Income Protection Plan Policy Wording

Transcription

1 American Home Assurance Company (Dubai Branch) 5 th Floor, JW Marriott Office Block A, P O Box 40569, Dubai - UAE Tel: Fax: URL: Income Protection Plan Policy Wording Registered under UAE Federal Law No 6 of Insurance Authority No. 79 Commercial License No Claims For Income Protection claims, call us on or write to us at [email protected] within 30 days after the occurrence of any covered loss. Assistance Call or fax and quote your policy number for assistance.

2 Introduction I. Introduction AIG will provide the insurance described in this Policy and any endorsements thereto for the Insured Period as defined in this Policy, to the Insured Persons detailed in the Certificate of Insurance and in reliance upon the information provided at the time of acceptance of the proposal, which shall be the basis of this Policy and are deemed to be incorporated herein in return for the payment of the required premium when due and compliance with all applicable provisions of this Policy. The insurance provided under this Policy is only with respect to such and so many of the benefits as are indicated by a specific amount stated in the Certificate of Insurance. This Policy will only be valid and in force if the Certificate of Insurance is signed by the Company authorized person. AIG. All rights reserved. 2

3 Defintions II. Definitions Company wherever used in this Policy shall mean American Home Assurance Company (Dubai Branch). Certificate of Insurance means the Certificate of Insurance duly signed by the Company which includes the Certificate number, the name of the Named Insured(s), the benefits, limits as well as Effective date and premium. Insured wherever used in this Policy shall mean the proposed Insured as stated on the Certificate of Insurance between the ages of 18 and 69 years. Named Insured(s) wherever used in this Policy shall mean the proposed Insured, and / or the spouse of the Insured as stated in the Certificate of Insurance. Spouse wherever used in the policy shall mean the Named Insured s legally married husband or wife between the ages of 18 and 69 years. Injury means bodily injury caused solely and directly by accidental, external and visible means occurring while this form is in force as to the Named Insured whose injury is the basis of claim, and resulting, directly and independently of all other causes, in loss covered by the policy Total Sum Insured wherever used in this Policy means the sum of the lump sum amount and the Monthly Benefits times 60 months over which the benefit stated in the Certificate of Insurance will be paid. Physician wherever used in this Policy means a person legally licensed to practice medicine and / or surgery other than the Named Insured or a member of the Named Insured s immediate family. Monthly Benefits wherever used in this form means the amount stated in the Certificate of Insurance in respects of each Named Insured and payable over a period of 60 months. Totally and Permanently Disabled wherever used in this form means the Named Insured is unable to engage in any occupation or employment for compensation or profit for which the Named Insured is reasonably qualified by education, training or experience. If at the time of the loss the Named Insured is unemployed, Totally and Permanently Disabled shall mean the permanent and total, inability to perform all the usual and customary duties of a person of like age and gender. Policy means the Certificate of Insurance and any other forms, endorsement, papers or riders. Scheduled Airline means any civilian aircraft operated by a civilian scheduled air carrier holding a certificate, license or similar authorization for civilian scheduled air carrier transport issued by the country of the aircraft s registry, and which in accordance therewith flies, maintains and publishes tariffs for regular passenger service between named cities at regular and specified times, on regular or chartered flights operated by such carrier. Terrorism means the use or threatened use of force or violence against person or property, or commission of an act dangerous to human life or property, or commission of an act that interferes with or disrupts an electronic or communication system, undertaken by any person or group, whether or not acting on behalf of or in any connection with any organization, government, power, authority or military force, when the effect is to intimidate, coerce or harm a government, the civilian population or any segment thereof, or to disrupt any segment of the economy. War means war, whether declared or not, or any warlike activities, including use of military force by any sovereign nation to achieve economic, geographic, nationalistic, political, racial, religious or other ends. AIG. All rights reserved. 3

