RuPay Insurance Program 2023-24 Annexure A

Claims Process – RuPay Insurance Program FY 2023-24 for RuPay PMJDY

Cards

A) Claim intimation

1. All the claims where incident has happened in the financial year 2023-24, should
be intimated to the dedicated claims id [email protected]

2. A printed copy of the captioned intimation email should be sent to The New India
Assurance Co. Ltd. along with all other documents.

3. Claim intimation should be within Ninety (90) days from the date of accident. In
case where a person is hospitalized (and under a critical condition) and is unable
to file claim within 90 days of loss/incident such claim cases will be accepted by
The New India Assurance Co. Ltd. for investigation and honoured, if all terms under
the policy are met as on date of accident.

B) Documents Receipt / Follow-up

All documents are to be received at The New India Assurance Co. Ltd. office at the below
mentioned address:

Senior Divisional Manager

Claims Hub,Mumbai
Regional office - 2 ,
Jeevan seva,
2nd Floor, S.V. Road,
Santacruz (W), Mumbai:- 400054.

1. Claim intimation should be within Ninety (90) days from the date of accident. In
case where a person is hospitalized (and under a critical condition) and is unable

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RuPay Insurance Program 2023-24 Annexure A

to file claim within 90 days of loss/incident such claim cases will be accepted by
The New India Assurance Co. Ltd. for investigation and honored, if all terms under
the policy are met as on date of accident.

2. All supporting documents relating to the claim must be submitted within sixty
(60) days from the date of intimation.

3. The eligible claims will be settled in ten (10) working days from the date of receiving
the complete documents set.

4. In case the settlement is not confirmed, the Bank should follow up with The New
India Assurance Co. Ltd. &/OR NPCI for status update of the claim and comply for
the pending requirements in hard copy by post/courier. (Scanned images of
required documents shall not be sent to the Insurance Company).

5. In case documents are not received within sixty (60) days of claim intimation, 1st
reminder, hard copy letter will be issued to Member Bank by The New India
Assurance Co. Ltd. followed by an email communication.

6. 2nd reminder hard copy letter will be sent by The New India Assurance Co. Ltd.
after eighty one (81) days from claim intimation followed by an email.

7. Closure letter, hard copy letter will be sent to Member Bank on 90th day from claim
intimation in case of no communication received from Member Bank.

C) Investigator Appointment (Specific cases that need detailed investigation)

Based on the merit of the claim, The New India Assurance Co. Ltd investigation team shall
be appointed. TAT: T +3 (T is the day on which the claim documents received from the
Member Bank).

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 RuPay Insurance Program 2023-24 Annexure A

In 30 days, Investigation report will be finalized. If there is a delay because of some more
facts, an interim report will be requested.

D) Claims Follow up / Processing

The reminders shall be sent by New India Assurance Co. Ltd. to Member Bank at regular
intervals for pending claim documents, a communication via letter in hard copy / email will
be sent to client with defined timeline. All emails sent for the purpose of follow up should
be marked to NPCI Insurance mail id [email protected].
Reminder process would be same for the documents deficiency also.
1st reminder T+61
2nd reminder T+81
Closure Letter T+90
T is Date of Intimation

E) Escalation Matrix

For Claims & Policy Administration

Sr. Escalation Name Designation E-Mail Id Contact No.

No. Level
First Ms Deepa Sr.Divisional [email protected] 022-26591702
Bavdankar Manager
Ms Sudha Asst. Manager [email protected] 022-26590156
Keluskar
Ms Narendra Admin. Officer [email protected] 022-26590156
Patil
Second Mr Sanjay Regional Manager [email protected] 022-26633237
Paigankar
Final Ms. Uma Chief Regional [email protected] 022-26633231
Iyer Manager

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RuPay Insurance Program 2023-24 Annexure A

F) Claim Payment

Once the claim is approved, the payment in the form of NEFT shall be done to the
cardholder (in case of Disablement) / to nominee or legal heir (in case of Death) along with
a covering letter.

G) Dispute Management

Committee of 3 people as mentioned below to resolve the dispute.

1. Representative from The New India Assurance Co. Ltd.
2. Representative from NPCI.
3. Representative/s of the disputing Bank/s.

H) Document check list –

For Accidental Death Claims:

a) Claim Form duly completed and signed.
b) Original or Certified copy of Death Certificate.
c) Original or Certified copy of FIR/ Police report giving description of the accident.
d) Original or certified copy of Post Mortem Report along with Chemical Analysis/
FSL reports (wherever applicable).
e) Aadhar copies of Cardholder and Nominee.
f) Declaration from Card Issuing Banks duly signed by authorized signatory and
bank stamp: specifying that:
1. Cardholder is holding a RuPay card on RuPay issued IIN and mention the 16
digit card number
2. Compliance of 90 days transaction criteria (to be supported with transaction log
/ account statement from the bank's system)
3. Nominee Name and its banking details (including Passbook copy)
4. Brief description of Accident as per FIR translated in English or Hindi.

