Personal Injury Cover Terms and Conditions

Transcription

1 Personal Injury Cover Terms and Conditions

2 Demands and Needs Statement This policy meets the demands and needs of those who wish to ensure that in the event of a motoring accident an insured person will be covered for bodily injury as described in the policy. Elephant does not make personal recommendations as to the suitability of the policy to individual circumstances. You are solely responsible for deciding whether the policy is suitable for your needs.

3 Personal Injury Cover Policy Summary 1 Policy Summary This policy summary does not contain full terms and conditions of the cover, which can be found in the policy document. It is important that you read the policy document which follows this policy summary carefully. Who the cover is underwritten by Admiral Insurance (Gibraltar) Limited, Suite 3G, Eurolife Building, 1 Corral Road, Gibraltar. Type of Insurance and Cover Personal Injury insurance covers the insured person as a driver of the insured vehicle. It also covers the insured person as a passenger in the insured vehicle when it is being driven by another insured person. The insured person is covered while travelling in, mounting into or dismounting from the insured vehicle. For camper vans, cover is only provided whilst travelling in the insured vehicle which is driven by an insured person. For policyholders only, cover is extended to travelling in, mounting into or dismounting from any other privately insured car within the UK. Significant Features and Benefits The significant benefits of your policy are shown below followed by the significant exclusions. Full details of the levels of cover and sums insured payable by this policy are shown in the policy document. death permanent total disablement loss of limbs loss of hands or feet loss of sight loss of speech or hearing loss of defined internal organs loss of thumbs, fingers or toes 3rd degree burns loss of teeth fractured bones hospital cash daily benefit Significant and Unusual Exclusions or Limitations you will only be provided with the cover set out in this policy, if you and any additional drivers on your policy, are permanently resident in Great Britain, Northern Ireland, the Isle of Man, Alderney, Guernsey and Jersey (Section 2 Eligibility) pre-existing conditions will be taken into account when determining benefits to be paid (Section 3 Benefits) the maximum benefit we will pay under this policy for all claims made by an insured person following a motoring accident is 50,000 if Personal Injury has been selected or 100,000 if Personal Injury Plus has been selected. (Section 4 Maximum Benefits) if your associated motor policy is declared void, or ceases to be in force for any reason, then this policy will also cease to be in force. (Section 6. When does the cover end?) under the hospital cash daily benefit, no benefit will be paid unless you are admitted into hospital or your condition is treated by a doctor or a nurse in an Accident and Emergency department. Payment will only be made once we have received a completed claim form and evidence of this assessment and/or admittance. (Section 3 Benefits)

4 2 Personal Injury Cover Policy Summary only those internal organs listed under the internal organs definition are covered. (Section 1 Meaning of Words) permanent total disablement benefit will only be paid if the insured person is unable to engage in employment of any and every kind for the remainder of their life. (Section 1 Meaning of Words) no benefit will be paid if the insured person: is found to be over the prescribed limit of alcohol is driving whilst unfit through drink or drugs, whether prescribed or otherwise fails to provide a sample of breath, blood or urine when required to do so, without lawful reason Duration of the cover From the date Personal Injury cover was added to the associated motor policy until its renewal or cancellation, up to a maximum of twelve months. As long as the policyholder remains eligible, this policy will automatically renew with the associated motor policy unless you inform EUI Limited otherwise. Your right to cancel You may cancel this product and receive a full refund, if you inform us within 14 days from the receipt of the confirmation letter or . Should you cancel outside the 14 day cancellation period, you will be charged on a daily pro rata basis for the time you have been on cover, plus a 5 cancellation charge. However, if a claim is made or has arisen during the period of insurance, the full premium is payable and no refund will be given. For further information on cancellation please refer to the section in the policy wording headed Section 7. Cancellation Rights. How to make a claim To make a claim please contact our Personal Injury Claims Line on Please have your address and policy number available when notifying us of a claim. How to make a complaint Complaints should be made to: The Quality Manager, EUI Limited, Capital Tower, Cardiff, CF10 3AZ. Tel: [email protected] Fax: If you have complained to us and we have been unable to resolve your complaint, you are entitled to refer your complaint to the Financial Ombudsman Service. Financial Services Compensation Scheme (FSCS) Admiral Insurance (Gibraltar) Limited is covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation if Admiral Insurance (Gibraltar) Limited is unable to meet its obligations to you under this contract. Cover is provided for 90% of the claim without any upper limit. Further information can be obtained from the Financial Services Compensation Scheme by phone on and on their website at

