IRCTC Travel Insurance Full Details
OPTIONAL TRAVEL INSURANCE FOR E-TICKET PASSENGERS
A.
Disclaimer
1. Insurance
policies are contractual obligations between the Insurance company/ies &
the passenger. In case, passenger opting for insurance, the claim/liability
shall be between passenger and the Insurance
Company.
2.
The Insurance Company is responsible for policy issuance and claims
settlement.
3.
All the correspondence by policy holder should be made directly with
the Insurance Company on their toll free no. , official E Mail IDs or offices
as mentioned in policy document. No correspondence to be made with IRCTC in
this regard
4.
IRCTC only provides linkage to transact with Insurance Company through its website to take insurance cover
and as such assume no responsibility or liability in respect of said policy,
under any circumstances.
5.
All information provided on the website is provided “As is“ and with no
warranties.
This Policy the Schedule and any Memoranda thereon shall be considered
one document and any word or expression to which a specific meaning has been
attached in any of them shall bear such meaning throughout.
B.
Terms & Conditions:-
1.
The scheme is applicable only for Indian Citizens who book their
e-ticket through NGeT Website Application only. Citizen of foreign countries
are not eligible for this scheme.
2. The scheme
is optional, however if the option is exercised it will be compulsory for all
passengers booked under one PNR number.
3. The premium is Re. 92 paise per passenger inclusive of
all taxes.
4. Customer
shall receive the policy information through SMS and on their registered email
IDs directly from Insurance Companies along with the link for filling
nomination details. However, Policy number can be viewed from Ticket booked
history at IRCTC Page.
5. After the
booking of ticket, the nomination details to be filled at respective Insurance
Company site. If nomination details is not filled then the settlement shall be
made with legal heirs, if the claim arises.
6. The
coverage for the policy shall be for each passenger under the PNR in case of Death, Permanent
Total Disability, Permanent
Partial Disability,
and
Hospitalization Expenses for Injury and Transportation of mortal remains
following Rail Accident or untoward incident.
7. The optional travel
insurance will not be provided for the children
below
5
years of age.
8. In case of
passenger opting for insurance, the claim/liability shall be between insured
and the Insurance Company.
9. In case of
short termination of trains due to any reason, if the passenger opts for the
alternate mode of transportation arranged by railway upto the destination
station, then this part of the journey of the passenger shall also be covered
under the policy taken by the passenger.
10. In case of
diversion of train due to any reason, the coverage shall be for the diverted route.
11. In case of
vikalp train, the policy obtained by the passenger for covering this journey in
the original train shall be valid in the vikalp train also.
12. Once the premium is paid by
the passengers no cancellations is allowed. Accordingly, no refund of premium
will be made in all cases including waitlisted
ticket.
13. The coverage for
Hospitalization Expenses for Injury
is over and above the death/permanent
total disability/partial disability
14. The Travel Insurance Scheme
shall be kept uniform for all classes:
Death
|
Permanent total Disability
|
Permanent partial
Disability
|
Hospitalization expenses
for injury
|
Transportation
of mortal remains
|
Rs. 10,00,000
|
Rs.10,00,000
|
Rs. 7,50,000
|
Rs.2,00,000
|
Rs. 10,000
|
C.
POLICY DETAILS
Train Accident is as defined under
section 123 read with Sections 124 and 124A of the Railways Act, 1989 subject
to the qualification that the coverage will be valid from the actual departure
of train from the originating station to actual arrival of train at the destination
station including’ process of entraining ‘ and process of detraining ‘ the
train.
Untoward incident means:
a) the
commission of a terrorist act within the meaning of sub-section (1) of section
3 of the Terrorist and Disruptive Activities (Prevention) Act, 1987(28 of
1987), or
b) the making of a violent
attack or the commission of robbery or dacoity; or
c)
the indulging in rioting, shoot-out or arson, by any person in or any
train carrying passengers or, from the actual departure from originating
station to actual arrival
of train at
destination station including
‘process of
entraining’ and ‘process of
detraining the train and Vikalp train, short termination and diverted route
d) The accidental falling of
any passenger from a train carrying passengers.
