ABSTRACT
Personal accident policies involve the payment of benefit, which is usually a specified money amount, in the event of accidental injury. By their very nature personal accident policies are consumer policies and therefore subject to the Ombudsman’s jurisdiction. In the circumstances the reported decisions of the Ombudsman are of some significance in determining the effect of the wording of the policy. An understanding of what is meant by “accident” is fundamental to a consideration of a claim under a personal accident policy. Deliberately self-inflicted injuries are not accidental. There may also be exclusion in the policy for any such injury. Deliberate self-harm by the insured is not accidental, but he must intend the harm or at least be reckless. Deliberate harm on the insured by some other person may be accidental if the insured did not voluntarily accept the risk of that type of harm.
