[SoumenD]

Came across this post on linkedin. The insurer is denied claim of accidental death as he died on a 346cc bike. Claim can be done only till 150cc bike deaths. Is there such a cap on cc?



P.S: Not sure if this is genuine or fake.

[rjainv]

Originally Posted by SoumenD

Came across this post on linkedin. The insurer is denied claim of accidental death as he died on a 346cc bike. Claim can be done only till 150cc bike deaths. Is there such a cap on cc?

Attachment 2220465

P.S: Not sure if this is genuine or fake.

I think wrong thread for an important issue if this is genuine... I hope mods pull this out to right place.

Is this for the mandatory personal accident cover that is forced down our throats when taking motor insurance policy?

[Captain Slow]

According to this link here is what it says -

https://www.hdfcbank.com/personal/in...ccident-plan-2

Exclusions
Bodily Injuries or sickness caused in the following situations are not covered under the policy:

Intentionally
Due to Civil War or Foreign War
Under the influence of Alcohol /drugs
Due to driving two wheeler of more than 150 cc

[UtkarshC]

Thanks to Roni Simon for sending this information in. Heartfelt gratitude for sharing it with other enthusiasts via this Team-BHP share page!

HDFC Ergo denied compensation as the rider was on a bike whose displacement was greater than 150cc. This is as per their fine print. It is mentioned in clause 8, under General Exclusions.

The following details are as per the company’s Personal Accident Insurance Policy:

GENERAL EXCLUSIONS

The Company shall not be liable to pay any benefit in respect of any Insured Person:

1. for Bodily Injury or Sickness occasioned by Civil War or Foreign War.
2. for Bodily Injury or Sickness caused or provoked intentionally by the Insured Person.
3. for Bodily Injury or Sickness due to willful or deliberate exposure to danger, (except in an attempt to save human life), intentional self-inflicted injury, suicide or attempt thereat, or arising out of non-adherence to Medical Advice.
4. for Bodily Injury or Sickness sustained or suffered whilst the Insured Person is or as a result of the Insured Person being under the influence of alcohol or drugs or narcotics unless professionally administered by a Physician or unless professionally prescribed by and taken in accordance with the directions of a Physician.
5. for Bodily Injury due to a gradually operating cause.
6. for Bodily Injury sustained whilst or as a result of participating in any sport as a professional player.
7. for Bodily Injury sustained whilst or as a result of participating in any competition involving the utilisation of a motorised land, water or air vehicle.
8. for Bodily Injury sustained whilst or as a result of riding or driving a motorcycle or motor scooter over one hundred fifty (150)cc.
9. for Bodily Injury whilst the Insured Person is travelling by air other than as a fare-paying passenger on an aircraft registered to an airline company for the transport of paying passengers on regular and published scheduled routes.
10. for Bodily Injury sustained whilst or as a result of participating in any criminal act.
11. for Bodily Injury or Sickness resulting from pregnancy within twenty-six (26) weeks of the expected date of birth.
12. for Bodily Injury or Sickness caused by or arising from the conditions commonly known as Acquired Immunodeficiency Syndrome (AIDS) or Human Immunodeficiency Virus (HIV) and/or any related illness or condition including derivatives or variations thereof howsoever acquired or caused. The onus shall always be upon the Insured Person to show that Bodily Injury or Sickness was not caused by or did not arise through AIDS or HIV.
13. for Bodily Injury or Sickness caused by or arising from or due to venereal or venereal related disease.
14. for Bodily Injury sustained whilst or as a result of active participation in any violent labour disturbance, riot or civil commotion or public disorder.
15. for Bodily Injury sustained whilst on service or on duty with or undergoing training with any military or police force, or militia or paramilitary organisation, notwithstanding that the Bodily Injury occurred whilst the Insured Person was on leave or not in uniform.
16. for treatments for nervous or mental problems, whatever their classification, psychiatric or psychotic conditions, depression of any kind, or mental insanity.
17. any pathological fracture.
18. for cures of any kind and all stays in long term care institutions (retirement homes, convalescence centres, centres of detoxification etc.)
19. for investigations, operations or treatment of a purely cosmetic nature; or for obesity; or undertaken to facilitate pregnancy or to cure impotence or to improve potency.
20. for Bodily Injury sustained whilst or as a result of engaging in, practicing for, or taking part in training peculiar to any kind of hazardous sport such as parachuting, hang gliding, parasailing, off-piste skiing or bungee jumping.
21. Any Medical Expenses incurred, the need of which arises out of a Pre existing Condition.
22. for Bodily Injury caused by or arising from or as a result of Terrorism.

There is yet another clause that says, if you are met with an accident on the way to a hospital even for a routine check-up, they can refute the claim.