Accident means :
(a) When in the
course of working a railway , an accident
occurs, being either a collision
between trains of which one is a train, carrying passengers or the derailment
of or other accident to a train or any part of a train carrying passenger.
(b) When in the
course of working a railway an untoward incident occurs, in the train carrying
passengers (any part of the train) or at the actual departure from the
originating station to actual arrival of train at the destination station.
Insured shall mean the passengers
travelling by Indian Railway of all class who book the e-ticket through IRCTC
site and opt for Travel insurance cover & paid the premium. However, the
child below 5 years of age is not covered.
Company/we/us shall means any of the 3
Insurance Companies namely Royal Sundaram General Insurance Co. Limited,
Shriram General Insurance Company and ICICI Lombard General Insurance Company
Limited.
Hazardous Sport / Hazardous Activities means
Persons whilst working in underground mines, explosives, magazines, workers
whilst involved in electrical installation with high tension supply, jockeys,
circus personnel, engaged in activities like racing on wheels or horseback, big
game hunting, mountaineering, winter sports, Skydiving, Parachuting, Scuba
Diving , Riding or Driving in Races or Rallies, Mountain Climbing, hunting or
equestrian activities, rock climbing, pot holing, bungee jumping, skiing, ice
hockey, ballooning, hand gliding, diving or under-water activity river rafting,
canoeing involving rapid waters, polo, yachting or boating outside coastal
waters and persons whilst engaged in occupation / activities of similar hazard.
Persons whilst engaged in the following occupations are also excluded.
Aircraft pilots
and crew, Armed Forces personnel, Artistes engaged in hazardous performances,
Aerial crop sprayer , Bookmaker (for gambling) , Demolition contractor, Explosives users , Fisherman (seagoing , Jockey
, Marine salvager
,Miner and
other occupations underground , nuclear installations, Off-shore oil or gas rig
worker , Policeman , Pop Musicians , Professional sports person , Roofing
contractors and all construction, maintenance and repair workers at heights in
excess of 50ft/15m , Saw miller , Scaffolder , Scrap metal merchant, Security
guard (armed) , Ship crew , Steeplejack ,Stevedore ,Structural steelworker
Tower crane operator ,Tree feller.
Hospital means any institution
established for inpatient Care and Day Care treatment for illness and/or
injuries and which has been registered as a Hospital with the local
authorities.
Injury means accidental
physical bodily harm excluding illness or disease solely and directly caused by
external, violent and visible and evident means which is verified and certified
by a Medical Practitioner.
Medical expenses
Medical
Expenses means those expenses that an Insured has necessarily and actually
incurred for medical treatment on account of Illness or Accident on the advice
of a Medical Practitioner, as long as these are no more than would have been
payable if the Insured had not been insured and no more than other hospitals or
doctors in the same locality would have charged for the same medical treatment.
Hospitalisation Expenses for Injury
The medical
expenses incurred by the Insured for hospitalization and medical treatment
taken on account of any Injury sustained by the Insured whilst on a Trip as
stated in the Policy Schedule.
Trip
Trip means the
actual departure of train from the originating station to actual arrival of
train at the destination station as mentioned in booked ticket through which
insurance cover has been opted including ‘process of entraining’ and ‘process
of detraining’ the train for which the Insured has paid the Premium.
Physical separation of hand means separation of hand at or above the wrist
Physical separation of foot means separation of foot at or above the ankle
The Insured and the Insurance Company agree that
1. The proposal shall be
incorporated in and be the basis of the contract
2. The passenger will pay the
Premium at the time of booking of ticket
3. The Insurance Company will
provide the Insurance subject to the terms, Warranties, Conditions &
Exceptions of this Policy
4. The
following shall be conditions precedent to any liability of the Insurance
Company
(a) Observance of the terms of
this Policy relating to anything to be done or complied with by the Insured
(b)
The truth of the statements made in the proposal
TABLE OF BENEFITS
Benefit 1 – In case of Death
Death
If during the Trip, the
Insured sustains accidental bodily injury which directly and independently of all
other causes results in death within 12 months from the date of accident or
untoward incident.
|
100% of the Sum Insured stated in the Schedule applicable
to such Insured is payable
|
Benefit 2 – In
case of Permanent total disability of nature specified below
Permanent total disability
If during the Trip, the
Insured sustains accidental bodily injury which directly and independently of all
other causes results in permanent total disability within 12 months from the
date of accident or untoward incident. For the purpose of this Insurance,
Permanent total disability shall mean either of the following and
compensation will be paid as per table below
|
100% of the Sum Insured
stated in the Schedule applicable to such Insured is payable
|
The
Disablement
|
Compensation expressed as a percentage of Total
Sum Insured
|
1.
