1 Personal Accident Insurance Your Policy. Our Promise. Zurich Insurance Middle East S.A.L
2 Welcome Thank you for choosing to purchase your personal accident insurance from Zurich. We have 140 years experience of protecting our customers against the unexpected, and we pride ourselves on providing high quality insurance solutions in more than 170 countries. Zurich has been serving customers in the Middle East for over 25 years. Our commitment to the region has seen us develop our business in Oman, Kuwait, Lebanon, Bahrain and the UAE. As a Zurich customer, you ll benefit from being with one of the leading and most secure financial services groups in the world. Our global expertise combined with our regional understanding means that you can be sure you will benefit from products and services tailored to your individual needs. We hope you are happy with the your policy and look forward to having the opportunity to be your preferred insurance provider for many years to come.
3 Contents Making a claim... 5 Personal accident insurance cover... 6 Part 1: Definitions... 7 Part 2: Important information... 9 Part 3: Benefits and covers...10 Part 4: General exclusions...14 Part 5: General conditions...17 Part 6: General provisions...18 Part 7: Our complaints procedure...24
4 Making a claim Please notify us within thirty days of any occurrence likely to give rise to a claim. If you wish to make a claim, please contact us on: 800 ZURICH ( ) Alternatively, you can us at:
5 Personal accident insurance cover Individual Benefit Bronze Silver Gold Platinum Accidental Death 100, , ,000 1,000,000 Accidental Death (common carrier) Permanent Partial Disablement Permanent Total Disablement 500,000 1,250,000 2,500,000 5,000, , , ,000 1,100, , , ,000 1,100,000 Individual & Spouse Benefit Bronze Silver Gold Platinum Accidental Death 100, , ,000 1,000,000 Accidental Death (common carrier) 500,000 1,250,000 2,500,000 5,000,000 Permanent Partial Disablement 110, , ,000 1,100,000 Permanent Total Disablement 110, , ,000 1,100,000 Family Benefit Bronze Silver Gold Platinum Accidental Death 100, , ,000 1,000,000 Accidental Death (common carrier) 500,000 1,250,000 2,500,000 5,000,000 Permanent Partial Disablement 110, , ,000 1,100,000 Permanent Total Disablement 110, , ,000 1,100,000
6 Part 1: Definitions Certain words have specific meanings when they appear in this policy. These meanings are shown below or in the section where they apply. They are printed in bold type. Any other words not appearing in the definition section will follow the English language definition: Accident a sudden, unforeseen and unusual specific event that happens unexpectedly caused solely and directly by violent, external and visible means which occur at an identifiable time and place resulting in injury and which is the sole and direct cause of accidental death or disablement. Accidental death loss of life due to an accident as determined by a physician/medical practitioner. Beneficiary The person or persons nominated by the insured person as stated on the policy schedule, if not mentioned then the beneficiary will be the legal heirs of the insured person. Children/child Biological off-springs, legally adopted or fostered children of the insured person who are not in full-time employment, unmarried, not pregnant, without children, primarily dependent on the insured person for support and who are between the ages of three (3) months and eighteen (18) years. Or under twenty three (23) years of age if a full time student Close relative Spouse, parent, parent-in-law, grandparent, son or daughter, son or daughter-in-law, brother or sister, brother or sister-in-law, grandchild, legal guardian, children or fiancé(e) of the insured person. Country of residence Your normal place of residence or dwelling in the United Arab Emirates of which you are a citizen or hold a valid resident status as of the time of the policy issuance. Excess The first amount of any claim for which you are responsible to pay for any one event. Or the amount we will subtract from any covered loss that we pay. Or the time period during which any claim will not be paid. If claims are made under two or more covers, for loss or damage caused by the same insured incidence at the same time, excess shall apply for each section as stated in the policy schedule. Family The insured person, spouse and unlimited dependent children. Injury Bodily injury sustained in an accident directly and independently of all other causes. Insurance period The date specified in your policy schedule.
