What type of policy is personal accident and sickness insurance?
A benefit policy that pays fixed amounts, not based on financial loss.
What is the main rating factor for personal accident insurance?
The occupation of the proposer (grouped into four risk classes).
Why do insurers limit the weekly benefit amount?
To ensure the benefit does not exceed normal earnings and avoid incentivising staying off work.
What does accident cover provide?
Compensation for accidental death or accidental bodily injury.
What makes an event ‘accidental’?
It must be identifiable, unexpected, and occur within a set time limit.
What are capital sums?
Lump‑sum payments for major injuries, loss of limbs, loss of sight, or death.
How long can weekly accident benefits be paid for?
Up to 104 weeks.
What does sickness cover provide?
A weekly benefit if the insured cannot work due to sickness or disease.
What is the sickness time franchise?
Usually 7 days — sickness under 7 days is not paid, but if it continues beyond 7 days, the whole period is covered.
What sickness is excluded at the start of the policy?
Sickness that begins within the first 21 days of cover.
What are the main benefit categories in personal accident and sickness policies?
Death, loss of sight, loss of limbs, permanent total disablement, temporary total disablement, temporary partial disablement, and medical expenses.
What is permanent total disablement?
A condition that prevents the insured from ever working again, usually paid as a capital sum.
What does the medical expenses benefit cover?
Necessary medical, surgical, hospital, and ambulance costs after an accident.
What is temporary partial disablement?
Being able to work only part of your usual duties, paid at a reduced weekly amount.
What is temporary total disablement?
Being temporarily unable to perform your usual occupation, paid weekly.
What optional extension is sometimes available?
Legal expenses to pursue a claim against a negligent third party.
What are the typical age limits for cover?
Accident: 16–70.
Sickness: 16–60.
Are children covered under family accident policies?
Yes, usually from 6 months to 16 years, sometimes up to 23 if dependent and in full‑time education.
What are common exclusions in personal accident and sickness insurance?
Alcohol/drug influence, self‑inflicted injury, pre‑existing conditions, dangerous sports, pregnancy and childbirth, war, sickness in the first 21 days.
What does medical expenses insurance provide?
Cover for private medical treatment outside the NHS.
What are the main inpatient benefits?
Hospital charges, specialist fees, ambulance and nursing costs.
What medical conditions are usually excluded?
Conditions treated in the five years before applying.
Does medical expenses insurance cover long‑term residential care?
No — this is excluded.
