Workmen s Compensation Insurance Policy

Transcription

1 Workmen s Compensation Insurance Policy Preamble WHEREAS the Insured named in the Policy s Schedule hereto (hereinafter referred to as the Insured ) has submitted to ABU DHABI NATIONAL INSURANCE COMPANY PJSC (hereinafter referred to as the Company ) the Insurance Proposal which shall be deemed as integral part and the basis of this Workmen s Compensation Insurance Policy (hereinafter referred to as this Policy ) and after the Insured complies with the terms and conditions of this Policy including but not limited to the payment of the due insurance premium(s), the Company shall compensate the Insured in accordance with the terms, conditions, limits and exclusions stated in this Policy. This Policy is based on the Insurance Proposal. In case the said Proposal contains any incorrect material statements or information or fails to disclose any material statements or information, then the Insured will lose its right in compensation by virtue of this Policy and the Company has also the right at its sole discretion to terminate/cancel this Policy. 1/12

2 Section 1: Scope of this Policy If at any time during the Term of this Policy any Employee in the Insured s immediate service shall sustain Accidental Bodily Injury arising out of and in the course of his employment by the Insured in the Business and if the Insured shall be liable to pay compensation for such Accidental Bodily Injury as stated under Federal Law No. 8 of UAE Labor Law and the Schedules attached hereto, the Company will indemnify the Insured against the sums for which the Insured shall be so liable and will in addition be responsible for all costs and expenses incurred with its consent in defending any claim for such compensation, subject always to the terms, conditions, limits and exclusions contained herein or endorsed hereon. Section 2: General Definitions The following words will have the same meaning wherever they appear in this Policy unless otherwise stated. 1. The Insured As stated in this Policy s Schedule. 2. The Company Abu Dhabi National Insurance Company PJSC. 3. This Policy i) All terms, provisions, exclusions, conditions, and limits of indemnity set out in this document; and ii) All endorsements, schedules, and annexures signed by the Company and the Insured and attached hereto. 4. Business The business carried on by the Insured and as declared in the Insurance Proposal and this Policy s Schedule. 5. Employee Any person employed by the Insured in accordance with the UAE laws for conducting the Business. 6. Term of this Policy This Policy shall be valid and effective for the period commencing from the Effective Date stated in the Insurance Policy Schedule until midnight (24:00) of the Expiry Date specified in the Insurance Policy Schedule unless terminated/cancelled in accordance with Termination/Cancellation Clause. 7. Accidental Bodily Injury Any accidental death, injury, illness, disease, or nervous shock incurred to the Employee(s) and arising out of in the course of Employment by the Insured in the Business as enumerated UAE Labor Law. 8. Costs and Expenses a) Claimants costs and expenses arising in respect of any claim against the Insured which may be the subject of indemnity under this Policy. b) All costs and expenses incurred by the Insured with Company s written consent in respect of any claim against the Insured which may be the subject of indemnity under this Policy. 9. Deductible/First Amount Payable/Excess The amount specified as such in the Schedule of this Policy which the Insured shall incur in respect to each and every claim including costs and expenses and in excess of which this Policy applies. It is being understood and agreed that if any expenditure is incurred by the Company which, by virtue of this clause, is the responsibility of the Insured, then such amount shall be reimbursed forthwith to the Company and upon Company s request by the Insured. 2/12

