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Note : A brief snapshot about the policy is given.For complete information refer to policy wordings or visit our nearest branch office.

Optional Sum Insured of Rs.50,000/-, Rs.1 lac & Rs.1.5 lacs.

The policy covers hospitalization expenses incurred on account of Accident to the Workmen during and in the course of the employment.

The target segment for this policy would be Factory Owners/Contractors/Other Commercial Establishment looking for limited Medical cover for Workers/Employees arising out of accidents in the course of employment.

1. ACCIDENT

An accident is a sudden, unforeseen and involuntary event caused by external and visible and violent means

2. HOSPITAL/NURSING HOME

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 establishments (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 lacs and at least 15 in-patient beds in all other places

Has qualified medical practitioner(s) in charge round the clock

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 companys authorized personnel.

The term ' Hospital / Nursing Home ' shall not include an establishment which is a place of rest, a place for the aged, a place for drug-addicts or place for alcoholics, a hotel or a similar place.

Ayurvedic hospitals are outside the scope.

3. 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.

4. MEDICALLY NECESARY

Medically Necessary treatment is defined as any treatment, tests, medication, or stay in hospital or part of a stay in hospital which

Is required for the medical management of the illness or injury suffered by the insured

Must not exceed the level of care necessary to provide safe, adequate and appropriate medical care in scope, duration or intensity

Must have been prescribed by a Medical Practitioner

Must conform to the professional standards widely accepted in international medical practice or by the medical community in India.

5. MEDICAL PRACTITIONER

A Medical Practitioner is a person who holds a valid registration from the Medical Council of any State of India or Medical Council of India or Council for Indian Medicine or for Homeopathy set up by the Government of India or a State Goverment and is thereby entitled to practice medicine within its jurisdiction and is acting within the scope and jurisdiction of licence.

The term Medical Practitioner would include Physician, Specialist and Surgeon. (The Registered Practitioner should not be the insured or close family members such as parents, in-laws, spouse and children).

6. POST HOSPITALISATION MEDICAL EXPENSES

Relevant medical expenses incurred immediately 60 days after the Insured person is discharged from the hospital provided that

Such Medical expenses are incurred for the same condition for which the Insured Persons Hospitalisation was required and

The In-patient Hospitalisation claim for such Hospitalisation is admissible by the Insurance Company.

7. QUALIFIED NURSE

QUALIFIED NURSE means a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any State in India and who is employed on recommendation of the attending Medical Practitioner.

8. ROOM RENT

Room rent shall mean the amount charged by a hospital for the Occupancy of a bed on per day (24 hours) basis and shall include associated medical expenses.

9. SURGERY OR SURGICAL PROCEDURE"

Surgery or Surgical Procedure means manual and/or operative procedure(s) required for treatment of an illness or injury, correction of deformities and defects, diagnosis and cure of diseases, relief of suffering or prolongation of life, performed in a hospital or day care centre by a Medical Practitioner.

10. Period of Insurance

the period of insurance means the period commencing from the inception date till five years or ten years as the case may be.

11. Policy Period

Policy Period is defined as the period of 12 months each commencing from the date of inception from which the risk has commenced.

12. Indemnity Limits

the limit of indemnity will be restricted to the Sum Insured per employee selected by the insured person as mentioned in the Schedule and will apply to each policy during the Period of Insurance separately.

13. Insured Person

An employee of the Insured in the Business who has been covered under this Policy and in respect of whom Insured would be liable under Workmens Compensation Act, 1923 for payment of compensation in the event of bodily injury caused by accident arising out of and in the course of employment.

The Policy provide the following benefits

Hospitalisation expenses

Room, Boarding and Nursing expenses and other expenses upto 1% of the Sum Insured per day. This includes Nursing care, RMO charges, IV fluids/Blood Transfusion/Injection administration charges and the like but does not include cost of materials. ICU unit upto 2% of the Sum Insured per day.

Surgeon, Anesthetist, Medical Practitioner, Consultants, Specialists Fees.

Anesthetic, blood, oxygen, Operation theatre charges, surgical appliances, Medicines & drugs, Diagnostic material, X-ray, Artificial limbs and similar expenses.

Reasonable Ambulance charges for carrying the insured person from the spot of accident to the Hospital/Nursing Home not exceeding Rs.2,500/- per insured person per event.

For detailed terms and conditions, please see our Prospectus and Policy in our website.

All claims shall be paid in Indian Rupees only.

Upon happening of any event, notice of Intimation of claim shall be submitted forthwith to the Company.

Claim form should be collected on intimation of claim. The completed claim form along with all required/relevant documents should be submitted to the Insurer within a calendar month after the event which may give rise to a claim under the policy.

For the purpose of any claim the Insured has to submit a Claim Form in the format required by the Company together with other documents as listed below:

a) Attested copy of F.I.R. / Panchnama

b) Newspaper cuttings (if applicable).

c) Photographs if any.

d) The original hospitalization / nursing home bills, discharge certificates, receipts, cash memos, prescriptions, X-rays, pathological reports.

e) A certificate from the attending physician stating the nature and extent of injury.

f) Any additional information and assistance as the Company may require.

g) Proof of employment showing employer-employee relationship, and attested copy of attendance register.

h) Salary Payment / Disbursement Register.

The Insured / Insured Person(s) shall allow any representative of the Company to examine the injured either at the residence or Hospital / Nursing Home at all reasonable times and should co-operate with the Company if any claim reduction measures are suggested.

Provided always that the Company shall not be liable under this policy in respect of

1. Any Injury by accident directly attributable to war, war like operation and other convulsion of nature, nuclear fuel or material and contaminated by radio activity.

1.1. the compensation payable by the Insured under Workmens Compensations Act, 1923 for the injury

1.2. The Insureds liability to employees of contractors of the Insured

1.3. Any employee who is not a workman within the meaning of laws

1.4. Any liability of the Insured which attaches by virtue of an agreement but which would not have attached in the absence of such agreement.

1.5. Any sum which the insured would have been entitled to recover from any party but for an agreement between the insured and such party.

1.6. Any reimbursement for expenses incurred for diseases mentioned in part c of schedule III of the WC Act, 1923 which have been brought within the scope of that act by the workmen's compensation (Amendment) Act, 1956.

2. Payment respect of injury or disablement directly or indirectly arising out of or contributed to by or traceable to any disability existing on the date of issue of this policy.

3. Payment in respect of injury arising out of or resulting from the Insured Persons

3.1 Intentional self-injury, suicide or attempted suicide.

3.2 Being under the influence of intoxicating liquor or drug.

3.3 Insanity (Directly or indirectly caused by insanity).

3.4 Committing any breach of law with criminal intent.

4. Any hospitalization expenses incurred because of bodily injury resulting directly or indirectly, proximately or remotely, from any accident other than arising out of and in the course of employment.

5. Expenses on vitamins and tonics unless forming part of the Hospitalization treatment for injury as certified by the attending Physician.

6. Naturopathy Treatment.

For detailed exclusions, please see policy in our website.

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