5 Personal Injury Cover Policy Document 3 Policy Document Your Policy Whenever a word appears in this policy document and is defined in Section 1 Meaning of Words, it takes on that special meaning. This policy document sets out the details of your insurance cover. Please read this policy carefully and keep it in a safe place. Provided the eligibility requirements in Section 2 are met, this policy provides benefits to an insured person in the event that they suffer a motoring accident in the effective time causing bodily injury. You must pay or agree to pay the premium for this insurance, and cover is for one period of insurance at a time. Section 1. Meaning of Words Please find below an explanation of the words used in this policy. Accident A sudden and unforeseen event which occurs after the start date and results in bodily injury including assault. Assault A sudden and unexpected attack by an unknown third party with deliberate intent to cause bodily injury at an identifiable time and place immediately following a road incident within the UK. Associated motor policy The valid motor insurance arranged by EUI Limited which has been taken out by you. Bodily injury Any injury to the insured person which is caused by an accident and which, within 52 weeks from the date of the accident, solely and independently of any other cause, results in death or any of the injuries listed in the Benefits Table in Section 3. Burns Full thickness burn or burns (third degree) covering more than 10% of the body surface. Effective time When cover is provided by this policy: all insured persons (except policyholder): Whilst travelling in, mounting into or dismounting from an insured vehicle which is being driven by an insured person. For camper vans, cover is only provided whilst travelling in the insured vehicle which is driven by an insured person. policyholder only: Whilst travelling in, mounting into or dismounting from an insured vehicle which is being driven by an insured person as well as whilst travelling in, mounting into or dismounting from any other private car within the UK. For camper vans, cover is only provided whilst travelling in the insured vehicle which is driven by an insured person. End date The date your insurance ends as set out in Section 6.

6 4 Personal Injury Cover Policy Document EUI Limited Elephant is a trading name of EUI Limited. Fracture A break in the full thickness of the bone (i.e. a complete break across the whole width of the bone). Hospital An institution which has accommodation for in-patients and facilities for diagnosis, surgery and treatment. It does not include a convalescence home, an extended care facility, a geriatric home, a long term nursing home or a rehabilitation home. Hospital cash daily benefit If the insured person is admitted to a hospital following bodily injury or if their condition is treated by a doctor or a nurse in an Accident and Emergency department, we will pay the sum shown in the Benefits table (Section 3. Benefits) for each 24 hour stay in hospital. Insured person You and any other persons named on the associated motor policy (including any temporary drivers covered by your associated motor policy at the time of an accident). Insured vehicle The vehicle defined in your associated motor policy. Loss of hearing Total, permanent and irrecoverable loss of hearing in both ears. This is considered to have occurred where the degree of hearing after correction results in the classification of profoundly deaf. Profoundly deaf is the inability to hear sounds when tested by an audiologist quieter than 90 decibels. Loss of speech Total, permanent and irrecoverable loss of speech. Loss of sight The permanent and total loss of sight which shall be considered as having occurred: (a) in both eyes, if the insured person s name is added to the Register of Blind Persons on the authority of a fully qualified ophthalmic specialist. (b) in one eye, if the degree of sight remaining after correction is 3/60 or less on the Snellen scale (meaning the insured person sees at 3 feet what they should see at 60 feet). Loss of tooth/teeth A chip, break or total dislodgement of a tooth/teeth as a result of an accident. Loss (in relation to limbs, hands, thumbs, fingers, feet, toes and internal organs) Complete, permanent and irrecoverable loss of use or loss by physical separation. Limb(s) Arm(s) or leg(s) at or above the wrist or ankle (excluding hands and feet). Hand(s) All the fingers and the thumb of a hand. Thumb(s) The entire thumb or thumbs. Finger(s) The entire finger (excluding thumbs). Foot (Feet) All the toes of a foot. Toe(s) The entire toe.

7 Personal Injury Cover Policy Document 5 Internal organs - category one Lung, kidney(s), liver, large intestine, small intestine, stomach, reproductive organ(s) and bladder. Internal organs - category two Spleen, gallbladder and pancreas. Period of insurance The period of your associated motor policy which runs concurrently with this policy and does not exceed 12 months. If Personal Injury Cover has been purchased after the start date of your associated motor policy, cover starts from the purchase date of Personal Injury Cover. Permanent total disablement Means physical disablement caused other than by of limb(s), loss of sight, loss of hearing or loss of speech, which has lasted for 52 consecutive weeks and will, in all probability, prevent the insured person from engaging in employment of any and every kind for the remainder of their life. Premium The premium that you must pay for cover under this policy. If you pay the premium annually rather than by monthly instalments, this is paid at the start of your associated motor policy. If you pay by monthly instalments, the premium is paid monthly alongside your associated motor policy. Your cover is renewed at the end of each period of insurance. Start date The date Personal Injury cover was added to the associated motor policy until its renewal or cancellation, up to a maximum of twelve months. As long as the policyholder remains eligible, this policy will automatically renew with the associated motor policy unless you inform EUI Limited otherwise. Supporting medical evidence This includes GP (doctors), hospital or consultants reports or a hospital discharge form. The evidence we require will depend on the benefit claimed. UK The United Kingdom, Channel Islands and Isle of Man. Underwriters Admiral Insurance (Gibraltar) Limited. We, Us, Our EUI Limited trading as Elephant and/or the underwriters. You, Your, Policyholder The person who has taken out the associated motor policy and who is named on this policy. Section 2. Eligibility The insured person is eligible for this insurance cover if: a. They are aged 17 or over at the start date; and b. They are permanently resident in Great Britain, Northern Ireland, the Isle of Man, Alderney, Guernsey and Jersey; and c. The insured person has, or is named, on an active associated motor policy; and d. The premium has been paid (including insurance premium tax, where applicable).

