既然有人愿意讨论那就多分享一些
第一点是关于意外的定义，有些合同里是这么写的
Accident means an unforeseen and involuntary event
而有些意外合同里会再加上一些限制比如常见的must be forced也就是暴力导致的，或者caused body injury也就是必须要有身体伤害
显然附加越多的限制条件对客户是不利的，因为索赔的时候会说因为没满足forced所以不算意外不可以索赔或者没满足body injury所以没受伤你去拍脑部MRI那是多余的所以不给报销，这些是我的客户以前用其他公司的意外保险索赔失败分享给我的。
第二点，关于索赔的时效性，有的公司是这么写的
We will pay the Insured Amount for the Accidental Death Benefit if the Insured dies due to an injury within 365 days from the date of the accident.
也就是发生意外后的365年内产生的相关结果可以被归类到这次意外，而其他公司的合同有些规定是3个月，有些是6个月，只要超过这个时效出现的问题保险公司就不对此次意外负责了，同样包括意外导致的永久残疾的情况。
第三点 烧伤定义
Shortening of leg by at least 5 cm
Third Degree Burns
Area damage as a percentage of total body
* (i) Head – equals to or greater than 2% but less than 5%
* (ii) Head – equals to or greater than 5% but less than 8%
* (iii) Head – equals to or greater than 8%
* (iv) Body – equals to or greater than 10% but less than 15%
* (v) Body – equals to or greater than 15% but less than 20%
* (vi) Body – equals to or greater than 20%
我相信至今任然有公司并没有把烧伤定义纳入意外保障范围，就算有，也可以看下烧伤的赔付金额是否和意外伤害的额度一致，还只是象征意义上的补偿几千块。
第四点 灰色索赔区域的明确定义
以下情况全部是明确被保的
Strike, riot and civil commotion
We will cover accidental death or injury of the Insured directly due to riot, strike and/or civil commotion, as a result of an accident if the Insured had not directly or indirectly collaborated, participated or provoked such act. For the avoidance of doubt and without prejudice to any other terms and conditions of this policy, point 3 of the Exclusions section expressly applies.
Terrorism
We will cover accidental death or injury of the Insured directly due to an act of terrorism, as a result of an accident, provided that the Insured had not directly or indirectly collaborated, participated or provoked such act. Cover includes the use of nuclear, biological and chemical devices during the act of terrorism. For the avoidance of doubt and without prejudice to any other terms and conditions of this policy, point 3 of the Exclusions section expressly applies.
“Act of Terrorism” means an act of any person or group of persons, whether acting alone, on behalf of or in connection with any organisation or government, committed for political, religious, ideological, economic, ethnic, nationalistic, racial, or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear. Robberies or other criminal acts primarily committed for personal gain and acts arising primarily from prior personal relationships between perpetrator and victims will not be considered as an Act of Terrorism. Act of Terrorism also includes any act which is verified or recognised by the relevant government as an act of terrorism.
Drowning and suffocation
We will cover accidental death or injury of the Insured directly due to suffocation by smoke, poisonous fumes, gas or drowning, as a result of an accident, if the event does not arise as a result of the Insured’s wilful and/or intentional act.
Exposure
We will cover accidental death or injury of the Insured due to an accident if he is unavoidably exposed to natural disasters including but not limited to floods, tornadoes, hurricanes, volcanic eruptions, earthquakes, tsunamis and landslides if the event does not arise as a result of the Insured’s wilful and/or intentional act.
Disappearance
We will cover the death of the Insured if the body of the Insured is not found within 12 months from the date of disappearance following the sinking, wrecking or destruction of an aircraft or other conveyance in which the Insured was travelling as a result of an accident. We may require a copy of the police report and death certificate issued by the relevant authorities in the country in which the insured event had occurred to be submitted to us. If the Insured is found to be living at any time after payment of the relevant benefits under this policy, all such payments shall be immediately refunded to us.
Hijack, murder and assault
We will cover accidental death or injury of the Insured directly due to hijack, murder and assault, as a result of an accident, provided that the Insured had not directly or indirectly collaborated, participated or provoked such act. For the avoidance of doubt and without prejudice to any other terms and conditions of this policy, point 3 of the Exclusions section expressly applies.
“Hijack” means any seizure or exercise of control by force or violence, or the threat of force or violence and with wrongful intent, of a Public Conveyance in transit, in which the Insured is travelling as a fare-paying passenger or a crew member.