The following details are as per the company’s Personal Accident Insurance Policy:

Specific Exclusions:

The Company shall not be liable to pay any benefit in respect of any Insured Person for:

1. any Medical Expenses incurred where an Insured Journey is undertaken against the advice of a qualified licensed medical practitioner.
2. any Medical Expenses incurred when the specific purpose of a journey is to receive medical treatment or advice.
3. any Medical Expenses incurred within the territorial limits that are not stated in the Schedule.
4. any medical treatment, drugs or medicines, prescribed or applied, before the Period of Insurance.
5. any dental work.
6. any claim caused by or arising from or due to Sickness of any and every kind.

[BeMyWings]

Thank you Roni and Utkarsh for sharing this with us.

I don't have all the details, so I would probably offer this as general guidance. If HDFC Ergo (or any insurer) sold you a Personal Accident policy as a top up for your Motorcycle policy (>150 CC) that they insured, but then turned around and denied a claim because the Motorcycle was greater than 150 CC, this would technically qualify as a "Bad Faith Claim" (because, the insurer knew the engine capacity of the bike they were insuring)
They also knew that their Personal Accident policy excludes accidental losses on that bike. Knowing full well that they will not cover the loss, they sold the add on when they never really had any intention to cover it in the first place.

Again, these are generalized opinions, the actual facts of that case may differ.

[sukiwa]

If I have to believe social media forwards, this claim has been settled by HDFC Ergo after escalations at multiple levels with Insurance ombudsman.
Sharing clarification from HDFC Ergo on motorcycles with engines more than 150cc..

[mac187]

Doesn't this qualify as mis-selling of Insurance (or some legal term)? I recall members posting about some Insurance company rejecting renewal of certain models over certain age. That I felt and had commented in the thread is a normal practice in countries where insurance penetration is high and can be the company's preview as to what they consider as risk portfolio.

This example is completely opposite to that, HDFC knowing sold the insurance to bike owners with higher CC and then backed out during the hour of crisis. In the clarification they have issued they have admitted that they followed the practice till Oct 2020!

While I am aware of perils of social media, examples like these justify some of the misdirected anger companies face by the public.

[ebonho]

Originally Posted by BeMyWings

I don't have all the details, so I would probably offer this as general guidance. If HDFC Ergo (or any insurer) sold you a Personal Accident policy as a top up for your Motorcycle policy (>150 CC) that they insured, but then turned around and denied a claim because the Motorcycle was greater than 150 CC, this would technically qualify as a "Bad Faith Claim" (because, the insurer knew the engine capacity of the bike they were insuring)

They also knew that their Personal Accident policy excludes accidental losses on that bike. Knowing full well that they will not cover the loss, they sold the add on when they never really had any intention to cover it in the first place.

Thank you for this information. This is key.

Cheers, Doc

[aargee]

Originally Posted by ebonho

Thank you for this information. This is key.

Cheers, Doc

Not really Sir, because...

Originally Posted by BeMyWings

If HDFC Ergo (or any insurer) sold you a Personal Accident policy as a top up for your Motorcycle policy (>150 CC) that they insured, but then turned around and denied a claim because the Motorcycle was greater than 150 CC, this would technically qualify as a "Bad Faith Claim" (because, the insurer knew the engine capacity of the bike they were insuring)

Boss, this is different from vehicle insurance, this is Personal Accident (PA) Insurance coverage; this means, you're insured as a rider on any vehicle. Put it this way, I can have a PA irrespective of the vehicle I ride, but I'm paying premium for a vehicle within certain CC (I still don't know what a CC has got to do; may be higher CC = higher premium, as risk goes up price goes up, may be)

So, I can take a PA while I own CBR 250R; however, the claims are pertinent only if I ride a vehicle less than 150 cc, say Activa or Rx100 for that matter.

These days govt (atleast in TN) has mandated taking PA for new vehicles without which RTO will refuse to register the new vehicle; from year 2 onwards it's self responsibility; I was told this by the dealership & I got hazy response from RTO website

And if you look at this news...

The Transport Department has also directed the vehicle registering authorities to ensure that the owner, driver, and passengers are also covered under accident insurance

And if you check every insurance company from HDFC, Foxcover, ICICI, Bajaj Allianz, everyone of them seems very personally interested in covering our lives!!

[ebonho]

Originally Posted by aargee

Not really Sir, because...

You can call me Doc bro. As a free Indian, the knighthood is denied to me.

I still do not understand how?

The Insurance company sold him an Insurance cover for riding a bike over 150 cc, with a built in exception that it would not honor the claim if an accident were to happen.

Do they then expect him to change his bike to conform?

Did the company offer a (similar) insurance option for vehicles greater than 150 cc?

Was the policy sold independently or bundled along with the purchase of the 350 cc bike?

Was there any data collected by the Insurer in the application form about the personal vehicle/s of the Insured at the time of selling the insurance?