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RuPay Insurance Program 2023-24 Annexure A

5. Bank official's Name and contact details with email ID.

Permanent Total Disability Claim: –

a) Claim Form duly completed and signed.

b) Discharge card along with case history confirmation therein duration &
percentage of disability duly certified by the concerned/treating
Physician/Surgeon.
c) Original or Certified copy of FIR/ Police report giving description of the accident.
d) All investigation report in original copies* thereof in respect of tests had
undergone pertaining to accident.
e) Additional documents, if any, based on merit of the loss.
f) Aadhar copies of Cardholder and Nominee
g) Declaration from Card Issuing Banks duly signed by authorized signatory and
bank stamp specifying that:
1. Cardholder is holding a RuPay card on RuPay issued IIN and mention the 16
digit card number
2. Meeting 90 days transaction criteria (include the transaction log / account
statement from the system)
3. Nominee Name and his banking details (including Passbook copy)
4. Brief description of Accident as per FIR translated in English or Hindi.
5. Bank official's Name and contact details with email ID.

** If the original claim documents are submitted to any particular General Insurance
co., copies of the same duly certified by Branch in-charge of RuPay card issuing
bank can be submitted.

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RuPay Insurance Program 2022-23 Frequently Asked Questions Annexure B

RuPay Insurance Program - RuPay PMJDY Cards for FY - 2023-24

Frequently Asked Questions

Death Claims

Q1. What is an accident?

Ans. Accident or Accidental means a sudden, unforeseen and involuntary event caused by
external, visible and violent means.

Q2. What are the benefits payable under this policy?

Ans. Now you can protect yourself with Personal Accident Insurance against accidental
injuries caused by all kind of accidents. The policy provides the benefits to you, for Accidental
Death and Permanent Total Disability.

Q3. Does the Personal Accident policy cover natural death, suicide or death due to
some illness/disease/pregnancy?
Ans. No, Personal Accident policy covers death occurring only due to accidents or accidental
injuries which are non- intentional or not self-inflicted.

Q4. What is the available sum insured under the plan?

Ans. Sum insured of Rs 1 lakh for RuPay cardholders of Old* PMJDY Cards and of Rs 2
lakhs for RuPay cardholders of New** PMJDY Card.

Q5. What is the eligibility criterion to avail Personal Accident Insurance cover on my
RuPay Card?
Ans: Benefits of Insurance will be available to the Cardholders who have performed
minimum one successful transaction as under:
1. financial or non-financial transaction at any Channel both Intra and Inter-bank i.e.
on-us (ATM/MicroATM/POS/e-com/Business Correspondent of the bank at
locations by any payment instrument) within 90 days prior to date of accident
including accident date of RuPay PMJDY Cardholders or off us (same bank
channels- Bank Customer/RuPay cardholder transactions at other bank channels).

Q6. Is there any age limit for availing Personal Accident Policy?
Ans. Personal Accident Insurance is open to all RuPay cardholders above 5 years subject to
fulfilment of the terms and conditions of the policy.

PMJDY OLD* – RuPay PMJDY Cards issued on PMJDY accounts opened till 28th Aug 2018
PMJDY New** – RuPay PMJDY Cards issued on PMJDY accounts opened after 28th August
2018
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RuPay Insurance Program 2022-23 Frequently Asked Questions Annexure B

Q7. Does the policy have a worldwide coverage?

Ans. Yes, the Personal Accident policy will cover you even if the incident has happened when
out of the country. Claim will be paid in Indian rupees as per the sum insured on submission
of required documentation. There is no negative list of countries.

Q8. Who can be the beneficiary?

Ans. The beneficiary could be nominee on the account of the cardholder or legal heir as per
competent court order.

Q9. Who is the beneficiary in case there are multiple heirs / beneficiaries?
Ans. In case of multiple beneficiaries the claim is settled in the name of heir as per legal heir
certificate submitted.
In case the legal heir absolutes his right of claim (i.e. legal heir doesn’t want to claim) we will
need the NOC from him/her and the claim can be settled in the name of other beneficiary so
nominated.

Q10. How do I make a claim?

Ans. Please fill the entire documents as per the checklist and submit the same to the Bank /
Bank branch where RuPay cardholder has an account.

Q11. Whom should I contact in case of a claim?

Ans. Please contact RuPay cardholder Bank / Bank branch of which RuPay cardholder has a
card for intimating claim.

