Insurance of the person, or personal insurance, is insurance by which a natural person is covered. Traveller s insurance is insurance of the person.

Transcription

1 GENERAL INSURANCE TERMS The general insurance terms apply to the insurance contract unless agreed otherwise with respect to group insurance contract, self-funded group insurance contract or special terms and conditions... 1 KEY CONCEPTS Insurance of the person, or personal insurance, is insurance by which a natural person is covered. Traveller s insurance is insurance of the person. Non-life insurance is a policy taken out to cover a loss incurred due to material damage, an obligation to pay damages, or other financial loss. Non-life insurance includes luggage insurance, travel liability insurance and legal expenses travel insurance. The essential content of an insurance contract is defined in the insurance policy and the insurance terms and conditions. Policyholder is a party who has concluded an insurance contract with the insurer. Insurer is ACE European Group Limited, branch in Finland (ACE). Insured is a party who is covered by personal insurance or for whose benefit non-life insurance is valid. Insurance period is the agreed period during which the insurance is valid. The contract continues for one agreed insurance period at a time, unless either of the contracting parties gives notice of termination. Premium period is the period for which a premium is paid at regular intervals as agreed. Insurance event is an event for which compensation is paid under the insurance. Safety regulation is the obligation to observe regulations on a device, procedure or other arrangement recorded in the non-life insurance policy or insurance terms and conditions, or otherwise in written form, aimed at preventing or restricting the occurrence of a loss. Group Insurance is an insurance which cover members of a group identified in an insurance contract and the premiums of which are paid by the policyholder. 2 DISCLOSURE OF INFORMATION PRIOR TO CONCLUDING AN INSURANCE CONTRACT 2.1 Obligation of the policyholder and the insured to disclose information Prior to the insurance being granted, the policyholder and the insured party must provide full and correct answers to all questions presented by the insurance company that may be relevant to the assessment of the insurance company s liability. During the validity of the insurance period, the policyholder and the insured party must also correct without undue delay any information provided to the insurance company by him/her that he/she has found to be incorrect or insufficient.

2 If the policyholder or the insured person has acted fraudulently with regard to the above-mentioned obligation, the insurance contract is not binding on the insurance company. The insurance company has the right to withhold all premiums paid, even if the insurance is annulled. 3 COMMENCEMENT OF THE INSURANCE COMPANY S LIABILITY AND VALIDITY OF THE INSURANCE CONTRACT 3.1 Commencement of the insurance company s liability If the insurance company has not agreed on any other date individually with the policyholder, the insurance company s liability will commence from the time when the insurance company or the policyholder has submitted or sent an affirmative reply to the offer/bid of the other contracting party. Payment of the premium for the insurance period is a precondition for commencement of the insurance company s liability - always in the case of a fixed-period travel insurance; - if the insurance company has set the payment of the premium for the first insurance period as a precondition before continuous travel insurance can enter into force; or - if there are special reasons, for instance, because of the policyholder s earlier default of payment. The insurance bill contains a mention to this effect. If the policyholder has submitted or sent a written insurance application to the insurance company and if it is apparent that the insurance company would have approved the application, the insurance company will also assume liability for an insurance event occurring after the application was submitted or sent. 3.2 Validity of insurance contract After the first premium period, the insurance contract is valid for one agreed premium period at a time, unless the policyholder or the insurance company terminates the contract. The insurance contract may also terminate for other reasons referred to in clauses 4.2 and 13 below. A fixed-period insurance contract is valid for the agreed insurance period. However, the insurance may terminate during the insurance period on grounds specified in clauses 4.2, 13.1 and 13.2 below. In fixed-period travel insurance, if the journey back to the insured person s country of residence is delayed for reasons beyond his/ her control, the validity period of the insurance will be extended by 48 hours. 4 INSURANCE PREMIUM 4.1 Premium payment The insurance premium must be paid within one month of the date on which the bill for the premium was sent by the insurance company to the policyholder. 4.2 Delayed premium