4 Coverage III. Coverage provided under this policy 3.1 Loss of Life Accident Indemnity When Injury results in loss of life of a Named Insured within three hundred sixty-five (365) days from the date of the accident, the Company will pay the Total Sum insured as shown on the Certificate of Insurance. 3.2 Permanent Total Disability If as a result of a covered Injury, a named Insured becomes Totally and Permanently Disabled, and such Disability is recognized and confirmed by a physician of the Medical Committee of the Ministry of Health, the Company will pay the Total Sum Insured applicable to such insured Person in accordance with the Certificate of Insurance. 3.3 Flying Coverage Coverage as respects flying is limited to Injury sustained during such trip while Named Insured is riding as a passenger (but not as a pilot, operator or member of the crew) in or on, boarding or alighting from a Scheduled Airline. 3.4 Benefit Period The Monthly Benefits shall be paid for as long as the beneficiary, over eighteen (18) years of age at the date of loss, lives, with a guaranteed of Sixty (60) Monthly Benefits. If the beneficiary does not survive to receive Sixty (60) Monthly Benefits, the Monthly Benefits will be paid to the estate of the beneficiary for the remainder of the Sixty (60) months. When the beneficiary is a child, under eighteen (18) years of age at the date of loss, the company will pay the Monthly Benefits for a period of Sixty (60) months to the child beneficiary through the child s legal guardian until the child attains eighteen (18) years of age. When the child beneficiary attains eighteen (18) years of age the Company will pay the Monthly Benefits for the remainder of the Sixty (60) months directly to the beneficiary. 3.5 Limitations No indemnity will be paid under any circumstances for more than one of the losses, the greatest for which provision is made in secion 3.1 Loss of Life accident indemnity or section 3.2 Permanent Total Disability. AIG. All rights reserved. 4

5 Postponement of Effective Date IV. Postponement of Effective Date No insurance provided by this Policy shall become effective as to a Named Insured if such Named Insured 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, provided monthly premium has been received. AIG. All rights reserved. 5

6 General Exclusions V. General Exclusions This Policy does not cover any loss or expense caused by or resulting from: A. Intentionally self-inflicted Injury, suicide or any attempt threat while sane or insane; nor B. War, civil War, invasion, insurrection, revolution, use of military power or usurpation of government or military power; nor C. Any period a Named Insured is serving in the Armed Forces of any country or international authority, whether in peace or war, and in such an event the Company, upon written notification from the Insured, shall return the pro rata premium for any such period of service; nor D. Loss sustained or contracted in consequence of a Named Insured being intoxicated or under the influence of any narcotic or drug unless administered on the advice of a Physician; nor E. Any loss of which a contributing cause, which the Named Insured attempted commission of, or willful participation in, an illegal act or any violation or attempted violation of the law or resistance to arrest by the Named Insured; nor F. Any loss sustained while flying in any aircraft or device for aerial navigation except as specifically provided herein; nor G. Congenital anomalies and conditions arising out of or resulting there from, hernia or dental treatment except to sound natural teeth as occasioned by Injury; nor H. Bacterial infections except pyogenic infections which are caused by an accidental wound; nor I. Flying in any aircraft owned, leased or operated by or on behalf of: the Named Insured or any subsidiary or affiliate of the Named Insured; nor J. Driving or riding as a passenger in or on (a) any vehicle engaged in any race, speed test or endurance test or (b) any vehicle being used for acrobatic or stunt driving; nor K. Any claim caused by opportunistic infection or malignant neoplasm, or any other sickness condition, if, at the time of the claim, the Named Insured had been diagnosed as having AIDS (Acquired Immune Deficiency Syndrome), ARC (AIDS Related Complex) or having an antibody positive blood test to HIV (Human Immune Virus). L. Terrorism, including any action taken in hindering or defending against an actual or expected incident of Terrorism; nor M. The use, release or escape of nuclear materials that directly or indirectly results in nuclear reaction or radiation or radioactive contamination; nor N. The dispersal or application of pathogenic or poisonous biological or chemical materials; nor O. The release of pathogenic or poisonous biological or chemical materials. P. Any event which is consequent to the Named Insured engaging in a sport in a professional capacity or where the Named Insured would or could earn income or remuneration from engaging in such sport; Participation in hazardous sports or activities such as rock climbing, mountaineering, bungee jumping, river rafting, pot-holing, skiing, parachuting, paragliding, etc. Q. Any terrorist or member of a terrorist organization, narcotics trafficker, or purveyor of nuclear, chemical or biological weapons. AIG. All rights reserved. 6

