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Understanding the Definition of Personal Accident in an Insurance

Posted At October 26th, 2018

Personal accident insurance is a type of insurance that offers personal protection and benefit in the form of compensation for death, disability, and medical treatment expenses due to accidents.

The main risk is accident.

However, it is possible that we have no understanding whatsoever about what personal accident means.

Understanding Personal Accident

Prior to obtaining a personal accident insurance policy, it is better for us to first know and understand the definition of personal accident.

Based on the Indonesian Personal Accident Insurance Standard Policy (PSAKDI), the definition of personal accident is an event or incident involving the element of violence, both physical or chemical.

The incident should occur suddenly, unwanted, unplanned, caused by external factors, visible, and has instant and direct effect on the insured, and cause physical injuries, which nature and location can be determined by medical science.

The followings are the events or incidents included in the forms of personal accident.

  • Poisoning due to inhalation of toxic gas or steam, unless if the insured intentionally use anesthetic drugs or other substances known to have negative effects, including illegal drugs.
  • Viral or bacterial infection because the insured unintentionally fall into water or other liquid substances.
  • Death by suffocation or drowning.

This is important for us to know in order to avoid misunderstanding with the insurance company regarding the coverages and exceptions in our insurance policy.

Characteristics of Personal Accident

The definition of an accident in a personal accident insurance must at least include the following nine factors.

1.     The cause of accident must be sudden.

The cause of the accident must be sudden, even if the effect of the accident happens / appears / is felt some time after the accident occurs.

Usually, there is a 12 months waiting period stated in the condition of the policy.

Therefore, if the death or permanent disability caused by the accident covered by the policy happens within the 12-month period after the accident, then it will be covered.

2.     The cause of accident must be external.

The incident must be caused by something outside our physical being such as an impact, a blow, or other things. This is to distinguish them from causes which come from internal physical condition such as chronic diseases.

3.     The cause of accident must involve violence.

The accident must involve the element of violence, both chemical (poisoning) or physical (impact) violence.

4.     The accident must be visible.

The event of the accident must be evidently visible. This is to distinguish it from fictive causes such as the acts of shamans, paranormal, witchcraft, and so on.

5.     The accident must be direct and isolated.

The accident has direct physical impact and is unaffected by other factors that may cause or magnify the effect of the accident.

This means, the resulting effect must be the direct and isolated outcome of the accident.

6.     The accident must be unwanted/unplanned/unintentional.

There must be no element of intent, and the accident must not be caused by any planned/wanted/intentional actions.

7.     The effect of the accident must be in the form of physical injuries.

Examples of physical injuries are scratches or lacerations on skin, broken or fractured bones, and so on.

8.     The physical injuries can be autopsied by medical science.

The physical injuries must be able to be autopsied for written report purposes, so that the cause of injury can be determined. For example, a puncture wound caused by sharp object.

9.     The relation between the cause and effect of an incident must not be disconnected.

This means, the cause and effect of an incident must be connected and it must take place instantly. For example, a fall which causes bone fracture.

Those are the nine factors which must be met in order for an incident to be qualified and categorized as a personal accident.

Therefore, by knowing the definition and characteristics of personal accident, we can have a better understanding about personal accident insurance.

Be Alert and Cautious

Nobody would ever wish for an accident to happen upon themselves. Personal accident must be avoided at all costs. However, personal accident cannot be predicted. It can happen all of a sudden, anytime and anywhere.

We need to stay alert and cautious against any incident which could potentially result in personal accident, and any loss incurred due to the accident.

Protecting yourself with personal accident insurance coverage is definitely a wise thing to do.


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