What is covered by accident insurance?

The scope of accident insurance generally refers to the injury to the body directly caused by an external, sudden, unintentional and non-disease objective event. This may be a little different from the accidents we know about every day.

Accident insurance generally only covers death, total disability, disability and medical expenses caused by accidents.

The structure of the accident insurance product will be simpler than other products, but there is a clear definition of the accident.

Daddy reminds me that only if these 4 conditions are met at the same time can the accident as defined by the insurance clause be satisfied.

For example, the sudden death of Gao Yixiang in the recording program, which was more sensational before, is actually not covered by most accident insurance.

Sudden death, although it satisfies the condition of suddenness, does not satisfy the non-illness condition, which is caused by the insured's own physical or medical problems.

So it's not an accident.

However, with the current probability of sudden death greatly increased, there are many accident insurance policies that also include sudden death in the scope of coverage.

So, what are the other situations where accident insurance is not covered? Daddy will tell you more about it next.

1. Pregnancy

Most accident insurance products will include exclusions for the insured's pregnancy, miscarriage, childbirth, etc.

Therefore, the insured person will not be able to receive compensation in the event of an accident during pregnancy.

If you want to be protected during pregnancy, you can consider maternity insurance, maternal and child insurance, etc.

2. Sudden death

Regarding the situation of sudden death, the father also mentioned to you just now that sudden death is actually not covered by most accident insurance.

However, in recent years, there are also some accident insurance that can come with sudden death protection.

3. Individual food poisoning

In general, if it is not a group poisoning (more than 3 people), but only an individual poisoning, it is not within the scope of accidents recognized by the insurance.

Because it may be caused by personal illness or poor physical fitness.

Fourth, surgical accidents

Surgery is inherently high-risk, and these risks are clearly identified before surgery.

Therefore, it does not meet the conditions of non-disease, sudden, and non-intended accident insurance.

5. Falling due to illness

For example, we see on the news that some elderly people accidentally fell due to a sudden heart attack and died after rescue efforts failed.

Assuming that they have purchased accident insurance, they will not be able to pay for it.

Because the cause of the fall is a heart attack, and the direct cause of death is also due to a heart attack, it is not covered by accident insurance.

6. High-risk sports

Most accident insurance excludes high-risk sports, which have a very high chance of accidents.

For example, extreme sports such as rock climbing, skydiving, bungee jumping, and exploration.

In addition to this, accident insurance is also the most restrictive for occupation.

And, in fact, there is no single type of insurance that can cover all of them.

We have also talked about how to scientifically configure insurance, and you can poke this article for details:"Debunking the Six Pitfalls of Insurance Sales! Teach you how to configure insurance correctly

Building a complete insurance system is done gradually. After purchasing accident insurance, if you have a sufficient budget, we can take a look at critical illness insurance and accident insurance to give yourself the best protection!

Hope!

General accident insurance covers accidental dismemberment, accidental death and accidental medical treatment. What we usually call accident insurance is mainly divided into two categories: accidental injury insurance and accidental medical insurance.

1. The specific definition of accident and the scope of claims

According to the official insurance terms, accidental injury refers to an external, sudden, unintentional, and non-disease injury to the body.

Therefore, if we want to apply for accident insurance, we must meet these four conditions.

1.Non-Disease: Generally means that the injury was not caused by the insured's physical illness

For example, pathological fractures caused by osteoporosis or sudden death due to chronic cardiovascular diseases are injuries caused by diseases and are not covered by the claim.

2.External: Generally refers to the signs of damage left inside and outside the human body due to external factors

For example, physical injuries such as collisions, falls, electric shocks, suppression, drowning, common cat scratches and dog bites, and chemical injuries caused by gas leaks, food poisoning, acids, alkalis, gas poisons, etc.

3.Unintentional: Generally refers to unforeseeable harm that is undesirable to the person

Injury caused by force majeure accidents that are not foreseeable by the parties and not of their own will.

If the result of the injury is an accident, but the cause is not an accident, it cannot be defined as an accidental injury: for example, if the bodily injury caused by driving at a speed exceeding the speed limit on the highway, for this kind of injury that is completely predictable and completely preventable, it is not an accidental injury.

