(IPI) POLICY WORDING

Transcription

1 INCOME PROTECTION INSURANCE (IPI) POLICY WORDING IP/CINZ/010406

2 1 ABOUT THIS POLICY 1.1 Welcome China Insurance (NZ) Company Limited is proud to be part of China Insurance Group, which has been writing insurance business since its inception in Today the Group is amongst the top insurance companies of the world with more than 20 subsidiaries spread over the globe in Europe, United States of America, Japan, Hong Kong, and South East Asia. In New Zealand, China Insurance (NZ) Company limited has been operating since 1994 and is committed to New Zealand for the long term. We are dedicated to providing you with the very best financial security in New Zealand which is supported through an extensive international reinsurance programme. We are members of the Insurance Council of New Zealand and the ISO (Insurance and Savings Ombudsman Scheme), and are also keen supporters of IBANZ (the Insurance Brokers Association of New Zealand). We continually strive for excellence as well as a reputation for paying claims in a fair and reasonable manner. We offer you the opportunity to join us in our long term goal of one day becoming one of New Zealand s foremost general insurance companies Your insurance policy: Your insurance policy consists of: Your proposal and any other information you supplied us, and This policy wording, and The policy schedule 1.3 Your free look period We will give you a full refund of your premium within the first 30 days if you are not completely happy with the policy. You can only do this if you never make a claim under it. 1.4 Your duty of disclosure When arranging this insurance, you must tell us everything you know (or could be reasonably expected to know) that a prudent insurer would want to take into account in deciding: Whether to accept your proposal, and IP/CINZ/010406

3 If so, on what terms. Examples of what you must tell us include: Anything that increases the risk of a claim Any criminal offending or convictions Any previous insurance claims Any refusal by another insurer to insure you on standard terms, or to continue to insure you on standard terms. You must also tell us this every time this policy renews, and when you make any changes to it. If you fail to do this, we may avoid the policy back to when it started as if you were never insured at all. When in doubt, disclose. We treat all information confidentially. 1.5 Your rights under the Fair Insurance Code We are members of the Insurance Council of New Zealand. It promotes a code of ethics amongst its members. This is called the Fair Insurance Code The Code sets out some of your rights when dealing with us. We view these as a minimum only. Please contact us if you would like to receive a copy of the Code. Alternatively, it can be located at: Premium Once you have paid, or agreed to pay, the premium, we will insure you on the terms set out in this policy. 2 HOW TO CLAIM UNDER THE POLICY 2.1 To make a claim You must: (c) (d) Tell us as soon as you are aware of any circumstances likely to result in a claim under this policy. Take steps to minimise your claim, and try to avoid any further claim Complete our claim form in full if we request it. Allow us to investigate the circumstances of the claim and provide any other information or assistance that we need IP/CINZ/010406

4 (e) (f) (g) (h) Authorise the disclosure to us of your personal information held by any other party that relates to your claim Forward to us all relevant information and correspondence as soon as you receive it. Provide a statutory declaration to verify the claim, if we request it. Where appropriate: You must not: Lay a complaint with the Police if you suspect burglary, theft, arson or intentional damage, and Take reasonable steps to obtain details of any other person, property or vehicle involved, and any witnesses. Say or do anything that may prejudice our ability to make recovery from any person who may be responsible for your loss. 2.2 Medical treatment You must ensure that the insured person: Obtains medical treatment from a registered doctor or hospital as soon as possible following the injury or illness, and Follows any medical advice or treatment given. 2.3 Other accident insurance If any other accident insurance is available (either public or private), you must also make a claim under that insurance. You must tell us immediately if any other accident insurer (either public or private) declines (for any reason) a claim relating to an injury or illness insured by this policy. 2.4 After you have made a claim After you have made a claim: We may request that: The insured person has one or more medical examinations, and A post-mortem examination is carried out if the insured person dies. If we request either of these, it is at our expense. We may take over in full any legal right of recovery that you have. If we do so, you must fully cooperate with us IP/CINZ/010406

