SUPPLEMENTARY GROUP PERSONAL ACCIDENT POLICY

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1 SUPPLEMENTARY GROUP PERSONAL ACCIDENT POLICY WHEREAS the Policyholder named in the Policy hereto has by signed proposal and declaration (hereinafter called Group Application Form ) has applied to MCIS ZURICH Insurance Berhad (hereinafter called the Company ) for the Insurance hereinafter contained and has paid or agreed to pay the Premium stated in the said Schedule as consideration for such Insurance. WHEREAS the parties hereto agree that the Group Application From together with any statement made by the Policyholder shall be the basis of this policy and held as incorporated herein. NOW THIS POLICY WITNESSETH THAT IN consideration of the payment by the Policyholder to the Company of premiums in accordance with the provisions of the Policy hereto the Company undertakes to pay compensation to the Policyholder on behalf of the legal personal representative or representatives of such employee the amount of assurance specified in the said schedule. This Supplementary Policy is issued in conjunction with Group Policy Number GLY0272 (hereinafter called the Basic Policy ) to which it is attached. In consideration of the application dated 08 May 2003 and the payment of the initial premiums, this Supplementary Policy shall take effect on 01 April 2003 and thereafter on each succeeding Policy Anniversary subject to the consent of the Company and payment of the renewal premiums. The coverage under this Supplementary Policy will automatically cease on the date of termination of the Basic Policy. DEFINITIONS In addition to the Definitions in the Basic Policy, the following definitions are used for the purpose of this Supplementary Policy. 1. REGISTERED MEDICAL PRACTITIONER means only a physician who is legally licensed and duly qualified to practice medicine and surgery authorized in the geographical area of his practice. 2. SUM ASSURED in respect of an Assured Member shall mean the amount of insurance as specified in the Schedule of Insurance in respect of Death and/or Permanent Disablement Benefit. 3. BODILY INJURY means injury suffered in the world caused solely and directly by violent accidental external and visible means and which injury shall solely and independently of any other cause result in the Assured Member s death or disablement within twelve (12) calendar months of the date of such injury. 4. TEMPORARY TOTAL DISABILITY (TTD) means total and continuous disablement so as to prevent the Assured from attending to or engaging in any business, profession or occupation of any kind whatsoever, the Company shall pay to the Assured weekly compensation calculated from the date of the injury for a maximum of 104 weeks. 5. TEMPORARY PARTIAL DISABILITY (TPD) means partial disablement so as to prevent the Assured from attending to a substantial part of his usual business profession or occupation whatsoever immediately following a period of such continuous partial disability compensation of the weekly indemnity specified for a maximum of 104 weeks. GPA(S)/Dec2000 1

2 The weekly compensation payable under this benefit is based on the limit stated in the Schedule. GENERAL PROVISIONS 1. EFFECTIVE DATE OF PARTICIPATION OF ELIGIBLE MEMBERS The coverage for an Eligible Member shall be effective from the first date he is eligible provided he is Actively-at-work, otherwise his Effective Date shall be deferred until 2 weeks after he becomes Actively-at-work. 2. CHANGES IN ASSURED MEMBER S COVERAGE If the insurance cover is based on occupational classification and/or salary the change in cover shall be effective on the date a change in classification and/or salary is effective if this falls on a Policy Anniversary otherwise on the next Policy Anniversary provided such changes are effected without discrimination among persons in like circumstances and provided that the Assured Member is Actively-at-work on the date of the change in benefit otherwise the Effective Date shall be deferred until 2 weeks after he becomes Actively at Work. If such Assured Member does not become Actively-at-work within 31 days after the due date of his increase in benefit shall be allowed without evidence of assurability satisfactory to the Company. BENEFIT 1. The benefits specified in the following sections are applicable without geographical limitation for 24 hours a day. 2. Always subject to all terms, conditions, exclusions and provisions of this Policy, upon receipt of proof of age and adequate documentary proof that the Assured Member sustains accidental bodily injury solely and independently of any other causes while covered under this Policy the Company shall pay to the Policyholder the benefits as provided for in the Schedule of Insurance according to the Schedule of Benefits and the appropriate percentages shown in the Schedule of Compensation in respect of any one accident. 3. Total and Permanent Disability - When as a result of injury and commencing within 180 days of the date of the accident the Assured Member is totally and permanently disabled and prevented from engaging in any occupation for compensation or profit for which he is reasonably qualified by reason of his education, training or experience the Company shall pay, provided such disability has existed for a continuous period of 365 days and is still total and permanent at the end of this period, the Sum Assured in one lump, less any other amount paid or payable under this Policy. 4. Notwithstanding the level of benefits provided for the Assured Members if an accident happens to a public conveyance the total amount of aggregated claims payable for Assured Members as a result of this accident is limited to RM2,500, GPA(S)/Dec2000 2