4.Sudden: Generally refers to the injury caused by a sudden invasion of the human body

For example, injuries and deaths caused by traffic accidents, building collapses, etc., are sudden and instantaneous.

Clause. 1. Death compensation. The insurance company pays a death benefit when the insured suffers death due to an accidental injury.

Clause. 2. Disability compensation. When the insured suffers an accidental injury resulting in disability, the insurance company pays disability benefits.

Clause. 3. Compensation for medical expenses. When the insured suffers an accidental injury and incurs medical expenses, the insurance company will compensate a certain percentage of the medical expenses.

Clause. 4. Compensation for lost work. When the insured suffers an accidental injury and is temporarily incapacitated and unable to work, the insurance company will compensate for lost work according to the number of days and the provisions of the insurance contract.

What is covered by accident insurance?

Legal analysis: 1. The accidental injury suffered by the insured must be an objective fact, not an imaginary or speculative one. 2. The objective fact that the insured suffers an accidental injury must occur within the insurance period.

3. Death or disability of the insured. 4. The death or disability of the insured is within the liability period.

Legal basis: Article 12 of the Insurance Law of the People's Republic of China The policyholder of life insurance shall have an insurance interest in the insured at the time of the conclusion of the insurance contract. The insured of property insurance shall have an insurable interest in the subject matter of insurance at the time of the occurrence of an insured event.

Life insurance is insurance that takes a person's life and body as the subject of insurance. Property insurance is an insurance that takes property and its related Litong Taetea as the subject of insurance. The insured refers to the person whose property or person is protected by the insurance contract and has the right to claim the insurance money.

The policyholder can be the insured. Insurance interest refers to the legally recognized interest of the policyholder or the insured in the subject matter of insurance.

Accident insurance is based on the body of the insured as the subject of insurance, and the death, disability, medical expenses or temporary loss of working ability caused by the insured's unintentional, external or sudden accidents are the conditions for the payment of insurance benefits.

Accidents in accident insurance generally need to meet the following 4 conditions:

1. External injury: refers to the injury caused by reasons other than the insured's own.

2. Unintentional injury: refers to the occurrence of injury that was not foreseen by the insured or contrary to his subjective wishes.

3. Sudden injury: refers to an accident that is too late to prevent in a very short period of time.

4. Non-disease: Because the occurrence of disease is a factor from within the body, it is not within the scope of accident insurance.

Accident insurance coverage liabilities can include accidental death liability, accidental disability liability, accidental medical liability, accidental hospitalization allowance liability, and can also extend sudden death liability.

Accidental death liability is the death liability insurance benefit paid to the insured due to the death caused by the accident;

Accidental disability liability is generally paid according to a certain proportion of the insured amount according to the disability level, and the disability level is divided into 1-10 levels;

Accidental medical liability includes outpatient or inpatient medical expenses incurred due to accidents, and the deductible and compensation ratio are generally agreed;

Accidental hospitalization allowance is based on the number of days the insured is accidentally hospitalized, and the hospitalization allowance is paid within the amount and number of days specified in the contract.

Different accident insurance products have different coverage and different conditions for paying insurance benefits.

Test your anti-risk index, experts will interpret it for you for free!

Hello dear, I am happy to answer for you, 1. What is included in accident insuranceAccident insurance is mainly for three aspects of protection. First, death or disability caused by an accident; second, medical expenses incurred due to accidents; The third is the loss of lost work (allowance) caused by accidents. Death or disability due to an accident is the basic protection content of accident insurance, and the latter two are usually combined with the former alone or together, thus forming a variety of accident insurance products.

How you apply for insurance depends on the actual situation. For consumers who only travel daily in the city, they can buy an ordinary accident insurance card, which generally covers 100,000 yuan to 200,000 yuan for death or total disability, and the annual premium is 100 yuan to 200 yuan, and some products can be cheaper; For consumers who frequently travel for business and tourism, they can purchase products that contain specific traffic accident liability, covering planes, trains, ships, cars and other means of transportation, with an insurance amount ranging from 200,000 yuan to 600,000 yuan, and even millions of insurance amounts, and the premiums vary accordingly; For consumers who like to travel by car, insurance companies also provide corresponding products, and there are a variety of options for the amount insured, but the premium will be higher than that of public transportation accident insurance. Generally, the cost of purchasing accidental death or dismemberment liability is 1% of the coverage amount.

