What is an Individual Accident Insurance?
The "Individual Accident" insurance contract guarantees the payment of a capital sum when the policyholder is the victim of an accident resulting in death, absolute and definitive invalidity or permanent invalidity.
The cover under this type of contract may be extended, subject to express stipulation, to cover medical, pharmaceutical and hospitalisation expenses as well as the cost of dental prostheses and eyewear, incurred by the policyholder as a result of a covered accident.
How Does it Work?
In the event of a claim, the Insurer must be notified within the time limit and in accordance with the terms of the contract.
The payment of the services shall be made within the period stipulated in the contract.
In the event of death following a covered accident, the policyholder capital is paid to the beneficiary or beneficiaries designated by the policyholder in the contract. If no beneficiary is designated or if, in the event of the designation of one or more beneficiaries, there is no longer a beneficiary at the death of the policyholder, the policyholder capital shall form part of the inheritance of the policyholder.
In the event of absolute and definitive invalidity of the policyholder, the guaranteed capital is paid to the policyholder.
If permanent disability cover is included in the policy, the Insurer guarantees to pay the policyholder the amount corresponding to the capital fixed in the policy's special conditions for "Permanent Disability" cover, multiplied by the Permanent Physical Disability (PPD) rate.
The PPD rate shall be, according to the choice of the Insurer specified in the contract:
- set in accordance with Decree No. 2-84-744 on the functional scale of disabilities (scale applied in particular in the context of compensation for victims of traffic accidents);
- or determined by applying the contractual scale attached to the contract.
For the extensions of cover relating to the above-mentioned expenses, the Insurer guarantees, within the limit of the sums fixed in the contract, the reimbursement of the expenses incurred.
Type of Insurance:
Individual accident insurance is personal insurance that is taken out individually or as part of a group insurance policy.
Rights and Obligations of the policyholder?
We invite you to refer to the "Insurance Guide" published on the ACAPS portal.
What does the Authority do?
Within the framework of the powers vested in it by Law No. 64-12 establishing the Insurance and Social Security Supervisory Authority, the latter institution ensures that any and all insurance products offered to consumers are understandable, balanced, useful and that they comply with the regulations in force. It also shall monitor the reliability of the information provided to policyholders and ensure the fair treatment of policyholders by Insurers.
Legal/Judicial Remedies in Case of Dispute with Your Insurer?
In accordance with Article 7 of Law No. 64-12, the Insurance and Social Security Supervisory Authority has the power to investigate complaints from customers of insurance companies and the intermediaries (brokers) thereof. Nevertheless, it is recommended that you first contact the broker or Insurer against whom your complaint is directed. If the dispute persists after this step, you can contact ACAPS by one of the means at your disposal. The Authority shall then examine your complaint and take the most appropriate action, in accordance with the legal and regulatory provisions and within the scope of its powers, to settle the dispute.