3 If the policyholder has neglected to pay the premium in part or in full by the due date as referred to in clause 4.1 above, the insurance company has the right to terminate the insurance contract in 14 days time after sending a notice of termination. However, if the policyholder pays the outstanding premium in full before the end of the notice period, the insurance will not cease to be effective at the end of the notice period. The insurance company will state this option in its notice of termination. If the premium is not paid by the due date referred to in clause 4.1 above, penalty interest shall be paid for the period of delay in accordance with the Interest Act. The insurance company is entitled to compensation for costs incurred due to collection of insurance premiums under the Act on the Collection of Debts. If the insurance company has to collect an unpaid insurance premium through legal action, it is also entitled to being recompensed for the statutory fees and charges incurred due to the legal proceedings. 4.3 Payment of a delayed insurance premium If the policyholder pays an insurance premium in full after the insurance has terminated, the insurance company s liability will commence on the day following payment. In such a case, the insurance is valid from the date of its reinstatement until the end of the insurance period originally agreed. However, if the insurance company does not wish to reinstate the insurance, the insurance company will, within 14 days of payment of the premium, notify the policyholder that it will not accept the payment. 4.4 Refund of premium upon termination of a contract If the insurance terminates before the date agreed, the insurance company is entitled only to the premium for the period during which it was liable. The rest of the premium paid will be returned to the policyholder. However, the premium will not be returned separately if the returnable euro amount is smaller than that mentioned in the Insurance Contracts Act. The insurance company charges a non-returnable minimum premium for travel insurance as stated in the insurance policy. 4.5 Setoff against premiums to be returned The insurance company may deduct any outstanding premiums overdue and other outstanding amounts from the premium to be returned. 4.6 Fixed-period insurance contract A fixed-period insurance contract is subject only to clauses 4.1 and 4.5 under 4. 5 DISCLOSURE OF INFORMATION DURING VALIDITY OF CONTRACT

4 5.1 The insurance company s obligation to disclose information to those insured If the terms and conditions of a group insurance contract include a provision to the effect that the insurer keeps a list of persons who are covered by the insurance, the insurer will, as soon as the contract takes effect and at reasonable intervals thereafter, dispatch the persons insured details of the scope of cover, major exclusions, obligations of the insured under the contract and how the validity of cover is dependent on the fact that the insured is a member of the group mentioned in the contract. If the insurance company does not keep a list of insured persons, the above-mentioned information will be given to the insured in a manner deemed fit in the circumstances. 5.2 Policyholder s obligation to disclose information about any increase in risk The policyholder must notify the insurance company of any changes in factors increasing risk that were reported when the insurance contract was concluded and that are relevant in terms of assessment of the insurance company s liability, such as changes in profession/occupation, leisure time activities or place of residence, or the termination of any other insurance cover. A change resulting in increased risk may be, for instance, residence abroad of the insured person for over a year on a continuous basis. 5.3 Notice of termination of group insurance If a group insurance contract is terminated on account of action taken by the insurance company or the policyholder, the insurer shall notify the insured of the termination of the contract in a manner deemed fit in the circumstances. From the insured's standpoint, the insurance contract terminates one month after the date at which the insurance company informed the insured of the termination. 6 OBLIGATION TO PREVENT AND MITIGATE LOSS OR DAMAGE UNDER NON- LIFE INSURANCE 6.1 Obligation to observe safety regulations The insured person must observe the safety regulations recorded in the insurance policy, or in the insurance terms and conditions or otherwise provided in writing. If the insured person has wilfully or through negligence which cannot be deemed minor failed to observe the safety regulations, the insurance company may reduce or disallow any compensation payable to him/her. The effect of the failure to observe the safety regulations on the occurrence of a loss or damage is taken into account when considering whether to reduce or disallow compensation. The insured person s intent or type of negligence and any other circumstances will also be taken into account. 6.2 Obligation to prevent and mitigate loss or damage (duty of salvage) In the case of an insurance event or the immediate threat of one, the insured person must, to the best of his ability, take the necessary action to prevent or mitigate the loss or damage. If the loss or damage is caused by a third party, the insured person must take the necessary action to uphold the insurance company s right vis-à-vis the liable party. The insured person must, for instance, attempt to establish the identity of the liable party. If the loss or damage resulted from a punishable act, the insured person shall, without delay, report it to the police and sue the offenders if the insurance

