any other person to give
notice or file claim within the prescribed time limit.

2) Claim Settlement

a. You agree that We need only make payment when You or someone claiming on behalf
has provided a claim to Our satisfaction
b. We will make payment to You or to Your Nominee. If there is no Nominee, We will pay
Your legal heir, executor or validly appointed legal representative as per succession
certificate issued in the manner prescribed under State Laws and any payment We make
in this way will be a complete and final discharge of Our liability to make payment
c. In the event of Insured Vehicle not being declared as a Total Loss/ Constructive Total
Loss and the Motor Insurance Policy not being cancelled, the reinstatement premium
required to reinstate the Sum Insured to the previous limits would be deducted from the
claim amount payable under this cover or the Motor Insurance Policy

E. Definitions
The words and phrases listed have special meanings We have set below whenever they
appear in bold type and initial capitals. Please note that references to the singular or to the
masculine also include references to the plural or to the female the context permits and if
appropriate.

1. Accident, Accidental: An accident is a sudden unforeseen and involuntary event caused

by external, visible and violent means.
2. Bodily Injury/ Injury: Injury means accidental physical bodily harm excluding illness or
disease solely and directly caused by external, violent and visible and evident means
which is verified and certified by a Medical Practitioner.
3. Condition Precedent shall mean a policy term or condition upon which the Insurer's
liability under the policy is conditional upon.
4. Day Care Treatment refers to medical treatment, and/or surgical procedure which is:
i. undertaken under General or Local Anesthesia in a hospital/day care centre in
less than 24 hrs because of technological advancement, and
ii. which would have otherwise required a hospitalization of more than 24 hours.

Treatment normally taken on an out-patient basis is not included in the scope of

this definition.
5. Grace Period means the specified period of time immediately following the premium
due date during which a payment can be made to renew or continue a policy in force
without loss of continuity benefits such as waiting periods and coverage of pre-
existing diseases. Coverage is not available for the period for which no premium is
received.
6. Hospital: A Hospital means any institution established for in- patient care and day care
treatment of illness and / or injuries and which has been registered as a hospital with the
local authorities under the Clinical Establishment (Registration and Regulation) Act 2010
or under the enactments specified under the Schedule of Section 56(1) of the said Act
OR complies with all minimum criteria as under:
- has qualified nursing staff under its employment round the clock;
- has at least 10 in-patient beds in towns having a population of less than
10,00,000 and at least 15 in-patient beds in all other places;
- has a fully equipped operation theatre of its own where surgical
procedures are carried out;
- maintains daily records of patients and makes these accessible to the
Insurance company’s authorized personnel.
7. Illness means a sickness or a disease or pathological condition leading to the
impairment of normal physiological function which manifests itself during the Policy
Period and requires medical treatment.
a Acute condition - Acute condition is a disease, illness or injury that is likely
to respond quickly to treatment which aims to return the person to his or her
state of health immediately before suffering the disease/illness/injury which
leads to full recovery.
 b. Chronic condition - A chronic condition is defined as a disease, illness, or
injury that has one or more of the following characteristics:—it needs ongoing
or long-term monitoring through consultations, examinations, check-ups, and
/ or tests—it needs ongoing or long-term control or relief of symptoms— it
requires your rehabilitation or for you to be specially trained to cope with it—
it continues indefinitely—it comes back or is likely to come back.

8. Insured Vehicle: The vehicle insured by Us under the Motor Insurance Policy
9. Medical Advise means any consultation or advice from a Medical Practitioner including
the issue of any prescription or repeat prescription.
10. Medical Practitioner/ Doctor: A Medical Practitioner is a person who holds a valid
registration from the Medical Council of any State or Medical Council of India or
Council for Indian Medicine or for Homeopathy set up by the Government of India or a
State Government and is thereby entitled to practice medicine within its jurisdiction; and
is acting within the scope and jurisdiction of license.
11. Nominee: Nominee means the person(s) nominated by the Insured to receive the
insurance benefits under this Policy payable on the death of the Insured.

12. Notification of claim is the process of notifying a claim to the insurer or TPA by specifying
the timelines as well as the address / telephone number to which it should be notified.
13. Own Damage Claim: The claim raised by You against Us for loss or damage to the Insured
Vehicle due to the perils mentioned under Motor Insurance Policy
14. Permanent Total Disablement: Doctor certified total, continuous and permanent:
• loss of the sight of both eyes
• physical separation of or the loss of ability to use both hands or both feet
• physical separation of or the loss of ability to use one hand and one foot
• loss of sight of one eye and the physical separation of or the loss of ability to
use either one hand or one foot
15. Policy/ Motor Insurance Policy: Private Car Package Policy issued by Us to which this
cover is extended
16. Policy Period: The period between and including the commencement date and expiry
date as shown in the Motor Insurance Policy Schedule
17. Portability: Portability means transfer by an individual health insurance policyholder
(including family cover) of the credit gained for pre-existing conditions and time- bound
exclusions if he/ she chooses to switch from one insurer to another.
18. Pre- existing Disease means any condition, ailment or injury or related condition(s) for
which you had signs or symptoms, and / or were diagnosed, and / or received medical
advice / treatment within 48 months to prior to the first policy issued by the insurer.
19. Reasonable and Customary charges means the charges for services or supplies, which
are the standard charges for the specific provider and consistent with the prevailing
charges in the geographical area for identical or similar services, taking into account the
nature of the illness / injury involved.
20. Renewal defines the terms on which the contract of insurance can be renewed on
mutual consent with a provision of grace period for treating the renewal continuous for
the purpose of all waiting periods.
21. Schedule: The Schedule and any Annexure or Endorsement to it which sets out Your
personal details, the type of insurance cover in force and the Sum Insured
22. Sum Insured: The amount stated in the Schedule, which is the maximum amount We
will pay for claims made by You, irrespective of the number of claims You make during
the Policy Period
23. Total Loss/ Constructive Total Loss: A loss under the Motor Insurance Policy where the
aggregate cost of retrieval and/or repair of the Insured Vehicle, subject to terms and
conditions of the Policy, exceeds 75% of the IDV of the Insured Vehicle
24. We, Our, Us: Bajaj Allianz General Insurance Company Limited
25. You, Your, Yourself: The person We insure as set out in the Schedule