Q12. What are the claim documents to be submitted in case of a claim, whether incident
has happened in India or overseas?
Ans. For Accidental Death Claims:
a) Claim Form duly completed and signed.
b) Original or Certified copy of Death Certificate.
c) Original or Certified copy of FIR / Police report giving description of the accident.
d) Original or Certified copy of Post Mortem Report along with Chemical Analysis/FSL
reports wherever applicable.
e) Aadhar copies of Cardholder and Nominee.
f) Declaration from Card Issuing Banks duly signed by authorized signatory and bank stamp
specifying that:
1. Cardholder is holding a RuPay card on RuPay issued IIN and mention the 16 digit
card number
2. Compliance of 90 days transaction criteria (to be supported with transaction log / account
statement from the bank's system)
3. Nominee Name and his banking details (including Passbook copy)
4. Brief description of Accident as per FIR translated in English or Hindi.
5. Bank official's Name and contact details with email ID.

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** If the original claim documents are submitted to any particular General Insurance co., copies
of the same duly certified by Branch in-charge of RuPay card issuing bank can be submitted.

Q13. In how many days the claims will be settled?

Ans. The claims will be settled in ten (10) working days from the date of receiving the complete
document set by The New India Assurance Co. Ltd.

Q14. In how many days should I intimate about claim?

Ans. The intimation should be immediate to The New India Assurance Co. Ltd. or Bank but
not later than ninety (90) days of the date of accident. In case where the person is hospitalized
(and under critical condition) and is unable to file claim within ninety (90) days of loss/incident
such claim cases will be accepted by The New India Assurance Co. Ltd for investigation and
honoured, if all terms under the policy are met as on date of accident.

Q15. In how many days should I submit the claim documents?

Ans. The claim documents must be submitted within sixty (60) days from the date of claim
intimation.

Q16. In case RuPay Cardholder having a Personal Accident policy with another
insurance Company, will this Insurance Policy will be an additional cover?
Ans. Yes, the policy is a benefit policy and hence it will be an additional cover over the other
Personal Accident insurance policies being held by the cardholder.

Q17. What do you mean by exclusions?

Ans. Exclusions are situations or conditions wherein The New India Assurance Co. Ltd is not
liable to pay the benefits to insured person in the event of accident.

Q18. What are the exclusions applicable?

Ans. The New India Assurance Co. Ltd. shall not be liable under this policy for the following
exclusions:
1. Compensation under more than one of the foregoing Sub-clauses in respect of the
same period of the same period of disablement of the Insured person.
2. Any other payment to the same person after a claim under one of the Sub-Clauses
(a), (b), or (d) has been admitted and become payable. However, amounts relating to
medical expenses, carriage of dead body would be payable in addition if applicable.
Sub-clause (a): If such injury shall within twelve calendar months of its occurrence be
the sole and direct cause of the death of the Insured person, the Capital Sum Insured
stated in the Policy Schedule hereto, applicable to such insured person.
Sub-Clause (b): If such injury shall within twelve calendar months of its occurrence be
the sole and direct cause of the total and irrecoverable loss of
1.a.a. Sight of both eyes, or of the actual loss by “physical separation” of two
entire hands or two entire feet, or of one entire hand and one entire foot, or of
such loss of sight of one eye and such loss of sight of one eye and such loss

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RuPay Insurance Program 2022-23 Frequently Asked Questions Annexure B
of one entire hand or one entire foot, the Capital Sum Insured stated in the
Policy Schedule herein applicable to such Insured person.

