MEDICAL ESTABLISHMENTS MALPRACTICE, PROFESSIONAL INDEMNITY, PUBLIC /PRODUCTS LIABILITY POLICY
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1 MEDICAL ESTABLISHMENTS MALPRACTICE, PROFESSIONAL INDEMNITY, PUBLIC /PRODUCTS LIABILITY POLICY The Insured named in the Schedule having applied to the Insurers for the Insurance and having agreed that any proposal or other information supplied by the Insured or on their behalf shall be the basis of this Contract of Insurance, the Insurers agree to indemnify the Insured subject to the terms, Exclusions and Conditions contained herein. SECTION ONE - MEDICAL MALPRACTICE INDEMNITY The Insurers will indemnify the Insured in accordance with the Operative Clause for bodily or mental injury to, illness, disease or death of any patient or person caused or alleged (other than by the Insured) to be caused by Malpractice arising out of the Business/Profession. SPECIFIC EXCLUSIONS The Insurers shall not be liable to indemnify the Insured in terms of this Section in respect of claims for and/or arising out of: 1. malpractice committed by any Medical Practitioners in their professional capacities as such, for which such Medical Practitioners would be entitled to indemnity under any other insurance policy, or where they would be entitled to assistance from the Medical Defence Union, Medical Protection Society, or any similar entity; 2. malpractice committed by any Obstetricians, Neuro-Surgeons, Gynaecologists, Plastic Surgeons, Anaesthetists and Orthopaedists. However, the Costs and Expenses incurred by the Insured (with the Insurers prior written consent) in their own defence (when sued jointly and severally with any such person) are not excluded. SECTION TWO - PUBLIC LIABILITY INDEMNITY The Insurers will indemnify the Insured in accordance with the Operative Clause for and/or arising out of Injury and/or Damage, but not against claims arising out of or in connection with the nature or condition of any Product. SPECIFIC EXCLUSIONS The Insurers shall not be liable to indemnify the Insured in terms of this Section in respect of claims for and/or arising out of damage to property owned, leased or hired by, or under hire purchase to, or on loan to the Insured or otherwise in the Insured's care, custody or control other than: a) directors', employees' and visitors' clothing and personal effects; b) property of Transnet, government or quasi-government departments, regional administrations, municipalities and/or similar bodies to the extent of any requirement by statute or statutory regulation; c) premises tenanted by the Insured for which the Insured is responsible. EXTENSION TO SECTION TWO - WRONGFUL ARREST/DISMISSAL INDEMNITY The Insurers will indemnify the Insured in accordance with the Operative Clause as a direct result of: a) wrongful arrest, including assault in connection therewith; b) wrongful dismissal of an Employee. Camargue Medmal 4 in 1 July 2013
2 The Insurers' total liability shall not exceed R each and every claim and no deductible shall be payable by the Insured. SECTION THREE - PRODUCTS LIABILITY INDEMNITY The Insurers will indemnify the Insured in accordance with the Operative Clause for and/or arising out of Injury and/or Damage, but only against claims arising out of or in connection with the nature or condition of any Product. SPECIFIC EXCLUSIONS The Insurers shall not be liable to indemnify the Insured in terms of this Section in respect of claims for and/or arising out of: 1. any defect in any Product of which the Insured s risk manager (if applicable) was aware prior to inception or renewal of this Policy; 2. the cost of repair, reconditioning or replacement of any Product or part thereof. For the purposes of this Exclusion the term "replacement" shall be deemed to include any credit or refund granted or alternative Product provided by or on behalf of the Insured in lieu of replacement of the defective Product; 3. costs incurred by the Insured in the recall of any Product or part thereof; 4. the failure of any Product or any part thereof to fulfil its intended function or to perform as specified, warranted or guaranteed, but this Exclusion shall not apply to consequent Injury or Damage; 5. any Product (including any mark eting advisory service in connection with any Product) within or en route to the United States of America, its possessions or territories, or Canada where such Product was to the knowledge of the Insured intended for sale or resale in the U.S.A. or Canada, or such sale or resale could reasonably have been contemplated by the Insured. 