Does Health Insurance Cover Accidents and Burns?

A boiling pot tips over in the kitchen, or a slip on the stairs leads to a fracture. Such freakish accidents might sound trivial, but they can cause serious injuries that might need hospitalisation and prolonged treatment. The seriousness increases even more in the case of road accidents.

Accidents and burns are two of the most unpredictable factors causing health emergencies. These often are accompanied by painful treatments and hefty hospital bills. In India, where most commuters use two-wheelers, the probability of meeting serious road accidents increases even further.

People often wonder if such emergencies and treatments are covered under regular health insurance, or if you need additional coverage or add-ons to get yourself protected for such contingencies. Let us find out whether your existing regular health insurance covers accidents and burns:

Are Accidents Covered in Standard Health Insurance Plans?

Let us talk about accidents, including road-related mishaps. A general answer to the question would be: Yes, a typical health insurance plan in India would cover treatment and hospitalization costs incurred due to accidents, but you should know about the scope and conditions. Suppose you suffer physical injuries from unforeseen external events like road accidents, falls, or workplace mishaps. In that case, your policy typically covers hospitalization, diagnostic tests, surgeries, room rent, ICU care, and post-treatment recovery.

However, your coverage generally starts after 24 hours of hospitalisation. For instance, if you have suffered minor bruises from a road accident and the doctor decides not to admit you. Your day-care procedures are not covered in your health insurance. However, there are a few insurance providers that have started to provide such reimbursements as well.

However, any claim for accident-related treatment shall be valid subject to the following factors:

• The accident occurred during the policy period
• The injury required medically necessary treatment
• The insurer is informed within the stipulated time (usually 24-48 hours)

In addition, you should follow all the best practices such as maintaining proper records and keeping all documents in line for a quick and hassle-free claim.

What About Burns? Are They Treated Differently?

Let us move to the next aspect: burns. Someone can suffer burns from household activities, such as water or oil, while cooking. Burns are also common during road accidents and in factories that use hazardous and flammable chemicals. Such injuries caused by burns are generally included in your insurance plan, but the extent of coverage depends on how the burns occurred and their severity. If the burns are accidental due to fire, hot liquids, electricity, or chemicals, they are typically eligible for coverage, including hospitalization, medication, and surgery.

Your insurance company will check the degree of burns (first, second or third degree) based on which you might be required to undergo special treatment. For instance, if the burns are severe, you might need ICU admission, skin grafting, or reconstructive procedures. While these are covered if deemed medically necessary, cosmetic or plastic surgery purely for appearance may not be unless you have an add-on rider.

Role of Personal Accident Insurance (Optional Add-On)

Let us now talk about different ways through which you can enhance your health insurance policy. As explained before, your health insurance plan typically covers treatment for injuries caused by accidents and burns. However, you can opt for a personal accident insurance add-on to receive a lump sum amount in case of accidental death or disability, whether partial, total, permanent, or temporary.

What Is Not Covered?

A typical health insurance policy has broad coverage but might have certain exclusions. You should know about such exclusions in order to prevent claim rejection. Here are a few things generally not covered:

How to Ensure a Smooth Claim for Accident/Burn Injuries?

If you or anyone from your family has suffered an accident or burn related injuries, the entire situation can be quite stressful. The last thing you need at that time is a claim rejection or delay in processing such requests. Here are a few things you should do to ensure smooth claim processing:

• Inform your insurer or TPA immediately (ideally within 24 hours of hospitalization).
• Opt for a network hospital for cashless treatment whenever possible.
• Preserve all medical records such as admission notes, discharge summaries, prescriptions, bills, and test reports. This should be a norm for all healthcare-related issues, not just accidents and burns.
• An FIR or incident report may be required in case of road accidents or burns from fire, or chemicals.
• Photographs of injuries (if applicable) can help substantiate claims.
• Follow up with the insurer to track approval and respond to document requests quickly.

Summing up

Accidents and burns include painful treatments and often come up without any warning. You cannot plan for such incidents in advance, but the financial aspect can be handled by evaluating your health insurance policy. Most standard plans cover such emergencies, but understanding the inclusions, exclusions, and optional riders is crucial. You can also go for a personal accident add-on for additional coverage.

FAQs

Are accidents covered under standard health insurance?

Yes, most health insurance plans cover treatment for accidental injuries, including hospitalization and surgery.

Does health insurance cover burns from fire or chemicals?

Yes, accidental burns are usually covered, but cosmetic or non-essential treatments may require additional riders.

What is excluded from accident and burn coverage?

Self-inflicted injuries, intoxication-related accidents, and illegal activity-related injuries are typically excluded.

How does Personal Accident Insurance help?

It provides a lump sum payout for accidental death or disability, acting as an income replacement or support during recovery.

What should I do to ensure a smooth claim process?

Inform the insurer promptly, use a network hospital, and maintain all medical records and documents related to the incident.