3 Section 2: General Definitions (continued) 10. Repatriation Expenses The expenses incurred in embalming and/or transporting the mortal remains of deceased Employee from work place to the employee s home country. Cover is also extended towards transportation expenses if an Employee is declared medically unfit for the job he was performing by the authorized UAE Medical Authority. Section 3: Limit of Liability 1. The total amount payable by the Company to the Insured for compensation and all Costs and Expenses in respect of any and all claims arising out of one sudden occurrence or series of sudden occurrences, consequent on or attributable to one source or one original cause shall not exceed the Limit of Indemnity stated in the Policy s Schedule irrespective of the number of Employee(s) who may sustain injury consequent on or attributable to the same source or original cause. 2. For the purpose of establishing the total amount payable by the Company in respect of one term it is understood that for any one claim where injury is caused over a period which extends outside such term the amount of compensation Costs and Expenses indemnifiable arising out of such claim shall be limited to no more than the proportion of the total amount of compensation Costs and Expenses for the claim as the length of such term (or part thereof as applicable) bears to the total length of the period during which such injury is caused. 3. In the event of any change in Law(s) or the substitution of other legislation therefore, this Policy shall remain in force but the liability of the Company shall be limited to such sums as the Company would have been liable to pay if the Law(s) had remained unaltered. Section 4: Extensions 1. This Policy covers repatriation expenses up to the amount as stated in this Policy s Schedule due to death or on medical advice following Accidental Bodily Injury. 2. This Policy covers medical and incidental transportation expenses, arising out of work related to Accidental Bodily Injury, up to the amount as stated in this Policy s Schedule. 3. This Policy covers the Employees whilst being transported to and from site of work within the Business hours provided they follow the normal and direct route. 4. This Policy covers sports and social activities of the Employees conducted under the Insured s auspices, but excluding dangerous and hazardous sports. 5. This Policy is subject to the automatic inclusion of Employees from the date of joining the Insured. 3/12

4 Section 5: Exclusions The Company shall not be liable under this Policy in respect of: a. Insured s Contractors and Sub-contractors employees b. Excluded Workmen Any person who is not an Employee of the Insured. c. Excluded Laws Any liability of the Insured with regard to any law other than UAE Labor Law and its attached Schedules. d. Wilful Act or Omission Any injury by accident or disease which results from a wilful act. e. Contractual Liability Any contractual liability of the Insured arising out of any agreement concluded with any third party. f. Recovery from Other Parties Any sum which the Insured would have been entitled to recover from any third party. g. Any Fines, Penalties, Liquidated Damages or Exemplary Damages h. Geographical Area Any Accidental Bodily Injury incurred outside the Geographical Area stated in this Policy s Schedule. i. Medical Expenses Medical expenses incurred in excess of the limit stated in this Policy s Schedule. j. Repatriation Expenses Expenses in excess of the limit stated in this Policy s Schedule incurred other than within the Geographical Area stated in this Policy s Schedule: i) In the transport or repatriation of any employee the subject of a claim hereunder. ii) In the transport of the body or ashes in the event of the death of any employee. k. Sickness and/or Disease Sickness and/or disease other than occupational disease as enumerated in Schedule (1) attached to UAE Labor Law. l. War & Terrorism Exclusion Loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing concurrently or in any other sequence to the loss: i) War, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power, mutiny, conspiracy, strike, riot, martial law or state of siege or any of the events which lead to the proclamation or maintenance of martial law or state of siege. ii) Confiscation or nationalization or requisition or destruction of or damage to property by or under the order of any government or authority. iii) Any act of terrorism including but not limited to any act or threat of violence, whatever its motives or purposes, that occurs in the advancement of an individual or collective criminal agenda and seeking to sow panic among people, causing fear by harming them, or placing their lives, liberty or security in danger, or seeking to cause damage to the environment or to public or private installations or property or to occupying or seizing them, or seeking to jeopardize a national resources. 4/12