7 Uniform Provisions VI. Uniform Provisions 1. ENTIRE CONTRACT - CHANGES: This Policy, together with the Certificate of Insurance, as well as any forms, riders and endorsements and papers hereto, constitutes the entire contract of insurance. No change in this Policy shall be valid until approved by Our authorized officer and such approval is endorsed hereon. No agent has authority to change this Policy or to waive any of the provisions of this Policy. 2. EFFECTIVE DATE: The Policy takes effect on the Policy Effective Date stated in the Certificate of Insurance. After taking effect the policy continues in effect until the expiry of the Period of Coverage stated in the Certificate of Insurance and may continue in effect thereafter subject to the "Grace Period and Renewal Conditions set forth herein. All periods of insurance shall begin and end at hours. at the address of the Insured Person. 3. REVIEW / FREE-LOOK PERIOD: You are entitled to a full refund of premium if coverage under the policy is cancelled upon written request by You within thirty (30) days from the date the first premium is debited from Your Visa / MasterCard Credit Card or Citibank Bank Account. We reserve the right to decline a second application following the cancellation of the first application under this plan. 4. GRACE PERIOD: A grace period of thirty (30) days will be granted for the payment of each premium falling due after the first premium, during which time the Policy shall be continued in force, unless the Policy has been cancelled in accordance with the Uniform Provision entitled Cancellation. You shall be liable to Us for the payment of the premium for the period the policy continues in force. If loss occurs within the Grace Period, any premium then due and unpaid will be deducted in settlement. 5. PREMIUMS: All premiums and applicable taxes are payable in advance by You on or before the date they become due; unless official notice of 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 the Uniform Provision entitled Grace Period. 6. EFFECTIVE DATE OF CERTIFICATE OF INSURANCE AND CHANGES: The persons eligible for inclusion as Insured Person(s) herein shall be the persons designated on the Certificate of Insurance. Coverage in respect of each Insured Person shall commence from the day Your Visa / MasterCard Credit Card / Citibank Bank Account is debited for the premium under the policy. However, at the time of first application the coverage shall commence from the Policy Effective Date. Non payment of the first premium will render this Policy null and void immediately, effective from the Policy Effective Date. 7. TERMINATION DATES OF CERTIFICATE OF INSURANCE: Your insurance shall terminate immediately on the earliest of: The date the Policy is terminated; The date You are no longer eligible within the definition of Insured Person; The premium due date if the required premium is not paid within the Grace Period; The date You have attained the age of 65 years old. Any such termination shall be without prejudice to any valid claim originating prior to the date of termination. AIG. All rights reserved. 7

8 Uniform Provisions 8. RENEWAL CONDITIONS: With Our consent the Policy may be renewed from term to term by payment of the premium in advance. Subject to provisions 4 and 5, Your Policy will be automatically renewed each month in the case of Monthly Premium and each year in the case of Annual Premium, subject to payment of premiums unless cancelled in writing. 9. REINSTATEMENT OF POLICY: When the policy terminates by reason of non-payment of premium, any subsequent acceptance of a premium and reinstatement of the policy by Us shall solely be at Our option and shall only cover loss resulting from Injury or sickness sustained after the date of such reinstatement. 10. CANCELLATION: We may cancel the policy at any time by written notice delivered to You or mailed to Your last address as shown in Our records stating when not less than fifteen (15) days thereafter such cancellation shall be effective. Such cancellation shall be without prejudice to any valid claim originating prior thereto. In the event the individual insurance offered to an Insured Person under the policy for which the Annual Premium has been paid in advance is cancelled by You or Us, the unearned premium shall be refunded on a pro-rata basis for the balance of the months of cover due under the plan. 11. NOTICE OF CLAIM/LOSS: It is a condition precedent to Our liability hereunder that written notice of claim must be given by You to Us within 7 days after an actual or potential loss begins or as soon as reasonably possible and in any event not later than 30 Days after an actual or potential loss begins. 12. CLAIM FORMS: We, upon receipt of a notice of claim, will furnish Your representative with such forms as We may require for filing proofs of loss. 13. TIME FOR FILING CLAIM FORMS AND EVIDENCE: Completed claim forms and written evidence of loss must be furnished to Us within ninety (90) Days after the date of such loss. Failure to furnish such evidence within the time required shall not invalidate nor reduce any claim if You can satisfy us that it was not reasonably possible for You to give proof within such time. However, no proof will be accepted if furnished later than eighteen (18) months from the time the loss occurred. 14. TIME OF PAYMENT OF CLAIM: Benefits payable under this Policy will be paid within a reasonable time upon receipt of due written evidence of such loss and any other documentation, information and assistance that We may request You pursuant to Uniform Provision 9 above. 15. TO WHOM INDEMNITIES ARE PAYABLE: Indemnity, if any, for loss of life of a Named Insured is payable to the beneficiary for such Named Insured named in the application provided such beneficiary survives the Named Insured by (30) days, otherwise to the estate of the Named Insured. Disability indemnities of this Policy are payable to the Named Insured. Any payment made by the Company in good faith pursuant to this provision shall fully discharge the Company to the extent of the payment. No Sum payable under this plan shall carry interest. 16. MEDICAL EXAMINATION: The Company, at its own expense, shall have the right and opportunity to examine a Named Insured when and as often as the Company may reasonably require during the pendency of a claim hereunder, and also the right and opportunity to make an autopsy in case of death where it is not forbidden by law. AIG. All rights reserved. 8

