It’s as if you’re getting double coverage. However, numerous individuals discover that policies don’t fit together when claiming. One pays. The latter causes difficulties. Sometimes they don’t pay what you’d hoped.
It’s actually a frequent problem in the event you have a personal accident policy as well as health insurance. Both are useful. However, if their coverage doesn’t align with their payouts, you can find gaps in coverage at a time when you need it.
What Each Policy Actually Covers
A personal accident policy pays an accident benefit when you’re injured in an accident. It provides coverage for the loss of income while recovering, permanent disability and accidental death. This payout is generally a lump sum and/or a set amount per week. Does not include sickness.
An insurance policy is a health insurance policy that covers the costs of hospital stays, either due to disease or injury. Covers doctor’s bills, surgery, medicine and room. It isn’t a replacement for your lost income if you’re unable to work.
Both policies may apply in the case of an accident. The accident policy takes care of your loss of income. Your hospital expenses are covered by the health plan.
Why Payout Terms Create Problems
The terms of pay-out determine when and how you will receive your money. If there are any discrepancies in these terms between your two policies then you have actual problems.
While dealing with one policy, you may forget to meet the claim time limit for the other. One claim could be prohibited by a waiting period. It may be possible to make a double claim on the same bill, which is not permitted.
If you are able to sync these terms, your payouts will flow in as smoothly as possible during recovery.
The Main Payout Terms to Compare
The rules and language are different for each policy. A trigger is what is known to another as a condition. You can’t see the gaps if you don’t look at them both together. It is easy to do from the table below.
| Payout Term | Personal Accident Policy | Health Insurance Plan |
| Payout Type | Lump sum or weekly benefit | Cashless or reimbursement |
| Trigger | Accident only | Hospitalisation for any cause |
| Waiting Period | Nil in most cases | 30 days for illness, nil for accident |
| Income Replacement | Yes | No |
| Sub-limits | Based on disability type | Room rent, specific procedures |
| Claim Deadline | 7 to 15 days usually | 15 to 30 days usually |
Compare both your policies using this table. You will quickly spot the gaps.
Steps to Sync the Two Policies
Insure accident coverage from the get-go
Typically, most personal accident policies do not include a waiting period. The best health insurance plan also includes accident coverage from the beginning. Check to see that your policies do this too. If you have an accident waiting period in your health plan, there’s an issue that needs to be addressed at health plan renewal time. In addition, see if your plan differentiates workplace accidents from road accidents. There are some plans that have clauses that may be overlooked. You’ll find this out from a quick call to your insurance company.
Do not double count an expense
A hospital bill can’t be billed to both health insurance companies. That is fraud. You can recoup your hospital bills from your health plan and income and disability from your accident policy. These are separate claims of various losses. Both are valid. Separate your discharge from bills and your disability documents. This simplifies filing of two claims without any confusion.
Match up the weekly benefit to your actual expenses
If you are unable to work due to an accident, you may be able to receive a weekly benefit under your accident policy. Verify that you have enough to pay your rent, food and EMIs in recovery. Otherwise, you might have to raise your sum insured. Be sure to also look into the number of weeks for which the benefit will be paid. Some policies only allow it to go up to 52 weeks. Others stop earlier. Find out how much you can take before you actually need to!
Align your claim filing dates
There are time limits on both policies. This is a very common error, missing while handling the other. On the same day as hospitalisation for an accident notify both insurers. Have one folder to store documents for both claims. Store insurer hotlines on your cell phone. If you are unable to make the calls, have another family member take them.
Know what is meant by the term disability.
Certain accident insurance plans only cover total and permanent disability. An injury that is temporary or a broken arm may not be eligible. Carefully read the meaning of the definition in your policy. If your plan only provides coverage for severe disability, make sure to have a rider for partial and/or temporary disability. There are various terms for the identical condition used by various insurers. Do not assume that both policies refer to the same.
Gaps That Catch People Off Guard
- Some treatments completed in less than 24 hours could not be covered by your health plan and may be considered a day-care treatment.
- While recovering from illness, self-employed individuals do not earn their income, and this is not covered by health plans.
- Some policies won’t cover accidents at home or in sports activities.
- People often think they will be able to receive more than they actually do when there are partial disability payouts.
These gaps will not be revealed right when buying the policy. They are only visible when a claim is submitted. At the time, it will be too late to repair anything. Do check for these at this time, when both policies are in effect.
A Simple Checklist
- They both include policies that have no waiting period for accidents.
- You don’t have to claim the same hospital bill twice.
- The weekly disability benefit is for the primary monthly expenses.
- The claim deadlines for both policies are stored in an easily-accessed location.
- You know the definition of a disability in your insurance policy.You know what constitutes disability in your policy.
- Both policies in effect and premiums paid
Putting It Together
A personal accident policy is just one of the components of a safety net, the other part being the best health insurance plan. One will be used to pay your doctor’s bills. The other one is for lost income.
They don’t let you down unless you don’t read them together! The vast majority of people purchase both, but never do a comparison for payouts. Then there’s a claim and the mismatch becomes apparent.
Compare the two texts. Make a note of the triggers, deadlines and the type of payouts. One hour can make a huge difference when you need the money.
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