PERSONAL ACCIDENT POLICY DOCUMENT HELP WHEN YOU NEED IT

Transcription

1 PERSONAL ACCIDENT POLICY DOCUMENT HELP WHEN YOU NEED IT

2 Free Business Advice Service Available 24 hours each day, 7 days every week, all year round This free helpline service is provided which you may use while your Policy is in force: Business Legal Advice Helpline Unlimited access to a team of solicitors and other legal experts, for 24 hours confidential legal advice and guidance on any commercial legal problem such as: employment VAT prosecution contract disputes landlord and tenant disputes. Please note that advice on motoring matters is not available. Legal advice can only be offered in respect of matters subject to the laws of and within the jurisdiction of courts or tribunals of: England Scotland Wales and Northern Ireland the Channel Islands and the Isle of Man any other member country of the European Union Switzerland and Norway.

3 Contents Opposite Emergency Assistance Telephone Number 2 Introduction 3 Definitions 4 Specific Conditions 5 Exclusions 6 Conditions 7 Important Information Personal Accident Policy Document 1

4 Personal Accident Policy Whereas the Insured named in the Schedule hereto has made to U K Insurance Limited trading as NIG (hereinafter called the Company ) a proposal which is the basis of this contract and is incorporated herein on behalf of those persons whose names are entered in the Schedule attached to this Policy (hereinafter individually referred to as Insured Person or Insured Persons ). Now it is hereby agreed that in consideration of the payment of the Premium the Company will during the Period of Insurance detailed in the Schedule and for any further period in respect of which the Company shall accept a renewal premium indemnify the Insured as detailed herein against accidental bodily injury caused solely and directly by violent external and visible means which shall independently of any other cause occasion death or disablement as defined herein to the Insured Person happening anywhere in the World. Provided such accident, and consequent disablement, occurs during the currency of this Policy or any period of renewal, and in the case of those Insured Persons covered for occupational risks, during the official periods of their business occupation. The Company hereby agrees in the event of a claim being substantiated under this Policy to pay the Insured or the Insured Person or their legal representatives according to the Scale of Compensation specified in the Schedule subject always to the terms and conditions of this Policy. 2 Personal Accident Policy Document

5 Definitions 1 Death means the death of the Insured Person within twenty four calendar months from the date of the accident solely and directly as a result of the accidental bodily injury. 2 Loss of Sight means total and permanent loss of all sight occurring within twenty four calendar months of the date of the accident. 3 Loss of a Limb means loss by physical separation of a hand at or above the wrist or of a foot at or above the ankle, occurring within twenty four calendar months from the date of the accident. 4 Loss of Hearing means permanent and total loss of the sense of hearing. 5 Loss of Speech means permanent and total loss of the power of speech. 6 Permanent Total Disablement means a disablement which permanently and continuously disables the Insured Person totally and absolutely from attending to business or occupation of any and every kind or if the Insured Person has no business or occupation necessarily and continuously prevents them from attending to their normal duties. 7 Temporary Total Disablement means a disablement which prevents the Insured Person from continuously attending to their usual business or occupation or if the Insured Person has no business or occupation from attending to their normal duties. 8 Temporary Partial Disablement means a disablement which prevents the Insured Person from engaging in or giving attention to a substantial part of their usual business or occupation. Personal Accident Policy Document 3

6 Specific Conditions Applicable to the Scale of Compensation 1 The compensation in respect of Permanent Total Disablement is not payable before 104 weeks from the date of the accident and is not payable at all following adjustment and settlement of a claim in respect of Loss of Sight or Limbs or Loss of Hearing or Speech. 2 The compensation in respect of Temporary Total Disablement and/or Temporary Partial Disablement is payable in the aggregate for a period up to 104 consecutive weeks for any single disablement but excluding the first 7 days of disablement. 3 Medical Expenses - In addition to any compensation payable on any admitted claim under 1 to 8 above any Medical Expenses incurred by the Insured Person will be paid by the Company but not exceeding: i ii in respect 1 to 6 above 25 per 1,000 of compensation in respect 7 and 8 above 20% of the weekly compensation and not exceeding 1,000 in all. 4 Accidental Death shall be presumed to have been suffered by the Insured Person if the Insured Person disappears and is missing for one year and the Insured produces to the Company sufficient evidence that leads the Company inevitably to the conclusion that Accidental Death has happened to such Insured Person and caused such disappearance. Provided that if the Insured Person is found to be living after Compensation has been paid by the Company then such Compensation shall be refunded to the Company. 5 No payment shall be due in respect of any claim for weekly sums under this Policy until the total amount thereof in respect of such claim shall have been settled and adjusted to the satisfaction of the Company unless an interim payment is allowed at the Company s discretion. Any payment made or adjusted in respect of weekly sums shall be deducted from any lump sum thereafter becoming claimable under the Scale of Compensation specified in the Schedule, the balance only of such lump sum then being payable. 6 No further liability shall attach to the Company under this Policy in respect of any one claim after adjustment and settlement of a claim in respect of any lump sum under the Scale of Compensation specified in the Schedule. 4 Personal Accident Policy Document