8 6 Personal Injury Cover Policy Document Section 3. Benefits The Benefits table below should be read in conjunction with Section 1 Meaning of Words. The insured person will be entitled to the following benefits if the insured person has an accident after the start date, during the effective time and before the end date which results in: Description Benefit Payable ( ) Personal Injury Item 1 Death 40,000 80,000 Item 2 Permanent total 50, ,000 disablement Item 3 A, loss of sight in 50, ,000 both eyes B, loss of sight in one eye 15,000 30,000 Item 4 A, loss of hearing in 25,000 50,000 both ears B, loss of hearing in 10,000 20,000 one ear Item 5 Loss of speech 25,000 50,000 Loss of: Item 6 A, two or more limbs 50, ,000 B, one limb 15,000 30,000 Item 7 A, both hands or 25,000 50,000 both feet B, one hand or one 12,500 25,000 foot Item 8 A, both thumbs 7,000 15,000 B, one thumb 3,500 7,000 Item 9 A, more than one 5,000 10,000 finger B, one finger 2,000 4,000 Item 10 A, both big toes 5,000 10,000 B, one big toe 2,500 5,000 Personal Injury Plus

9 Personal Injury Cover Policy Document 7 Description Benefit Payable ( ) Item 11 A, more than one toe (excluding big toes) B, one other toe (excluding big toes) Item 12 A, internal organ(s) category one B, internal organ(s) category two Personal Injury Personal Injury Plus 1,000 2, ,000 10,000 20,000 2,500 5,000 Item 13 Burns 5,000 10,000 Item 14 Fractures to: A, the pelvis, arm, leg, 1,000 2,000 skull, vertebrae, jaw, knee, hand or facial bones (excl. nose) B, the foot, shoulder 500 1,000 blade, elbow, sternum, wrist, ankle, collar bone or coccyx C, any other body part (incl. nose) Item 15 Hospital cash daily benefit Item 16 A, loss of one tooth B, loss of two or more teeth Maximum policy benefit 50, ,000

10 8 Personal Injury Cover Policy Document In relation to the Benefits table (Pages 6 & 7): 1. Benefit may be paid for more than one item (up to the maximum policy benefit shown in Section 4) except for the following: a. We will not pay benefits under items 7 to 11 as well as item 6 for any one limb. b. We will not pay benefits under items 8 to 11 as well as item 7 for any one hand or foot. c. We will not pay benefits under items 2 to 16 as well as item 1 2. Only one benefit can be claimed under each item, other than for items 12 and Benefit will only be paid upon receipt of supporting medical evidence. The cost of obtaining this evidence will be paid by us provided they are incurred with our consent. 4. Under item 15, no benefit will be paid unless you are admitted into hospital or your condition is treated by a doctor or a nurse in an Accident and Emergency department. Payment will only be made once we have received a completed claim form and evidence of this assessment and/or admittance. 5. If the insured person has a pre-existing condition, sickness, disease or injury, then we will assess the effect of the accident on your bodily injury, and we will reduce the benefit by an appropriate amount to take this into account. Expert medical advice will be gained to ensure any reduction in the payment is proportionate to the preexisting condition. Section 4. Maximum Policy Benefit The maximum benefit we will pay under this policy for all claims made by an insured person following each motoring accident is 50,000 if Personal Injury has been selected or 100,000 if Personal Injury Plus cover has been selected. These limits apply to each insured person, per motoring accident. Section 5. Exclusions We shall not be liable in respect of any claim: 1. Directly or indirectly as a result of: a. War, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, insurrection or military or usurped power and any act of terrorism. b. The insured person committing, or attempting to commit suicide or intentional self-injury. c. The insured vehicle or any vehicle in which you are a passenger being used on the Nurburgring Nordschleife, or for racing formally or informally against another motorist, pace-making, competitions, rallies, track days, trials or tests, speed trials or speed tests, either on a road, track, or at an off-road 4x4 event. d. When the insured person: is found to be over the prescribed limit of alcohol is driving whilst unfit through drink or drugs, whether prescribed or otherwise fails to provide a sample of breath, blood or urine when required to do so, without lawful reason

