Falls, strains & injuries from sport: a complete guide to comparing accident insurance coverage

Accidents can happen anytime, anywhere — a fall on the street, a sports injury or even a burn from hot water can disrupt your life and lead to expensive medical bills. If you already have medical insurance, you might be wondering if you really need accident insurance as well. In this article, we’ll address your questions one by one to help you understand the importance of accident insurance.

To understand the unique value of accident insurance, it is essential to clarify the differences between it, medical insurance and critical illness insurance. While all three are health-related, their purposes and compensation methods are distinctly different.

In short, medical insurance covers your medical bills, accident insurance provides income support if you can’t work due to an injury and critical illness insurance offers a lump sum to help you through a serious illness. These three types of insurance complement each other, ensuring you have complete peace of mind.

Comprehensive accident insurance coverage should encompass everything from medical expenses to death and disability. Additionally, extra coverage can be provided based on individual needs. The main areas of coverage can be divided into the following four categories:

1. Accidental death and permanent disability coverage

This is the essential type of coverage provided by accident insurance. If the insured person passes away or suffers permanent disability due to an accident, a lump-sum payout is provided to give the family immediate financial support.

• MSIG iSafe Accident Insurance provides coverage of up to HK$1,000,000 for you and your family members

2. Personal liability protection

Covers any claim against you if you are legally liable to pay compensation for accidents which happen within Hong Kong and result in third-party bodily injury or property damage.

• MSIG iSafe Accident Insurance: personal liability protection of up to HK$1,000,000 under the adult plan

3. Medical expenses arising from accidents

This type of insurance also reimburses medical expenses resulting from accidents. Beyond basic consultation and hospital fees, check whether the coverage also includes follow-up treatments such as physiotherapy, Chinese bone setting or chiropractic sessions.

• MSIG iSafe Accident Insurance 
  o    Covers medical expenses up to HK$20,000 per accident
  o    Coverage also extends to physiotherapy, chiropractic, bone setting & acupuncture treatment expenses, with annual benefits of up to HK$2,500

4. Additional coverage

As well as the three core benefits, a good plan also offers extra coverage to give you more comprehensive protection.

• MSIG iSafe Accident Insurance also covers the following:
  ○    Hospitalisation cash allowance: Up to HK$500 per week, for a maximum of 52 weeks
  ○    Damage to personal belongings: Covers damage to clothing and personal effects, up to HK$2,000 per accident

Many people mistakenly believe that personal accident insurance covers all bodily injuries that are not intentionally caused. However, in reality, the policy terms have a precise definition of what constitutes an “accident”. To understand more, we can start with the following claims cases.

After doing two hours of housework, Mrs Chu felt pain in her back. She suspected that she had strained herself due to poor posture while cleaning, so she consulted her family doctor and filed a claim with her personal accident insurance company for medical expenses. However, the insurance company ultimately rejected her claim.

The reason is that Mrs Chu’s injury did not meet the definition of “bodily injury” in the policy: “‘The insured’ is injured purely due to accident, an external force, violence and visible factors, rather than any other cause or any disease, condition, gradual deterioration of bodily functions or mental impairment.”

Since Mrs Chu’s strain was not caused by an external force, violence or visible factors, the insurance company was unable to compensate her. Different personal accident insurance policies in the market have varying definitions of “bodily injury”, but most only cover injuries resulting purely from the aforementioned factors.

For example, there is a clear distinction between the following situations:

• Covered: Injuries such as cutting a finger with a sharp object or fracturing an elbow due to slipping over are included in the policy coverage because they involve external and visible factors.
• Not covered: Straining an arm or the back while reaching to clean the ceiling or window does not involve an external force, violence or visible factors, so it falls outside the coverage.

Therefore, it is advised to read the policy carefully to choose the most suitable coverage.

A well-designed accident insurance policy provides targeted coverage for life’s different stages.

• For children: coverage for school activities and rehabilitation
  Children are active as they grow, leading to a higher risk of accidents. Targeted coverage should include additional protection for accidents occurring during school activities, allowances for parents who need to take leave to care for their children and expenses for purchasing rehabilitation equipment (such as wheelchairs and crutches).

