Scope of Cover The Policy pays to the Insured, if any of the Insured Persons sustain any bodily injury resulting solely and directly from accident, caused by external, violent and visible means, to the extent and in the manner hereinafter provided.

          Categories of Benefits The benefit payable to or on behalf of the Insured Person will be as per the following categories but not exceeding the Capital Sum Insured as specified.

          1 Death The Capital Sum Insured, as stated, be paid if the death of the Insured Person is within a period of twelve months from the date of bodily injury, and such bodily injury be the sole and direct cause of the death of the Insured Person.

          II Permanent Total Disablement (PTD) i) If such injury shall within twelve months of its occurrence be the sole and direct cause of the total and irrecoverable loss of

          a. Sight of both eyes, or of the actual loss by physical separation of two entire hands or two entire feet, or one entire hand and one entire foot, or of such loss of sight of one eye and such loss of one entire hand or one entire foot, then the Capital Sum Insured, as applicable to such Insured Person.
          b. Use of two hands or two feet, or of one hand and one foot, or of loss of sight of one eye and loss of use of one hand or one foot, then the Capital Sum Insured, as applicable to such Insured Person.
          c. The sight of one eye, or of the actual loss by physical separation of one entire hand or one entire foot, then fifty percent (50%) of the Capital Sum Insured, as applicable to such Insured Person.
          d. Total and irrecoverable loss of use of a hand or a foot without physical separation then fifty percent (50%) of the Capital Sum Insured, as applicable to such Insured Person

NOTE : For the purpose of clause (iii) and (iv) above, physical separation of a hand or foot means separation of hand at or above the wrist, and of foot at or above the ankle. If such injury shall as a direct consequence thereof, immediately, permanently, totally and absolutely, disable the Insured Person from engaging in being occupied with or giving attention to any employment or occupation of any description whatsoever, then a lump sum equal to hundred percent (100%) of the capital sum insured, as stated.

          Carriage of Death Body : In the event of death of the Insured Person due to accident as defined in the Policy out side his/her residence, the Company shall reimburse in addition to the amount payable under clause I above, expenses incurred for transportation of Insured’s dead body to the place of residence subject to a maximum of 2% of capital sum insured or Rs.2,500/- whichever is less.

          Exclusions and Limitations :The Company shall not be liable under this Policy for:

          1. Compensation under more than one of the categories specified above. In respect of the same period of disablement of the Insured Person. However, amounts relating to medical expenses, and/ or carriage of dead body would be payable in addition, if applicable.
2. Payment of compensation in respect of death, injury or disablement of Insured Person (a) from intentional self-injury, suicide or attempted suicide; (b) whilst under the influence of intoxicating liquor or drugs; (c) whilst engaging in aviation or ballooning, or whilst mounting into, or dismounting from or traveling in any balloon or aircraft other than as a passenger (fare-paying or otherwise) in any duly licensed standard type of aircraft anywhere in the world. Standard type of aircraft means any aircraft duly licensed to carry passengers (for hire or otherwise) by appropriate authority irrespective of whether such an aircraft is privately owned or chartered or operated by a regular airline or whether such an aircraft has a single engine or multiengine; (d) directly or indirectly caused by venereal disease or insanity; (e) arising or resulting from the Insured committing any breach of the law with criminal intent.
3. Payment of compensation in respect of death, injury or disablement of the Insured Person due to, or arising out of, or directly or indirectly connected with or traceable to, war, invasion, act of foreign enemy, hostilities (whether war be declared or not) civil war, rebellion, revolution, insurrection, mutiny, military or usurped power, seizure, capture arrests, restraints and detainment of all kinds.
4. Payment of compensation in respect of death of, or bodily injury or any disease or illness to the Insured Persons.
Misc 05

          Misc 05 : a. Directly or indirectly caused by or contributed to by or arising from ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste or from the combustion of nuclear fuel. For the purpose of this exception, combustion shall include any self-sustaining process of nuclear fission.
          b. Directly or indirectly caused by or contributed to by or arising from nuclear weapon materials.
5. Death or disablement resulting directly or indirectly caused by and/or contributed to and/or aggravated or prolonged by childbirth or pregnancy or in consequence thereof.

          Major Conditions to be fulfilled by the policy holder : i) Upon the happening of any event, which may give rise to claim under this Policy, written notice with full particulars must be given to the Company immediately. In case of death, written notice must be given before internment, cremation and in any case, within one calendar month after the death, unless reasonable cause is shown. In the event of loss of sight or amputation of limbs, written notice thereof must also be given within one calendar month after such loss of sight or amputation.
          ii) Proof satisfactory to the Company shall be furnished of all matters upon which a claim is based. Any medical or other agent of the Company shall be allowed to examine the insured Person(s) on the occasion of any alleged injury or disablement when and so often as the same may reasonably be required on behalf of the company and in the event of death to make a post-mortem examination of the body of the Insured Person. Such evidence as the company may from time to time require shall be furnished and a post-mortem examination report, be furnished within a period of thirty days.
          iii) In the event of a claim in respect of loss of sight, the Insured Person's shall undergo at the Insured’s expense such operation or treatment as the Company may reasonably deem desirable. In the event the sight is not regained after such operation or treatment, and such loss of sight is of a permanent nature, compensation shall be payable as per the terms of the policy.
          iv) Position after a claim :
          (a) In case of death or Permanent Total Disablement (as specified in Basis of Assessment) the Company shall delete the name of the Insured Person in respect of whom such sums shall become payable from the schedule without any refund of the premium.
          (b) The Proposer shall give immediate notice to the Company of any change in any of the business or occupation of any of the Insured Persons.
          (c) The Proposer shall on tendering any premium for the renewal of this Policy give notice in writing to the Company of any disease, physical defect or infirmity with which any of the Insured Person(s) have become affected since the payment of the last preceding premium.
The scope of cover shall extend on a world wide basis, and therefore the cause of action may arise in India or elsewhere.

          1. Claim settlement procedure :

          1. Claim Documents : The Insured shall be required to furnish the following for or in support of a claim :

          a. Duly completed claim form
          b. Doctors Report
          c. Police report, wherever necessary
          d. Death certificate, wherever necessary/applicable
          e. Medical Bills, wherever applicable

          2. Procedure for lodging the claim shall be as under

          Upon the happening of any event giving rise or likely to give rise to a claim under this Policy:

          i) The Insured shall give immediate notice thereof in writing to the Company.

          ii) The Insured shall deliver to the Company, within 14 days of the date on which the event shall have come to his knowledge, a detailed statement in writing as per the claim form, and any other material particular, relevant to the making of such claim.

          iii) The Insured shall tender to the Company all reasonable information, assistance and proofs in connection with any claim hereunder.