5 company s interest so requires. The insured person must, in other respects too, observe all instructions given by the insurance company aimed at preventing and mitigating loss or damage. The insurance company will indemnify for reasonable expenses incurred due to fulfilling the above duty of salvage even if the sum insured were thus be exceeded. If the insured person has willfully or through negligence which cannot be deemed minor failed to observe the duty of salvage referred to above, the insurance company may reduce or disallow the compensation payable to him/her. The effect of the insured person s failure to observe the duty on the occurrence of the loss or damage is taken into account in considering whether to reduce or disallow compensation. The insured person s intent or type of negligence and any other circumstances will also be taken into account. 6.3 Failure to observe the safety regulations and the duty of salvage under liability insurance Under liability insurance, negligence on the part of the insured person will not lead to compensation being reduced or disallowed. However, if the insured person has willfully or through gross negligence failed to observe the safety regulations or the duty of salvage, or if the insured person s use of alcohol or other intoxicant has contributed to the negligence, compensation may be reduced or disallowed. If the insured person has through gross negligence failed to observe the safety regulations or the duty of salvage or if his/her use of alcohol or other intoxicant has contributed to the negligence, the insurance company will nevertheless pay under the liability insurance that portion of the compensation which the natural person who has suffered the loss or damage has been unable to collect because of the insured person s state of insolvency as authenticated by distraint or bankruptcy. 7 CAUSING AN INSURANCE EVENT The insurance company is released from liability to any insured person who has willfully caused a loss event. If the insured person has caused the insurance event through gross negligence, the insurance company s liability may be reduced, depending on what is deemed reasonable in the circumstances. If a person entitled to compensation or benefit other than the insured person has willfully caused the insurance event, the insurance company is released from liability to such party. If a person has caused the occurrence of an insurance event through gross negligence or if he/she was at such an age or in such a state of mind the he/she could not have been sentenced to punishment for a crime, the person may be entitled to full or partial compensation or benefit only if considered reasonable in view of the circumstances in which the occurrence of the insurance event was caused. If the insured person has died, other parties entitled to compensation or benefits are paid that part of the compensation or benefits not paid to the person or persons who caused the insurance event. 8 BENEFICIARY CLAUSE 8.1 Beneficiary

6 The insurance company and the policyholder may agree about a beneficiary clause in the group insurance contract. Alternatively a beneficiary clause may be included in the insurance terms. The beneficiary may be changed provided that the right to change the beneficiary has been agreed in the group insurance contract. If the beneficiary clause is valid, the benefit payable due to the death of the insured person is not part of the insured person s estate. The benefit is part of the insured person s estate if there is no beneficiary clause and if the benefit is not payable to the policyholder under the insurance terms and conditions. 8.2 Form of the beneficiary clause A beneficiary clause, its cancellation or amendment is null and void unless it has been submitted to the insurance company in writing. 9 CLAIMS 9.1 Duties of claimant The claimant shall observe the regulations on making a claim entered in terms 16 below and submit the documents mentioned therein to the insurance company. The claimant shall obtain and submit to the insurance company said documentation and information at his/her own expense, unless otherwise stipulated in the terms and conditions or agreed otherwise. The claimant is required to obtain the documentation which he/she is reasonably able to obtain, though taking into account that the insurance company may also acquire such documentation. All crimes must be reported to the local police without delay. The insurance company is not obliged to pay compensation before it has received the above documentation. If the claimant has, after the insurance event, fraudulently provided the insurance company with incorrect or insufficient information relevant to the assessment of the insurance company s liability, his/her compensation may be reduced or disallowed, depending on what is reasonable in the circumstances. Insurance companies share a non-life insurance information system which can be used in processing claims to check claims submitted to different companies. 9.2 Limitation on right to obtain compensation A claim for compensation must be presented to the insurance company within 12 months of the date when the claimant became aware of the insurance and was informed of the insurance event and the damaging consequences of that event. A claim for compensation must in any case be presented within 10 years of the date when the insurance event occurred or, in the case of insurance taken out against bodily injury or liability for damages, the damaging consequences were caused. Making a notification of an insurance event is comparable to presenting a claim. If the claim is not presented within said period, the claimant loses his/her entitlement to compensation. 9.3 The insurance company s obligations

