Accident Benefits 意外保險利益

Accidental Death and Dismemberment 意外死亡及喪失肢體

An accidental death benefit rider pays a sum in addition to the death benefit under the basic policy. If the rider sum insured equals the basic sum assured, total payment on accidental death is twice the basic amount, which is why it is often called double indemnity. The two amounts need not match, so add the basic sum assured and the rider sum insured to find the total. On death from illness or natural causes, only the basic policy pays.

A claim generally requires that accidental bodily injury caused the death, independently of other causes such as illness; that death occurred within a specified period after the accident; and that the basic policy and rider were in force at the time of the accident. Policies often describe the accident as violent, external and visible, as opposed to something arising inside the body. If illness is the proximate cause, such as a stroke that leads to a fatal fall, the rider generally does not pay.

A dismemberment benefit pays a percentage of the rider sum insured according to a schedule in the policy, for losses such as a hand, a foot or sight, and the life insured does not need to die. The percentage generally rises with severity, so losing both hands attracts a higher percentage than losing one. A common term caps the combined accidental death and dismemberment payments from one accident at the rider sum insured. Unless the policy says otherwise, this payment does not reduce the basic death benefit.

Common exclusions include suicide or intentional self-injury, war, the life insured's criminal acts, the influence of drugs or alcohol, certain hazardous activities, and flying other than as a fare-paying passenger. The rider usually ends when the life insured reaches a specified age or when the basic policy lapses or is surrendered, and it generally has no surrender value. Occupation has a strong effect on accident risk, so underwriters pay close attention to it.

Other Accident Benefits 其他意外保險利益

Besides accidental death and dismemberment, common accident benefits include accident medical expenses, a hospital cash benefit for accident-related stays, and weekly income during temporary disablement caused by an accident. Some policies also pay a higher multiple of the benefit if the accident happens while the life insured is travelling on public transport. The benefits actually available vary by insurer and product.

Candidates should be clear about how each benefit is calculated. Accident medical expense cover is reimbursement-based: the insurer pays actual reasonable costs up to the policy limit, possibly after an excess, so it works as an indemnity. Hospital cash and weekly income are fixed-amount benefits, calculated by days in hospital or weeks of disablement rather than actual spending, and subject to a maximum benefit period.

These benefits also depend on an accident having occurred: hospital stays or treatment caused by illness are generally not covered. They are subject to the rider's exclusions and termination terms too, and if the basic policy has lapsed, the rider normally ends with it.