7 Insured person/you/your/yours Each person specified as an eligible person in the policy schedule and for whom the appropriate insurance premium has been paid and accepted for coverage. Medical condition The unforeseen and emergent occurrence of symptoms for a disease, illness or injury which, unless treated immediately by a physician, may lead to death or serious impairment of your health. Paraplegia Permanent loss of use of both legs and the permanent loss of use of part of or whole of the lower half of the body. Permanent total disablement Disablement which for fifty two (52) consecutive weeks immediately following an accident entirely prevents the insured person from attending their usual occupation if employed. Or if not employed, from attending employment of any and every kind. Disablement at the end of that time should be beyond reasonable hope of improvement, total, continuous and permanent. Permanent partial disablement Disablement which for fifty two (52) consecutive weeks immediately following an accident prevents the insured person from attending their usual occupation at full physical capacity if employed. Or if not employed, from attending employment of any and every kind at full physical capacity. Partial disablement at the end of that time should be beyond reasonable hope of improvement, total, continuous and permanent. Physician/medical practitioner A person other than the Insured person or close relative of the insured person, who is qualified by degree in western medicine and legally authorized in the geographical area of his/her practice to render medical and surgical services. Policy schedule All policy documents issued by us outlining information and policy details such as, but not limited to, terms and conditions, premium, covers/benefits and limits, enclosed cover(s), extensions, exclusions and conditions, along with any endorsements issued. Pre-existing medical conditions The insured person received medical treatment, diagnosis consultation or prescribed drugs, or medical condition for which the insured person is on a waiting list for hospital in-patient treatment. Or an ongoing or recurring medical condition for which medical advice or treatment was recommended by a medical practitioner within a two (2) year period preceding the original inception of the policy. Public common carrier Any mechanically propelled conveyance operated by a company or an individual licensed to carry passengers for hire, including but not
8 limited to aircraft, bus, coach, ferry, hovercraft, hydrofoil, ship, train, tram or underground train. Quadriplegia Permanent loss of use of both arms and both legs. Spouse A person who has a legitimate marital contract to the insured person as recognized by United Arab Emirates laws between the ages of eighteen (18) years and seventy (70) years. Sum insured Maximum amount payable under each cover of the policy schedule as set to be payable by the policy s terms and conditions. We/us/our/ours Zurich Insurance Middle East S.A.L. Part 2: Important information Conditions and exclusions There are conditions and exclusions which apply to individual sections of the policy and general conditions and exclusions which apply to the whole policy. Please make sure that you read these as well as the cover shown in each section. Eligibility To be eligible for this insurance: You must be a valid resident of the United Arab Emirates; and have a valid business, employment or residency visa in the United Arab Emirates; Age limit You must be between the ages of eighteen (18) years and seventy (70) years at the commencement date of this policy. Chosen plan There are four (4) available plans to choose from and your policy schedule will show the plan you have chosen. You may elect to extend your plan to include your spouse or your family as per the terms, conditions and limits set forth in this policy and provided the premium is paid for the appropriate extension and we agree to accept it.
9 Geographical areas Unless specifically mentioned in the schedule, your cover does not apply to Iraq and Afghanistan and in countries where war has been declared or after it has been recognized as a war zone by the United Nations. Policy information If you require information or advice on any aspect of this policy please contact us on 0800 ZURICH ( ) Part 3: Benefits and Covers These covers only apply if shown in the policy schedule and up to the maximum amount shown. Section A: Accidental death We will pay the appropriate compensation applicable to the insured person up to the maximum amount shown on the policy schedule and in accordance with the percentage stated in the compensation table hereunder, less any other amount paid or payable under the policy for Section C and/or Section D arising from the same accident, if, during the insurance period, a covered injury which solely and independently of any other cause results in death of the insured Person within fifty two (52) consecutive weeks after the date of the accident. Subject to the following extensions: Under this section, we extend to pay; Disappearance clause: If the body of the insured person has not been found within fifty two (52) consecutive weeks after the date of the disappearance and a death certificate issued from the country of residence officials due to disappearance, sinking or wrecking of the aircraft or other public common carrier in which the insured person was travelling at the time of the accident and under such circumstances as would otherwise be covered hereunder, it will be presumed that the insured person suffered death resulting from an accident covered by this policy at the time of such disappearance, sinking or wrecking.
10 Section B: Accidental death (public common carrier) We will pay the appropriate compensation applicable to the insured person up to the maximum amount shown on the policy schedule and in accordance with the percentage stated in the compensation table hereunder, less any other amount paid or payable under the policy for Section C and/or Section D arising from the same accident, if, during the insurance period, the insured person suffers an injury from an accident; when riding solely as a passenger (not as operator, pilot, or crew member) in or on, boarding or alighting from any public common carrier outside the country of residence, resulting in death of the insured person within fifty two (52) consecutive weeks after the date of the accident. Section C: Permanent total disablement due to accident We will pay the appropriate compensation applicable to the insured person up to the maximum amount shown on the policy schedule and in accordance with the percentage stated in the compensation table hereunder, less any other amount paid or payable under the policy for Section D arising from the same accident, if, during the insurance period, as a result of a covered injury, and commencing within fifty two (52) consecutive weeks after the date of the accident, an insured person is totally and permanently disabled and such disability has continued for period of fifty two (52) consecutive weeks. The disability must be total, continuous and permanent at the end of the period. Section D: Permanent partial disablement due to accident We will pay the appropriate compensation applicable to the insured person up to the maximum amount shown on the policy schedule and in accordance with the percentage stated in the compensation table hereunder, if, during the insurance period, a covered injury which solely and independently of any other cause results in anyone of the events outlined in the compensation table, under permanent partial disablement, to the insured person within fifty two (52) consecutive weeks after the date of the accident.
11 Compensation Table Events Percentage of maximum benefits 1. Accidental death or accidental death (public common carrier) 100% 2. Permanent total disablement 100% A. Permanent paraplegia, quadriplegia or incurable paralysis of all limbs 100% 3. Permanent partial disablement A. Permanent total loss of sight of both eyes 100% B. Permanent total loss of sight of one eye 25% C. Loss of or the permanent total loss of use of two limbs 100% D. Loss of or the permanent total loss of use of one limb (i) Right hand 70% (ii) Left hand 50% (iii) One foot 70% E. Loss of speech and hearing 100% F. Permanent total loss of hearing in (i) both ears 75% (ii) one ear 15% G. Loss of speech 50% H. Loss of or the permanent total loss of use of four fingers and thumb of (i) Right hand 70% (ii) Left hand 50% I. Loss of or the permanent total loss of use of four fingers of (i) Right hand 40% (ii) Left Hand 30% J. Loss of or the permanent total loss of use of one thumb (i) both right joints 30% (ii) one right joint 15% (iii) both left joints 20% (iv) one left joint 10% K. Loss of or the permanent total loss of use of fingers (i) three right joints 15% (ii) two right joints 10% (iii) one right joint 7.50%
12 (iv) three left joints 10% (v) two left joints 7.50% (vi) one left joint 5% L. Loss of or the permanent total loss of use of toes (i) all one foot 20% (ii) great both joints 7.50% (iii) great joint 5% (iv) other than great each toe 2% 4. Permanent partial disablement not otherwise provided for under Event 3. Such percentage of the lump sum amount as we in our absolute discretion shall determine and being in our opinion not inconsistent with the compensation provided under Event 3. Event 4 is limited to 75% of the maximum amount shown in the policy schedule. All covers and benefits provided under this policy will be subject to the following provisions and limitations: Should more than one (1) of the covers occur from the same accident and/or injury, the total indemnity payable shall be computed by adding the indemnity payable corresponding to each cover with 100% as the highest compensation payable. No indemnity will be paid under any circumstances for more than one of the losses payable for section A or section B. The insurance for any insured person under this policy shall terminate upon the occurrence of any compensation for which total indemnity is 100% payable, but such termination shall be without prejudice to any claim originating out of the accident causing such loss. When a limb or organ which had been partially disabled prior to an injury covered under this policy and which becomes totally disabled as a result of such injury, the
13 Percentage of maximum benefits payable shall be determined by us having regard to the extent of disablement caused by the injury. However, no payment shall be made in respect of the loss of a limb or organ which was totally or partially disabled prior to the injury. Total and irremediable functional loss of use of a limb or organ shall be considered as total loss thereof. For reduced functional use, the percentage of maximum benefits as stated in the compensation table shall be reduced in proportion to the lost functional use. If the insured person is left-handed and has specifically mentioned this on the application, the percentages set out above from Events 3(H) 3(K) for the various disabilities of right hand and left hand will be transposed. If a claim is payable for loss of or loss of use of a whole part of the body a claim for any component part of that part cannot also be made. Compensation to children being limited to 10% of the sum insured and up to a maximum of AED 90,000 and subject to the Percentage of Maximum Benefits as stated in the Compensation Table. Part 4: General Exclusions Applicable to all sections of the policy, we will not cover loss, injury, damage or legal liability caused by, sustained, or arising directly or indirectly from: 1. Any pre-existing condition, congenital and hereditary condition; 2. Any illegal or unlawful act by the insured person or confiscation, detention, destruction by customs or other authorities; 3. The insured person is not taking all reasonable efforts to avoid injury to minimize any claim under this insurance; 4. Riding or driving in any kind of motor racing, or engaging in a sport in a professional capacity or where the insured person would or could earn income or remuneration from engaging in such sport; 5. Willful or deliberate exposure to danger (except in an attempt to save human life), suicide or attempt thereat, or intentional self-inflicted injury;
