Guidelines for Ex-servicemen on DSP Account Accident Insurance Claim 

All Armed Forces Pensioners are entitled to get the DSP Account facility from their Pension drawing Bank.  SBI has provided Insurance cover for personal accident to all DSP Pension account holder for a sum of Rs 30 Lakh.  This is genuine and the bank has provided the insurance claim to thousands of beneficiaries in past years. Due to ignorance, most of the affected exserviceman failed to avail the insurance benefit.

Policy No 580000/48/2025/152,
Policy Period 04^th Apr 2024 (0000 Hrs.) till 03^rd Apr 2025 (2359) hrs

What is DSP Account Insurance Cover and How to get the Benefit

1. PAI (Death) Cover will be available only in case of death resulting solely and directly from accident caused by external, violent, and visible means.
2. The current Policy is valid from 04.04.2024 to 03.04.2025.
3. The Personnel Accident Insurance Cover will be available to all the Salary Package customers of CSP / DSP / DSP-Agniveers / CAPSP /ICGS / RSP / SGSP / CGSP / PSP / Start-Up / PSP-Home Guards and pension account holders of DSP / CAPSP / ICGSP and SBI Family Rishtey.
4. Insurance Cover will be available to the existing as well as newly opened / converted Salary Package/Pension Account holders.
5. Only Primary Salary Package Account holders will be eligible for coverage under the policy (i. e. account holder for whom salary is being credited).  There should be minimum one Salary/Pension Credit within 90 days prior to the  date of accident for claims being eligible, except for the accounts opened in last 90 days.
6. The benefit of PAI and AAI will be available to the claimant only if the account is under the Salary Package with appropriate product codes in banks CBS system.
7. In case of multiple accounts related to a single CIF, the account in which salary was credited will be taken into consideration. However, where salary / pension is credited in both the accounts higher of the eligible claim amount will be taken into consideration (except for DSP Pension, CAPSP Pension & ICGSP Pension)
8. Joint account holders of Salary Package Accounts, Account holders of Special Package for Insurance & Commission Agents (SPICA), Broking Clients, Pensioners of DSP, CAPSP, ICGSP, minors holding SBI Family Rishtey account and Sailors below 18 years of age opened under DSP (Navy) are not included under PAI /AAI Cover.
9. In case of Defence (Army, Air Force, and Navy) and Central Armed Police (CAPSP), including their pilots and co-pilots, death due to aircraft accident/ship accident other than declared war by Government of India shall also be covered. Death due to high altitude conditions will also be treated as eligible for Accident Insurance cover.
10. Death of Defence and Central Armed Police personnel, including their pilots & co-pilots crew members, resulting directly & solely from an injury sustained because of an aircraft accident, in situation which is not declared war, including while conducting rescue operations for civilians during natural disasters like flood, and other such civilian operation, are covered under the Policy.
11. Death due to Snake Bite will also be covered. For DSP, CAPSP, ICGSP and PSP, personnel serving in North-eastern states, deaths due to poisonous insect bites in Northeast be covered as well. (Mosquitoes be excluded as at present)
12. The Salary Account Holders of Commercial Airlines/ Ships including crew i.e., Pilots/Crew members of Commercial Airlines/Ships will be covered under the policy.
13. Air Accident Claim will be treated as a valid claim only if, Air ticket have been purchased by debit to Salary Package Account, or where ticket is not required to be purchased by the account holder (e.g. service/combat/chartered aircrafts of Defence/Paramilitary/Police forces) or is provided by the department for official duty), with Any one Accident (AoA) clause of ₹ 25 Crore and Any one Year (AoY) clause of ₹ 50 Crore.
14. Claimants may submit claim forms either directly to the Insurance Company/ Insurance Broker or through Branch. The Insurance Company will settle  claims independently. Bank will not be a party to any dispute between the  claimant and Insurance Company.
15. All the claims will be payable by the insurance company. Bank / Broker shall have no liability whatsoever in respect thereof.
16. Intimation of claims by claimants/ senders will generally be done through email/ fax/ letter within 90 (ninety) days of the death of the Salary Package Account Holder. The relevant supportive documents as per the arrangement may be submitted by the claimant/ branch after intimation within 180 days of the date of death. Claims occurring between 04.04.2025 to 30.06.2025 will have additional 60 days window for claim intimation (150 days) & Documents submission (240 days).
17. On receipt of the claim, the insurance company shall send an acknowledgement to the claimant/ sender.
18. The insurance Company shall, on receipt of complete set of documents, process the claim. Any requirement/ deficiencies in the documents submitted shall be sought by the Insurance Company within 10 working days of receipt of the claim. All the documents being in order, the Insurance Company will settle the claim within 15 working days from the date of receipt.
19. The Beneficiary on death of Primary Salary Account Holder shall be as follows:
20. In case of account opened in single name, the nominee registered in Salary Package account of deceased will be beneficiary for the purpose of insurance claim. (Bank’s role will be limited only to certify the names of nominee as per Bank records).
21. In case, the account is opened as joint account, then the beneficiary will be the surviving account holder(s) for the purpose of insurance claim even if the nominee is available in the account. (Bank’s role will be limited only to certify the names of surviving joint account holder(s) as per Bank records).
22. In case, the account is opened as joint account, in event of death of all the account holders, the nominee, if available, will be the beneficiary for the purpose of insurance claim. (Bank’s role will be limited only to certify the names of nominee as per Bank records).
23. In cases other than a, b and c above the claim shall be settled as per the procedure of the insurer. The identification of legal heirs and the authenticity of the claim will be the responsibility of the insurer.