Left and right, of course, this is linked to the specific responsibility of the commodity, and it cannot be generalized. The cost of premiums for accidental medical treatment and benefit liability is higher than this. Generally speaking, 100 yuan to 200 yuan, you can buy an insurance card with a medium amount that integrates the above basic responsibilities (death or disability insurance amount of tens of thousands to hundreds of thousands, medical insurance amount of less than 10,000 yuan, and lost work allowance of 10 to 30 yuan), and all insurance companies have this type of commodity sales.

This is a relatively common way to apply for insurance. The coverage period of accident insurance is generally 1 year, and there are short-term ones of several days. Consumers generally buy 1-year term more affordable.

Single accident insurance is mainly for consumers who have long vacations or short-term travel, but if they have already bought 1-year accident insurance, there is no need to buy short-term single accident insurance, unless the consumer feels that the insurance amount is not enough. 2. Compensation Scope of Personal Accident Insurance1. In the event of death due to accidental injury, the insurance amount shall be paid in full. 2. If you are permanently and completely blind in both eyes or permanently and completely disabled in both limbs due to accidental injury, or if you are permanently and completely blind in one eye and permanently complete disabled in one limb at the same time, the insurance amount shall be paid in full.

3. If one eye is permanently and completely blind or one limb is permanently and completely disabled due to accidental injury, half of the insurance amount shall be paid. 4. If the injury caused by an accidental injury accident causes permanent and complete loss of working ability or physical function, or permanent partial loss of working ability or physical function, all or part of the insurance amount shall be paid according to the degree of loss. 5. During the validity period of the insurance policy, the insurance company stipulates that the insurance company shall pay the insurance money, regardless of whether it is due to one or consecutive accidents.

However, the cumulative total amount of benefits cannot exceed the full sum insured. When the total amount of benefits reaches the full sum insured, the insurance will be terminated. The above is all about personal injury, that is to say, in accident insurance.

There are four types of compensation scope of accident insurance: 1. Death benefit: When the insured suffers death due to accidental injury, the insurer pays death insurance benefits.

The death benefit is a full payment. 2. Disability benefits: When the insured is disabled due to accidental injury, the insurer will pay disability insurance benefits according to the degree of disability.

Disability benefits are paid in installments. 3. Medical benefits: When the insured suffers medical expenses due to accidental injury, the insurer shall pay according to the actual situation.

There is a maximum limit for medical benefits, and accident medical insurance is generally not covered separately, but as an add-on to accidental death, disability, and disability. 4. Suspension of work payment: When the insured temporarily loses the ability to work due to accidental injury and is unable to work, the insurer pays the suspension insurance benefit.

Full text of the judicial interpretation on compensation for personal injury》 Article 17: Where a victim suffers a personal injury, the person obligated to compensate for all expenses incurred for medical treatment** and the loss of income due to lost work, including medical expenses, lost work expenses, nursing expenses, transportation expenses, accommodation expenses, hospital meal subsidies, and necessary nutrition expenses. If the victim is disabled due to injury, the compensation obligor shall also compensate for the necessary expenses incurred by the victim due to the increase in living needs and the loss of income caused by the loss of the ability to work, including disability compensation, disability assistive device expenses, and living expenses for dependents, as well as the necessary expenses, nursing expenses, and follow-up expenses actually incurred due to nursing care and continuation. Where the victim dies, the compensation obligor shall, in addition to compensating the relevant expenses provided for in the first paragraph of this article on the basis of the circumstances of the rescue, also compensate for the funeral expenses, the living expenses of the dependents, the death compensation expenses, and other reasonable expenses such as transportation expenses, lodging expenses, and lost work expenses incurred by the victim's relatives in handling funeral matters.