Personal Accident Insurance Cover for Growers

Personal Accident Insurance Cover for Growers

Personal Accident Insurance Cover for Growers

1. Personal Accident Insurance Scheme : Introduction:

Personal Accident Insurance Scheme was introduced by PSF Trust, Department of Commerce, Government of India as a social security measure for the grower members of Price Stabilisation Fund Scheme in 2005 with a cover of Rs.25,000/- per grower. The premium on behalf of growers was paid by PSF Trust. Coverage of member growers enrolled in the PSF scheme under the Personal Accident Insurance Cover is given in the Table below:

Coffee

Rubber

Tea

Total

Total

11561

18471

14402

44704

* Premium @ Rs. 9.00 per member was borne by the PSF Trust.

2. Salient features of the Personal Accident Insurance Scheme:

Standard Perils Covered, Exclusions and Scope of Cover:

The insurance covers death / disablement due to accidents caused by external violent and visible means e.g. fire, drowning, snake bite, road/rail accidents, electrocution, attack by wild animals. Sterilization risk is also covered.

The exclusions are death, injury or disablement arising out of (a) intentional self injury, suicide, insanity, drunkenness, (b) breach of law with criminal intent and (c) war or warlike operations and/or nuclear devices.

The scope of cover is as under :

(a)

Death due to accident

Rs.25,000/-

(b)

Permanent total disablement due to accident

Rs.25,000/-

(c)

Loss of one eye or one limb

Rs.12,500/-

(d)

Loss of two limbs, one eye &
one limb or both eyes

Rs.25,000/-



3. Salient features of the Modified Personal Accident

     Insurance Scheme (Modified PAIS):

The Personal Accident Insurance Scheme was reviewed and GOI has approved a modified Personal Accident Insurance Scheme for the growers/workers in the sectors of Tea, Coffee, Rubber, Tobacco and Spices.

Salient features are as under:

(a)           Nodal Agency :

Price Stabilisation Fund Trust (PSFT) will be the nodal agency for implementation of modified Personal Accident Insurance Scheme (Modified PAIS), as earlier.

(b)        Implementing Agency:

M/s Cholamandalam MS General Insurance Co. Ltd. will be the implementing Insurance Agency for modified PAIS during 2011-12 and 2012-13.

(c) Eligibility for coverage:

· The scheme will cover the growers in the sectors of Tea, Coffee, Rubber, Tobacco and Spices (Ginger, Chilly, Pepper, Turmeric and Cardamom) having plantations up to 4 hectares only.

· The Scheme will also cover all workers working on the plantations in the sectors of Tea, Coffee, Rubber, Tobacco and Spices (Ginger, Chilly, Pepper, Turmeric and Cardamom).

(d)        Membership Fee:

· Growers in the sectors of Tea, Coffee, Rubber, Tobacco and Spices (Ginger, Chilly, Pepper, Turmeric and Cardamom) who have not enrolled themselves as members of PSFT earlier, will have to become members of PSFT by paying one time entry fee of Rs.100/- for the purpose of PAI Scheme coverage in addition to annual premium of Rs.11.03 (i.e. 50% share of the annual premium of Rs.22.06/-).

· Existing members of PSFT will not be required to pay any additional membership fee.

· The workers will not be required to pay the membership fee and will only pay the annual premium of Rs.11.03 (i.e. 50% share of annual premium of Rs.22.06/-).

(e) Target Coverage :

The Scheme is targeted to cover a total of 57.17 lakh growers and workers.

  (d)        Sharing of Premium:

· The premium will be shared between the beneficiary & PSFT in the ratio 50:50.

· The premium rate per annum per grower/worker is Rs.22.06/- for 2011-12 and 2012-13.

(e)      Standard Perils covered, Exclusions & Scope of Cover:

· The insurance cover is for death / disablement due to accidents caused by external violent and visible means e.g. fire, drowning, snake bite, road/rail accidents, electrocution, attack by wild animals, natural calamities such as floods, earthquakes and tornados etc.

· The exclusions are death, injury or disablement arising out of (a) intentional self injury, suicide, insanity, drunkenness, (b) breach of law with criminal intent and (c) war or warlike operations and/or nuclear devices.