9 Uniform Provisions 17. LEGAL ACTIONS: No action at law or in equity shall be brought to recover on the policy prior to the expiration of sixty (60) days after written proof of loss has been furnished in accordance with the requirements of the policy. No such action shall be brought after the expiration of three (3) years after the time written proof of loss is required to be furnished. 18. DESIGNATION OR CHANGE OF BENEFICIARY; ASSIGNMENT: The right of designation or change of beneficiary is reserved to the Named Insured.. No assignment of interest shall be binding upon the Company until the original of a copy thereof is received by the Company. The Company assumes no responsibility for the validity of such designation or change of beneficiary or assignment. 19. CONSENT OF BENEFICIARY: Consent of the beneficiary, if any, shall not be requisite to change of beneficiary or to any other changes in the policy. 20. MISSTATEMENT OF AGE: If the age of any Insured Person has been misstated, all amounts under this Policy will equal the Benefit amounts for which the premium would have been paid had the correct age been stated. In the event that age of any Insured Person was misstated and if, according to the correct age of the Insured Person, the coverage provided would not have become effective, or would have ceased prior to acceptance of such premiums, then Our liability will be limited to the refund, upon written demand, of all premiums paid for the period not covered by this Policy less any reasonable expenses incurred by Us. 21. FILING OF PREMIUM RATES AND CLASSIFICATION OF RISKS: If the law of the country in which the Named Insured is located at the time the policy is issued requires that prior to the policy issue a statement of the premium rates and classification of risks pertaining to the policy shall be filed with a government official having supervision of insurance in such country, then the premium rates and classification of risks mentioned in the policy shall mean only such as have been last filed by the Company in accordance with such law, but if such filing is not required by such law, then they shall mean the Company's premium rates and classification of risks last made effective by the Company in such country prior to the occurrence of the loss for which the Company is liable. 22. COMPLIANCE WITH POLICY PROVISIONS: Failure to comply with any of the provisions contained in this Policy shall invalidate all claims hereunder. 23. CHANGE IN PREMIUM RATES: We may change the premium rates for the Policy, by advance written notice delivered to You or mailed to Your last address as shown on Our the records, no later than thirty (30) days prior to such anniversary. 24. GOVERNING LAW & JURISDICTION : This policy is governed by the laws of the United Arab Emirates. Any dispute arising between the insured & the insured company is subject to the exclusive jurisdiction of Dubai Courts. 25. CONFORMITY WITH STATUTES: Any provision of the Policy which, on the Policy Effective Date, is in conflict with statutes of the jurisdiction in which the Policy is issued, is hereby amended to conform to the minimum requirements of such statutes. 26. OTHER INSURANCE WITH THE COMPANY: If a like policy or policies previously issued by the Company to the Named Insured be in force concurrently herewith, making the aggregate indemnity for the Total Sum Insured in excess of the Global Maximum of AED 2,000,000 (UAE Dirhams Two Million), the excess insurance shall be void and all premiums paid for such excess shall be returned to the Named Insured or his estate. AIG. All rights reserved. 9

10 Uniform Provisions 27. ECONOMIC SANCTIONS EXCLUSIONS: Notwithstanding anything to the contrary in this Policy, the following shall apply and shall be paramount to all other Policy terms and conditions: If, by virtue of any law or regulation which is applicable to the Insurer at the inception of this Policy or any time thereafter, providing coverage under this Policy or paying any claim or other benefit under this Policy is or would be unlawful because it is prohibited or restricted by an embargo, sanction or other similar program as embodied in such law or regulation, the Insurer shall provide no coverage and have no liability whatsoever nor pay any claim or other benefit under this Policy, to the extent that such coverage or payment would be in violation of such law or regulation. 28. COMPLAINTS AND DISPUTES: If you have a complaint about your Policy, please contact: Customer Service Group American Home Assurance Company (Dubai Branch) JW Marriott, Office Block A, 5th Floor P.O. Box 40569, Dubai, UAE Tel: , Fax: [email protected] 29. DATA DISCLOSURE: By executing this application or by entering into this contract of Insurance, the Insured consents to the Insurer processing data relating to the Insured for providing insurance products and services, legal, administrative and management purposes and in particular to the processing of any sensitive personal data relating to the Insured. The Insured consents to the Insurer making such information available to third parties including but not limited to any Group Company, those who provide products or services to the Insurer or any Group Company, and regulatory authorities, within and outside the Insured s country of domicile. To review our privacy policy, go to: AIG. All rights reserved. 10