6. any Claim insured or excluded by Sections 1 or 4. In any action, suit or other proceedings where the Insurers allege that by reason of the provisions of this Exclusion any liability is not covered by this Policy, the burden of proving that such liability is covered shall be upon the Insured. SECTION FOUR - PROFESSIONAL INDEMNITY (if stated in the schedule to be applicable) The Insurers will indemnify the Insured in accordance with the Operative Clause against claims resulting from: a) any breach of professional duty in terms of the business named in the schedule; b) any breach of implied warranty of authority or of trust committed in good faith; c) defamation and/or injuria; d) infringement of copyright; e) the destruction of, damage to or loss of any documents entrusted to the Insured; on the part of the insured in the conduct of the business. GENERAL 1. OPERATIVE CLAUSE The Insurers will indemnify, as set out hereinafter, the Insured against their legal liability to pay compensatory damages (which term shall include claimant's costs and Defence Costs) in respect of claims first made against the Insured during the Period of Insurance arising out of the performance of the Business/Profession anywhere in the world excluding the United States of America, its Camargue Medmal 4 in 1 July
3 possessions or territories, and Canada and in accordance with the law and procedure applicable in the Republic of South Africa, but not in respect of any judgement, award or settlement made within countries which operate under the laws of the United States of America, its possessions or territories, and Canada or to any order made anywhere in the world to enforce such judgement, award or settlement either in whole or in part. This Insurance Contract is conditional upon and will only come into effect following payment of the premium by the Insured and the receipt thereof by or on behalf of the Company. 2. POLICY INTERPRETATION For the purpose of determining the indemnity granted by this Policy, any word or phrase contained herein requiring and capable of legal interpretation shall be interpreted in accordance with the law prevailing within the Republic of South Africa. 3. POLICY DEFINITIONS For the purpose of determining the indemnity granted by this Policy: 3.1 "The Insured" shall mean the insured named in the schedule, any current or former principal, officer, partner, director, member, employee, "in-house" consultant or committee member of the named insured or of their predecessors in business, and in the event of the death or incapacity of any such person, his estate, heirs and/or legal representatives, in respect of any claim made against such person arising out of the conduct of the business/profession by the named insured or their predecessors in business and refer to exclusions 1 and 2 of Section 1. Any person entitled to indemnity shall as though they were the named insured be subject to the terms, exclusions and conditions of this insurance in so far as they can apply. 3.2 "Deductible" shall mean the first amount stated as such in the Schedule, for which the Insurers are not liable to indemnify the Insured in respect of each claim and/or loss (or series of claims and/or losses arising out of one original cause or source) except claimants costs and expenses. 3.3 "Employee" shall mean person/s employed under a contract of service or apprenticeship with the Insured. Including any Qualified and registered assistants. 3.4 "Malpractice" shall mean any negligent act, error or omission in the professional or other services rendered, or which should have been rendered, by the Insured. 3.5 "Damage" shall mean loss of or physical damage to tangible property. 3.6 "Injury" shall mean death, kidnap/abduction, bodily injury, illness or disease of or to any person. 3.7 "Vehicle" shall mean any self-propelled land vehicle and trailer or semi-trailer (including any machinery or apparatus attached thereto) irrespective of whether such vehicle is subject to motor vehicle registration other than a railway locomotive and rolling stock. 3.8 "Product" shall mean any tangible property after it has left the custody or control of the Insured which has been manufactured, constructed, installed, sold, supplied, distributed, treated, serviced, altered or repaired by or on behalf of the Insured. 3.9 Claim A claim is considered to be made when the insured first: receives a written demand for damages of the type covered by this Section, including the service of suit or institution of legal or arbitration proceedings; or becomes aware of the intention of any person to make such a demand against them; or becomes aware of any fact, circumstance or event which could reasonably be anticipated to give rise to such a demand at any future time and shall give:- Camargue Medmal 4 in 1 July