Permanent Total Disablement
|
100%
|
2.
Permanent and incurable insanity
|
100%
|
3.
Permanent Total Loss of two Limbs
|
100%
|
4. Permanent Total Loss of Sight in both eyes
|
100%
|
5. Permanent Total Loss of
Sight in one eye and one Limb
|
100%
|
6.
Permanent Total Loss of Speech
|
100%
|
7.
Complete removal of the lower jaw
|
100%
|
8. Permanent Total Loss of Mastication
|
100%
|
9.
Permanent Total Loss of the central nervous system or the thorax and all
abdominal organs resulting in the complete inability to engage in any job
|
100%
|
and the inability to carry
out Daily Activities essential to life without full time assistance
|
|
10.
Permanent total disablement not otherwise provided for under above Items
inclusive up to a maximum of Sum Insured
|
100%
|
Benefit 3 –In case of
Permanent partial disability of nature specified below
Permanent partial disability
If during the Trip, the
Insured sustains accidental bodily injury which directly and independently of
all other causes results in permanent partial disability within 12 months
from the date of accident or untoward incident. For the purpose of this
Insurance, Permanent partial disability shall mean either of the following
and compensation will be paid as per table below :
|
75% of the Sum Insured
stated in the Schedule, applicable to such Insured is payable
|
The
Disablement
|
Compensation expressed as a percentage of Total Sum Insured as
specified against permanent partial disability
|
1. Permanent Total Loss of Hearing in both ears
|
100%
|
2. Permanent Total Loss of
one Limb
|
67%
|
3. Permanent Total Loss of
Sight of one eye
|
67%
|
4. Permanent Total Loss of Hearing in one ear
|
20%
|
5. Permanent Total Loss of
the lens in one eye
|
33%
|
6. Permanent
Total Loss of use of four fingers and thumb of either hand
|
53%
|
7. Permanent Total Loss of
use of four fingers of either hand
|
27%
|
8. Permanent Total Loss of
use of one thumb of either hand
|
27%
|
9.
Permanent Total Loss
of one
|
7%
|
finger of either hand
|
|
10. Permanent Total Loss
of use of toes
|
20%
|
11. Established non union of fractured leg or kneecap
|
13%
|
12. Shortening of leg by
atleast 5 cms.
|
10%
|
13. Any loss is of the
elbow, hip or knee
|
27%
|
14. Any other Permanent
Partial not included in above items
|
% as assessed by Doctor.
|
Benefit-4 Hospitalisation Expenses for Injury
The Insurance Company shall indemnify the Insured for the expenses, upto
Rs.2 lakh, incurred by the Insured for Hospitalization and medical treatment,
taken on account of any Injury sustained by the Insured whilst on a Trip during
the Period of Insurance.
The Medical Expenses incurred for Hospitalization Treatment:
a. Room rent,
boarding expenses,(Room Rent to be capped at 2% of the sum insured and ICU/CCU
to be capped at 4% of the sum insured)
b. Nursing,
c. Intensive care unit,
d. Medical Practitioner,
e. Anesthesia, blood, oxygen, operation theatre charges, surgical Appliances,
f. Medicines, drugs and consumables,
g. Diagnostic procedures,
h. The cost of prosthetic and
other devices or equipment if implanted internally during a Surgical Procedure.
i. No OPD charges to be
covered. However, procedures followed under day care shall also be covered.
