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Does Health Insurance Cover Car Injuries?

Uncertainty seems to be the only certainty in these times. While we cannot avoid being “surprised” or “shocked” by life’s antics every once and again, we can do our best to be well-prepared when it greets us. One of the best and time-tested ways of mitigating uncertainty is insurance. You can get an insurance policy for almost anything you wish to protect against possible loss, like a new business, your new car, your family’s health, your health, your life and more.

Getting insured is a wise and prudent decision to make, but how do you decide the type of insurance you want on a priority? And how do you maximize the benefits you get out of your chosen policy? Well, we’ll talk about a few key points you can keep in mind and also try to address a few questions that may arise! 

I think we all agree that your health is the most valuable asset you possess at any given point in time. This is because your health is intrinsically linked to every other asset that you will build or accumulate in your lifetime. And preserving your health is of utmost importance to lead a happy and successful life. So, when it comes to insurance, health insurance is pretty much the first choice for anybody.

But what is the coverage under a standard health insurance policy in India? Suppose you have a freak car accident and unfortunately, you injure yourself. You have multiple fractures, and one of them requires major surgery, the funds for which you cannot immediately arrange. Will your health insurance policy cover the costs? If yes, how much of it will be covered? What are the formalities you should be aware of while buying an insurance policy to ensure such coverage? 

These are all valid questions to pose, as road accidents have injured 439,262 people in 2019 alone, according to statistics by National Crime Records Bureau, India. The number of car accidents is on the rise because of a variety of reasons like drunken driving, speeding, texting/calling while driving etc. And while this is an unfortunate situation none of us would like to imagine happening to us, it is also smart to be prepared in case the exigency does arise. 

So let’s talk about car accident coverage by health insurance policies in India! 

Firstly, there is no single determinant for whether or not your regular health insurance policy will cover car accident injuries. Several factors influence the final outcome.  

What is the usual health insurance coverage? 

Regular health insurance policies provide for medical costs during treatment, hospitalization costs and pre and post-hospitalization treatment costs. Earlier, this was limited to illnesses only, but gradually insurance providers have been expanding their coverage to include several kinds of medical issues. Insurance plans are also being diversified accordingly, into “Critical Illness Insurance”, “Maternity Insurance” etc. Health insurance also plans, subject to terms and conditions, cover car accident injuries. 

Do health insurance policies cover all costs from accident injuries? 

Health insurance policies do not provide a blanket cover for accident injury treatments. Usually, some degree of coverage is ensured under your existing plan. This can include:

  1. Ambulance costs – Most health insurance policies allow ambulance costs to be claimed up to a specific limit. So, if you are in a car accident and have to be taken to the hospital in an ambulance, you can, in most cases, claim the ambulance costs under your health insurance policy. 
  1. Hospitalization costs – Most health insurance policies also cover hospitalization costs. This includes the bed and room charges, doctor visit charges, surgery charges and medicine charges. So, the health insurance policy covers the medical and hospitalization costs that you incur because of the car accident injury treatment. These can be claimed in the usual routine, by filing a claim along with relevant supporting documents. 
  1. Post-hospitalization costs – Health insurance policies also cover individual post-hospitalization costs like physiotherapy if needed, diagnostic medical tests or doctor follow-up consulting fees. This coverage, however, is only up to a certain number of days post-discharge. The exact number of days depends on the specifications of your policy, but the average duration is about 60 days post-discharge. Suppose there are any post-hospitalization charges incurred due to your accident and the subsequent treatment. In that case, you should be able to claim these costs by submitting the receipts, discharge summary, doctor’s reports etc. and get your benefit. 

Regular health insurance covers a limited amount of costs due to car accidents. However, if you are looking for full or maximum coverage of your car accident injury, then you would have to purchase a separate personal accident policy as well. 

This can be done in two ways: 

Purchasing an accident cover as an add-on – Many health insurance providers in India have several ‘add-ons’ in the policy benefits list so that the customer can customize the insurance plan according to his own needs. If you purchase a personal accident add-on along with your health insurance policy, all or most of the costs including all hospitalization, surgery, post-operative care etc. would be covered under it. This would also include non-car accident injuries, such as getting hit on the road by a bus or any other such incidents. A personal accident add-on is a safer option than just relying on your regular health insurance policy, as this offers more benefits which are specially customized for the case of accidents. 

Buying an independent personal accident insurance policy- A personal accident insurance policy is a comprehensive plan that covers all kinds of expenses or losses incurred due to an accident. This can be in various forms. Some plans offer a lump-sum amount on the occurrence of an accident. It is up to the injured person or the family members of the injured person on how to use the amount. It can be used to cover family expenses or medical expenses or any other expenses, as required. Other plans offer full coverage of treatment costs, hospitalization costs, post-hospitalization costs that you may face due to the accident. A personal accident insurance policy is a good bet to keep you somewhat secure in the face of uncertainties caused by a car accident. 

Does the health insurance policy cover accidental death? 

Your health insurance policy will not provide any benefit in the case of accidental death caused due to a car accident. This is because it is a health insurance plan can only cover for medical costs that are incurred due to an accident. If there is immediate death in the accident, the health insurance plan is not even activated. If there is hospitalization and subsequent death, then your plan will cover for the hospitalization and treatment costs but will not pay any death benefit as that is not part of the plan. A personal accident insurance plan, on the other hand, can pay an accidental death-benefit depending upon the specifics of your plan. 

Facing a car accident is an incredibly stressful situation, irrespective of who was at the wheel or whose fault it was. There is a sense of emotional upheaval, financial loss, and a looming sense of uncertainty. You have to fight the situation in the best way you can, and one way to make it easier is to know your policy beforehand. This will help you make wise and quick decisions during the crisis and claim the maximum benefit. 

FAQs: Health Insurance for Injuries From Car Accidents

How do I know if I have car accident injury coverage under my regular health plan?

The policy document covers all the terms and conditions of your policy. Read the policy benefits and exclusions carefully, where the details of what is included and excluded under the policy will be mentioned clearly. If your policy covers car-accident injuries, then it will be noted under “Benefits”. The conditions and requirements for a successful claim will also be detailed in the same, so read the fine print

Does my health insurance plan cover accidental disability?

No, your health insurance plan normally does not cover accidental disability. It will cover the medical expenses associated with the disability after the accident for a certain number of days. But there will not be any additional accidental disability benefit paid out from your health insurance plan. Again, personal accident insurance can include accidental disability benefits.

Does my health insurance plan cover OPD costs in the event of accidents?

Health insurance plans usually require a minimum of 24 hours of hospitalization before you can make a medical insurance claim, so OPD costs will typically not be covered under your plan. However, this is policy-specific. The exact details of OPD coverage will be detailed in your policy document, which will mention the coverage amount if you do have coverage.

Is there a waiting time before I can claim for a car accident injury from my health policy?

There is no waiting time before you can make a health insurance claim, under normal circumstances. You can check your policy document for any such waiting period or call up the insurance call center and verify the same.

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