|Methods and techniques|
Accident policy is a document in which the insurer confirms the conclusion of the insurance contract. One of the basic insurance documents. Traditionally, it is issued by the insurer to the insuring party. There is a certain minimum set of data that should be included in the policy:
- insurer's data,
- data of the policyholder,
- designation of the subject of insurance,
- identification of insured risks (dangers),
- specification of the time for which the insurance contract was concluded,
- insurance period (beginning and end of the protection period, usually one year),
- sum of insurance,
- place and date of issuing the policy,
- signature of the insurer.
Terms of the accident policy
When the insurer is a legal person, the insurer usually requires more data. These include the company name, business address, REGON, NIP. In some cases, the sum insured is the minimum guarantee sum that the legislator imposes on the employee. Most often in such cases, on the policy, there is information that the sum insured is the minimum guarantee sum in accordance with the relevant act. In most voluntary insurance, the insurer applies reductive or integral franchise. The amounts of these franchises are usually included in the general terms of insurance. However, when the amount of the franchise differs from those in the general insurance conditions, an appropriate entry should be made in the insurance policy.
The issuing policy is required to provide information on the type of insurance and the general insurance terms applicable. In addition, any additional or different provisions from general or special conditions of insurance should be included in the content of the policy. As usual, the moment the policy is delivered to the policyholder sets the beginning of the insurer's protection. Every professionally active person may fall into an accident while performing their duties or fall into an occupational disease - they losing their ability to work temporarily or permanently. Thanks to accident insurance, the employee acquires the right to many benefits that will help him during this time. In principle, accident insurance covers the three most important situations when an employee suffers an injury or death:
- during or in connection with the employee's performance of ordinary activities or orders of his superiors,
- during or in connection with the employee performing activities for the benefit of the employer even without a recommendation,
- while the employee is at the disposal of the employer on the way between the employer's seat and the place of performing the obligation resulting from the employment relationship.
In each of these situations employee is entitled to benefits from accident insurance. The accident must be sudden, caused by an external cause, unintentional and have a direct relationship with your employment - otherwise you will not be able to benefit from the benefits. Employee also lose his rights when the accident was due to his negligence, non-compliance with the regulations and employee were under the influence of alcohol or drugs.
It must be remember, that accident insurance does not only cover sudden events. If the conditions of employee's work have contributed to the occurrence of occupational disease, employee can also apply for benefits from sickness insurance - this applies, for example, to the inhalation of toxic fumes. Employee is entitled to sickness benefit in connection with the loss of his health. If he continue to be unable to work until his sickness benefit is exhausted, but employee's condition will be able to improve in the future, employee have the right to additionally provide rehabilitation. In the case of total loss of work capacity, employee can apply for a pension and care allowance (if employee lose ability to function independently). Loss of ability to work is permanent or temporary contributes in many cases to a reduction in earnings. In this situation, employee should get a compensation allowance. It may also happen that employee lose his ability to perform his current profession. Then seek a training pension that will help him retrain and continue to be professionally active. Other sickness benefits are one-off compensation, survivor's pension and supplement to the survivor's pension. Employee is entitled to one-time compensation as an injured person or his relatives in the event of his death. In the event of death, the family is also entitled to a survivor's pension and an addition to it (when his child is completely orphaned as a result of his death) .
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- Doyle J., (2006)., Health Insurance, Treatment and Outcomes: Using Auto Accidents as Health Shocks, Review of Economics and Statistics, Volume 87, Issue 2
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- Murphy, L.E., Downs A.B., Levin J.M. (2007)., Property Insurance Litigator's Handbook, American Bar Association
- Seale, J.H. (2017)., System and Method for Processing Insurance Claims
Author: Aleksandra Malczyk