RBI/2004-05/156
RPCD.PLFS.BC.NO
24/05.05.09/2004-05
August
28,2004
The Chairman & Managing
Director/CEO
All Scheduled Commercial Banks
(excluding RRBs)
Dear
Sir,
Personal Accident Insurance
Scheme (PAIS) For KCC holders - Renewal of Master Policy
Please
refer to our Circular RPCD.PLFS.BC.NO.
1/05.05.09/2000-01 dated July 2, 2001, introducing the Personal Accident Insurance
Scheme (PAIS) for KCC holders for uniform adoption by all scheduled commercial
banks throughout the country. The Master Policy under the Scheme was valid for
a period of three years from its effective date, and modification/ alteration
of any of or all the terms and conditions of the policy was to be made at the
end of the three year period. It is heartening to note that banks, by and large,
have adopted/implemented the Scheme and provided personal accident insurance cover
to the KCC holders since 2001. The three year Master Policy has now fallen due
for renewal.
2. In view of the urgent
need to provide personal accident insurance coverage to KCC holders, on an ongoing
basis, General Insurers’ (Public Sector) Association of India (GIPSA) has, as
an interim measure, agreed to renew the Master Policy for a period of one year,
on the existing terms/rates and conditions, pending a review of the Scheme in
detail.
3. Banks may, therefore,
initiate action at their level to get the Master Policy under PAIS renewed for
a period of one year, on the existing terms and conditions. The Scheme would continue
to be serviced by the designated General Insurance Co. on a zonal basis, as per
the existing arrangements. Banks may make all possible efforts to cover all the
KCC holders under the Scheme. For this purpose, banks may give wide publicity
to PAIS during their KCC campaign.
4. Further, clarifications given by GIPSA on certain operational problems/ issues
concerning PAIS, are indicated in the Annexure. GIPSA would also be issuing suitable
instructions in the matter to their offices/member General Insurance Cos., thus
paving the way for effective and smooth implementation of the Scheme.
Yours
faithfully,
(
K.Bhattacharya)
General Manager
Annexure
PAIS
- Operational Problems/Issues - Clarifications by GIPSA
(a)
Delay in settlement of claims -
It
will be the endeavour of Insurance Cos. to settle the claims within a period of
30 days from receipt of claims. In case of non-settlement of claims within 30
days, interest @2% p.a. over and above the Bank Rate would be paid to the beneficiaries/nominees.
GIPSA would be issuing suitable instructions to their offices/member General Insurance
Cos., to handle personal accident insurance claims under KCC, on priority basis.
(b)
Denial of claims for death due to snake bite, murder, etc. as also accidental
deaths occurring outside rural area
The
Scheme covers KCC holders against death or permanent disability resulting from
accidents caused by external, violent and visible means and occurring within the
geographical jurisdiction of India. Accidental death/ permanent disability (provided
it does not occur on account of the insured committing any breach of law), including
death arising due to snake bite, murder (except murder on account of provocation
by the deceased based on circumstantial evidence) are covered. However, in case
of specific instances of non-settlement of claims in such cases or on the ground
that the accident did not occur in the rural area, Insurance Co. would reopen/
reconsider the genuine/deserving cases, depending on facts of each case.
(C)
Age criteria/age proof
If there
are specific instances of insurance cos. having prescribed different age criteria
for coverage under PAIS (as against 70 years under the Scheme), the anomalies
would be corrected by GIPSA. The prescribed outer age limit is applicable only
at the time of entry to the Scheme and not at the time of accident.
Further,
age proof is an essential document for claim settlement. Banks could collect the
age proof at the time of issuance of KCC holder under PAIS itself. Even ration
card is an acceptable age proof.