1.a.b. Use of two hands or two feet, or of one hand and one foot, or of such
loss of sight of one eye and such loss of use of one hand or one foot, the
Capital Sum Insured stated in the Policy Schedule hereto, applicable to such
Insured person.
Sub-Clause (c): If such injury shall within twelve calendar months of its occurrence be
the sole and direct cause of the total and irrecoverable loss of
1. the sight of one eye, or of the actual loss by physical separation of one
entire hand or of one entire foot, fifty percent (50%) of the Capital Sum
Insured stated in the Policy Schedule hereto, applicable to such Insured
person.
2. total and irrecoverable loss of use of a hand or a foot without physical
separation, fifty percent (50%) of the Capital Sum Insured stated in the
Policy Schedule hereto, applicable to such Insured person.
Note: For the purpose of Clauses (b) and (c) above, physical separation of a hand
means separation at or above the wrist and of the foot means at or above the ankle.
Sub-Clause (d): If such injury shall, as a direct consequence thereof, immediately,
permanently, totally and absolutely, disable the Insured person from engaging in being
occupied with or giving attention to any employment or occupation of any description
whatsoever, then a lump sum equal to hundred percent (100%) of the Capital Sum
Insured, stated in the Policy Schedule hereto applicable to such insured person.
Any payment in case of more than one claim in respect of such insured person under the
Policy during any one period of insurance by which the maximum liability of the Company
specified in the Policy schedule applicable to such Insured person would exceed the sum
payable under sub-clause (a) of this Policy to such insured person. However, amount relating
to medical expenses and carriage of dead body would be payable in addition if applicable.
Sub-clause (a): If such injury shall within twelve calendar months of its occurrence be
the sole and direct cause of the death of the Insured person, the Capital Sum Insured
stated in the Policy Schedule hereto, applicable to such insured person.
1. Payment of weekly compensation until the total amount shall have been ascertained
and agreed.
2. Payment of compensation in respect of Death, injury of Disablement of the Insured
person (a) from intentional self-injury, suicide or attempted suicide, (b) whilst under the
influence of intoxicating liquor or drugs (c) whilst engaging in Aviation or Ballooning
whilst mounting into, dismounting from or traveling in any balloon or aircraft other than
as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft
anywhere in the world, (d) directly or indirectly caused by venereal diseases, aids or
insanity, (e) arising or resulting from the insured person committing any breach of law
with criminal intent, (Standard type of Aircraft means any aircraft duly licensed to carry
passengers ( for hire or otherwise) by appropriate authority irrespective of whether
such an aircraft is privately owned OR chartered OR operated by a regular airline OR
whether such an aircraft has a single engine or multi engine.
3. Payment of compensation in respect of Death, Injury or Disablement of the Insured
person due to or arising out of or directly or indirectly connected with or traceable to:
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RuPay Insurance Program 2022-23 Frequently Asked Questions Annexure B
War, Invasion, Act or foreign enemy, Hostilities (whether war be declared or not), Civil
War, Rebellion, Revolution, Insurrection, Mutiny, Military or Usurped Power Seizure,
Capture, Arrests, Restraints and Detainments of all kings, princes and people of
whatsoever nation condition or quality.
4. Payment of Compensation in respect of death of, or bodily injury or any disease or
illness to the Insured person -
▪ Directly or indirectly caused by or contributed to by or arising from
ionizing radiations or contamination by radioactivity from any nuclear
fuel or from any nuclear waste from the combustion of nuclear fuel. For
the purpose of this exception, combustion shall include any self-
sustaining process of nuclear fission.
▪ Directly or indirectly caused by or contributed to by or arising from
nuclear weapons material.
• Provided also that the due observance and fulfilment of the terms and
conditions of this Policy (which conditions and all endorsements hereon are to
be read as part of this Policy) shall so far as they relate to anything to be done
or not to be done by the Insured and/or Insured person be a condition
precedent to any liability of the Company under this Policy.
5. Pregnancy Exclusion Clause: The Insurance under this Policy shall not extend to cover
death or disablement resulting directly or indirectly caused by contributed to or aggravated or
prolonged by child birth or from pregnancy or in consequence thereof.

Q19. If the incident occurs in a timeline of 0-90 days of issuance of the RuPay card,
thereby not giving a window of 90 days qualifying criteria for doing a transaction in
order to be eligible for the insurance benefit, is the Cover still valid?
Ans. Yes, as an exception in such cases the cover is still valid and claim can be intimated as
applicable for RuPay PMJDY Cardholders.

Q20. Since the cover is effective 1st April, 2023 and upto 31st March, 2024, if incident
happens on 15th April, 2023 and the transaction has happened prior to the policy period
is the cover valid?
Ans. Yes, as long as the incident has happened in the policy period the cover is valid.

Q21. For how many cards will I be eligible for the compensation of Insurance cover?
Ans. The Insurance policy is applicable for the compensation of only one eligible RuPay card
per cardholder or per customer, even if multiple cards held by cardholder of same / different
banks meet the eligibility criteria. The choice of the card for the claim would rest with the
customer.

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RuPay Insurance Program 2022-23 Frequently Asked Questions Annexure B
Permanent Total Disability

Q1. What is Permanent Total Disability?

Ans. Permanent Total Disability is defined as permanent loss of ability to use a body part due
to accidental injuries. The cover is restricted as mentioned in table in answer to Question No
3 below.

Q2. What is the benefits payable under this policy?

Ans. This policy pays for any Permanent Total Disability due to an accident.

Q3. What is covered under Permanent Total Disability whether incident has happened
in India or overseas?
Ans. Permanent Total Disability due to an accident will cover the following:

The Disablement Compensation %

1) Permanent Total Disablement 100%

2) Permanent and incurable insanity 100%
3) Permanent Total Loss of two Limbs 100%
4) Permanent Total Loss of Sight in both eyes 100%
5) Permanent Total Loss of Sight of one eye and 100%
one Limb
6) Permanent Total Loss of Speech 100%
7) Complete removal of the lower jaw 100%
8) Permanent Total Loss of Mastication 100%
9) Permanent Total Loss of the central nervous 100%
system or the thorax and all abdominal organs
resulting in the complete inability to engage in
any job and the inability to carry out Daily
Activities essential to life without full time
Assistance
10) Permanent Total Loss of Hearing in both ears 75%
11) Permanent Total Loss of one Limb 50%
12) Permanent Total Loss of Sight of one eye 50%
13) Permanent Total Loss of Hearing in one ear 15%
14) Permanent Total Loss of the lens in one eye 25%
15) Permanent Total Loss of use of four fingers and 40%
thumb of either hand
16) Permanent Total Loss of use of four fingers of 20%
either hand
17) Permanent Total Loss of use of one thumb of
either hand:
a) Both Joints 20%
b) One joint 10%