4 a) a description of the specific fact event or circumstance which may give rise to a claim being made against the Insured, and b) the identities of the potential claimants, the consequences which have resulted or may result from such specific fact event or circumstance which may give rise to a claim being made against the Insured, and c) the damages which may result from such specific fact event or circumstance which may give rise to a claim being made against the Insured, and d) and the circumstances by which the Insureds first became aware of such specific fact event or circumstance which may give rise to a claim being made against the Insured 3.10 Documents shall mean mortgage bonds, title deeds, transfer deeds, powers of attorney, tender documents and agreements, wills, manuscripts, business books, maps, plans, specifications, computer programmes, records (whether on paper, microfilm, magnetic tape or discs), and written or printed documents and forms of any nature, but excluding stamps of any kind, bank or currency notes or other negotiable instruments including cash, credit, charge or other similar cards. 4 CROSS LIABILITIES Each legal entity indemnified is separately indemnified in respect of claims made against any of them by any other, subject to the Insurers' total liability not exceeding the stated Limits of Indemnity. 5 COSTS AND EXPENSES The Insurers will pay all Costs and Expenses incurred with the written consent: 5.1 In the defence or settlement of any claim under this policy; 5.2 in the representation at any Inquest, Accident Inquiry in respect of Injury which may form the subject of indemnity by this Policy, and/or defending any proceedings in a Court of Summary Jurisdiction in respect of matters which may form the subject of indemnity by this Policy. 5.3 In the defence of any prosecution of the Insured for breach of any statute up to a limit of R250,000 in the aggregate during the Period of Insurance. 6 LIMIT OF INDEMNITY The Insurers' total liability to pay compensation and claimants' costs in connection therewith and Costs and Expenses, shall not exceed the limit stated in the Schedule in respect of any one claim or all claims arising from one original cause or source and/or where stated in the aggregate, during the Period of Insurance. Should any Limit of Indemnity be altered during the Period of Insurance, then the previous Limit of Indemnity shall apply to all claims made or deemed to have been made prior to the effective date of such alteration. 7 EXTENSIONS 7.1 MITIGATION COSTS The Insurers will indemnify the Insured up to the 10% of the Annual Aggregate Limit of Indemnity in respect of reasonable costs incurred by the Insured, with the Insurer s written consent (which shall not be unreasonably withheld), in mitigating the consequences of any act error or omission which, in the absence of such mitigation, would give rise to a Claim. Notwithstanding anything contained in the Policy to the contrary, the Insured may, prior to notifying the Insurers, take such reasonable action as aforesaid as the Insured may consider to be Camargue Medmal 4 in 1 July
5 necessary immediately, and it is agreed that any such action will not prejudice the Insured s rights to indemnity in terms of this extension, provided always that the Insurers are notified of such action and the cost thereof as soon as reasonably practicable but in any event not more than fourteen days thereafter. The indemnity afforded by this Extension is included within the Limit of Indemnity otherwise provided. 7.2 RENEWAL PREMIUM DISCOUNT (IF STATED IN THE SCHEDULE TO BE INCLUDED) The insurers will allow 10% (ten percent) discount off the initial premium paid if the policy is renewed for a further twelve (12) month period with the Insurer, via the Broker, provided that there have been no claims or losses reported or which should have been reported in the prior period of insurance 7.3 AUTOMATIC REINSTATEMENT (IF STATED IN THE SCHEDULE TO BE INCLUDED) In the event of the exhaustion of the aggregate limit under this Insurance by reason of any one loss and/or series of losses such aggregate limit shall be reinstated, without payment of an additional premium, but any such reinstated amount shall apply only in respect of payments which are totally unrelated to any payment(s) that give rise to such reduction. It being understood that the total liability of Insurers under this Insurance shall be limited to twice the amounts shown in the Schedule during the Period of Insurance. If the Insured has in effect any Insurance or Insurances providing excess coverage for limits beyond the amounts available under this Insurance, the reinstatement herein provided for shall become effective only AFTER the total exhaustion of the limits of all such excess coverage by reason or payments thereunder. 