14 6. Insanity, mental or nervous disorders including, but not limited to, anxiety disorders, eating disorders, psychotic disorders, affective disorders, personality disorders, substance use disorders, somatoform disorders, dissociate disorders, psychosexual disorders, adjustment disorders, organic mental disorders, mental retardation and autism; 7. (a) any condition under the influence of alcohol, drugs or narcotics (unless such drugs or narcotics were administered by a medical practitioner or unless prescribed by and taken in accordance with the directions of a medical practitioner); (b) alcohol abuse, alcoholism, substance abuse, solvent abuse, drug abuse or addictive conditions of any kind; (c) an insured person being under the influence of alcohol with more than the legal limit of alcohol in his/her blood or breath; 8. Any condition resulting from pregnancy, childbirth or miscarriage, abortion, pre-natal care as well as post-natal care and other complications arising therefrom, venereal disease, services and supplies related to the diagnosis or treatment of infertility or other problems related to inability to conceive a child; birth control, including surgical procedures and devices; 9. Congenital anomalies and conditions arising out of or resulting there from, and hernia; 10. Air travel where the insured person is acting as pilot or part of the aircraft crew other than as a fare-paying passenger on a regular scheduled airline or licensed chartered aircraft; 11. Flying in any aircraft owned, leased or operated by or on behalf of an insured person or close relative; 12. Engaging in any kind of occupational activities underground or aerial photography; handling or requiring the use of explosives; naval, military or airforce service or operations or armed force services (including being in service or on duty with or undergoing training with any military or police force, or militia or paramilitary organization); 13. Any Injury, illness, death, loss, expense or other liability attributable to HIV (Human Immunodeficiency Virus) and/or HIV-related illness including AIDS and/or any mutant derivative or variations thereof however caused or however named; 14. Any sexually transmitted or transmissible disease, or infection or virus of any sort emanating from a sexually transmitted or transmissible disease;
15 15. Chronic fatigue syndrome or myalgic encephalomyelitis (M.E.) (anticardiolipin antibody positively); 16. (a) any pre-existing medical condition; or (b) any cardiac or cardio vascular or vascular or cerebral vascular illness or conditions or sequelae thereof or complications that, in the opinion of a medical practitioner appointed by us, can reasonably be related thereto, if the insured person has received medical advice, treatment or prescribed medication for hypertension within 2 years prior to the commencement of the insurance period; 17. Any event arising from war, invasion, act of foreign enemy, hostilities (whether war is declared or not), civil war, rebellion, revolution, insurrection, labor disturbance, riot, strike or lockout, military force or coup; 18. Any expenses, consequential loss, legal liability or loss of or damage directly or indirectly arising from: ionising radiation or contamination by radioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel; the radioactive, toxic, explosive or other hazardous properties of any nuclear assembly or nuclear component; 19. The release, the dispersal or application of pathogenic or poisonous biological or chemical materials; 20. Deliberate violation of criminal law; 21. Consequential loss of any kind or financial loss and/or expense not otherwise specifically covered; 22. Any type of adventure sports or extreme adventure sports (such as but not limited to, sky diving, parachuting, hand gliding, bungee jumping, scuba diving, mountain climbing, martial arts or all forms of motor racing); 23. Any terrorist act or bomb incident or threat thereof; 24. The intentional use of military force to intercept, prevent, or mitigate any known or suspected terrorist act; 25. any terrorist or member of a terrorist organization, narcotics trafficker, or purveyor of nuclear, chemical or biological weapons; 26. Notwithstanding any other terms under this insurance contract, no insurer shall be deemed to provide coverage or will make any payments or provide any service