5 (c) You must reimburse us if you receive any money from any person ordered to make reparation to you. 2.5 Death to be presumed If the insured person disappears, their death will not be presumed unless they have been missing for more than 12 months. However, if: It can be reasonably assumed that the disappearance is due to death by injury, then we shall consider the disappearance to fall under Event 1; and At any future date the insured person is established to be still alive, you must return any claim payment. 2.6 Dishonest or fraudulent claims If your claim is dishonest or fraudulent in any way we may, at our discretion: Decline your claim, wholly or partially, or Declare this policy unenforceable from the date of the dishonest or fraudulent act. 3 COVER 3.1 Benefits payable If the insured person: Suffers any event listed in the List of Policy Benefits in Part 4 below, during the period of insurance, and The event is an insured event, We will pay you the corresponding benefit payable. 3.2 Continuity of Cover After an injury or illness is notified to us during the period of insurance, we will continue to cover subsequent insured events, provided that: The subsequent insured event first commences within 12 months of the original notification, and The subsequent insured event is caused by the same injury or illness. 3.3 Rehabilitation Costs Event IP/CINZ/010406

6 If you become entitled to a benefit payable under any part of Event 2, we will also pay all reasonable costs the insured person incurs for therapy, tuition or professional advice, provided that: The costs are incurred as part of a programme to retrain the insured person for a new occupation, and The therapy, tuition or professional advice: Is undertaken with our prior consent, and Is undertaken with the support of the insured person's doctor, and Cannot be claimed for from any other person or organisation. The most we will pay for any one event is $1,000 per calendar month, for up to 12 months. 3.4 Rehabilitation Costs Events 3, 4, 5 or 7 If you become entitled to a benefit payable under Events 3, 4, 5 or 7, we will also pay all reasonable costs the insured person incurs for therapy, tuition or professional advice, provided that: (c) The costs are incurred as part of a programme to help the insured person recover and return to their occupation, and It is provided by an appropriately licensed institution, and It is undertaken: With our prior consent, and On the recommendation of the insured person's doctor, and It cannot be claimed for from any other person or organisation. The most we will pay for any one event is $500 per calendar month, for up to 12 months. 3.5 Inflation protection If, following the occurrence of Events 3, 4 or 5, you become entitled to a benefit payable for a period exceeding 12 months, we will increase the payments made after the first 12 months by any percentage increase of the 'Consumer Price Index' recorded in New Zealand over the first 12 month period. 3.6 Worldwide cover IP/CINZ/010406

7 This policy covers the insured person in New Zealand, and anywhere else in the world provided they do not leave New Zealand on a permanent basis. If the insured person intends to travel out of New Zealand for a period of 12 months or longer, you must tell us. We may modify the terms of this policy depending on the insured person's travel and residency plans. 3.7 Damage to teeth If, following the occurrence of any of Events 2 to (l): You become entitled to a benefit payable, and The insured person: Suffers loss of one or more teeth, or Requires one or more teeth to be capped, we will pay up to $1,000 towards the associated dental costs. We will only pay these costs where they cannot be claimed for from any other person or organisation. 3.8 Funeral costs If, following the occurrence of Event 1: You become entitled to a benefit payable, and You incur funeral expenses for the insured person, we will pay up to $2,500 towards the funeral expenses. We will only pay these costs where they cannot be claimed for from any other person or organisation. 4 LIST OF POLICY BENEFITS EVENT Event 1 Event 2 Death caused by an injury that occurs during the period of insurance. Any permanent total disablement (listed in to (l) below), that is caused by an injury, which occurs during the period of insurance. BENEFIT PAYABLE The sum insured shown in the schedule for this Event The following percentages of the sum insured shown in the schedule for Event 1 permanent and incurable total disablement 100% IP/CINZ/010406

8 permanent and total loss of sight in one or both eyes 100% (c) permanent and total loss of speech 100% (d) permanent and total loss of hearing in both ears 100% (e) loss of use of any arm(s) and/or leg(s) 100% (f) loss of use of both hands or feet 100% (g) loss of use of one hand 75% (h) third-degree burns or disfigurement by burns, covering more than 30% of the body 60% (i) permanent and total loss of hearing in one ear 35% (j) loss of use of one foot 35% Event 3 Event 4 Event 5 (k) loss of use of any one finger (and multiples thereof up to five) (l) loss of use of any one toe (and multiples thereof up to five) Temporary total disablement caused by an injury that occurs during the period of insurance. Temporary partial disablement caused by an injury that occurs during the period of insurance. Temporary total disablement caused by an illness that occurs during the period of insurance. 15% 7.5% The sum insured shown in the schedule for this Event for each week of disablement 25% of the benefit payable for Event 3 The sum insured shown in the schedule for this Event for each week of disablement Event 6 Medical expenses relating to an insured event. The medical expenses you incur over any annual period up to a maximum of the sum insured shown in the schedule for this Event Event 7 The employment of temporary staff, made necessary by a temporary total disablement that: is caused by an injury or illness, and occurs during the period of insurance. The actual cost of wages you reasonably incur to hire a person as temporary staff up to the sum insured shown in the schedule for this Event for each week of total disablement IP/CINZ/010406