5 Section 5: Exclusions (continued) The Exclusion stated in this Sub-section (l) includes also any loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in any way relating to points (i), (ii) and/or (iii) of this Subsection (l). m. Radioactivity Any liability of whatsoever nature directly or indirectly caused by or contributed to by or arising from: i) Nuclear weapons or material and/or, ii) Ionising radiations or contamination by radioactivity from any nuclear fuel, radiations or contamination or from any nuclear waste from the combustion of nuclear fuel Solely for the purpose of this exception combustion shall include any self-sustaining process of nuclear fission. n. Asbestos Exclusion Any liability of whatsoever nature directly or indirectly caused by or contributed to by or arising from Asbestos in accordance with the following: All claims and losses based upon, arising out of, directly or indirectly resulting from or in consequence of, or any way involving: i) Asbestos, or ii) Any actual or alleged asbestos related injury or damage involving the use, presence, existence, detection, removal, elimination or avoidance of asbestos or exposure or potential exposure to asbestos. The Exclusion stated in this Sub-section (n) shall not, however, encompass injury or damage involving products containing Asbestos where the existence of Asbestos is not in itself a direct or indirect cause of the injury or damage. o. Other Exclusions Natural death or Non Occupational disease Any claim arising of or attributed to electromagnetic fields, genetically modified organism, transmissible spongiform encephalopathy, toxic moulds Avian Flu Pre-existing conditions, sickness and/or congenital infirmity Participation in any kind of race Section 6: Conditions 1. Privity of this Policy All benefits, rights and obligations under the terms hereof belong to or are owned by the Insured and the Company only. The Company is under no obligation whatsoever to defend, settle, compromise, or otherwise respond to any action or claim brought directly and solely against the Company in respect of any risk covered by this Policy by any person who is not a party to this Policy. Nothing in this clause or condition or in this Policy shall prevent the Company from exercising its rights of subrogation against any person who is not a party to this Policy. 5/12

6 Section 6: Conditions (continued) 2. Precautions, Prevention of Accidents, and Compliance with Statutory Obligations The Insured will take all reasonable care to prevent loss and maintain the premises, plant, and everything used in connection with the Insured risk in proper working condition, to employ only competent Employees, and to comply with all statutory obligations and regulations imposed by the law or by any UAE authority. The Insured will forthwith make good or remedy any defect and/or danger and/or condition that is likely to give rise to an incident which becomes apparent, take reasonable and cautionary action at its own expense to prevent such defect, danger and/or condition from causing loss and/or damage and take such additional precautions as the circumstances may require and/or imposed. The Company may at any reasonable time inspect any property related to the Business. In the event of any defect and/or danger and/or hazard and/or risk being apparent, the Company may give written notice to the Insured when all liability of the Company arising from such defect or danger shall be terminated with immediate effect. 3. Adjustment of Premium(s) and Records Retention The first premium and all renewal premiums that may be accepted by the Company are to be regulated by the amount of wages and salaries and other earnings paid by the Insured to employees during each Term of this Policy. The name of every Employee together with the amount of wage salary and other earnings shall be properly recorded by the Insured and the Insured shall at all times allow the Company to inspect such records and shall supply the Company with a correct account of all such wages and salaries and other earnings paid during any Term of this Policy and within one (1) month from the expiry date. If the amount so paid shall differ from the amount on which premium has been paid the difference in premium shall be met by a further proportionate payment to the Company or a refund by the Company as the case may be. 4. Termination/Cancellation Clause This Policy may be terminated/cancelled by the Company with immediate effect, by giving a notice in writing to the Insured of this termination/cancellation where the Insured has: i) Failed to comply with the Insured s duty of utmost good faith; or ii) Failed to comply with the Insured s duty of disclosure at the time when this Policy was entered into, varied, altered or renewed; or iii) The misrepresentation of information and/or documentation to the Company during the negotiations of this Policy, prior to the Company agreeing to issue this Policy; or iv) Failed to comply with any material obligation under this Policy. This Policy may be terminated/cancelled by the Insured or the Company at any time, by giving thirty (30) days notice in writing to the other party. If this Policy is terminated/cancelled by the Company, the Company will refund on a pro rata basis the paid premium, for the time remaining on this Policy less any non-refundable duties and/or reasonable inspection charges, the Company may have incurred. If this Policy is terminated/cancelled by the Insured, the Company shall refund the premiums according to the Short Period Scale below less any non-refundable duties and/or reasonable inspection charges the Company may have incurred unless a claim has been made or circumstance notified under this Policy prior to termination/cancellation. 6/12

7 Section 6: Conditions (continued) Short Period Scale Months in force Up to 1 Up to 2 Up to 3 Up to 4 Up to 5 Up to 6 Up to 7 Up to 8 Up to 9 Over 9 Percentage Annual Premium refunded 75% 65% 60% 50% 40% 30% 25% 20% 15% 0% 5. Alterations of Risk If any change occurs materially varying any of the circumstances disclosed by the Insured to the Company, the Insured shall as soon as reasonably practicable give notice of such change with full particulars thereof and the Company shall have the right to vary the terms of this Policy accordingly. 6. Amendments No amendments, additions, or deletions of this Policy or waiver of any of the terms and provisions hereof shall be deemed valid unless effected by means of a signed written amendment to this Policy or written waiver executed by the Company and the Insured. 7. Claims Provisions and Procedures. a) Fraudulent/Dishonest Claims If a claim upon this Policy be in any respect fraudulent or if any false declaration is made or used in support thereof, or if any fraudulent means or devices are used by the Insured or any one acting on his behalf to obtain any benefit under this Policy or if the loss, destruction or damage be occasioned by the wilful act or with the connivance of the Insured all benefits under this Policy shall be forfeited. b) Notice of Claims/Claim Process It shall be a condition precedent to the liability of the Company that the Insured shall: i) Immediately give written notice to the Company of any circumstances which may give rise to a claim against the Insured and for which there may be liability under this Policy; ii) Immediately give written notice to the Company when a claim is actually made against the Insured (whether written or oral) for which there may be liability under this Policy; and iii) Immediately advise the Company in writing should the Insured have any knowledge of any impending prosecution inquest and/or fatal accident inquiry in connection therewith. c) Claims Co-operation Clause The Insured shall at the request and expense of the Company do and concur in doing and permit to be done all such acts as may be required by the Company for the purpose of: i) Defending any claim. ii) Enforcing any rights and remedies or of obtaining relief or indemnity from other parties to which the Company shall be or would become entitled or subrogated upon its paying any claim under this Policy whether such acts shall be or become necessary before or after Insured s indemnification by the Company. 7/12

8 Section 6: Conditions (continued) d) Claims Control Clause No admission, offer, promise, payment, or indemnity in connection with any claim arising out of this Policy shall be made or given by or on behalf of the Insured without the written consent of the Company. The Company shall be entitled if it so desires to take over and conduct in the Insured s name the defence or settlement of any claim or to prosecute in his name for its own benefit any claim for indemnity or damages or otherwise and shall have full discretion in the conduct of any proceedings and in the settlement of any claim and shall give all such information and assistance as the Company may require. 8. Contribution Clause If at the time any claim(s) arise(s) under this Policy where there is a duplication of insurance coverage for the same loss, damage and/or liability whether effected by the Insured or by any other person or persons, the Company shall not be liable to pay or contribute more than their rateable proportion of any claim for such loss, damage, or liability. 9. Subrogation The Insured shall at the expense of the Company do and concur in doing and permit to be done all such acts and things that may be necessary or required by the Company of any right and/or remedies, and/or of obtaining relief or indemnity from parties (other than those insured under this Policy) to which the Company are or would become entitled or which is or would be subrogated to them upon their paying for or making good any loss or damage under this Policy, whether such acts and things shall become necessary or required before or after the Insured s indemnification by the Company. 10. Audit Representatives of the Company shall at any reasonable time have the right to inspect and examine the risk and the Insured shall provide the representatives of the Company with all requested details and information. 11. Condition Precedent The due observance and fulfillment of the terms of this Insurance Policy in so far as they relate to anything to be done or complied with by the Insured and the truth and comprehensiveness of the statements and answers in the Questionnaire and Insurance Proposal made by the Insured shall be a condition precedent to any liability of the Company. 12. Disclosure It is a condition of this Policy that the Insured has disclosed to the Company, before this Policy was concluded, every material fact and/or circumstance which was known to the Insured, and the Insured is deemed to know every circumstance which, in the ordinary course of Business, ought to be known by the Insured. If the Insured has failed to make such disclosure, the Company may avoid this Policy. Every circumstance is material which would influence the judgment of a prudent Company in fixing the premium, or determining whether they will take the risk. It is also a condition of this Policy that the Insured shall notify the Company during the validity of this Policy, and before the renewal(s) are concluded and during the validity of each renewal, of any changes in the material fact and/or circumstances which may increase the risk to be borne by the Company. 8/12