   

• For adults: additional coverage for holiday sports and transportation accidents
  Urban life can be busy, and accident coverage should address everyday details. These includes extra compensation for accidents occurring on weekends or holidays, double compensation for death resulting from public transportation incidents, and even coverage for necessary cosmetic surgery due to accidents.

   

• For aging parents: coverage for fractures and prosthetic costs
  As people age, the risk of fractures from falls increases. Plans for seniors should provide a lump sum for fractures and cover the costs of installing prosthetics. Generally, the maximum insurable age is 70, with the possibility of renewal until age 75.

When comparing different accident insurance options, you can focus on the following three areas to make the best decision.

• One: impact of occupational categories
  When taking out accident insurance, your occupation is a crucial factor affecting premiums and eligibility. Insurance companies typically categorise jobs based on risk. MSIG iSafe Accident Insurance is designed for professionals engaged in non-manual labour, aiming to provide comprehensive coverage for them. The various plans mainly cover Class One (office-based) and Class Two (other non-manual) occupations, such as office clerks, accountants and salespeople. When applying, you need to accurately declare your occupation to ensure the plan aligns with your job nature.

   

• Two: compare compensation limits and details
  In addition to comparing the total coverage for accidental death or permanent disability, pay attention to the compensation limits for various scenarios. For example, for treatments like physical therapy or trauma care, confirm whether the compensation limit is calculated per incident or annually, and what the limit is for each treatment session.

   

• Three: understand exclusions
  Every policy has exclusions. Common examples include engaging in professional sports, participating in or conducting skydiving, paragliding, competitions, speed races, endurance races, hiking or trekking at altitudes over 5,000 metres, and scuba diving at depths exceeding 30 metres. Taking the time to read the policy before purchasing will help you establish a clear understanding of your coverage and avoid misunderstandings.

1. I already have group accident insurance provided by my company. Do I need to buy an additional policy?

Before deciding, consider a few points. First, the coverage amount of your company’s insurance might not be sufficient, especially in the case of serious accidents. Second, the coverage is often limited to work-related accidents. Finally, the coverage will cease when you leave the company. Therefore, purchasing a personal accident insurance policy can provide you with more comprehensive protection that is not affected by job changes.

2. What is the difference between accident insurance and medical insurance?

Medical insurance covers medical expenses caused by either “accidents” or “illnesses”, primarily reimbursing medical bills on a “fee-for-service” basis. In contrast, accident insurance offers broader protection against a range of “accident” scenarios and their associated outcomes. Besides reimbursing medical expenses from accidents, its core function is to provide a cash lump sum for death or disability resulting from an accident, helping to replace lost income or address long-term lifestyle changes.

3. Does accident insurance cover common incidents like falls, strains or sprains?

Yes. As long as the injury meets the policy’s definition of an “accident” (i.e., caused by external and sudden factors), related medical expenses will be covered. For example, if you fall over due to a slippery surface or twist an ankle after tripping over an object, the costs for consulting a registered Chinese medicine practitioner or for physiotherapy would fall under the coverage for accident-related medical expenses.

4. Are injuries sustained while participating in sports, such as hiking or playing basketball, considered covered “accidents”?

Yes. As long as you are participating in an amateur capacity, most sports, such as hiking, basketball, soccer and yoga, are covered for accidental injuries. MSIG’s accident insurance even includes some high-risk sports, such as winter sports, horse riding, water skiing and scuba diving, allowing you to pursue your interests with greater peace of mind.

5. How do I file a claim for accident insurance?

You can easily complete your application through MSIG’s EASY Claims online system:

• Step 1 (prepare information): Before starting, please have your policy number ready, along with clear photos or scans of all relevant documents (such as medical reports and original receipts).
• Step 2 (fill out and upload online): Go to the EASY Claims online portal, follow the instructions to fill out your information, and upload your documents.
• Step 3 (submit and inquire): After completing and submitting the form, you will receive a claim reference number. You can check the claim progress at any time by entering this number on the claims progress page.
• Step 4 (receive compensation): Once the claim has been approved, the compensation amount will be transferred to the bank account you provided, ensuring convenience and speed.

The product information provided above is for reference only. For details on coverage and policy terms, please refer to your insurance policy.