j. A Hospital means any
institution established for inpatient Care and
Day Care treatment for illness and/or injuries and which has been
registered as a Hospital with the local authorities
k. In case
happening of an accident, initial treatment be taken from nearest hospital of accident site and upon
written referral of this hospital, treatment be taken from any specialized hospital
Benefit -5 Transportation of mortal remains:
If the Insured dies as specified in the Table of Benefits described
hereunder, solely and directly due to train accident and untoward incidents
as defined under section 123 read with sections
124 and 124A of the Railways Act, 1989,
occurring
during the Trip, then the Insurance Company will reimburse Rs.10,000/- as the
cost of either transporting his mortal remains to his usual place of residence
or to a cremation or burial ground. No documentary evidence is required to be
produced.
Insurance Company’s maximum liability
Any payment in
case of more than one claim in respect of any Insured under this Policy during
any one Period of Insurance should not exceed the Sum Insured applicable to
such Insured. However, the amount relating to carriage of dead body of the
Insured and medical expenses would be payable in addition, if applicable.
EXCEPTIONS
The Insurance
Company shall not be liable under this Policy for
(1) compensation under more than
one of the foregoing Benefits in respect of same accident or period of
disablement of the Insured
(2) any other payment in respect
of the Insured after a claim under one of the Benefits 1 has been admitted and
become payable. However, amounts relating to carriage of the dead body of the
Insured and medical expenses will be payable in addition if applicable.
(3) payment of Benefit in
respect of accident, death, injury or disablement of the Insured
(a) from intentional
self-injury, suicide or attempted suicide
(b) whilst under the influence
of intoxicating liquor or drugs
(c) arising or resulting from
the Insured committing any breach of law with criminal intent
(d) while crossing the railway tracks
(e)
due to mental disorders or disturbance of conscious, strokes, fits or
convulsions which affect the entire body and pathological disturbances caused
by the mental reaction to the same and damage of health caused by curative measures, radiations, infection,
poisoning except where arise from accident
(f) Whilst engaging in any sort
or form of adventurous sport
(g) Directly or indirectly
caused or contributed by congenital anomaly, venereal disease, sexually
transmitted disease, AIDS or insanity
(4) any payment in respect of
death or disablement resulting directly
or indirectly from, caused by, contributed to or aggravated or prolonged
by child birth or pregnancy or in consequence
thereof.
(5) Any natural cause or disease
or medical or surgical treatment unless such treatment becomes necessary due to
injury caused by the said untoward incident.
(6) any payment in respect of
death, injury or disablement of the Insured due to or arising out of directly
or indirectly connected with or traceable to war, invasion, act of foreign
enemy, hostilities (whether war be declared or not), civil war, rebellion,
revolution, insurrection, mutiny, military or usurped power, seizure, capture,
arrests, restraints and detainments.
(7) Persons whilst engaged in
Hazardous sports or Hazardous Activities.
(8) any payment in respect of
death of, or bodily injury or any disease
or illness to the Insured
(a)
directly or indirectly caused to or contributed to by or arising from
ionising radiations or contamination by radioactivity from any nuclear fuel or
from any nuclear waste from the combustion of nuclear fuel. For the purpose of
this Exception, combustion shall include any
self sustaining process of nuclear fission.
(b)
directly or indirectly caused by or contributed to by or arising from
nuclear weapons material
(9) any losses directly or
indirectly arising out of, or contributed to or caused by, or resulting from or
in connection with any act of
nuclear, chemical, biological
terrorism (as defined below) regardless of any other cause or event contributing
concurrently or in any other sequence to the
loss.
For the
purpose of this Exception, Nuclear, Chemical, Biological terrorism shall mean
the use of any nuclear weapon or device or the emission, discharge, dispersal,
release or escape of any solid, liquid or gaseous Chemical agent and/or
Biological agent during the period of insurance by any person or group(s) of
persons, whether acting alone or on behalf of or in connection with any
organization(s) or government(s), committed for political, religious or
ideological purposes or reasons including the intention to influence any government
and/or to put the public, or any section of the public, in fear. Chemical agent
shall mean any compound which, when suitably disseminated, produces
incapacitating, damaging or lethal effects on people, animals, plants or
material property. Biological agent shall mean any pathogenic (disease
producing) micro-organism(s) and/or biologically produced toxin(s) (including
genetically modified organisms and chemically synthesized toxins) which cause
illness and/or death in humans, animals or plants. If we allege that by reason
this exclusion any loss is not covered by
this insurance the burden of proving the contrary shall be upon the Insured.