Add on Covers (Details), Terms & Conditions

1. Cost of Plastic Surgery/Burn : In case the Salary Account Holder (also referred to as “Insured Person”) dies due to accident tenable under terms & conditions of the policy, the insurance company will reimburse the actual cost of plastic surgery due to burn, incurred prior to death of insured person, subject to a maximum limit of ₹ lakh, as an additional benefit.

2. Transportation of Imported Medicine : Insurance Company will reimburse the expenses incurred as freight charges for importing medicines on producing invoice copy of freight expenses, subject to maximum of ₹ 5 Lakh, as an additional benefit.

3. Death after Coma: In case the insured person has gone into Coma after accident for more than 48 hrs, prior to his death, then the insurance Company will pay ₹ 5 lakh, as an additional benefit.

4. Air Ambulance : If the claim is accepted as a valid claim then the expenses incurred for engaging an Air Ambulance for transporting the insured person to the nearest hospital prior to his death, will be paid by the Insurance Company, subject to maximum amount of upto ₹ 10 lakhs, as an additional benefit.

Specific Conditions for Death Claim under DSP Pension Account

• Expenses for air ambulance transportation are restricted within India.
• Return transportation to Salary Account Holder’s (the Insured Person) home by ambulance is excluded.

5. Child Higher Education Cover (For Graduation): If a claim is accepted as a valid claim, Education cover is extended for Graduation of children of age between 18 to 25 years of the insured person, pursuing fulltime Graduation course in a recognized college/university. An amount of up to 25% of PAI Sum Insured subject to maximum of ₹ 8 lakh (For Girl child maximum ₹ 10 lakh, only for one Girl child) is payable, while ₹ 5 lakh under DSP/CAPSP Pension accounts (both for Girl and Boy child) , in case the insured person has died due to accident.

6. Girl Child Cover for Marriage (as an additional benefit)- Marriage (18- 25 yrs): If a PAI claim is accepted as a valid claim then this benefit will be extended to dependent Girl Child of the insured person, whose age is between 18-25 years at the time of accident. An amount of up to 20% of PAI Sum Insured subject to maximum of ₹ 10 lakh for two Girl Children, (₹ 5 lakh each) is payable. In case of single Girl Child fulfilling eligibility criteria as above, an amount upto 20% of eligible PAI claim, subject to maximum of ₹ 5 lakh is payable to the Girl child. Under DSP/CAPSP Pension accounts maximum of ₹ 5 lakh is payable irrespective of number of dependent girl children.

• Ambulance Charges: Expenses incurred towards Ambulance Charges, subject to maximum of ₹ 50,000/- will be paid as an additional benefit.
• Personal Loan (Xpress Credit Loan) insurance cover for SBI loan accounts: If a PAI claim is found admissible for Defence/Police/Paramilitary Personnel Covered under DSP/ CAPSP/ICGSP/PSP only, where death occurred in action against Anti National Activities/Terrorist /Naxalite/ Foreign enemy/Ambush action, an amount equal to outstanding, including interest and charges upto the date of accident in “Xpress Credit” loan account, subject to maximum of ₹ 10 lakh will be payable as an additional benefit. The Xpress Credit loan must have been availed from and SBI Branch.
• Additional PAI cover for DSP/CAPSP/ICGSP/PSP, death in action against Anti National Activities/Terrorist /Naxalite/ Ambush/Foreign enemy : If a PAI claim is found admissible for Defence/Police/Paramilitary Personnel Covered under DSP/ CAPSP/ICGSP/PSP only, where death occurred in action against Anti National Activities/Terrorist /Naxalite/ Foreign enemy/Ambush action an amount of ₹ 10 lakh will be payable as an additional benefit.
• Additional Cover for all Salary Packages, death while performing duties on foreign soil : If a PAI claim is found admissible for any of the Salary Packages, while performing bonafide duties on foreign soil, an amount of ₹ 10 lakh will be payable as an addition benefit.

vi.  Girl Child Cover for Marriage (Age 18-25 Years) — 20 % of entitled PAI Cover. (If PAI  claim is found admissible), Maximum 10 Lakh for two girl children (5 lakh each) or 5 lakh  for 1 Girl Child.