7 After the occurrence of an insurance event, the insurance company is under an obligation to provide the claimant (eg the insured person, the beneficiary and, in liability insurances, the person who has suffered injury, loss or damage) with information on the contents of the insurance and the claim procedure. Any advance information that may have been given to the claimant on the compensation, its amount or method of payment will not affect the obligation to pay compensation stated in the insurance contract. The insurance company will pay the compensation resulting from the insurance event in accordance with the insurance contract or notify the claimant of non-payment of compensation without delay and, at the latest, in one month s time of the date on which it received the documentation and information necessary for the assessment of its liability. If the amount of compensation is disputed, the insurance company will nonetheless pay any undisputed part of the compensation within the abovementioned period. In the case of a claim settlement decision under liability insurance, the insurance company will also inform the person who has suffered the loss or damage. If the total amount of compensation payable to a legally incompetent person for losses other than expenses or loss of property exceeds 1,000 euros, the insurance company will notify the guardianship authority in the locality of the legally incompetent person of such compensation. The insurance company will pay penalty interest on any delayed payment of compensation in accordance with the Interest Act. 9.4 Setoff against compensation The insurance company may deduct any outstanding premiums overdue and other outstanding overdue amounts from compensation. 10 LODGING AN APPEAL AGAINST A DECISION TAKEN BY THE INSURANCE COMPANY The policyholder or claimant has several ways of appealing against a decision taken by the insurance company. If his/her matter remains unsettled after he/she has contacted the insurance company, he/she can ask for advice and counselling from the Finnish Financial Ombudsman Bureau or request a recommendation for the decision from the relevant board. A policyholder or claimant who is dissatisfied with the insurance company s decision may also bring action against the insurance company Right to correct If a policyholder or claimant suspects that the insurance company has made a mistake in its claim settlement decision, he/she has the right to obtain more information about matters which have led to the decision. The insurance company will correct the decision if the new investigations give cause to do so Finnish Financial Ombudsman Bureau and boards issuing recommendations

8 If the policyholder or claimant is dissatisfied with the insurance company s decision, he/she may ask the Finnish Financial Ombudsman Bureau for advice and counselling. The Bureau is an impartial body tasked with advising consumers in insurance and claims matters. The insurance company s decision can be submitted to the Finnish Insurance Complaints Board within the Bureau. The Board is tasked with issuing recommendations for decisions in disputes which concern interpretation and application of the law and insurance terms and conditions in an insurance relationship. The insurance company s decision can also be submitted to the Consumer Disputes Board, which provides recommendations for decisions on the basis of consumer protection legislation. These boards will not handle a case while it is pending in court or when a ruling has been given in court. These counselling services and board statements are free of charge District court If the policyholder or claimant is dissatisfied with the insurance company s decision, he/she may bring action against the insurance company in the district court of his/her domicile in Finland, of the insurance company s domicile or of the place of loss in Finland, unless otherwise provided by Finland s international agreements. Action against the insurance company s decision must be brought within three years of the policyholder or claimant being informed in writing of the insurance company s decision and the time limit. The right to bring action ceases once the time limit has expired. Handling of a case by any of the above-mentioned boards will interrupt the limitation period for the right to bring action. 11 INSURANCE COMPANY S RIGHT OF RECOVERY 11.1 Insurance company s right of recovery vis-à-vis a third party The insured person s right to claim damages from a third party which is held liable transfers to the insurance company up to the amount of compensation paid by the insurance company. 12 ALTERING AN INSURANCE CONTRACT The insurance company has the right to alter the insurance terms and conditions, and premiums and other terms of contract at the end of the insurance period on the basis of - new or amended legislation or a regulation by the authorities - an unforeseeable change in circumstances (e.g. an international crisis, exceptional natural event, catastrophe) - a change in the claims expenditure. The insurance company also has the right to make minor changes to the insurance terms and conditions and other terms of contract provided that the changes do not affect the primary content of the insurance contract.