8 GENERAL EXCLUSIONS The Insurers will not indemnify the Insured for claims arising out of or as a consequence of: 8.1 Any dishonest, fraudulent, malicious or illegal act or omission of the insured's principals, partners, directors, officers, members, employees, "in-house" consultants, or agents; 8.2 the deliberate, conscious or intentional disregard by the Insured of the need to take all reasonable precautions to prevent loss, injury or damage; 8.3 or for liquidated, multiple or exemplary damages, or out of any performance warranty or penalty clauses, except to the extent that the Insured would have been liable in the absence of such clauses; 8.4 the insolvency, liquidation or judicial management of the Insured or of any party who enters into an agreement with the Insured. 8.5 loss of or damage to property of any kind belonging to or in the custody or control of the Insured, not otherwise specifically covered in terms of this Policy; 8.6 death of or injury to, or illness or disease contracted by any person employed by or under a contract of service or apprenticeship to the Insured and arising out of such employment, service or apprenticeship; 8.7 any claim that may be indemnifiable hereunder or fact circumstance or event which occurred prior to the Retroactive Date (if any) stated in the Schedule, provided that nothing contained within this Exclusion shall be interpreted as releasing the Insured from their obligation to reveal as a material fact all details of claims made or outstanding or facts circumstances or events likely to give rise to a claim; 8.8 liability assumed under a contract or agreement which would not have attached in the absence of such contract or agreement; Camargue Medmal 4 in 1 July
6 8.9 which the Insured is entitled to indemnity under any other insurance, or Medical Defence Union or the equivalent thereof, except in respect of any excess beyond the amount which would have been payable under such insurance had this policy not been effected any claim made against the Insured by any holding, controlled or subsidiary company, or by any person or entity having a financial or executive interest in the operation of the Insured, unless emanating directly from a third party any claims and/or cisurmstances which may give rise to a claim which were or ought to have been notified under any other policy or certificate attaching prior to inception of this policy 8.12 ionising radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel however this shall not include medical isotopes. For the purpose of this Exclusion only, combustion shall include any self-sustaining process of nuclear fission; 8.13 nuclear weapons material; 8.14 any legal liability arising from the discharge, dispersal, release or escape of smoke, vapours, soot, fumes, acids, alkalis, toxic chemicals, liquids or gases, waste materials or other irritants, contaminants or pollutants into or upon land, the atmosphere or any water course or body of water, but this Exclusion shall not apply if such discharge, dispersal, release or escape is sudden and accidental; 8.15 clinical trials of drugs any legal liability arising out of any employment related wrongful acts; 8.17 fines, punitive damages or any similar awards; 8.18 the ownership, possession or use by or on behalf of the Insured of any Vehicle other than claims: a) caused by the use of any tool or plant forming part of or attached to or used in connection with any Vehicle; b) arising beyond the limits of any carriageway or thoroughfare caused by the loading or unloading of any Vehicle; c) arising out of any Vehicle temporarily in the Insured's custody or control using parking facilities gratuitously provided by the Insured; d) arising out of the possession or use by or on behalf of the Insured of any Vehicle the property of Transnet, government or quasi-government departments, regional administrations, municipalities and/or similar bodies to the extent of any requirement by statute or statutory regulation; e) for damage to any bridge, weight-bridge, road or thoroughfare or anything beneath caused by the weight of any Vehicle or of the load carried thereon; 8.19 any fact, circumstances or event compulsorily insurable by legislation governing the use of any Vehicle; 8.20 the ownership, possession or use by or on behalf of the Insured of any aircraft, watercraft or hovercraft; 8.21 any blood bank or blood transfusion services; 8.22 loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing concurrently or in any other sequence to the loss; Camargue Medmal 4 in 1 July