(10) Claim on account of injury
due to accident or untoward incident
prior to the date and time of journey
and post the date and time of journey would be excluded from the scope of the policy, however
any delay in the time of
departure and
arrival of the respective train would be taken into consideration
(11) Claim in
instances wherein ticket was booked by the Insured; however the train was not
boarded. This is irrespective of whether the train ticket was cancelled or not.
(12) Claim in instances wherein
ticket was booked by the Insured; however the ticket was not confirmed but
still the passenger boarded the train.
(13) The treatment of any illness
even if caused by the Accident or untoward incident suffered by the Insured
except any caused by Accident or untoward incident and requiring immediate
medical treatment in order to maintain life or relieve immediate pain or distress.
(14) Any medical treatment which
was not medically necessary.
(15) Plastic or cosmetic surgery
unless this is certified by the attending Medical Practitioner to be medically
necessary for reconstruction following an Accident or untoward incident.
(16) Dental treatment or surgery
of any kind, unless to sound natural teeth and necessitated by an Accident or
untoward incident.
(17) Any health
check-ups or examinations or measures primarily carried out for diagnostic or
investigative reasons for any purpose other than treatment related to an
Accident or untoward incident.
(18) Any costs relating to
physiotherapy unless undertaken while the Insured is hospitalized.
(19) Any costs or periods of
residence incurred in connection with rest cures or recuperation at spas or
health resorts, sanatorium, convalescence homes or any similar institution.
(20) Any costs in any way related
to psychiatric or mental disorders.
(21) Any costs
relating to the Insured’s pregnancy, childbirth or the consequences of either.
(22) Any congenital internal or
external diseases, defects or anomalies.
Claims Procedure & Documentation
(i) The Insured or his nominee
or legal heir shall deliver to the nearest office of the Insurance Company, not
later than 4 months from the date of occurrence of the Insured Event, a
detailed statement in writing as per the claim form and any other material particular,
relevant to the making of such claim.
The Insured or
his nominee or legal heir shall tender to the Insurance Company all reasonable
information, assistance and proofs in connection with any claim hereunder.
(ii) Proof in accordance with the
policy details shall be furnished to the Insurance Company in connection with
all matters upon which a claim is based.
Documentation
required: In case of Death Claim:
Submit the duly filled in claim
form signed by nominee/legal heir along with the NEFT mandate details and
cancelled cheque with the following documents:
• Report of the Railway
Authority confirming the accident of the train or untoward incident
• Report of the Railway
Authority carrying the details of the passengers declared dead.
• Duly Completed Personal
Accident Claim Form signed by Nominee / Legal Heir along with the NEFT mandate
details & cancelled cheque
•
Photo identity proof of nominee
• For Death Claims, claim will
be settled only to nominee declared at the time of buying insurance through
IRCTC portal
• In absence of nominee, claim
will be paid to Legal Heir only – as per Legal Heir / Succession Certificate
In case of Disablement Claim:
• Report of the Railway
Authority confirming the accident of the train or untoward incident
• Report of attending doctor
confirming the extent of disability.
•
Medical bills corresponding to doctor’s prescription.
• Duly Completed Personal
Accident Claim Form signed by insured / Nominee
• Attested copy of disability
certificate from Civil Surgeon of that Hospital in which the treatment has
undergone stating percentage of disability.
•
Attested copy of FIR.
• All X-Ray / Investigation
reports and films supporting to disablement.