9 If the insurance company alters the insurance contract as outlined above, it will notify the policyholder of the changes in the insurance premium and other terms of contract. This notification will state that the policyholder has the right to terminate the insurance. In the case of insurance of the person, the change will take effect from the beginning of the next premium period or, if no premium period has been agreed, from the beginning of the next calendar year following one month from the date the notification was sent. In the case of non-life insurance, the change will take effect from the beginning of the next insurance period following one month after the date the notification was sent. 13 TERMINATION OF INSURANCE CONTRACT 13.1 Policyholder s right to terminate the insurance The policyholder has the right to terminate the insurance contract anytime during the insurance period. Notice of termination must be given in writing. Notice of termination given in any other manner shall be null and void. If the policyholder has not specified a later termination date for the insurance, the insurance will terminate on the date the notice was submitted or sent to the insurance company. However, the right of termination does not exist if the agreed period of validity of the insurance contract is shorter than 30 days The insurance company s right to terminate the insurance at the end of the insurance premium period The insurance company has the right to terminate an insurance contract as of the end of the insurance premium period. The notice of termination will be sent one month before the end of the insurance premium period at the latest. 14 RIGHTS OF A THIRD PARTY UNDER NON-LIFE INSURANCE 14.1 Right to compensation under liability insurance of a person who has suffered injury, loss or damage A person who has suffered injury, loss or damage has the right, under liability insurance, to claim compensation in accordance with the insurance contract from the insurance company directly if the insured has been declared bankrupt or is otherwise insolvent. If the insurance company is presented with a claim, it will notify the insured thereof without undue delay and reserve him/her an opportunity to explain the insurance event. The insured will also be notified about the subsequent processing of the matter. If the insurance company accepts the claim of the person who has suffered the injury, loss or damage, this acceptance is not binding on the insured Right of appeal under liability insurance of a person who has suffered injury, loss or damage A person who has suffered injury, loss or damage has the right to bring action against the insurance company regarding a claim settlement decision taken by the insurance company or to submit the matter to the Finnish Insurance Complaints Board or the Consumer Disputes Board as provided under section GEOGRAPHICAL RESTRICTION ON THE VALIDITY OF THE INSURANCE

10 ACE is a subsidiary of a US parent and ACE Limited, a NYSE listed company. Consequently ACE, is subject to certain US laws and regulations in addition to EU, UN and national sanctions restrictions which may prohibit ACE from providing cover or paying claims to certain individuals or entities or insuring certain types of activities related to certain countries such as Iran, Syria, North Korea, North Sudan and Cuba. All other terms and conditions of the policy remain unchanged. 16 CLAIMS SETTLEMENT PROCEDURE 16.1 Actions to be taken in the event of an incident The claimant must provide ACE with the documents and information it needs to assess its liability. A travel loss report must be made on the insurance company s form, whenever possible, and be signed. In the event of loss or damage, contact the insurance company, or in case of emergency, contact the emergency assistance company SOS International. In the event of a claim, please contact: Tel: Emergency assistance company: SOS International, Copenhagen, Denmark Tel (24 h service in Finnish, Swedish and English) In cases that incur minor costs, the insured must first meet these costs himself/herself before subsequently applying for indemnity upon his/her return from the trip by presenting the original receipts Loss report The loss report shall include at least: a brief description of the claim, travel ticket or other proof of the trip. Medical expenses: physician s certificate, duly dated and signed, with an accurate description of the illness or injury, original receipts for services, treatment and medication costs and prescriptions. Trip cancellation: physician s certificate, duly dated and signed, with an accurate description of the illness or injury or other certificate, a certificate of any remuneration or compensation from the transport company or tour operator, in case of death, death certificate. Trip delay a certificate from the transport company concerning the delay, original receipts and a statement concerning food and accommodation costs.

