Accident and Health Insurance

An accident in insurance means a sudden, unforeseen, external impact on the human body, the result of which is a temporary or permanent health disorder, as well as the death of the insured.     The object of accident insurance is the property interests of the insured associated with disability or death due to an accident. Each insurance company develops a detailed list of events that are recognized as accidents and are included in insurance coverage. Traditional insurance events are:

  • injuries and other bodily harm,
  • burns, poisoning, hypothermia and frostbite;
  • disability and death of the insured.

 Excluded from insurance coverage:

  • suicide
  • injuries resulting from unlawful actions;
  • accidents due to alcohol or drug intoxication;
  • military operations, etc.

 Accident insurance is carried out in mandatory and voluntary forms. Compulsory accident insurance is carried out in three areas:

 1. Obligatory insurance against industrial accidents. It is one of the elements of the state social insurance system. It covers the risks of work-related injuries and occupational diseases. Insurance is entrusted to the Social Insurance Fund.      This insurance was introduced by the Law of July 24, 1998. No. 125 FZ. Under the current law, all enterprises pay contributions differentiated by industry and enterprise depending on working conditions and the level of occupational injuries (from 0.2 to 10.7% of the wage bill). The law provides for the following insurance coverage:       • temporary disability allowance in the amount of 100% of average earnings; 
      • lump sum payment (as a result of death of 60 minimum wages); 
      • monthly payments to the insured in case of disability; 
      • payment of additional medical expenses. 

2. Compulsory insurance of civil servants whose professional activities are associated with an increased risk of accident in the performance of their official duties. In the Russian Federation, military personnel, employees of the Ministry of Internal Affairs, tax inspectorates, tax police, rescuers, court and prosecutor’s employees, astronauts, etc. are subject to compulsory insurance. Insurance indemnity is determined based on official salary or minimum wage. 

3. Compulsory passenger insurance applies to citizens transported by air, rail and road transport on intercity and tourist routes. According to the law, the obligation to pay the fee rests with the insured – passenger when buying a ticket. Transport organization – the carrier selects the insurance company and concludes an agreement with it on the implementation of this insurance. The maximum amount is -120MROT.    

  Voluntary accident insurance provides insured persons and their families with comprehensive protection against the economic consequences of disability or death resulting from a sudden, unforeseen, external impact on the human body. Diseases and everyday negative environmental effects are excluded.      Under this agreement, the insurer assumes the obligation to pay the insured or the beneficiary upon occurrence of insurance events provided for by the insurance contract.      The insurance amount is determined by agreement of the insurer and the insured (has no restrictions). It completely depends on the financial capabilities of the insured, since the larger the insurance amount, the greater the insurance premium must be paid (S * T = P). With a very large sum insured, the insurer has the right to appoint a medical examination to exclude the presence of serious (AIDS, cancer, etc.) diseases.      The duration of the contract is usually one year or several years.

 Short-term insurance for several months (for work, travel) is also possible.      The tariff is from 1 to 3% of the sum insured. The size of the tariff depends on the gender, age, profession of the insured, as well as on the method of payment of security in case of injury:

 1) a table of the cost of living is used. According to the table, any injury is a certain percentage of the cost of living. For example: finger fracture – 5% of the cost of living; 

2) a percentage of the sum insured for one day of incapacity for work (usually from 0.2 to 2%) is calculated by the contract. The higher the percentage set in the contract, the higher the tariff;

 3) a fixed amount for one day of disability. The amount of this amount depends on the sum insured under the contract. Most often, the second payment method is used.    

 In case of disability or death of the insured, the amount of security shall be determined:    

 • third group ~ 50% of the sum insured; 
     • second group ~ 70-80% of the sum insured; 
     • the first group or death ~ 100%. Insurance coverage is paid to the policyholder or a third party, regardless of the amounts due to them under other insurance contracts, as well as social insurance, social security and compensation for harm. At the same time, insurance coverage for personal insurance due to the beneficiary in the event of the death of the insured is not included in the estate.

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