1. Birth certificate/ Date of birth proof of girl child.
2. Document showing relationship with deceased Salary Account holder.

vii. Family Transportation: (Travelling cost incurred by immediate 2 family members to reach place of accident)

1. Original bill, receipt and travel ticket showing date of travel, Sector (from/ to) and amount incurred.
2. Copy of proof of the immediate family member such as Ration Card.

viii.            Repatriation of mortal remains:

a) Original Bill and receipt for transport of mortal remains, showing date and sector (From/to)

ix. Ambulance charge:

a) All related original bills and their receipts.

x. Personal Loan (Xpress Credit Loan) insurance cover for SBI loan accounts  (Defence/Police Personnel Covered under DSP/ CAPSP/ICGSP/PSP only) death in  action against Anti National Activities/Terrorist /Naxalite/ Foreign enemy/Ambush.

xi. Additional PAI cover for DSP/CAPSP/ICGSP/PSP, death in action against Anti National  Activities/Terrorist /Naxalite/ Ambush/Foreign enemy.

xii. Additional Cover for all Salary Packages, death while performing duties on foreign soil. Covers at Serial No (k) or (I) are exclusive to each other and both will not be available together)

7             Claimant should submit the Claim Form completed in all respects, with relevant documents mentioned under Para 4 above, directly to OICL. The system generated Claim Number/ Salary Account No. should be mentioned on the Claim Form while sending the physical documents. The Claim No. can be used for any queries/further follow up with the OICL claim department.

8.      However, claim application received by the SBI Bank Branch having the Salary Account, should be forwarded to OICL Mumbai Office along with a detailed covering letter.

9      The total period for intimation and claim submission is 180 days maximum i. e. period for intimation + claim submission = 90 + 90 = 180 maximum (from date of death).

10. All claims shall be entertained by OICL where accident has occurred within the period of policy and death has occurred:

1. Within the period of policy or
2. Within 12 months of date of accident, in event where death occurs after the expiry of policy.

How to Contact for DSP Pension Account Insurance Claim

Contact Details And Escalation Matrix “The Oriental Insurance Co. Ltd.” (OICL)

Claim documents are to be sent to:

“The Oriental Insurance Co. Ltd.” (OICL)
SBI GPA Claims Cell
Mumbai Regional Office 1, 2nd Floor, Oriental House, 7 J. Tata Road, Churchgate,
Mumbai-400020

Status of the claims can be sought, using system generated claim number/ Account Number, by any of the following channels:

Escalation Matrix (OICL) – Contact Details

If claimant is not satisfied with Insurance Company’s services, he/ she can lodge a online complaint with OICL or send email to Ms. Olivia N. Assistant Manager at olivia.nameirakpam@orientalinsurance.co.in.

ii. After investigating the matter internally and subsequent closure, the Insurance Company will send their response within a period of 15 days from the date of receipt of the complaint. In case the resolution is likely to take longer time, they will inform the claimant of the same through an interim reply.

Escalation Level 2

For lack of a response or if the resolution still does not meet Claimants expectations, Claimant can write to the Reginal Manager OICL,
at pote.ninad@orientalinsurance.co.in.

Escalation Level 3
Within 30 days of lodging a complaint with OICL, if satisfactory response is not received from the Insurance Company, grievance may be raised with the Internal Ombudsman of ICL(list available at https://orientalinsurance.org.in/list-of-ombudsman or Insurance Regulatory and Development Authority (IRDA) may be approached on
address mentioned hereunder:
General Manager
Insurance Regulatory and Development Authority of India(IRDAI)
Consumer Affairs Department – Grievance Redressal Cell.
Sy.No.115/1, Financial District, Nanakramguda,
Gachibowli, Hyderabad – 500 032
Email ID: nonlifecomplaints.pvt@irda.gov.in
Toll Free Number: 155255 or 1800 4254 732
Email ID: complaints@irda.gov.in

If the claimant is not satisfied with the Insurer Company’s redressal of his grievance, through any of the above methods the claimant may approach the nearest Insurance Ombudsman for resolution of the grievance. The details of Insurance ombudsman are available on Insurance Regulatory and Development Authority (IRDA) website:

www.irdai.gov.in .The complainant may register his grievance through IRDA online, at
www.policyholder.gov.in/igms_complaint_logging.aspx.The guidelines for taking
up the complaint with the Insurance Ombudsman, along with their address are available
on the consumer education website of the IRDA, http:
www.policyholder.gov.in/ombudsman.aspx.