11 Trip interruption: physician s certificate, duly dated and signed, with an accurate description of the illness or injury or other certificate, a certificate of additional costs, in case of death, death certificate. Accidental death in the event of death, a death certificate, the record of an autopsy, if any, and documents defining the beneficiaries (e.g. deed of estate inventory, extract from the personal register giving details of relatives), police investigation report, if any. Permanent Disability due to an accident in the event of an accident, a description of the loss event and names and contact details of witnesses, if any, physician s certificate, duly dated and signed, with an accurate description of the injury, date of the examination carried out by a physician and the physician s contact details. Luggage cover description of lost luggage, a copy of the claim form presented to the carrier and/or theft report presented to the police, in the event of delayed luggage, a certificate issued by the airline and a certificate of the return of the luggage to the insured, original receipts of costs for or renting of essential articles. Legal expenses contact ACE or SOS International, Liability cover contact ACE or SOS International. If needed ACE will ask for additional documentation and attachments. If ACE has asked the insured to submit to a medical examination carried out by a physician, ACE will indemnify the insured for the expenses arising from the examination. In the event of indemnity paid on the death of the insured, ACE is entitled to request that an autopsy be performed, of which the costs will be paid by ACE Procedure for indemnification of medical treatment expenses The claimant must pay medical treatment expenses himself/herself and apply for compensation under the Finnish Health Insurance Act. An application for compensation under the Health Insurance Act must be submitted to the Social Insurance Institution within six (6) months of payment of the medical treatment costs. The claimant must submit to ACE the original receipts for any compensation paid by the Social Insurance Institution and copies of any receipts submitted to the Social Insurance Institution by the claimant. Any receipts against which the claimant has not received compensation under the Sickness Insurance Act or any other act and which are then submitted to ACE must be original. If the entitlement to compensation under the Health Insurance Act has been cancelled, ACE will deduct from the indemnity the part that would have been paid under the Health Insurance Act.

12 17 EURO PAYMENT REDOMINATION 17.1 Euro conversion If the Euro ceases to exist as a lawful single currency for any reason and/or the Euro ceases to be recognized as the lawful currency of Finland then: (i) (ii) all payments and currency values under this Agreement shall be in the new lawful currency of Finland; and unless prohibited by the Applicable Law any conversion from Euro to the new lawful currency of Finland shall be at the official rate of exchange recognized by the government of Finland Review of a profitability clause 1. A review of Premium Rates shall take place where there is an event associated with economic and monetary union in the European Union. 2. Following a trigger of the review process pursuant to clause 1, the parties will discuss appropriate changes to Premium Rates charged and /or Premium and performance which may involve a change in product benefits, benefit levels and performance measures, in order to realign the book performance with the agreed business goals of the parties. In the event that the parties cannot agree such changes any party shall be entitled to serve 6 months written notice on the other parties to terminate the Agreement. 3. For the purposes of this clause and clause 17.3 an event associated with economic and monetary union in the European Union includes, without limitation, each (and any combination of) the following events: (i) (ii) (iii) (iv) (v) (vi) The withdrawal from legal tender of the Euro; The replacement of the Euro by any alternative single or unified currency by two or more Member States; The withdrawal from the Euro (which for the avoidance of doubt may also include withdrawal from the European Union) by any Member State; The introduction of a new currency as a lawful currency in a Member State; The fixing of conversion rates between the Euro and a new currency introduced pursuant to (ii) or (iv) above; The disappearance or replacement of a relevant price source for the Euro Contract continuation The occurrence of an event associated with economic and monetary union in the European Union shall not have the effect of altering or invalidating any term of, or discharging, or

13 excusing performance under this Agreement, or give either party a right unilaterally to alter or terminate this Agreement other than specifically provided in this Agreement. 18 APPLICABLE LAW The insurance contract is subject to Finnish law. ACE European Group Limited, Branch in Finland PB 687 (Mannerheimintie 16 A 9) Helsinki Phone: Fax: Business ID asiakaspalvelu@acegroup.com vahingot@acegroup.com Head office: ACE European Group Ltd Limited company, registration number , United Kingdom 100 Leadenhall Street, London EC3A 3BP, United Kingdom. ACEs operations in Finland are monitored by the Financial Supervisory Authority PB 103 (Snellmaninkatu 6 ja Mikonkatu 8) Helsinki Phone: ACE European Group Ltd is monitored by the Prudential Regulation Authority (PRA), United Kingdom. 20 Moorgate, London EC2R 6DA UK Phone: Fax: