Personal Accident

Claim case sharing

How is an "accident" defined in personal accident insurance?

Mrs. Chu felt pain in her back after doing 2 hours of housework and thought that she had accidentally sprained her back by adopting an incorrect posture. As a result, she consulted her family doctor and then filed a claim with her insurance company for personal accident medical expenses. 

However, it was rejected by her insurer. Why was Mrs. Chu's claim rejected?
The insurer rejected her medical expenses claim on the grounds that Mrs. Chu's injury did not fulfil the definition of "bodily injury". According to Mrs. Chu's personal accident policy, "bodily injury" means:

"Bodily injury suffered anywhere in the world caused solely and directly from accidental external violent and visible means and which are independent of any other cause and not by sickness, disease or gradual physical or mental wear and tear."

As no element of accidental external violent and visible means could be identified in Mrs. Chu's case, her insurance company was unable to indemnify her medical expenses.

Many people have a misconception that all unintentionally caused injuries are covered by personal accident insurance. In reality, a personal accident insurance claim is decided by the facts of the situation leading up to the injury. Though the definition of "bodily injury" varies between different personal accident insurance policies available in the market, most of them only cover "bodily injury" caused solely and directly by accidental external violent and visible means. For example, a cut finger or bone fracture caused by slipping over is covered by most policies as there is evidence of accidental external violent and visible means, but an arm or back sprain caused by cleaning a ceiling or window is not covered as there is no evidence of accidental external violent nor visible means. Customers are therefore advised to read any policy carefully in order to have the most suitable protection for their needs.

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