Personal accidents: Real-life cases

ST ILLUSTRATION: ADAM LEE

Payouts tend to increase with age, and the likelihood of claims being made varies at different stages of one's life

Claims for personal accident insurance can vary from small claims, such as those for ankle sprains, burns suffered during food preparation, injury from falls and food poisoning, to large claims involving death or disablement benefit payments.

According to insurance practitioners, children below 18 are up to twice as likely to experience an event leading to a personal accident claim than adults.

However, a child's claim size is smaller than that of an adult. There is a correlation between the amount paid out for claims and the age of the person. Claims paid out tend to increase with age.

Ms Koh Yen Yen, Sompo Insurance Singapore's chief distribution officer, pointed out that even for adults aged 18 and above, there are variations in the likelihood of them making a claim at different life stages. For example, those between 30 and 50 are more likely to make a claim than other age groups.

"We have seen strong take-up by people during their working age, that is, mid-20s till retirement. Personal accident policies are particularly attractive to customers in life stages around starting and raising a family and taking up loans between the 30s and the mid-40s," said Ms Koh.

Here are five real-life examples of personal accident claims.

SEE INVEST

Case 1

Mr Caleb Ho (not his real name), 55, was involved in a road accident and sustained injuries to his shoulder, neck and back. He went for an X-ray and received outpatient treatment which cost him $165 at a traditional Chinese medicine clinic.

His insurer Sompo reimbursed him fully for his outpatient treatment.

Mr Ho's annual premium was $338 for a family plan which offered a sum assured of $100,000 each for him and his spouse, and a sum assured of $25,000 for his child.


Case 2

Aaron Lim (not his real name), five, fell from the third storey of a staircase to the level-two landing. Besides sustaining wounds to his left eye, chest and groin area, he sustained a fatal injury causing brain trauma which led to brain death.

He was taken to Tan Tock Seng Hospital and pronounced dead 10 days later. Sompo paid $12,500 for accidental death and $1,500 for medical expenses.

Aaron was covered as a child under a family plan for $12,500 while the parents were each covered for a sum assured of $200,000.

The annual premium for the family plan was $383.


Case 3

Mr David Soh (not his real name), 36, visited Malaysia to celebrate Chinese New Year and met with a motorbike accident as the ground was slippery after the rain.

He sustained a right-foot fracture, with a foreign object stuck between his second and third metatarsal bones.

Sompo paid out a total claim amount of $1,644 to him. The claim comprised $965 for medical expenses, $100 for miscellaneous benefits and $579 for the weekly income benefit as he had medical leave for 49 days.

His annual premium for his personal accident plan was $223 and it came with a sum assured of $50,000 each for him and his spouse, and a child cover of $12,500.


Case 4

Mr Thomas Tan, 53, met with an accident at work where he was pinned by the tyre of a container stacker.

He was pronounced dead at the scene by paramedics. The cause of death stated on the death certificate was "multiple injuries".

A total of $257,000 was paid out by AXA to Mr Tan's beneficiary. The sum of $257,000 included a death benefit of $200,000, burial expenses of $2,000 and a benefit for family security of $5,000. There was also an automatic increase in benefit payout of $50,000, which is an additional payout upon accidental death when there are no previous claims.

Mr Tan was covered under AXA's group personal accident policy, with the annual premium per employee ranging from $40 to $200.


Case 5

Administrator Carina Loh (not her real name), 50, was on a staycation in Sentosa when she slipped and fell on a flight of stairs. She sustained cuts and bleeding to her left leg and elbow, as well as a right-ankle sprain.

She visited a local public hospital for outpatient treatment for her cuts and ankle sprain, and the medical bill totalled $450. The claim under her Tokio Marine personal accident plan submitted to the insurer was successful, with the cost of $450 fully reimbursed.

"We note that in this case, Madam Loh would not have been able to cover her medical bill using her MediShield Life or Integrated Shield plan as she had not been hospitalised. Even if the claim were possible, it would still be subject to deductible and co-insurance payments," said Mr Bevan Cheong, head of accident and health business at Tokio Marine Life Insurance Singapore. Madam Loh's annual premium was $259 for a sum assured of $100,000.

A version of this article appeared in the print edition of The Sunday Times on April 16, 2017, with the headline 'Personal accidents: Real-life cases'. Print Edition | Subscribe