(f)          Scope of Cover :



(i)

Death due to accident

Rs.1.00 lakh

(ii)

Permanent Total Disablement due to accident

Rs.1.00 lakh

(iii)

Loss of two limbs or two eyes

Rs.1.00 lakh

(iv)

Loss of one eye and one limb

Rs.1.00 lakh

(v)

Loss of one limb or one eye

Rs.0.60 lakh

(vi)

Compensation for loss of employment for a continuous period of 3 months or more

Rs.0.15 lakh or equivalent to three months prevalent wages whichever is lower

Insurance Company’s Procedure for Settlement of Claims:

The Insurance cover is to be provided by the M/s Cholamandalam MS General Insurance Co. Ltd. during 2011-12 and 2012-13. The documents required for submission of claims in death or disablement cases are as under:

(a) General Requirement for all cases:

· Claim Form duly filled in

· Photograph of the injured

· PSF Registration no./certificate

(b) Specific Requirement:

(i) In the event of death arising out of accident:

· First Information Report / Police Report

· Medical Report / post-mortem Report

· Death certificate issued by Competent Authorities

· Driving license, if the insured person was driving

(ii) In disablement cases:

· First Information Report / Police Report as applicable

· Disability certificate issued by a Registered Medical Practitioner

Indicating the percentage of disability

Procedure to be followed by the Commodity Boards:

For lodging claims with the Insurance Company, the following procedure may be followed:

(a)        The Field Officer of the respective Commodity Boards would get the claim form filled by the respective member grower within 7 days of the accident. In the event of the death of the member grower, the representative of the Member shall lodge the claim, in the prescribed claim form, to the Field Officers of the respective Commodity Board. Field Officers would forward the claim form to the Head Office of the Commodity Board. The claim forms should also be certified by the Field Officer of the respective Commodity Boards.

(b) The Commodity Boards would forward all claims for settlement, complete in all respects, within 7 days to the M/s Cholamandalam MS General Insurance Co. Ltd. to:

The Business Development Manager

M/s Cholamandalam MS General Insurance Co. Ltd.

Ist Floor, Plot no. 6,

Near Metro Pillar no. 81,

Pusa Road, Karol Bagh,

New Delhi 110 005

Phone : 011-39813100, 39813155, Fax : 011-39813110

Note : For policies issued during 2010-11 by NICL, The Claims are to be forwarded to :-

The Senior Divisional Manager,

National Insurance Co. Ltd.,

Division no. XIV, Plot no. 5,

D (P) Block,

L.S.C., Pitampura,

Delhi – 110088.

(c) A copy of the communication as indicated in item (b) above will be simultaneously sent to:

The Chief Executive Officer,

Price Stabilisation Fund Trust,

Room No 2003, 20th Floor,

Jawahar Vyapar Bhawan,

Tolstoy Marg,

Connaught Place,

New Delhi 110001.

Phone : 011 23701164 , Fax : 011 23701165

^{(d) Cholamandalam MS General
Insurance Co. Ltd. will process the claims
and forward the demand draft to the Commodity Board for onward transmission
to the insured person/successor within one month from the date of receipt of
such claims.
(e) A copy of the communication referred to in item (d)
above will be sent by

M/s Cholamandalam MS GIC
to PSF Trust for
appropriate action.
FORMS TO BE USED IN CASE OF INJURIES/DEATH DUE TO
ACCIDENT:

1.
SAMPLE FORM – PAIS-1- PERSONAL ACCIDENT INSURANCE CLAIMANTS STATEMENT
2.
SAMPLE FORM – PAIS-2- PERSONAL ACCIDENT INSURANCE CLAIM FORM
3.
SAMPLE FORM – PAIS-3 - PERSONAL ACCIDENT INSURANCE – MEDICAL
REPORT}

FORM – PAIS 1

PERSONAL ACCIDENT INSURANCE – CLAIMANTS STATEMENTS

(The issue of this form does not constitute admission of liability. Please return this form duly completed together with Death Certificate from the Hospital or the Medical Attendant, Post Mortem Certificate, and Police Panchnama if any, should there be delay in obtaining any forms, kindly return this claim form first to the Office which issued the policy.)

Claim No.

Policy No.

1.        (a) Name of Claimant (in full). If more than one state

            names of all.)

       (b) Full Postal Address.

       (c) Relationship of Claimant with the deceased.

(a)

(b)

(c)

2.        State nature of title under which Claimant is claiming the amount.

Particulars of the Insured Person who died in the accident

3.        (a) Name (in full)

(b) Last full Postal Address

(c) Last occupation

(d) Age at the time of the accident

(a)

(b)

(c)

(d)

4.        (a) When did the accident happen? (Give date and exact time.)

(b) Where did the accident happen?

(c) Give full description of the accident, its cause and injuries sustained.

(d) State date, time and place of death.

(a)

(b)

(c)

(d)

       5.    On what date did the claimant receive information in regard to the accident and from whom?

       6.    Give the names and addresses of two persons who witnessed the accident.

7.        (a) Was the deceased free from infirmity at the time of accident? If not, give particulars.

(b) Was the deceased under the influence of drugs or drink at the time of the accident?

(c) Is the Claimant satisfied that the death was directly due to the accident.

(d) Give the names and addresses of:

(i)    The Hospital, Clinic or Nursing Home where the deceased was treated after the accident.

(ii)    The Physician/Surgeon who attended on the deceased after the accident.