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18) Permanent Total Loss of one finger of either
hand:
a) Three joints 5%
b) Two joints 3.5%
c) One joint 2%
19) Permanent Total Loss of use of toes:
a) All-one foot 15%
b) Big-both Joints 5%
c) Big-one joint 2%
d) Other than Big- each toe 2%
20) Established non-union of fractured leg or kneecap 10%
21) Shortening of leg by at least 5cms 7.50%
22) Ankylosis of the elbow, hip or knee 20%

Q4. What is the available sum insured under this insurance cover?
Ans. Sum insured of upto Rs 1 lakh for RuPay cardholders of Old PMJDY Cards and of upto
Rs 2 lakhs for RuPay cardholders of New PMJDY Card.

Q5. What is the eligibility criterion to avail Permanent Total Disability Insurance cover
on my RuPay Debit Card?
Ans : Benefits of Insurance will be available to the Cardholders who have performed
minimum one successful transaction as under :
1. financial or non-financial transaction at any Channel both Intra and Inter-bank i.e.
on-us (ATM/MicroATM/POS/e-com/Business Correspondent of the bank at
locations by any payment instrument) within 90 days prior to date of accident
including accident date of RuPay PMJDY Cardholders or off us (same bank
channels- Bank Customer/RuPay cardholder transactions at other bank channels).

Q6. Is there any age limit for opting Permanent Total Disability Policy?
Ans. Permanent Total Disability Insurance policy is open to all RuPay cardholders above 5
years’ subject to fulfilment of the terms and conditions of the policy.

Q7. Does the policy have a worldwide coverage?

Ans. Yes, the Permanent Total Disability policy will cover you even if the incident has happened
when out of the country. Claim will be paid in Indian rupees as per the sum insured on
submission of required documentation. There is no negative list of countries.

Q8. Who can be the beneficiary?

Ans. Beneficiary will be the insured under this policy.

Q9. What are the claim documents to be submitted in case of claim?

Ans. Permanent Total Disability Claim Forms:-

a) Claim Form duly completed and signed.

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RuPay Insurance Program 2022-23 Frequently Asked Questions Annexure B
b) Discharge card along with case history confirmation therein duration & percentage
of disability duly certified by the concerned/treating Physician/Surgeon.
c) Original or Certified copy of FIR/ Police report giving description of the accident.
d) All investigation report in original copies* thereof in respect of tests had
undergone pertaining to accident.
e) Additional documents, if any, based on merit of the loss.
f) Aadhar copies of Cardholder and Nominee
g) Declaration from Card Issuing Banks duly signed by authorized signatory and
bank stamp specifying that:
1. Cardholder is holding a RuPay card on RuPay issued IIN and mention the 16 digit
card number
2. Meeting 90 days transaction criteria (include the transaction log / account
statement from the system)
3. Brief description of Accident as per FIR translated in English or Hindi.
4. Bank official's Name and contact details with email ID.

** If the original claim documents are submitted to any particular General Insurance
co., copies of the same duly certified by Branch in-charge of RuPay card issuing bank
can be submitted.

Q10. In how many days the claim will be settled?

Ans. The claims will be settled in ten (10) working days from the date of receiving the complete
document set by The New India Assurance Co. Ltd.

Q11. Whom should I contact in case of a claim?

Ans. Please contact RuPay cardholder Bank/Bank branch of which RuPay cardholder has a
card for intimating claim.

Q12. How do I make a claim?

Ans. Please fill the entire documents as per the checklist and submit the same to the
Bank/Bank branch where RuPay cardholder has an account.

Q13. In how many days should I intimate about claim?

Ans. Please intimate about the claim within 90 days of the date of accident. In case where the
person is hospitalized (and under critical condition) and is unable to file claim within 90 days
of loss/incident such claim cases will be accepted by The New India Assurance Co. Ltd. for
investigation and honored, if all terms under the policy are met as on date of accident.

Q14. In how many days should I submit the claim documents?

Ans. The claim documents needs to be submitted within 60 days from the date of claim
intimation.

Q15. Can I claim additional cover on my existing Permanent Total Disability cover from
other Insurer (s) company?

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RuPay Insurance Program 2022-23 Frequently Asked Questions Annexure B
Ans. Yes, it will be an additional cover over any other existing insurance cover being held by
the cardholder.