3 EXCLUSIONS The insurance under this Policy shall not cover death, disablement or any other loss caused directly or indirectly, wholly or partly by: (a) (b) (c) (d) (e) (f) self-inflicted injuries or any attempt thereat, while sane or insane. insurrection, war (declared or undeclared) or any warlike operations or military or naval service under orders for warlike operations. participation in a strike, riot or civil commotion or committing an assault or felony. any form of flying except as a passenger in an aircraft licensed to carry passengers. hunting, mountaineering, racing in any form (other than on foot), winter sports and scubadiving. any form of radioactivity or radiation. PAYMENT OF CLAIMS 1. Upon the happening of any accident likely to give rise to a claim under this Policy the Policyholder shall within 14 days after the happening of the accident give notice to the Company with full particulars of the accident and injuries and the Assured Member shall as soon as possible procure and act on proper medical or surgical advice. 2. The Assured Member shall at his expense furnish to the Company all such certificates, information and evidence as may be required by the Company and the Assured Member shall whenever reasonably required to do so submit to medical examination on behalf of the Company. In the event of the death of the Assured Member the Company shall be entitled to have a post mortem examination (unless forbidden by Law) at its own expense and notice shall when practicable be given to the Company before interment or cremation stating the time and place of any inquest appointed. 3. If the Company shall disclaim liability to the Assured Member for any claim hereunder, in no case shall the Company be liable in respect of such claim after the expiration of twelve months from the date of such disclaimer unless the claim is the subject of pending court action or arbitration. GPA(S)/Dec2000 3

4 SCHEDULE OF BENEFITS SECTION BENEFITS A B C D E F DEATH TOTAL AND PERMANENT DISABLEMENT OTHER PERMANENT DISABLEMENT TEMPORARY TOTAL DISABLEMENT TEMPORARY PARTIAL DISABLEMENT MEDICAL EXPENSES The Sum Assured, reduced by any benefits previously paid in respect of any Loss or Losses noted in Section B, C, D and E below incurred as a result of the same Accident. The Sum Assured as stated in the Schedule of Compensation, reduced by any benefits previously paid in respect of any Loss or Losses noted in Section C, D and E below incurred as a result of the same Accident. Such proportion of the Sum Assured as stated in the Schedule of Compensation. The amount of benefit payable under this Section will be reduced by any benefits previously paid in respect of any Loss or Losses noted in Section D and E below incurred as a result of the same Accident. The Weekly Benefit Assured for the period during which the Assured Member is wholly and continuously disabled calculated from the date Assured member was first examined by a qualified Medical Practitioner. The Weekly Benefit Assured for the period during which the Assured Member is continuously partially disabled calculated from the date the Assured Member was first examined by a Registered Medical Practitioner, except that the benefit will not be payable whilst the benefit under Section D continues to be payable. Expenses for medical and surgical treatment by a Medical Practitioner, hospital confinement or employment of a trained nurse which may be regarded as actual, necessary reasonable and customary for such treatment or services. GPA(S)/Dec2000 4

5 SUPPLEMENTARY GROUP PERSONAL ACCIDENT POLICY SCHEDULE OF COMPENSATION Section A Percentage Of Compensation Of The Assured Member s Sum Assured. (1) Death Section B (1) (2) (3) (4) (5) (6) (7) (8) Loss of both hands Loss of both feet Complete and irrecoverable loss of sight in both eyes Loss of one hand and one foot Complete and incurable insanity Injuries resulting in permanently being bedridden Any other injuries causing permanent total disablement Complete and incurable paralysis Section C (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) Loss of arm at shoulder Loss of arm between shoulder and elbow Loss of arm at elbow Loss of arm between elbow and wrist Loss of hand at wrist Loss of leg at hip Loss of leg between knee and hip Loss of leg below knee Loss of eye - whole Loss of eye - sight of Complete and irrecoverable loss of sight in one eye except Perception of light Loss of lens of eye Loss of four fingers and thumb of one hand Loss of four fingers Loss of thumb - both phalanges Loss of index finger - three phalanges Loss of middle finger - three phalanges Loss of ring finger - three phalanges 40% 25% 10% 10% 8% 6% 5% GPA(S)/Dec2000 5

6 SUPPLEMENTARY GROUP PERSONAL ACCIDENT POLICY SCHEDULE OF COMPENSATION Percentage Of Compensation Of The Assured Member s Sum Assured. (19) (20) (21) (22) (23) Loss of little finger Loss of metacarpals Loss of toes Loss of hearing Total loss of speech - three phalanges - first or second (additional) - third, fourth or fifth (additional) - all - great both halanges - great one phalanx - other than great, if more than one toe lost each - both ears - one ear 3% 3% 15% 5% 1% 75% 15% Loss of use above shall mean permanent total loss of use or entire physical loss occasioned by physical separation. Loss of limb shall mean loss of use of a hand or foot at or above the wrist or ankle or of an arm or leg at or above the elbow or knee. Loss of eye shall include total and irrecoverable loss of all sight in any eye. Loss of hearing shall mean total and irrecoverable loss of the ability of hearing. Loss of speech shall mean total and irrecoverable loss of the ability to utter intelligible sounds. In addition compensation is payable for any permanent partial disablement (other than loss of sense of taste or smell) not specified above, the proportion being assessed by the Company which is not inconsistent with the provisions as specified above after consulting its Medical Advisors without taking into consideration the Assured Member s occupation. The total compensation payable under this Policy shall not exceed of the Assured Member s Sum Assured. GPA(S)/Dec2000 6

7 ENDORSEMENT TO BE ATTACHED TO AND READ AS PART OF GROUP POLICY NO: GLY0272 BENEFIT: SUPPLEMENTARY GROUP PERSONAL ACCIDENT Notwithstanding anything contained herein to the contrary, it is hereby declared and agreed that this Policy does not cover Temporary Total Disablement, Temporary Partial Disablement and Medical Expenses. In all other respects, the terms, conditions and exclusions of this Policy shall remain unaltered. GPA(S)/Dec2000 7

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