Personal accident insurance

Personal accident insurance pays out if you:

• suffer a serious injury
• die as a result of an accident
• become totally and permanently disabled

Policies pay a fixed amount of money for specific injuries, depending on the level of cover. For example, a policy might pay £10,000 for loss of a limb, £8,000 for loss of an eye, £100,000 for the death of a policyholder, etc. The policy document will set out the levels of cover for different injuries.

Unlike most insurance policies, personal accident insurance does not indemnify you. This means it doesn’t try to put you back in the position you were in before the accident occurred. It pays out a fixed amount of money if you meet the policy terms.

Most personal accident policies specify that the injury must be “solely and directly” caused by an accident. They usually contain an exclusion for death or injury caused by sickness, disease or any naturally occurring condition. 

The difference between personal accident and other types of insurance

Personal accident insurance is often confused with payment protection insurance (PPI) and income protection insurance.

Payment protection insurance (PPI)

PPI protects your payments if you have an accident, or become sick or unemployed. It covers accidents but is not the same as personal accident insurance. Find out how we can help you if you have a complaint about PPI.

Income protection

This insurance protects your income if you fall ill and can’t work. Personal accident policies pay a one-off cash benefit, but income protection policies pay a percentage of your income each month. Find out how we can help you if you have a complaint about income protection insurance.

Critical illness insurance

Critical illness cover pays a lump-sum cash payment if you develop a critical illness like cancer, heart failure or stroke. Find out how we can help you if you have a complaint about critical illness insurance.

Personal accident policies are sold as stand-alone policies – either individual policies, or group policies taken out by an employer.

Policies can also be:

• included with other insurance products – like travel insurance, car insurance or with a bank account
• sold as ‘road and travel’ cover to protect you if you have an accident while travelling in cars, trains, planes and boats

The most common type of complaint we see is where an insurer has declined a claim, perhaps because:

• the death or injury wasn’t caused by an accident
• the death or injury wasn’t “solely and directly” caused by an accident – for example, the accident only contributed to the injury
• a specific exclusion clause applies
• the customer’s injury or disability isn’t serious enough to meet the terms of the policy

We’ll consider all the evidence including the policy wording and what is fair and reasonable in all the circumstances.

If you need help with a complaint about a declined claim, use our information on personal accident claims issues.

Get help with your complaint if you feel your policy was mis-sold to you.

If you have a complaint about personal accident insurance, talk to your insurer first. They need to have the chance to put things right. They have to give you their final response within 8 weeks for most types of complaint.

If you’re unhappy with their response, or if they don’t respond, let us know. We’ll check your complaint is something we can deal with, and if it is, we’ll investigate to understand what happened and what went wrong.

Find out more about how to complain.

We use the following rules and regulation to help us deal with complaints about personal accident insurance.

• Insurance Conduct of Business Sourcebook (ICOBS)
• Treating Customers Fairly