Q16. Accidental Injury can I avail the cashless facility?

Ans. This is not a mediclaim policy hence, cashless facility is not available for Personal
accident policy.

Q17. What do you mean by exclusions?

Ans. Exclusions are situations or conditions wherein The New India Assurance Co. Ltd is not
liable to pay the benefits to insured person in the event of accident.

Q18. What are the exclusions applicable?

Ans. The New India Assurance Co. Ltd. shall not be liable under this policy for the following
exclusions:
1. Compensation under more than one of the foregoing Sub-clauses in respect of the
same period of the same period of disablement of the Insured person.
2. Any other payment to the same person after a claim under one of the Sub-Clauses (a),
(b), or (d) has been admitted and become payable. However, amounts relating to
medical expenses, carriage of dead body would be payable in addition if applicable.
Sub-clause (a): If such injury shall within twelve calendar months of its occurrence be
the sole and direct cause of the death of the Insured person, the Capital Sum Insured
stated in the Policy Schedule hereto, applicable to such insured person.
Sub-Clause (b): If such injury shall within twelve calendar months of its occurrence be
the sole and direct cause of the total and irrecoverable loss of
1.a.a. Sight of both eyes, or of the actual loss by “physical separation” of two
entire hands or two entire feet, or of one entire hand and one entire foot, or of
such loss of sight of one eye and such loss of sight of one eye and such loss
of one entire hand or one entire foot, the Capital Sum Insured stated in the
Policy Schedule herein applicable to such Insured person.

1.a.b. Use of two hands or two feet, or of one hand and one foot, or of such
loss of sight of one eye and such loss of use of one hand or one foot, the
Capital Sum Insured stated in the Policy Schedule hereto, applicable to such
Insured person.
Sub-Clause (c): If such injury shall within twelve calendar months of its occurrence be
the sole and direct cause of the total and irrecoverable loss of
1. the sight of one eye, or of the actual loss by physical separation of one
entire hand or of one entire foot, fifty percent (50%) of the Capital Sum
Insured stated in the Policy Schedule hereto, applicable to such Insured
person.
2. total and irrecoverable loss of use of a hand or a foot without physical
separation, fifty percent (50%) of the Capital Sum Insured stated in the
Policy Schedule hereto, applicable to such Insured person.
Note: For the purpose of Clauses (b) and (c) above, physical separation of a hand
means separation at or above the wrist and of the foot means at or above the ankle.

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RuPay Insurance Program 2022-23 Frequently Asked Questions Annexure B
Sub-Clause (d): If such injury shall, as a direct consequence thereof, immediately,
permanently, totally and absolutely, disable the Insured person from engaging in being
occupied with or giving attention to any employment or occupation of any description
whatsoever, then a lump sum equal to hundred percent (100%) of the Capital Sum
Insured, stated in the Policy Schedule hereto applicable to such insured person.
Any payment in case of more than one claim in respect of such insured person under the
Policy during any one period of insurance by which the maximum liability of the Company
specified in the Policy schedule applicable to such Insured person would exceed the sum
payable under sub-clause (a) of this Policy to such insured person. However, amount relating
to medical expenses and carriage of dead body would be payable in addition if applicable.
Sub-clause (a): If such injury shall within twelve calendar months of its occurrence be
the sole and direct cause of the death of the Insured person, the Capital Sum Insured
stated in the Policy Schedule hereto, applicable to such insured person.
1. Payment of weekly compensation until the total amount shall have been ascertained
and agreed.
2. Payment of compensation in respect of Death, injury of Disablement of the Insured
person (a) from intentional self-injury, suicide or attempted suicide, (b) whilst under the
influence of intoxicating liquor or drugs (c) whilst engaging in Aviation or Ballooning
whilst mounting into, dismounting from or traveling in any balloon or aircraft other than
as a passenger (fare paying or otherwise) in any duly licensed standard type of aircraft
anywhere in the world, (d) directly or indirectly caused by venereal diseases, aids or
insanity, (e) arising or resulting from the insured person committing any breach of law
with criminal intent, (Standard type of Aircraft means any aircraft duly licensed to carry
passengers ( for hire or otherwise) by appropriate authority irrespective of whether
such an aircraft is privately owned OR chartered OR operated by a regular airline OR
whether such an aircraft has a single engine or multi engine.
3. Payment of compensation in respect of Death, Injury or Disablement of the Insured
person due to or arising out of or directly or indirectly connected with or traceable to :
War, Invasion, Act or foreign enemy, Hostilities (whether war be declared or not), Civil
War, Rebellion, Revolution, Insurrection, Mutiny, Military or Usurped Power Seizure,
Capture, Arrests, Restraints and Detainments of all kings, princes and people of
whatsoever nation condition or quality.
4. Payment of Compensation in respect of death of, or bodily injury or any disease or
illness to the Insured person -
▪ Directly or indirectly caused by or contributed to by or arising from
ionising radiations or contamination by radioactivity from any nuclear
fuel or from any nuclear waste from the combustion of nuclear fuel. For
the purpose of this exception, combustion shall include any self-
sustaining process of nuclear fission.
▪ Directly or indirectly caused by or contributed to by or arising from
nuclear weapons material.
• Provided also that the due observance and fulfilment of the terms and
conditions of this Policy (which conditions and all endorsements hereon are to
be read as part of this Policy) shall so far as they relate to anything to be done
or not to be done by the Insured and/or Insured person be a condition
precedent to any liability of the Company under this Policy.
P 10 of 11
RuPay Insurance Program 2022-23 Frequently Asked Questions Annexure B
5. Pregnancy Exclusion Clause : The Insurance under this Policy shall not extend to cover
death or disablement resulting directly or indirectly caused by contributed to or aggravated or
prolonged by child birth or from pregnancy or in consequence thereof.