•
Claim form with NEFT details & cancelled cheque of the beneficiary
•
Photograph before & after disability
In case of Hospitalization Expenses for
Injury
·
Report of the Railway Authority confirming the accident of the train or
untoward incident
·
Discharge summary
·
Original Hospital Bills and medical bills
corresponding to doctor’s prescription
·
Advance and final receipts (All receipts shall be numbered, signed and
stamped)
·
Prescriptions for medicines
·
Diagnostic Test Reports, X Ray, Scan, ECG and others including doctor’s
advice demanding such tests)
·
Cash memos/bills for medicines purchased from outside
The claim documents should be sent to the
Claims department of the nearest Office of the Insurance Company through which
this insurance is effected. List of the
address of the office of the Insurance Company to be obtained from the website
of the Insurance Company.
Claims Settlement / Rejection
1.
Benefits payable under this policy will be paid within 15 days of the
receipt of last necessary document.
2.
The Insurance Company shall be released from any obligation to pay
insurance benefits if any of the obligations are breached
3.
All claims under this Policy shall be payable in Indian Currency.
4.
The Insurance Company shall be liable to pay any interest at 2% above
the bank rate prevalent at the beginning of the financial year in which the
claim is reviewed, for sums paid or payable under this Policy, upon acceptance
of an offer of settlement by the insured but there is delay in payment beyond 7
days the date of acceptance.
5.
No Claim is admissible beyond 365 days from date of
expiry of the policy in respect of hospitalization commencing within the Period
of Insurance.
6.
No liability under the Policy will be admitted, if the claim is
fraudulent or supported by fraudulent means.
7.
At the time of claim settlement, Insurance Company may insist on KYC
documents of the insure/nominee/legal heir as per the relevant AML guidelines
in force
GENERAL CONDITIONS
1. Notice
Every notice
and communication to the Insurance Company required by this Policy shall be in
writing to the nearest office of Insurance Company through which this Insurance
is affected.
2. Fraud –
Forfeiture of Cover
If any claim shall be in any respect fraudulent or if any fraudulent
means or devices be used by the Insured or anyone acting on the Insured’s
behalf to obtain benefit under this Policy all benefit hereunder shall be
forfeited.
3. Arbitration
In the event
any dispute arises between the Parties out of or in connection with this
Agreement, including the validity thereof, the Parties hereto shall endeavor to
settle such dispute amicably in the first instance. The attempt to bring about
an amicable settlement shall be treated as having failed as soon as one of the
Parties hereto, after reasonable attempts, which shall continue for not less
than 30 days, gives a notice to this effect, to the other party in writing. In
case of any dispute, controversy or claim arising out of or relating to this
Agreement, the Services or any matter or issue arising there from (‘Dispute’)
shall be resolved in accordance with Arbitration and conciliation Act 1996.
Such dispute, controversy, or claim shall be referred to the Sole Arbitrator to
be mutually appointed by the parties as per the provisions of “The Arbitration
and Conciliation Act-1996’.In case, the parties fail to appoint Sole Arbitrator
within 30 days, the event shall be referred
to a three member Arbitral tribunal. One member each shall be appointed
by both the parties. They shall, within 30 days of their appointment, mutually
decide on the name of the third arbitrator. Arbitration proceedings shall be
deemed to commerce only on the first date of meeting of all the three
arbitrators. The award of the arbitrator shall be final and binding on the
parties to this contract. The venue of the Arbitration shall be New Delhi. The
fees and expenses of the Arbitration Tribunal all other expenses of the
Arbitration shall be borne jointly by the Parties in equal proportion.The
Parties submit to the exclusive jurisdiction of the Courts of Delhi. This
Agreement shall be interpreted in accordance with Indian law.
4. Grievances:
In case the Insured is aggrieved in any way, the Insured may contact the
Insurance Company at the specified address, during normal business hours for
the following grievances:
a. Any partial or total
repudiation of claims by the Insurance Company.
b. Any dispute regard to
premium paid or payable in terms of the policy.
c. Any dispute on the legal
construction of the policies in so far as such disputes relate to claims.
d. Delay in settlement of claims.
e. Non-issue of any insurance
document to customer after receipt of the premium.
f.
Any other grievance.
The Insured may
approach the Insurance Ombudsman, within whose
jurisdiction the branch or office of the Insurance Company (ies) is located
5. Jurisdiction:
The Policy is
subject to the laws of India and the jurisdiction of its Courts in New Delhi
only.
Above details may be outdated, kindly refer the source