9 Section 6: Conditions (continued) 13. Notices Any notices, formal communications, information, and reports given or disclosed by one Party under this Policy shall be in writing by hand and/or by fax and/or by and/or by registered mail. 14. Governing Law & Jurisdiction This Policy shall be construed and governed by the laws of United Arab Emirates. Any dispute arising out of or in relation to this Policy shall be referred to and settled by the competent courts in the United Arab Emirates. 15. Premium Payment Clause As per the Annexure A attached hereto. 16. Claims Reporting Procedure As per the Annexure A attached hereto. 9/12

10 Annexure A Premium Payment Clause The Company and the Insured hereby agree that notwithstanding any provision to the contrary within this Policy or any endorsement hereto in respect of non-payment of premium, only the following clause shall apply: The Insured undertakes that the premium will be paid in full to the Company by the due date(s) stipulated in the Schedule of this Policy. If the premium due under this Policy has not been so paid to the Company by its due date(s), the Company shall have the right to terminate this Policy by giving the Insured a prior Notice of Termination of fifteen (15) calendar days. If the premium due is paid in full to the Company before the period of the Notice of Termination expires, the said Notice shall automatically be revoked. If the premium due is not paid in full to the Company before the period of the Notice of Termination expires, this Policy shall automatically terminate at the end of the period of the Notice with no further notice or court judgment. In the event of termination, premium is due to the Company on a pro rata basis for the period that the Company is on risk, but the full Policy premium shall be payable to the Company in the event of a loss or occurrence prior to the date of termination which gives rise to a valid claim under this Policy. Any premium paid by the Insured to their Insurance Broker shall not be considered in any respect as being paid to the Company unless it has actually been received by the Company. Commercial lines insurance claims reporting procedure Should there be any incident capable of giving rise to a claim under your Insurance Policy with us, it should be immediately reported to our Claims Department. Our Commercial Lines Claims Department can be contacted in several ways by telephone, fax or , whichever is more convenient for you. Land Lines: Non Marine Claims Marine and Aviation Claims Fax: Non Marine Claims Marine and Aviation Claims s: Non Marine Claims comclaims.nm@adnic.ae Marine and Aviation Claims comclaims.ma@adnic.ae Report a claim outside of business hours: If you need to notify a claim outside regular business hours (before 8:00 am and after 4:00 pm) and/or on holidays or weekends requiring immediate response from the Company due to an emergency situation, please contact: Non Marine Claims: Deputy Chief Claims Officer: / Marine & Aviation Claims: Senior Manager: / /12

11 Annexure A (continued) Information to provide when reporting a claim: It is quite possible that all relevant details of the loss are not known at this time;. The minimum information expected during reporting of a loss for deciding suitable course of action are: Policy Number under which the claim would be covered. Date of loss/discovery. Location of the Incident and contact details of the person to be approached by the Surveyor/Loss Adjuster for further information/assistance. Brief description of circumstances of the claim and loss estimate, if available. What to do at the time of a loss: Your Insurance Policy may require you to comply with certain provisions and follow specific procedures. In general, the initial steps you need to take are the following: Take all reasonable steps to minimize/contain the loss. Hold suspected Third Party, if any, responsible for the loss. Lodge a Report with the Police for any claims arising from Burglary/Fidelity Guarantee. Preserve evidences of loss where emergency repairs are carried out. What not to do at the time of a loss: Do not make any incorrect statement as it may prejudice your claim. Do not make any voluntary payment or admit liability. 11/12

12 Annexure B Endorsements and Special Conditions 12/12