Q19. Is there is provision for interim relief on Insurance?

Ans. There is no provision for interim relief until establishment of entitlement upon which the
claim is payable as qualified.

Q20. If the incident occurs in a timeline of 90 days of issuance of the RuPay card,
thereby not giving a window of 90 days qualifying criteria for doing a transaction in
order to be eligible for the insurance benefit, is the Cover still valid?
Ans. Yes, as an exception in such cases the cover is still valid and can be intimated as
applicable for Non-Premium Cardholders.

Q21. Since the cover is effective 1st April, 2023 and upto 31st March, 2024 if incident
happens on 15th April, 2023 and the transaction has happened prior to the policy period
is the cover valid?
Ans. Yes, as long as the incident has happened in the policy period the cover is valid.

Q22. For how many cards will I be eligible for the compensation of Insurance cover?
Ans. The Insurance policy is applicable for the compensation of only one eligible RuPay card
per cardholder or per customer, even if multiple cards held by cardholder of same / different
banks meet the eligibility criteria. The choice of the card for the claim would rest with the
customer.

P 11 of 11
 The New India Assurance Company Limited
Regd & Head Office: New India Assurance Building, 87, M.G. Road, Fort,
Mumbai - 400 001.

Policy Issuing Office: Claims Hub, Mumbai Regional office - 2,

Jeevan Seva, 2nd Floor, S.V. Road, Santacruz (W),
Mumbai. 400054
Contact no.(022) 26590070 / 26590156

RuPay CARDHOLDER’S PERSONAL ACCIDENT INSURANCE

CLAIM FORM 2023-24
Policy Number – 14230042230100000007
THE ISSUE OF THIS FORM IS NOT TO BE TAKEN AS ADMISSION OF LIABILITY
ALL QUESTIONS ARE MANDATORY AND HAVE TO BE COMPULSORILY ANSWERED.
RuPay CARD TYPE [ PMJDY [OLD/NEW] ]
NAME OF RUPAY CARDHOLDER
AADHAR NUMBER OF CARDHOLDER
BANK ACCOUNT NUMBER
RUPAY CARD NUMBER
A/c. Opening date in case of PMJDY
account
NAME OF NOMINEE [CLAIMANT]
ADDRESS OF CLAIMANT WITH
DISTRICT AND PINCODE
DATE AND TIME
OF ACCIDENT
PLACE OF ACCIDENT

BRIEF DESCRIPTION OF
ACCIDENT
[MANDATORY IN ENGLISH / HINDI]

IF SPACE IS INSUFFICIENT, PLEASE

ATTACH SEPERATE SHEET.
NATURE OF CLAIM DEATH / DISABLEMENT
ANY OTHER RuPay CARD HELD YES / NO
BY THE SAME PERSON
IF YES PLEASE GIVE DETAILS

I hereby declare that the foregoing statements are made by myself and are true in all respect and that I have not attempted to conceal from the
Company anything which it ought to be made acquainted and also that I have not abstained from any usual occupation longer than absolutely
necessary and I agree that if I have made, or in any further declaration the Company may require, shall make any false or fraudulent statement
or any suppression, concealment or untrue averment whatever, the Policy shall be void and my right to compensation forfeited and I am willing, if
required to make a Statutory Declaration before a Justice of the Peace of the truth of the whole of the foregoing statement or any other statement
I may make in connection with this claim.

BANK SEAL AND SIGNATURE OF

SIGNATURE CLAIMANT
MOBILE NUMBER OF CLAIMANT
 WITNESS CERTIFICATE
[TO BE FILLED UP AND SIGNED BY AN EYE WITNESS TO THE ACCIDENT IF ANY]

I hereby certify that I was present when the Accident occurred to Mr./ Ms. on
the day of 20 in the manner stated
by him/her over leaf, that it was caused by which * was /
was not his/her wilful act and that he /she * was / was not under the influence of intoxicating liquor at the
time.