Cheers, Doc

[aargee]

Originally Posted by ebonho

I still do not understand how?

The Insurance company sold him an Insurance cover for riding a bike over 150 cc, with a built in exception that it would not honor the claim if an accident were to happen

Then in that case, it's unethical practice of business by HDFC

because, the insurer knew the engine capacity of the bike they were insuring

What I'm saying is for the above because the insurance company should not care what CC of two-wheeler is being ridden if they've sold a policy for >150cc and will not know the CC of bike the rider owns/rides until a mishaps happens

[ebonho]

Originally Posted by aargee

Then in that case, it's unethical practice of business by HDFC


What I'm saying is for the above because the insurance company should not care what CC of two-wheeler is being ridden if they've sold a policy for >150cc and will not know the CC of bike the rider owns/rides until a mishaps happens

Please re-read my reply to you. I've added 2-3 additional key questions.

If the policy was bundled along with the purchase of the 350 cc bike, its malpractice.

Similarly, a Personal Accident Policy needs to capture details of the Personal Vehicles at the time of application for purchase of the policy.

Otherwise, if its simply an Accidental Death rider to a Life Insurance policy (where typically your survivors get double the sum assured) then it could be generic and the above fine print apply (even then, it could be argued that 1) such should have been explained and documented at the time of purchase, and 2) the company should have the option of insuring for higher cubic capacity for a higher premium if so).

A hospital cannot refuse an accident victim.

Similarly an Insurance Company cannot not insure a customer for an accident when operating a certain class of vehicle.

Cheers, Doc

[aargee]

Originally Posted by ebonho

If the policy was bundled along with the purchase of the 350 cc bike, its malpractice

IMHO, PA is sold separate & not bundled with the vehicle. I can buy an interceptor or Activa regardless of PA, is what I've been told by the dealers

Originally Posted by ebonho

a Personal Accident Policy needs to capture details of the Personal Vehicles at the time of application for purchase of the policy

I don't think this is done by RTO to my knowledge

I asked the dealer, what if I buy 2 vehicles on same day & why should I take 2 PA? Dealers said, with every new vehicle (regardless of the CC), PA is must atleast for 1st year otherwise TN RTO wouldn't register. May be I've to check what type of PA is being covered with every vehicle whether its vehicle dependent or not.

[ebonho]

Originally Posted by aargee

IMHO, PA is sold separate & not bundled with the vehicle. I can buy an interceptor or Activa regardless of PA, is what I've been told by the dealers

I understand that. But I said it is malpractice if it is bundled along with the purchase of the vehicle. Not predating it.

Even so, in case of the latter, a policy cannot be for an accident only for and within a certain cubic capacity. If it is a generic umbrella policy, there needs to be data captured about the intended usage case of the Insured for which the policy is being purchased, and the OPTION of extended cover that covers all cubic capacities.

Please note that the Personal Accident policy exclusions make no mention of cars or 4-wheelers, regardless of cubic capacity. Only 2 wheelers.

I don't think this is done by RTO to my knowledge

I wasn't talking about the RTO. I was talking about the Insurance company. The policy is a contract between the Insurer and the Insured.

I asked the dealer, what if I buy 2 vehicles on same day & why should I take 2 PA? Dealers said, with every new vehicle (regardless of the CC), PA is must atleast for 1st year otherwise TN RTO wouldn't register. May be I've to check what type of PA is being covered with every vehicle whether its vehicle dependent or not.

Please see above.

Cheers, Doc

[BeMyWings]

Everyone's made some great points (in their own place, all accurate as well), and while technical, they are important to be understood because these affect our rights as Consumers and Insureds.

It is not my intent to denigrate by sharing what I know, I am merely helping you with the knowledge I have

Insurance is a highly technical subject, what with it being based on Contract Law and Policy wording that no regular Joe ever reads.

The regular Joe purchases a policy from an insurer with the faith that if I pay my premium and adhere to the law, the insurer will cover me from covered losses.

Anyone who buys PA coverage, buys it for protecting themselves while they ride/drive their own vehicle. If an insurer offers to sell a policy while full well knowing that they do not cover the rider while they ride the same bike, it goes into a very grey area.

As an example, let me ask all of you this question. How often does a Regular Joe ride some other bike or someone else's bike? (Maybe a moot question on this forum, but we're talking about Regular Joe here). Most of the premium paying customers in India look at Cars/Motorcycles as a commuting medium, not a passion.

There is reason why HDFC Ergo quickly realized that their Policy Wording was contrary to their selling practices (and it had nothing to do with Social Media).

Let me restate, I am offering my knowledge and opinions of the subject matter.

As a funny side, maybe HDFC Ergo should call it "PA coverage for all bikes but your own"!

Safe motoring everybody