Personal Accident Insurance pays out if you are severely injured or in the worst case scenario, die in an accident in the hired car.
Policyholders receive a tax-free lump sum if they are involved in an accident resulting in the loss of one or more limbs, one or both eyes, the loss of use of any of the above, or some other form of permanent disability.
If you are travelling abroad you may have similar cover on your travel insurance policy so definitely worth checking before you end up paying for duplicate insurance, and may also be covered on a credit card if you use it to pay for the hire.
If you travel regularly and want this cover, buy it from an insurer directly. Personal Accident Insurance is very cheap due to the policy limitations, so it's not at all cost effective to buy multiple short term policies. US car hire firms, however, are very keen on selling it so some car hire excess insurers include it as a benefit in their policies to save their customers facing an inquisition at the desk. The cover through car hire excess policies does tend to be fairly limited and may only cover the driver.
You can find policies that include PAI by ticking the Policy Inclusion box for Personal Accident Cover (from the filters at the top) on your results page when you run an online comparison with MoneyMaxim.
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If you have any queries do call a member of the MoneyMaxim car hire insurance team.