11 Personal Injury Cover Policy Document 9 2. Use of vehicles other than private motor cars or light vans as detailed in your associated motor policy. 3. For any injury not specifically listed in the Benefits table (Section 3. Benefits). 4. Where the insured vehicle is driven by an insured person who does not hold a valid driving licence or are breaking the conditions of their driving licence. Section 6. When does the cover end? 1. This cover ends automatically as soon as one of the following happens: a. The day and time your associated motor policy ends. b. You die. c. Your associated motor policy is declared void or ceases to be in force for any reason. 2. The cover for other individuals named in your associated motor policy will also end if they die. 3. We may cancel this policy at any time by sending 7 days notice in writing to your last known address if: you are in breach of any of the conditions of your policy you fail to respond to written requests for further information or documentation you provide inaccurate information about your residency Section 7. Cancellation Rights a. Your Cancellation Rights You may cancel this product and receive a full refund, if you inform us within 14 days from receipt of the confirmation letter or . Should you cancel outside the 14 days, you will be charged on a daily pro rata basis for the time you have had on cover plus a 5 cancellation charge. If a claim is made or has arisen during the period of insurance, the full premium is payable and no refund will be given. Please contact EUI Limited (trading as Elephant) Capital Tower, Greyfriars Road, Cardiff, CF10 3AZ. Alternatively, if you wish to phone us please call (calls to 0871 numbers are charged at 8p per minute plus network extras). b. Our Cancellation Rights If any claim under this policy shall be in any respect fraudulent, or if any fraudulent means or devices shall be used by you, the insured person or anyone acting on the insured person s behalf, to obtain any benefit under this policy, we shall be under no liability in respect of such claim and shall be entitled to terminate the policy. If your associated motor policy is cancelled, this product will also be cancelled. If we cancel your policy, you will be charged on a daily pro rata basis for the time you have had on cover plus a 5 cancellation charge.

12 10 Personal Injury Cover Policy Document Section 8. General Governing law and language This insurance shall be subject to English Law, unless specifically agreed to the contrary. All communication is to be conducted in English. Assignment and surrender value You cannot transfer your rights or interests in this policy to any other person. This policy will not have any value at the end date or if it is cancelled. Rights of Third Parties This agreement is made for the benefit of the parties to it and is not intended to benefit, or be enforceable by, any other person in accordance with the Contracts (Rights of Third Parties) Act 1999 or otherwise. Section 9. What to do if You wish to claim To make a claim please call the Personal Injury Claims Line on Please have your address and policy number available when notifying us of a claim. Section 10. Our Promise of Service EUI Limited aims at all times to provide a first class standard of service. However, there may be occasions when you feel that this objective has not been achieved. Any enquiry or complaint regarding this policy should be addressed to: The Quality Manager, EUI Limited, Capital Tower, Cardiff CF10 3AZ. Tel: [email protected] Fax: If we have given you our final response and you are still unhappy, or more than 8 weeks have passed since we received your original complaint, you may refer your complaint to the Financial Ombudsman Service (FOS). Their details are as follows: The Financial Ombudsman Service Exchange Tower London E14 9SR Tel: free for people phoning from a fixed line (e.g. a landline at home). Or: free for mobile phone users who pay a monthly charge for calls to numbers starting 01 or [email protected]

13 Personal Injury Cover Policy Document 11 Section 11. Providers and Suppliers This policy is arranged and administered by EUI Limited (FCA Registration No ), Capital Tower, Greyfriars Road, Cardiff, CF10 3AZ and is underwritten by Admiral Insurance (Gibraltar) Limited, Suite 3G, Eurolife Building, 1 Corral Road, Gibraltar. EUI Limited is authorised and regulated by the Financial Conduct Authority. Admiral Insurance (Gibraltar) Limited is licensed and regulated by the Gibraltar Financial Services Commission under the Financial Services (Insurance Companies) Act 1987 of Gibraltar. Section 12. Financial Services Compensation Scheme EUI Limited and Admiral Insurance (Gibraltar) Limited are covered by the Financial Services Compensation Scheme (FSCS). You may be entitled to compensation from the scheme if we cannot meet our obligations. This depends on the type of business and the circumstances of the claim. Most insurance contracts are covered for 90% of the claims costs. You can get more information about the compensation scheme arrangements from the FSCS. The contact information is: The FSCS, 10th Floor, Beaufort House, 15 St Botolph Street, London EC3A 7QU. Tel: or [email protected]

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16 This booklet is made from recycled paper. EL