(iii)    His regular Physician, if any.

(a)

(b)

(c)

(i)

(ii)

(iii)

8.        Did the deceased have any other Accident Insurance on his life? If so, state the name of the insurer/s and amount/s claimed.

I/We hereby affirm and declare that the answers to all the above questions are full and true in every respect.

Place: ………………………..

Date: …………………………

Witnesses

1.        Signature

Name……………………………………

Address…………………………………

2.        Signature

Name……………………………………

Address…………………………………

        Signature of Claimant

FORM – PAIS - 2

PERSONAL ACCIDENT INSURANCE – CLAIM FORM

(For Disablement Claims only)

The issue of this form does not constitute admission of liability. Please return the form duly completed within Fourteen days of the accident together with the relevant prescriptions, bills, receipts etc.)

Claim No.

Policy No.

1.        INSURED

(a)      Name

(b)     Address

(a)

(b)

2.        INJURED PERSON

(a)      Name

(b)     Address

(c)      Occupation

(If more than one state all)

(d)     Age next Birthday

(e)      Height

(f)      Weight

(a)
(b)

(c)

(d)                             Years

(e)                              cms.

(f)                               Kgs.

3.        (a) When did the accident happen? (Please state date and exact time.)

(b) Where did the accident happen?

(c) Give full description of the accident, its cause and injuries sustained.

(d) Was the Injured Person under the influence of drugs or drinks at the time of the accident?

(e) Give the names and addresses of witnesses, if any to the accident.

(a)

(b)

(c)

(d)

(e)

4.        (a) Give details of medical attention given and the name and address of the Medical Attendant.

(b) If the Medical Attendant named above is not the Injured Person’s usual Medical Attendant, give the name and address of his usual Medical Attendant.

(c) Has he or any other Medical Attendant treated the Injured Person previously for any illness or injury?

(d) State where a Medical Officer of the Company can visit the Injured Person, if necessary.

(a)

(b)



(c)

(d)

5.        State the period during which the Injured Person has been

(a)      confined to bed/house and unable to attend to his normal duties at all.

(b)     Partially able to attend his normal duties, whether confined to house/or not.

(a) From

     To

(b) From

     To

6.     State date on which the Injured Person has been/will be able to resume normal duties.

7.     (a) Has the Injured Person made any claim or     received compensation under any Policies of Accident or Sickness in the past? If so, give particulars.

(b) State whether the Injured Person holds any other Accident Policy. If so, give the name (s) of the Insurer (s).

(a)

(b)

I/We hereby declare that I/the Person named above have/has sustained the injuries described above and that the foregoing particulars are true in every respect.



Place:

Signature of Insured

Date:

Signature of Injured Person



Note: The Words “Injured Person” may be read as “Insured” if the Insured and the Injured Person are one and the same.

FORM – PAIS - 3

PERSONAL ACCIDENT INSURANCE-MEDICAL REPORT

(This form is to be completed and signed by the Medical Attendant)

1. Name and Address of Injured Person

2. Describe nature and extent of injuries

3. Cause of the accident so far as is known to you

4. (a) When did you first attend on the Injured Person following the accident?

    (b) Are you still attending on him?

(a)

(b)

5. Are you his usual Medical Attendant? If you have treated him for any previous illness or injury, please give details.

6. (a) Are his injuries

(i) solely due to the accident or

(ii) traceable to any disease, infirmity, previous injuries or any other cause?

(b) Is the Injured Person suffering from any disease or injury (apart from this injury) which directly or indirectly

(i) may have contributed to the accident, or

(ii) is likely to retard his recovery from the injuries, or

(iii) is likely to aggravate his condition?

(c) Was he to your knowledge under the influence of intoxicants or drugs at the time of accident?

(a)

      (i)

      (ii)

(b)

       (i)

       (ii)

       (iii)

(c)

7. (a) According to you how long has the Injured Person been confined to bed/house as the direct and sole consequence of the injuries sustained?

(b) During this period will the Injured Person be able to attend to any portion of his normal duties? If so, from what date?

(c) If not, please state probable date of

(i)                   his being able to attend to any portion of his normal duties.

(ii)                 his resumption of normal duties fully.

(a)



(b)

(c)

        (i)

        (ii)

8. Any other remarks you wish to make.

I hereby certify that the injuries sustained by the Person mentioned above are in accordance with the nature of the accident as described to me and that I treated him for the said injuries.

Place:                                                                    Signature:

Date:                                                                     Name:

                                                                               Address:

                                                                               Qualifications:

                                                                                Registration No.:

Note: The fee, if any for this Report will be borne by the Injured Person.

