Among the four major life insurances, accident insurance is cheap, simple to protect, and affordable to everyone. However, many people are confused about the coverage of accident insurance, and cannot tell which situations the accident insurance can compensate and which situations the accident insurance cannot compensate. Let’s talk about it briefly today.
1. What kind of coverage does accident insurance include?
Accident insurance covers injuries caused by “sudden, external, and unintentional” accidents. They are classified into:
• Comprehensive accidents: Generally, the coverage is comprehensive, including drowning, electric shock, burns, falls, cat scratches and dog bites, etc.
• Aviation accident: specifically refers to an aviation accident that occurs while on a civil aviation flight
• Traffic accident: generally refers to an accident that occurs when riding on operational public transportation, including traffic accidents such as ships, trains, and cars.
If the above accidents occur, the accident insurance will pay compensation according to the circumstances.
• If the insured dies due to an accident, the accident insurance will pay 100% of the insured amount
• If the insured is disabled due to an accident, the insured will be compensated in proportion to the degree of disability. For a disability of level 10 , 10% of the insured will be compensated ; for a disability of level 9, 20% of the insured will be compensated; and so on. For a disability of level 1, 100% of the insured will be compensated .
• If the insured is injured due to an accident, the accident insurance will reimburse the corresponding medical expenses, up to a maximum reimbursement amount.
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2. In which three situations can accident insurance not be compensated?
The three situations in which accident insurance cannot be compensated generally refer to: insurance accidents caused intentionally, insurance accidents caused by one’s own illegal acts, and insurance accidents caused by pathological reasons.
1. Intentional insurance accident: If the insurance accident is caused intentionally by the policyholder the insurance company will not pay compensation. For example:
• Fighting, assault or murder caused by the provocation or intentional behavior of the insured;
• Self-inflicted injury or suicide by the insured;
2. Insurance accidents caused by illegal acts: If the insured person causes an accident while committing a crime, the insurance company will not pay compensation. For example:
• The insured commits a crime or resists arrest;
• The insured actively smokes or injects drugs
• The period during which the insured is driving under the influence of alcohol, driving without a valid driver’s license, or driving a motor vehicle without a valid driving license.
3. Insurance accidents caused by pathological reasons: If the insured person suffers an accident due to illness or other reasons, the insurance company will not pay compensation. For example:
• Sudden death of the insured due to cardiac causes
• The insured person suffers a pathological fracture or is diagnosed with osteoporosis and suffers injuries caused by the disease;
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For the part that will not be compensated, accident insurance will generally state it clearly in the insurance contract, namely the “exemption clause”. The policyholder / insured can carefully check it when purchasing accident insurance and find out that accident insurance often does not compensate for things like dental care, childbirth care, etc.