*Strike out which is not applicable

SIGNATURE & DATE

NAME OF WITNESS
ADDRESS
OCCUPATION

MEDICAL CERTIFICATE for DISABILITY CLAIMS ONLY

Disability Claims must be supported by medical evidence furnished by the Insured and at his expense.

NAME OF INJURED PERSON [CLAIMANT]

SEX : [ MALE / FEMALE] AGE :
NATURE OF ACCIDENT
WHETHER THE INJURIES ARE CONSISTENT TO THE
DESCRIPTION OF ACCIDENT.
DATE ON WHICH YOU FIRST ATTENDED THE
CLAIMANT FOR THE INJURY
HAS THE CLAIMANT BEEN DISABLED TOTALLY OR
PARTIALLY
IS THE CLAIMANT SUFFERING FROM ANY DISEASE/
ILLNESS/SYMPTOMS APART FROM THE INJURY WHICH
MAY TEND TO RETARD RECOVERY?
IF YES, PLEASE GIVE DETAILS.
TYPE OF DISABILITY AS DEFINED IN ANNEXURE

Having personally examined the above named Insured, I certify that the above statements are correct and that the
insured person is necessarily disabled by the accident referred to

Signature:

Name & Qualification:

Address:
Date:
 ANNEXURE

The Disablement Compensation expressed as a

percentage of Total Sum Insured.

1) Permanent Total Disablement 100%

2) Permanent and incurable insanity 100%
3) Permanent Total Loss of two Limbs 100%
4) Permanent Total Loss of Sight in both eyes 100%
5) Permanent Total Loss of Sight of one eye and one Limb 100%

6) Permanent Total Loss of Speech 100%

7) Complete removal of the lower jaw 100%
8) Permanent Total Loss of Mastication 100%
9) Permanent Total Loss of the central nervous system or 100%
the thorax and all abdominal organs resulting in the
complete inability to engage in any job and the
inability to carry out Daily Activities essential to life
without full time assistance
10) Permanent Total Loss of Hearing in both ears 75%
11) Permanent Total Loss of one Limb 50%
12) Permanent Total Loss of Sight of one eye 50%
13) Permanent Total Loss of Hearing in one ear 15%
14) Permanent Total Loss of the lens in one eye 25%
15) Permanent Total Loss of use of four fingers and thumb 40%
of either hand
16) Permanent Total Loss of use of four fingers of either 20%
hand
17) Permanent Total Loss of use of one thumb of either
hand:
a) Both Joints 20%
b) One joint 10%
18) Permanent Total Loss of one finger of either hand:
 Three joints
 Two joints 5%
 One joint 3.5%
2%
19) Permanent Total Loss of use of toes: a) All-one foot
 Big-both Joints 15%
 Big-one joint 5%
 Other than Big- each toe 2%
2%
20) Established non-union of fractured leg or kneecap 10%
21) Shortening of leg by at least 5cms 7.50%
22) Ankylosis of the elbow, hip or knee 20%
 Annexure D

Declaration from Member Bank [on Bank's letterhead]

We hereby confirm that Mr./Mrs. having

Aadhar number is holder of
account number no. and was issued a RuPay
PMJDY Card bearing no. .
Account opening date:

Card type: [PMJDY [OLD/NEW] (please specify)

A. Details of Customer induced transaction qualifying for the RuPay Insurance Program 2023-24
Date of Transaction :
Type of Transaction :
Brief Description of transaction :

[Copy of Account Statement of cardholder with highlighted qualifying transaction to be

attached]

B. Details of Nominee / Legal Heir

Name of Nominee / Legal Heir:
Aadhar Number of Nominee/ Legal Heir:
Relation with Cardholder:
Nominee’s/ Legal Heir's Bank Name:
Nominee’s/ Legal Heir's Account number:
Nominee's/ Legal Heir’s Account IFSC code:
[Copy of Pass Book / Cancelled Cheque of Nominee/Legal Heir's A/c. to be attached]
[In case Nominee details are not available, Legal Procedure to be adopted as per bank's
guidelines and Legal Heirs details to be provided.]

AUTHORISED SIGNATORY
WITH BANK SEAL.
C. Brief Description of Accident [to be narrated in English / Hindi only by Bank Official]

D. Details of Bank's Official for follow up regarding the captioned claim.

Name and Address of Bank :

Name of Official :
Contact Number : Mobile:
Landline:
Email ID of Bank Branch :
Email ID of Bank RO/ZO :

We hereby solemnly affirm that the above statements are true and correct to the best of my/our
knowledge and belief.

We also confirm that the documents sent in support of the captioned claim are true copies and
have been verified by us with the original documents.

AUTHORISED SIGNATORY
WITH BANK SEAL.