Personal Accident

Claim case sharing

Accidental bodily injury must be solely and directly caused by accident

A few days ago, Mr. Lo discovered that the canine tooth on his lower jaw had become loose after he had accidentally bitten a bone biting onto a bone accidentally while dining. He then went to see his dentist who confirmed that his canine had cracked horizontally. After the consultation, Mr. Lo decided to have the tooth extracted.

Mr. Lo has a Personal Accident Insurance policy. As he thought his broken canine was caused accidentally by biting on bone, he filed a claim with his insurance company.

Mr. Lo’s insurance company later informed him that his claim had been declined since they discovered from his medical report that his dental problem was a complication of his periodontal disease. The periodontal disease had caused bone loss around Mr. Lo’s canine, as a result of which his canine had become more fragile. However, Mr. Lo still did not understand why his claim was declined.

MSIG’s advice:

As mentioned in last month’s Personal Accident Tips, “Accidental Bodily Injury” is bodily injury caused solely and directly from accidental external violent and visible means, as evidenced by visible bruise or wound on body, and which are independently of any other cause and not by sickness, disease or gradual physical or mental wear and tear.

In Mr. Lo’s case, his insurance company rejected his claim as it was proved by Mr. Lo’s dentist that Mr. Lo’s broken canine was not solely caused by biting on bone but also by the complication of his existing periodontal disease. Consequently, Mr. Lo’s Personal Accident Insurance cover was not applicable.

To ensure that customers can enjoy comprehensive coverage, they are strongly advised to clearly understand the definition of “Accident” before taking out a Personal Accident Insurance policy.

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