16 or benefit to any insured or other party to the extent that such cover, payment, service, benefit and/or any business or activity of the insured would violate any applicable trade or economic sanctions law or regulation. Part 5: General Conditions The following conditions apply to this policy 1. If the same insured person/family is insured by more than one (1) voluntary insurance policy underwritten by us and our affiliated companies respectively and claims for the same cover under such policies due to any one (1) accident or loss, only the policy with the greatest compensation for the same cover shall apply and our aggregate liability under such policies shall not exceed the sum insured of the same cover under the policy with the greatest compensation. 2. The insured person must give us all the documents needed to deal with any claim. we will not be responsible for any costs involved in doing this. 3. The insured person must agree to have a medical examination if requested by us. If insured person die, we are entitled to have a post-mortem examination. 4. We may refuse to reimburse you for any expenses for which you cannot provide receipts, bills or any claim supporting documents deemed necessary to process the claim. 5. If any claim is covered by any other insurance, we will not pay for more than our share of that claim. 6. We can, at any time, do the following: Take over the defence or settlement of any claim. Try to recover expenses or compensation from any other third party at any time in your name or in the name of anyone else claiming under this policy. Reserve the right to access any of your current or prior medical records in order to finalize and/or proceed with the assessment of a claim and/or render medical assistance. By virtue of this clause, the insured person shall be deemed to have given us written consent to access any of his/her current or prior medical records. Additionally any items which become the subject of a claim for damage must be retained for our inspection and shall be forwarded to our Agents upon request at your or your legal personal representative s expense. All such items shall become our property following final settlement of the claim.
17 7. No insurance provided by this policy shall become effective as to an insured person if such insured person is hospital confined, disabled, or receiving payment for a claim when such insurance would otherwise take effect. The coverage on such person shall take effect thirty-one (31) days after such hospital confinement or disability terminates, or payment of claim ceases, whichever is the latter. 8. If a family is insured by this policy, our maximum liability to any one (1) accident for such family shall not exceed AED 2,270,000 under this policy. Part 6: General Provisions The following provisions apply to this insurance 1. Entire Contract This policy including application, policy schedule, riders, endorsements, attachments and amendments, if any, will constitute the entire contract between the parties. No agent or other person has the authority to change or waive any provision of this policy. No changes in this policy shall be valid unless approved by us and evidenced by endorsement of amendment. 2. Marketing Should any discrepancies arise between the policy and any literature received by the insured person, the terms, conditions, endorsements and exclusions in the policy will govern in all cases. 3. Third Party This policy is between us and the insured person only and all of its provisions and conditions are for the sole and exclusive benefit of those parties. Nothing in this policy, expressed or implied, is intended to confer upon any other person any rights or remedies of any nature whatsoever under this policy or any of its provisions. Receipt of benefits paid will be a valid discharge of our liability under this policy. This policy cannot be ceded, assigned or in any way transferred to a third party. 4. Tax or Imposts The onus will always be on the insured person to ensure, correctly admit and pay any tax liability in consideration of any benefit being paid that may incur tax or imposts of any nature.
18 5. Age Limit The insurance shall apply to an insured person who is eighteen (18) years to seventy (70) years of age on the commencement date of this policy. When a family policy is issued, the children must be aged between three (3) months and eighteen (18) years, Or under twenty three (23) years of age if a full time student 6. Misstatement of Age If the insured person s age has been misstated, the premium difference would be returned or charged according to the correct age. In the event that the insured person s age has been misstated and if, according to the correct age, the coverage provided by this policy would not have become effective, or would have ceased prior to the acceptance of each premium or premiums, then our liability during the period that the insured person is not eligible for coverage shall be limited to the refund of all premiums paid for the period covered by this policy. 7. Liability We shall not be liable or responsible for: a) the negligence, wrongful acts and/or omissions of any legal and/or health care professional or any other person or persons or legal entity that provide direct or indirect service to the insured person; b) The failure of any agent or broker to explain adequately the terms, conditions, endorsements, terminations and exclusions of this policy. 8. Notice of Claims Written notice of claim must be given to us within thirty (30) days of the date of the incident causing such loss. In the event of accidental death, immediate notice thereof must be given to us by the insured person s legal representative. 9. Proof of Loss Written proof of loss must be furnished to us within thirty (30) days from our receipt of the claim form provided by us. Failure to furnish such proof within the time required shall not invalidate any claims if it was not reasonably practicable to give proof within such time, provided that such proof is furnished as soon as reasonably practicable, and in no event later than ninety (90) days from the time when such proof is otherwise required. All certificates, information and evidence in such form and of such nature and within such time as we may reasonably require shall be furnished without expense to us. 10. Medical Examination We shall be entitled in the case of non-fatal injury to call for examination by a medical referee appointed by us whenever required and in the event of death to have a post-mortem examination at our expense.