7 war, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power; or any act of terrorism. For the purpose of this exclusion an act of terrorism means an act, including but not limited to the use of force or violence, by any means whatsoever, including chemical and/or biochemical means, and/or the threat of such force or violence, by any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organisation(s) or government(s), committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear. This exclusion also excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in any way relating to and/or above. If the Insurers allege that by reason of this exclusion any loss, damage, cost or expense is not covered by this insurance the burden of proving the contrary shall be upon the Insured. In the event any portion of this exclusion is found to be invalid or unenforceable, the remainder shall remain in full force and effect any actual or alleged liability whatsoever for any claim or claims in respect of loss or losses directly or indirectly caused by, arising out of, resulting from, in consequence of, in any way involving, or to the extent contributed to by, the hazardous nature of asbestos in whatever form or quantity for any act giving rise to a claim or series of related claims relating to a past present or prospective employee of the insured and arising out of any actual or alleged unfair or wrongful dismissal, discharge or termination, either actual or constructive, of employment, employmentrelated misrepresentation, wrongful failure to employ or promote, wrongful deprivation of career opportunities, wrongful discipline; failure to furnish accurate job references; failure to grant tenure or negligent employee evaluation; or sexual or workplace or racial or disability harassment of any kind (including the alleged creation of a harassing workplace environment); or unlawful discrimination, whether direct, indirect, intentional or unintentional, or failure to provide adequate employee policies and procedures 9 GENERAL CONDITIONS 9.1 This Policy and the Schedule shall be read together as one contract and any word or expression to which a specific meaning has been attached in any part of the Policy or the Schedule shall bear such specific meaning wherever it may appear. 9.2 Premium is payable before the inception date or renewal date as the case may be. The Company shall not be obliged to accept premium tendered to it after such date but may do so upon such terms as it, in its' sole discretion, may determine. 9.3 If the Premium is shown in the Schedule to be adjustable then the Premium is provisional being based on estimates provided by or on behalf of the Insured. The Insured shall as soon as reasonably possible after expiry of the Period of Insurance declare the turnover and/or fees achieved during the Period of Insurance (and such other particulars as the Insurers may require). The Premium shall be adjusted accordingly and any difference paid by or allowed to the Insured as the case may be, subject to any minimum premium that may apply. 9.4 If the Limit of Indemnity is increased during a Period of Insurance then the lower Limit of Indemnity shall apply to all claims made or circumstances notified or required to have been notified to the Insurers prior to such increase in the Limit of Indemnity. Unless otherwise stated the Retroactive Date for new Limit of Indemnity shall be the effective date thereof. 9.5 The Insurers will not require the Insured to dispute any claim unless a senior counsel advises that the claim could be contested with a reasonable prospect of success by the Insured, and the Insured consents to such a claim being contested, such consent not to be unreasonably withheld. Camargue Medmal 4 in 1 July
8 In the event of any dispute between the Insured and the Insurers as to what constitutes an unreasonable refusal, such dispute shall be referred to arbitration in accordance with the provisions of the Arbitration Act in force at the time. 9.6 The Insurers shall be entitled if they so desire to take over and conduct in the name of the Insured the defence or settlement of any claim, or to prosecute in the name of the Insured for their own benefit any claim for indemnity or damages or otherwise. The Insurers shall have full discretion in the conduct of any proceedings and in the settlement of any claim, and the Insured shall give all such information and assistance as the Insurers may require. 9.7 The Insurers may at any time pay to the Insured in connection with any claim or series of claims under this Policy to which a Limit of Indemnity is applicable, the amount of such limit (after deduction of any sum or sums already paid as damages and/or Defence Costs) or any lesser amount for which such claim or claims may be settled. Upon such payment being made the Insurers shall relinquish the control and conduct of such claim or claims and be under no further liability in connection therewith. 9.8 The Insured shall not without the Insurers' consent waive any right of recourse against any agent, correspondent, external consultant or other person with whom the Insured may be associated. 