9 5 EXCLUSIONS 5.1 Events not covered This policy does not insure any injury or illness connected with any of the following: (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) the insured person's suicide or attempted suicide, the normal effects of childbirth or pregnancy, any psychiatric or psychological conditions including mental stress, Acquired Immunodeficiency Syndrome (AIDS), and its related syndromes including Lymphadenopathy Syndrome (LAS), and AIDS Related Complex (ARC), Human Immunodeficiency Virus (HIV), any sexually transmitted conditions, the insured person being under the influence of any intoxicating liquor, narcotics or drugs (unless the drug's use has been prescribed by a medical practitioner). war, invasion, act of foreign enemy, hostilities or warlike operations (whether was is declared or not), civil war, mutiny, rebellion, revolution, insurrection, military or usurped power, nuclear power generation or nuclear weapons, ionising radiations or contamination by radioactivity from any nuclear fuel, or from any nuclear waste from the fusion or fission of nuclear fuel. an act of terrorism regardless of any other cause or event contributing concurrently or in any other sequence to injury or illness. any action taken in controlling, preventing, suppressing or in any way relating to an act of terrorism. 5.2 Activities not covered This policy does not insure any injury or illness in connection with the insured person's participation in: any professional sporting activities, whether: training, or coaching, or participating in, or air travel other than: IP/CINZ/010406

10 as a fare-paying or ticket-holding passenger in an aircraft fully licensed for the carriage of passengers for hire or reward and operated by a regular airline or established charter service, or as a passenger in any top dressing or aerial survey plane, where the insured person is there for the purpose of directing the pilot, or (c) any criminal acts punishable by imprisonment. 6 HOW MUCH YOU RECEIVE 6.1 Death and disablement Events 1 or 2 If the insured person suffers from more than one event arising from the same injury and: one of the events is Event 1, then the most we will pay, in total, is the benefit payable for Event 1. two or more events from Event 2 to (l) apply, then the most we will pay, in total, is the highest for the events that occur. 6.2 Weekly benefits Events 3, 4, 5 or 7 You can only claim for one event We will only pay weekly benefits for one of Events 3, 4, 5 or 7 for the same injury or illness. Stand down period No claim can be made under Event 5 for any illness that occurs during the first 14 days, of the first period of insurance. (c) Maximum number of weeks The maximum period we will pay under Events 3, 4, 5 or 7 is 104 weeks. (d) Deferment period If any deferment period is shown in the schedule, we will reduce the 104-week maximum period (see Part (c) above) by the deferment period. (e) Maximum amount payable The most we will pay under Events 3, 4, 5 or 7 is 80% of the insured person's earnings. 6.3 Recurrence of Events If the insured person suffers a recurrence of Events 3, 4, 5 or 7, and: IP/CINZ/010406

11 it occurs within six months of the end of the previous period of total disablement or partial disablement, and it arises from the same injury or illness for which we have paid a benefit, then, 6.4 Accident compensation no further excess is payable, and the previous period of total disablement or partial disablement will be included when calculating the maximum number of weeks (see Part 6.2(c) above) The weekly benefit payable for Events 3, 4, 5 or 7 will be reduced by the equivalent amount of any compensatory payments (whenever received) under the Injury Prevention, Rehabilitation and Compensation Act You should also refer to Part 6.2(e) above. 7 GENERAL CONDITIONS 7.1 Comply with the policy You must meet the following conditions before we pay you: You must comply with all the policy terms, and All statements and answers, whether by you or anyone else, must be true when you: Apply for this insurance, and Notify us about any change in circumstances, and Make any claim. These conditions apply equally to anyone else entitled to claim under the policy. 7.2 Cancellation You may cancel the policy by giving us notice. We will refund to you 80% of the unexpired portion of any premium you have already paid to us. We may cancel this policy at any time by giving notice to you. Cancellation will be effective from 4.00pm 14 days after the notice is given. The 14-day period starts on the day the notice is delivered or posted to you. We will refund to you the unused portion of any premium you have already paid to us. 7.3 Change in circumstances IP/CINZ/010406

