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What Personal Sickness and Accident Insurance Covers
Personal accident insurance replaces part of your income when injury, sickness or disability stops you working, and it pays lump sum benefits for permanent disablement.
Benefits are paid weekly while you cannot work, or as a lump sum after a permanent injury. That keeps household bills and loan repayments covered while you recover.
Whether you are self-employed, a contractor or a business owner without sick leave, personal sickness and accident insurance is fundamental personal protection. It sits beside health and medical insurance, which pays for treatment rather than replacing lost income. It sits within our personal insurance range at Fortis Risk Solutions.
Personal Accident Insurance: Cover Sections and Benefits
What Personal Sickness & Accident Insurance does not cover
Personal accident insurance pays a benefit when injury or illness stops you working. It is not health cover and it does not pay for treatment. The usual exclusions are:
- Pre existing conditions and any injury or illness you already had when the policy started
- Pregnancy, childbirth, and elective or cosmetic procedures
- Self inflicted injury, and claims arising while under the influence of alcohol or drugs
- Stress, anxiety and other psychological conditions unless the policy specifically includes them
- Injury from professional sport, motor racing and similar declared activities
- Work injuries that fall to workers compensation, which is compulsory for employers in every state
- The waiting period at the start of each claim, and anything past the stated benefit period
The real gaps sit around occupation definitions and waiting periods. FRS checks the wording against your trade, your hours and any cover you already hold through super, so two policies do not pay for the same week.
How Personal Sickness & Accident Insurance premiums are set
Personal accident insurance is rated on what you do for a living and on how much income you want replaced. Underwriters work through a short set of questions:
- Your occupation, and whether the work is manual, mixed or purely office based
- The weekly benefit sought, and how it compares with what you actually earn
- The waiting period before benefits start
- The benefit period, which may run for a set number of weeks or for years
- Your age, and whether you smoke
- Medical history, previous claims and any declared pastimes such as motorcycling or diving
- Whether the policy is written for one person or across a working directors group
A longer waiting period cuts the premium, and most people can carry more waiting time than they first think once sick leave and savings are counted. FRS works through that trade with you before quoting.
How to claim on Personal Sickness & Accident Insurance
A personal accident insurance claim turns on medical evidence and on dates, so start the paperwork on day one rather than when the waiting period ends. The FRS process:
- Tell FRS as soon as you stop work, even if you expect to be back quickly
- See a doctor and ask for a certificate recording the date you became unfit and the reason
- Keep every certificate, referral and treatment record for the whole period off work
- Report an accident to police where a vehicle or a third party was involved
- FRS lodges the claim, submits the income evidence and handles the insurer’s questions and progress certificates
- Benefits are paid across the agreed period and the cover is reviewed when you return to work
Begin the process on our make a claim page.
Personal Sickness & Accident Insurance compared with Income Protection
| Question | Personal Sickness and Accident | Income Protection |
|---|---|---|
| What it covers | A weekly benefit after injury or illness, plus lump sums for defined injuries | A monthly benefit while you cannot work in your occupation |
| Who buys it | Sole traders, contractors and working directors | Employees and self employed people, usually inside a life insurance product |
| Typical trigger | An accident or sickness that stops work, sometimes on accident only terms | Illness or injury that meets the occupation definition |
| Sits with | Business pack and public liability | Life, trauma and total and permanent disability cover |
Many trades hold the general insurance version because it is written quickly and sits beside a business insurance pack. It usually runs for a shorter benefit period. Where a long illness is the real worry, put the two side by side before renewal.
Personal Accident Insurance FAQs
Personal accident insurance is the simpler, shorter-term product, paying defined benefits for a set period. Income protection is the broader, long-term income replacement contract.
Yes. Policies can cover both injury and illness, subject to waiting periods and the medical definitions in the wording.
Yes. Claims usually need medical certification confirming that you cannot work.
Personal accident policies differ widely in benefit definitions, exclusions and waiting periods. As your broker, FRS helps you:
- Set benefit amounts and waiting periods that suit your income
- Match the cover to your occupation and how you are paid
- Compare policy wording, not only premium
- Handle claims and insurer communication
Business owners usually hold this cover alongside their business insurance. Self-employed professionals who give advice should also review their professional indemnity insurance.