19 11. Payment of Claims Indemnity for death of the insured person is payable to the beneficiary of the insured person. we shall not be liable for any claim arising under this policy that occurs prior to the commencement date of this policy. Any payment made by us pursuant to this provision shall fully discharge us to the extent of the payment. 12. Liability Claims The insured person must not admit, deny, or settle a claim without our consent. 13. Misrepresentation If the insured person or anyone acting for the insured person makes a statement in the application form or in connection with any claim knowing the statement is false or uses any fraudulent means or devices to obtain any benefit under this policy, we will not be liable for any claim, all covers under this policy shall cease and no premium will be refunded. This policy shall be considered void (at our discretion) in the event of misrepresentation, misdescription or nondisclosure by or on behalf of the insured person of any information material to this policy. 14. Legal Action No legal action against us shall be brought to recover on this policy before filling a written claim on us in accordance with the procedures mandated by General Provision 8 Notice of Claims set out above. 15. Subrogation We have the right to commence or take over legal proceedings in the insured person s name for the defense or settlement of any claim, or to sue or prosecute any other party to recover monies payable by them at law. The insured person must co-operate with us and do nothing to hinder our rights. 16. Compliance The insured person must follow our advice or instruction otherwise we may decline to pay the whole or any part of the claim. Also, failure to comply with any of the provisions contained in this policy shall invalidate all claims hereunder. 17. Other Insurance If at the time of a claim there is any other policy insured by other insurance company which also covers the same benefits as this policy, we will only be liable for our proportionate share. 18. Premium Payments The premium, and any applicable taxes, are payable in advance by the insured person on or before the date they become due; unless official notice of
20 termination has been given, a grace period will be granted for the payment of any premium falling due after the first premium, subject to the terms of General Provision 19 Grace Period. We shall not be liable for any claim arising under this policy that occurs prior to receipt of the premium. We shall not be obliged to accept premium tendered to us or to any intermediary after such date, but may do so at our discretion. We reserve the right to ask for proof of payment of premium at any time. Such proof must be to our satisfaction. 19. Grace Period We will allow the insured person one calendar month for the payment of each premium falling due after the first premium. During this period we will keep this policy in force. The insured person shall be liable to pay us the premium for the period the policy continues in force. If any claims occur during this period, the outstanding balance must be paid to us in full before we settle the claim. If after this period the premium remains unpaid, this policy will lapse at the end of the grace period. 20. Reinstatement of Policy If this policy lapses due to non-payment of premiums, it may be reinstated with our approval. Benefits will not, however, be payable for any event likely to give rise to a claim under this policy which occurs while this policy has lapsed and pre -existing condition should re-apply as if this policy commenced on such reinstatement date. 21. Renewal The policy may be renewed with our consent from term to term by payment in advance of the total premium specified by us, which premium shall be at our premium rate in force at the time of renewal. Subject to General Provision 19 Grace Period and all other terms and conditions of the policy, the insurance in respect of the insured person will be automatically renewed each calendar year, subject to payment of premiums unless cancelled in writing by the insured person/us. 22. Cancellation This policy may be cancelled at any time by us or the insured person by issuing a fifteen (15) days written notice in advance. Such cancellation shall be without prejudice to any valid claim originating prior thereto. In the event the plan offered to the insured person under the policy for which the Monthly Premium has been paid in advance is cancelled by the insured person or us, the policy will then lapse at the end of the current calendar month.