12 After the start of the policy, you must tell us immediately if you know about any material fact that will: Increase in the risk insured, or Alter the risk insured. (c) (d) You must also tell us immediately if the insured company amalgamates with, or is acquired by, any other company. After you have told us, we may immediately amend the terms of your policy, including the premium. If you fail to tell us, we may: 7.4 Double insurance Declare this policy unenforceable, or Refuse to pay any subsequent claim. You must notify us immediately of any other insurance policy that covers any of the risks covered under this policy. If there is such a policy, we will only pay over and above the limit payable under that policy. 7.5 Goods and Services Tax For Event 1 Death The benefit payable for Event 1 is inclusive of GST. For all other insured events Where GST is recoverable by us under the Goods and Services Tax Act 1985: 7.6 Governing Law all Sums Insured exclude GST (unless otherwise stated), and GST will be added, where applicable, to claim payments. The law of New Zealand applies to this policy and the New Zealand Courts have exclusive jurisdiction. 7.7 Insurance Law Reform Acts The exclusions and conditions in this policy are subject to your rights under the Insurance Law Reform Acts 1977 and IP/CINZ/010406

13 7.8 Notices Notices from you to us must be delivered personally, posted or ed to us. Notices from us to you must be delivered personally, posted or ed to your last known address, or that of your insurance broker. 7.9 Take reasonable care You, and anyone else covered under this policy, must take reasonable care to avoid circumstances that may result in a claim. Your claim will not be covered if you, or they, are reckless or grossly irresponsible Acts of Parliament Where this policy refers to any Act of Parliament, this includes any Statutory Regulations made under it. It also includes any Act or Regulations enacted in substitution Separate insurance (c) All parties insured under this policy are insured separately (as though a separate policy had been issued to each party). However, the limits contained in this policy are the most we pay to all parties combined. The proposal is a separate application for insurance by each party insured under this policy. No statement or knowledge possessed by one party shall be imputed to any other party Headings Headings in this policy are for ease of reference only. They do not form part of the policy, and are not to be used as an aid to interpretation. 8 DEFINITIONS 8.1 When the following words (and any derivatives) are marked in bold in this policy, this is what they mean: Accident means an event or omission that is unexpected and unintended from your point of view. Act of terrorism means an act, including but not limited to the use of force or violence and threat of any person or group, whether acting alone or on behalf of or in connection with any organisation or government that from its nature or context is done for, or in connection with political, religious, ideological, ethnic or similar purposes or reasons, including the intention to influence any government and, or, to put the public or any part of the public in fear IP/CINZ/010406

14 Benefit payable means the benefit payable corresponding to an event in the List of Policy Benefits in Part 4. Earnings means: If earning salary or wages: The insured person's weekly pre-tax income (excluding commissions, bonuses, overtime payments and any allowances) averaged over: A period of 12 months before the disablement occurred, or Any shorter period that he or she has been employed. If self-employed The insured person's weekly pre-tax income derived from their personal enterprise (after deducting all operating expenses from the business or practice) averaged over: A period of 12 months before the disablement occurred, or Any shorter period that he or she has been self-employed. Excess means the amount stated in the policy or shown in the schedule. Event means one of the Events listed in the List of Policy Benefits in Part 4. Illness means sickness or disease. Injury means internal or external bodily injury caused solely and directly by violent, accidental, external and visible means (including exposure to the elements and medical misadventure). Insured event means an event listed in the schedule. Insured person means the person named as 'Insured Person' in the schedule. Loss of use means either: the physical severance of part of the insured person's body, or permanent, incurable and total loss of use (including permanent paralysis) of part of the insured person's body. Medical expenses means all medical, surgical, hospital and nursing home expenses for inpatient or outpatient treatment provided they result from an injury or illness for which you are entitled to a benefit payable under Events 2, 3, 4 or 5. Occupation means the insured person's business or occupation as shown in the schedule or any other occupation that he or she is reasonably qualified for by education, training or experience IP/CINZ/010406

15 Partial disablement means an injury or illness to the insured person that results directly in their inability to engage in, perform, or attend to a substantial part of their occupation. Period of insurance means the period of time shown in the schedule. Total disablement means an injury or illness to the insured person that results directly in their inability to engage in, perform, or attend to any part of their occupation. Schedule means the most recent Schedule to this policy that we issued to you. We/us/our means China Insurance (NZ) Company Limited. You means the person(s) or entity named as 'Insured' in the schedule IP/CINZ/010406