Personal Accident cover for owner-driver is dealt in Section 3 of the Motor Insurance policy. This section talks about bodily injury or death of the owner-driver while driving the car. It says that the said bodily injury or death of the owner driver must happen in direct connection with the vehicle insured:
- while driving
- while mounting the vehicle i.e., while getting into the car
- while dismounting from the vehicle or getting out of the car
- while travelling in it as a co-driver.
This section also gives details as to how the said bodily injury or death must happen. The injury or death to the driver owner should happen by violent, accidental, external and visible means. The said injury or the death, after the accident, must surface within six calendar months. I repeat – within six calendar months.
If injury or death of owner driver of the vehicle is to surface during the 7th month then the Motor Insurance policy is not going to pay. The injury or death should happen within six calendar months. The total amount payable to the driver owner of the vehicle is Rs 15,00,000 (Fifteen lakh rupees).
- If the death happens, Rs. 15 lakhs paid.
- If two limbs are lost, Rs. 15 lakhs paid.
- Two eyes are lost, Rs. 15 lakhs paid.
- One limb and one eye are lost, Rs. 15 lakhs paid.
- One Limb is lost, Rs. 7.50 lakhs paid
- One Eye is lost, Rs. 7.50 lakhs paid.
If there were to be Permanent Total Disablement other than the above-named, then the policy promises to pay Rs 15 lakhs. This is a vague condition/promise in the Motor Policy. As a customer, I have no notion of:
- What is Permanent Total Disablement?
- What are the injuries which should cause that Permanent Total Disablement?
These 2 aspects are not explained. This gives a huge scope to the insurer to define as per his convenience. Further, the policy does not explain the following:
Loss of one limb – For example, a leg – Is it above the knee or below the knee? When are you going to pay if the loss of limb? For example, if an insured in an unfortunate accident were to lose 2 legs below the knee, will the insurer pay 100%? Or in an unfortunate accident if the insured were to lose both the legs above the knee, will the insurer pay 100% compensation? If the policyholder were to lose foot without ankle bone, how much will insurer pay? If the policyholder loses a thumb or index finger, then how much? Thus, the list goes on. As per the present policy terms and conditions if I were to lose two fingers, then the policy pays nothing. This is what I can conclude from the policy wording given to the customer.
Defining Personal Accident cover for the owner-driver the way it is defined in the Motor policy shows the lack of understanding of the nature of injuries by both the Insurer and the Regulator. The less talked of the Insurance Ombudsman, the better. The courts will go according to the policy wording as this is an agreed contract. Therefore, the courts are not wrong.
The person who finally gets screwed in the entire Motor Insurance gamble under personal accident cover for owner-driver is the insured. I pity you insured.
About the Author
Dr. K. Raja Gopal Reddy is a seasoned internationally qualified Insurance professional.
What you are reading here, may not answer all the questions we have, but has the absolute power of asking unsettling questions which increase the interest in the strange world, and show the contradictory wonders lying just below the surface of the commonest things of life. Look at this disturbing but beautiful thought of Friedrich Nietzsche “God is dead. God remains dead. And we have killed him”.
Dr. Reddy can be reached at: raja66gopal@gmail.com