Food poisoning
We will cover accidental death or injury of the Insured resulting from accidental food poisoning if the event does not arise as a result of the Insured’s wilful and/or intentional act.
Private flight
We will cover accidental death or injury of the Insured caused by an accident while he is travelling as a non fare- paying passenger in any properly licensed private aircraft and/or helicopter forming part of a business trip whilst the Insured is travelling outside Singapore.
Insect/animal bites, stings or attacks
We will cover accidental death or injury of the Insured caused by a bite, sting, attack or such similar event by an insect or animal if the event does not arise as a result of the Insured’s wilful and/or intentional act. This cover includes dengue fever.
Amateur sports
We will cover accidental death or injury of the Insured while he is engaging in sports or activities as a form of recreation.
For the avoidance of doubt, sports carried out in a professional capacity or where the Insured would or could earn income or remuneration from engaging in such sport are expressly excluded.
Motor-cycling (rider and pillion)
We will cover accidental death or injury of the Insured while he is riding a motorcycle (whether as a rider or as a pillion-rider) if at the time of the accident, he was wearing a safety helmet and has a valid motorcycle license that allows him to ride such motorcycle, and was not engaging in or practising for racing, hill climbing contests, reliability trials and speed or duration testing.
有些公司的合同没有这个部分，是否对客户有利我的理解是更有利的，比如提到的最后一条motor，或许很多人不知道这条款有时候是会被放到排除条款里的，除非额外加保费才有保到
最后一点排除不保条款
7. Exclusions
There are certain conditions whereby the benefits under this plan will not be payable. These are stated as exclusions in the contract. The exclusions for this plan include, but are not limited to the following conditions. You are advised to read the policy contract for the full list of exclusions.
* (a) war (whether declared, undeclared or otherwise), invasion, civil war, revolution or any warlike operations; or
* (b) violation or attempted violation of the law or resistance to arrest; or
* (c) the Insured engaging or taking part in air, military, naval training, exercises, manoeuvres, warlike operations or
handling of explosives, demolition materials or while under orders for restoration of public order, whether in time of peace, declared, undeclared war or otherwise, except where operationally ready national service duties are carried out in Singapore or overseas (if applicable) pursuant to the Enlistment Act (Cap 93); or
* (d) the Insured engaging in air travel (except as a fare-paying passenger in any properly licensed private and/or commercial aircraft, or as a crew member in a properly licensed commercial aircraft operated by a commercial passenger airline on a regular scheduled passenger trip over its established passenger route, or as covered under the section on Private Flight of the Policy Extensions section); or
* (e) suicide or attempted suicide or intentional self injury or from deliberate exposure to exceptional danger (except in an attempt to save human life), whether sane or insane; or
* (f) childbirth, pregnancy, miscarriage, abortion, sterilisation, contraception, treatment for infertility or any complications concerning therewith notwithstanding that such event may have been accelerated or induced by injury; or
* (g) any form of dental care or treatment (unless necessitated by Injury and provided that such dental care and/or treatment shall be applied to sound natural teeth). Dentures and all related expenses are expressly excluded; or
* (h) any form of cosmetic, plastic or elective surgery unless necessitated by injury; or
* (i) treatment of alcoholism, drug abuse or any other complications arising there from, or accidents caused by or
whilst under the influence of drugs or alcohol; or
* (j) the Insured engaging in a sport in a professional capacity or where the Insured would or could earn income or
remuneration from engaging in such sport; or
* (k) the Insured engaging in racing of all kinds (other than on foot and swimming and where expressly covered under
section on Amateur Sports of the Policy Extensions section); or
* (l) treatment for congenital anomalies and physical defects; or
* (m) any kind of disease or illness (including but not limited to osteoporosis or other bone diseases) save as expressly
covered under sections on Food Poisoning and Insect/Animal Bites, Stings or Attacks of the Policy Extensions
section; or
* (n) AIDSandHIVoranycomplicationsassociatedwithanyHIV;or
* (o) anypre-existingcondition.
这个好理解，就是保险公司明确说了不保的情况，这里的条款和意外的定义类似，是越少越对客户有利。
也希望同行能把自己手上的资料拿出来对比分享大家互相学习。我晚点再回来回复
Huasing Association 1999 - 2013