9.9 If the Insurers disclaim liability for any claim for indemnity or for costs or expenses in connection therewith and the Insured does not institute legal proceedings within twelve (12) months of the date of such disclaimer, the Insurers shall be entitled notwithstanding Condition 9.15 to assume that the claim has been abandoned and the Insurers shall not thereafter be liable to make payment whatsoever in connection therewith The Insured shall not without the Insurers' consent accept responsibility for the breach of professional duty of any Agent, Correspondent or external Consultant practising in any Business/Profession whether or not the fees accruing to such Consultant are included in the declaration of fees as provided for in Condition In the event of a claim arising out of or being contributed to by any dishonest act or omission of any Principal, Partner, Director, Officer, Member, Employee or "in-house" Consultant of the Insured, any monies which but for such dishonesty would be due to such person from the Insured shall be deducted from the Insured's loss to the extent that the Insured may legally do so The Insurers waive their rights of subrogation against any Principal, Partner, Director, Officer, Member, Employee or "in-house" Consultant of the Insured, unless such person has committed a dishonest or criminal act in relation to matters the subject of a claim hereunder If any claim under this Policy is in any respect fraudulent or if any fraudulent means or devices are used by the Insured or anyone on their behalf to obtain any benefit under this Insurance, all benefit under this Policy shall be forfeited in respect of the particular claim The Insured shall give written notice to the Insurers as soon as reasonably possible after the occurrence of any fact circumstance or event that may give rise to a claim under this Policy, and shall give all such additional information as the Insurers may require. Every letter, claim, writ, summons or process shall be forwarded to the Insurers within a reasonable time In the event of the Insured giving notice in accordance with Condition 9.14 of this Policy during the Period of Insurance of any fact circumstance or event which may reasonably be expected to give rise to a claim against the Insured, then for the purpose of the Operative Clause of this Policy the claim resulting therefrom shall be deemed to have been made during the Period of Insurance The Insured shall take all reasonable precautions to prevent claims and shall give notice as soon as possible of any fact or event which materially affects the risks covered by this Policy It is condition precedent to the Insured's right to indemnity under this Policy that the Insured shall notify the Insurers immediately upon becoming aware of any claims or any fact circumstance or event that may give rise to a claim (not having been disclosed to Insurers) during the period/s between: Camargue Medmal 4 in 1 July
9 9.18 Interlocking a) the date of the proposal; and b) the inception and/or renewal hereof; or c) the date the Insurers are placed on risk. As the Insured has purchased coverage under this Insurance AND each of the Sections hereof is subject to a separate Limit of Indemnity specified in the Schedule BUT as the Insurers subscribing to this Insurance are underwriting each of the said Sections AND since it is their intention not to increase or compound their coverage to the Insured, IT IS therefore agreed as follows: If the Insured shall sustain any one loss and/or series of losses arising out of one or the same event, for which coverage is afforded under more than one of the Sections of this Insurance, it is agreed that the total aggregate liability of the Insurers under all such Sections combined for such loss and/or series of losses shall not exceed an amount equal to the highest Limit of Indemnity available to the Insured under any one of the Sections, but subject to the highest deductible applicable to any Section of this Insurance Should a loss arise which falls within the terms and conditions of paragraph above, the individual proportion of such loss (including the Deductible) that shall be allocated to each Section involved shall be mutually agreed between the Insured and Insurers and shall be taken into account in calculating the aggregate liability of Insurers in respect of each Section in any claim and in any action, suit or proceeding to enforce a claim under this Insurance for loss or damage the BURDEN OF PROVING that such loss or damage does not fall within the provisions of this Clause shall be upon the Insured Whenever this Policy provides for notice to be given to the Insurers, such notice shall be given to: Camargue Underwriting Managers (Pty) Ltd Camargue House 33 Glenhove Road Melrose Estate 2196 Camargue Medmal 4 in 1 July
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