	Coffee	Rubber	Tea	Total
Total	11561	18471	14402	44704

(a)	Death due to accident	Rs.25,000/-
(b)	Permanent total disablement due to accident	Rs.25,000/-
(c)	Loss of one eye or one limb	Rs.12,500/-
(d)	Loss of two limbs, one eye & one limb or both eyes	Rs.25,000/-

(i)	Death due to accident	Rs.1.00 lakh
(ii)	Permanent Total Disablement due to accident	Rs.1.00 lakh
(iii)	Loss of two limbs or two eyes	Rs.1.00 lakh
(iv)	Loss of one eye and one limb	Rs.1.00 lakh
(v)	Loss of one limb or one eye	Rs.0.60 lakh
(vi)	Compensation for loss of employment for a continuous period of 3 months or more	Rs.0.15 lakh or equivalent to three months prevalent wages whichever is lower

1. (a) Name of Claimant (in full). If more than one state names of all.) (b) Full Postal Address. (c) Relationship of Claimant with the deceased.	(a) (b) (c)
2. State nature of title under which Claimant is claiming the amount.
Particulars of the Insured Person who died in the accident
3. (a) Name (in full) (b) Last full Postal Address (c) Last occupation (d) Age at the time of the accident		(a) (b) (c) (d)
4. (a) When did the accident happen? (Give date and exact time.) (b) Where did the accident happen? (c) Give full description of the accident, its cause and injuries sustained. (d) State date, time and place of death.		(a) (b) (c) (d)
5. On what date did the claimant receive information in regard to the accident and from whom?
6. Give the names and addresses of two persons who witnessed the accident.
7. (a) Was the deceased free from infirmity at the time of accident? If not, give particulars. (b) Was the deceased under the influence of drugs or drink at the time of the accident? (c) Is the Claimant satisfied that the death was directly due to the accident. (d) Give the names and addresses of: (i) The Hospital, Clinic or Nursing Home where the deceased was treated after the accident. (ii) The Physician/Surgeon who attended on the deceased after the accident. (iii) His regular Physician, if any.		(a) (b) (c) (i) (ii) (iii)
8. Did the deceased have any other Accident Insurance on his life? If so, state the name of the insurer/s and amount/s claimed.

1. INSURED (a) Name (b) Address	(a) (b)
2. INJURED PERSON (a) Name (b) Address (c) Occupation (If more than one state all) (d) Age next Birthday (e) Height (f) Weight	(a) (b) (c) (d) Years (e) cms. (f) Kgs.
3. (a) When did the accident happen? (Please state date and exact time.) (b) Where did the accident happen? (c) Give full description of the accident, its cause and injuries sustained. (d) Was the Injured Person under the influence of drugs or drinks at the time of the accident? (e) Give the names and addresses of witnesses, if any to the accident.	(a) (b) (c) (d) (e)
4. (a) Give details of medical attention given and the name and address of the Medical Attendant. (b) If the Medical Attendant named above is not the Injured Person’s usual Medical Attendant, give the name and address of his usual Medical Attendant. (c) Has he or any other Medical Attendant treated the Injured Person previously for any illness or injury? (d) State where a Medical Officer of the Company can visit the Injured Person, if necessary.	(a) (b) (c) (d)
5. State the period during which the Injured Person has been (a) confined to bed/house and unable to attend to his normal duties at all. (b) Partially able to attend his normal duties, whether confined to house/or not.	(a) From To (b) From To
6. State date on which the Injured Person has been/will be able to resume normal duties.
7. (a) Has the Injured Person made any claim or received compensation under any Policies of Accident or Sickness in the past? If so, give particulars. (b) State whether the Injured Person holds any other Accident Policy. If so, give the name (s) of the Insurer (s).	(a) (b)

1. Name and Address of Injured Person
2. Describe nature and extent of injuries
3. Cause of the accident so far as is known to you
4. (a) When did you first attend on the Injured Person following the accident? (b) Are you still attending on him?	(a) (b)
5. Are you his usual Medical Attendant? If you have treated him for any previous illness or injury, please give details.
6. (a) Are his injuries (i) solely due to the accident or (ii) traceable to any disease, infirmity, previous injuries or any other cause? (b) Is the Injured Person suffering from any disease or injury (apart from this injury) which directly or indirectly (i) may have contributed to the accident, or (ii) is likely to retard his recovery from the injuries, or (iii) is likely to aggravate his condition? (c) Was he to your knowledge under the influence of intoxicants or drugs at the time of accident?	(a) (i) (ii) (b) (i) (ii) (iii) (c)
7. (a) According to you how long has the Injured Person been confined to bed/house as the direct and sole consequence of the injuries sustained? (b) During this period will the Injured Person be able to attend to any portion of his normal duties? If so, from what date? (c) If not, please state probable date of (i) his being able to attend to any portion of his normal duties. (ii) his resumption of normal duties fully.	(a) (b) (c) (i) (ii)
8. Any other remarks you wish to make.