7 Exclusions This Policy does not extend to the death or disablement of any Insured Person resulting from or contributed to by: a b c d e f g h Intentional self-injury, suicide or attempted suicide, provoked assault, fighting (except in bona fide self-defence), or wilful exposure to needless peril (except in an attempt to save human life). The influence of intoxicating liquor or drugs taken by the Insured Person (other than for drugs taken under medical supervision unless for the treatment of drug or alcohol addiction) or insanity (whether temporary or otherwise) or any sexually transmitted or communicable disease. Aviation other than as a fare-paying passenger in an aircraft operated by a regular airline or in an aircraft of a recognised charter operator. Winter sports, mountaineering requiring the use of guides or ropes, sub-aquatic or subterranean pursuits, aeronautic sports. Riding or driving in or practising for any race, polo playing, steeplechasing, hunting, showjumping, motor cycling (the term motor cycling includes motor scooters but not motor-assisted pedal cycles), pillion riding of any kind. Any consequence of war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power. Any cause after expiry of the Period of Insurance during which the Insured Person has attained the age of 75 years unless otherwise acknowledged by memorandum or endorsement signed by the Company. The Insured Person suffering from illness or disease not resulting from bodily injury or suffering from bodily injury due to any gradually operating cause. Personal Accident Policy Document 5

8 Conditions 1 This Policy and the Schedule shall be read together as one contract and any word or expression to which a specific meaning has been attached in any part of this Policy or of the Schedule shall bear such specific meaning wherever it may appear. 2 The Company shall not be bound to send any notice of the Renewal Premium becoming due, nor to renew this Policy. The insurance by this Policy may be cancelled at any time by registered letter from the Company to the Insured s last known address giving 30 days notice of such cancellation and in such event the Company will return a pro-rata portion of the premium for the unexpired period of Insurance. 3 The Insured shall give immediate notice in writing to the Company of any material change or alteration in the facts set out in the original Proposal Form. Failure to comply with this condition shall render the Policy void (at the discretion of the Company) unless the Company shall have consented to such change by memorandum or endorsement signed by the Company. 4 The total liability of the Company in respect of death or disablement to the Insured Person whether under this or any other contract of insurance shall not exceed the benefit payable under this Policy, unless a memorandum of the Company s consent to such other contract be endorsed hereon. 5 In the event of accident causing death or disablement notice in writing must be sent to the Company as soon as possible. All certificates and information and evidence required by the Company shall be furnished at the expense of the Insured or Insured Person and shall be in such form and of such nature as the Company shall prescribe. If the Insured Person is disabled following an accident they must as early as possible place themself under the care of a duly qualified Medical Practitioner and act upon medical or surgical advice as soon as practicable and submit to medical examination at the Company s expense as often as the Company may require. 6 In no case will the Company be liable to pay compensation to the Insured Person or to their representatives until any Medical Officer appointed by the Company has made any medical or surgical examinations and re-examinations of the Insured Person as the Company may require. 7 In the event of death of the Insured Person the Company if it deems necessary shall arrange for a post-mortem examination of the body. No surgical examination of the body of the Insured Person shall be made at the instance of their representative without due notice having been first given to the Company, so as to enable the Company to have its Medical Officer present at the same time. 8 If any part of the Premium is calculated on estimates given by the Insured the Insured shall keep an accurate record containing all relevant particulars and shall at any reasonable time allow the Company to inspect such record. The Insured shall within one month from the expiry of each Period of Insurance supply such information as the Company requires or if requested by the Company figures certified by the Insured s auditors so that the premium for that period shall be calculated and the difference paid by or allowed to the Insured as the case may be. 6 Personal Accident Policy Document

9 9 This Policy shall be voidable in the event of misrepresentation, misdescription or non-disclosure. 10 The due observance and fulfilment of the terms provisions and conditions so far as they relate to anything to be done or complied with by the Insured or Insured Person shall be a condition precedent to the liability of the Company. 11 The parties to an Insurance contract are free to choose the law that will apply. In the absence of a specific agreement between the parties the law applying to this contract is English Law. Personal Accident Policy Document 7

10 Important Information Your right to cancel If this cover does not meet your requirements, please return all your documents and any certificate to the broker, intermediary or agent who arranged the Policy within 14 days of receipt. We will return any premium paid unless a claim has been made. Termination If you wish to terminate the contract at any other time, please contact the broker, intermediary or agent who arranged the Policy. Any return of premium will be made based on the number of days remaining in the Policy period, unless a claim has been made when no refund is due. How to make a claim Please contact, in the first instance, the Broker, Intermediary or Agent who arranged the Policy. Please quote your policy number. How to complain If you have an enquiry or complaint arising from your Policy, please contact the broker, intermediary or agent who arranged the Policy for you. If the broker is unable to resolve your complaint or it is regarding the terms and conditions of the policy they will refer it to NIG. If your complaint is still outstanding you can write to NIG direct at the following address, quoting your policy number. The Chief Executive, NIG Churchill Court, Westmoreland Road, Bromley BR1 1DP. Once you receive a written response and if you remain dissatisfied, you may refer your complaint to the Financial Ombudsman Service (FOS). Their address is: South Quay Plaza, 183 Marsh Wall, London E14 9SR Telephone: or Details about our Regulator NIG policies are underwritten by U K Insurance Limited who is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority, registration number The Financial Conduct Authority website, which includes a register of all regulated firms can be visited at or the Financial Conduct Authority can be contacted on The Prudential Regulation Authority website can be visited at or the Prudential Regulation Authority can be contacted on Financial Services Compensation Scheme Under the Financial Services and Markets Act 2000, should we be unable to meet our liabilities to policyholders, compensation may be available. Insurance advising and arranging is covered for 90% of the claim, without any upper limit. For compulsory classes of insurance, insurance advising and arranging is covered for 100% of the claim, without any upper limit. Information can be obtained on request, or by visiting the Financial Services Compensation Scheme website at Whoever you are contacting, please always quote your Policy Number as it will help your enquiry or complaint to be dealt with promptly. 7 Personal Accident Policy Document

11 NIG policies are underwritten by U K Insurance Limited, Registered office: The Wharf, Neville Street, Leeds LS1 4AZ. Registered in England No U K Insurance Limited is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. Calls may be recorded. NIG2988M/05/13