Can the engine size of a bicycle constitute grounds for refusing an accident insurance claim?


Can the family of a person with an individual accident insurance policy obtain claims if they die in an accident while driving a two-wheeler with a capacity greater than that stated in the policy? ? In an incident last year, HDFC Ergo denied the accidental death claim made by family members of someone based in Ludhiana because the engine displacement of the two-wheeler he was driving was greater than 150 cm3.

The incident came to light when the letter found its way to Twitter.

The rejection scenario: According to the tweet, the letter issued by HDFC Ergo read, “We want to get your attention. Your complaint has been denied for the reason mentioned below, which is the basis for rejecting the complaint, an excerpt of which is mentioned below for your ready reference. “

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“According to the documents submitted, the insured died on 19/04/2020 due to a head injury. The insured was riding a 346 cc bicycle and according to the terms and conditions of the policy, the claim is not not payable under General Exclusion Clause 8, for bodily injury sustained while or as a result of the operation of a motorcycle or scooter over 150 cc. “

The tweet did not tag HDFC Ergo’s official Twitter account, however.

The insurer, however, responded to TBEN’s request. HDFC Ergo said, “The specific case highlighted in social media is an old case and, in fact, the claim is already paid to the customer. We would like to clarify that the special exclusion that existed in all of our old products was removed in October 2020. We would also like to assure our existing and new customers that our PA (Personal Accident) policy covers all motorcycles, regardless of displacement (CC). We pride ourselves on our industry’s best claims settlement rate and the highest number of settled claims in the industry. We continue to strive to maintain this benchmark and continuously evolve to meet customer needs and market changes.

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What you should do in such a scenario

“When purchasing an insurance policy, it is important that the consumer understands all the benefits and terms of the insurance coverage. Although consumers want to know the benefits of the claim, they often tend to ignore policy exclusions or disclaimers, “said Indraneel Chatterjee, co-founder of RenewBuy.

The incident makes it clear that you should not purchase insurance until you have read the terms and conditions. It would be all the more useful for you to be vigilant when renewing your policy. Get help from financial advisers when renewing your policy. To avoid deviations, you can also consider switching to a standard insurance policy, Saral Suraksha Bima, issued by the regulator, Insurance Regulatory and Development Authority of India (Irdai) last year.

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