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.co.uk does not make personal recommendations as to the suitability of the policy to individual circumstances.

3 Personal Injury Cover Policy Summary 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. Name of The Insurance Undertaking 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 Significant benefits The following benefits are paid as a result of You suffering Bodily Injury following a motoring Accident 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 private car within the UK. Significant Features and Benefits: This policy provides cover for Insured Persons The significant benefits of Your policy are shown on the table 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. Policy reference (the relevant policy section is shown in brackets) Definition of Bodily Injury, Accident and Effective Time (Section 1. Meaning of Words) and the Benefits table (Section 3. Benefits) Death Permanent Total Disablement Definition of Permanent Total Disablement (Section 1. Meaning of Words) Loss of Limbs Definition of Loss of Limbs (Section 1. Meaning of Words) Loss of Hands or Feet Definition of Loss and of Hand and Foot (Section 1. Meaning of Words) Loss of Sight Definition of Loss of Sight (Section 1. Meaning of Words) Loss of Speech or Hearing Definition of Loss of Hearing and Loss of Speech (Section 1. Meaning of Words) Loss of defined Internal Organs Definition of Loss and of Internal Organs - category one and Internal Organs - category two (Section 1. Meaning of Words) Loss of Thumbs, Fingers or Toes Definition of Loss of Thumb, Finger and Toe (Section 1. Meaning of Words) 3rd degree Burns Fractured bones Hospital Cash Definition of Burns (Section 1. Meaning of Words) Definition of Fracture (Section 1. Meaning of Words) Definition of Hospital and of Hospital Cash daily benefit (Section 1. Meaning of Words) Page 1

4 Other Significant and Unusual Exclusions or Limitations (the relevant policy section is shown in brackets): You must be living permanently in the UK for at least 40 weeks in any one year and throughout the Period of Insurance; or up to a minimum of 26 weeks if extended European cover is purchased with Your Associated Motor Policy (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) Cover is not provided to any person over 80 (Section 5 Exclusions) 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 benefit, no benefit will be paid for the first 24 hour period You are in Hospital. For any further period in Hospital, payment will only be made once You are discharged and We have received a completed claim form and hospital discharge form. (Section 3 Benefits) 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 gainful employment of any and every kind for the remainder of their life. (Section 1 Meaning of Words) Duration The period of Your Associated Motor Policy which runs concurrent with this policy and does not exceed 12 months. Cancellation You may cancel this product and receive a full refund, subject to You not making a claim, if You inform us within 14 days from receipt of the confirmation letter or . Should You cancel outside the 14 day cancellation period, additional charges, including a 5 cancellation fee will apply for the time on cover. Please contact EUI Limited (trading as elephant.co.uk) 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. Claim Notification 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. Page 2

5 Personal Injury Cover Policy Document How to Complain Complaints should be made to: The Quality Manager, EUI Limited, Capital Tower, Cardiff, CF10 3AZ. Tel: Fax: (calls to 0871 numbers are charged at 8p per minute plus network extras) In the event that You remain dissatisfied You can complain to: The Financial Ombudsman Service (FOS). Their details are as follows: The Financial Ombudsman Service South Quay Plaza 183 Marsh Wall 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 complaint.info@financialombudsman.org.uk Financial Services Compensation Scheme We are members of the Financial Services Compensation Scheme (FSCS). If We were unable to meet Our obligations You may be entitled to compensation from the scheme, depending on the type of insurance and circumstances of any claim. Cover for the claim or policy is provided at 90%. You can get more information about the compensation scheme arrangements from the FSCS. The contact information is: The FSCS, 7th Floor, Lloyds Chambers, Portsoken Street, London, E1 8BN. Tel: enquiries@fscs.org.uk Page 3

6 Policy Document Page 4 Thank you for taking out Our Personal Injury cover. We are confident Our friendly, fast and efficient service will ensure You remain a satisfied customer now and for years to come. This leaflet explains the cover You have bought, but if You have any queries call elephant.co.uk Customer Services on and We ll be happy to help. (Calls to 0871 numbers are charged at 8p per minute plus network extras.) 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. This policy is arranged and administered by EUI Limited (FSA 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 are authorised and regulated by the Financial Services 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. 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.

7 Personal Injury Cover Policy Document 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. EUI Limited elephant.co.uk 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 We will pay the sum shown in the Benefits table (Section 3. Benefits) for each 24 hour stay in Hospital up to a maximum of 45 days after a 24 hour qualifying period. Insured Person You and any other persons named in the schedule of 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 (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 (excluding hands and feet) Hand(s) All the fingers and the thumb of a hand Thumb(s) The entire thumb or thumbs Insured Vehicle The vehicle defined in Your Associated Motor Policy. Finger(s) The entire finger (excluding thumbs) Page 5

8 Foot (Feet) All the toes of a foot Toe(s) The entire toe Internal Organs - category one Lung, Kidney(s), Liver, Large Intestine, Small Intestine, Stomach and Bladder Internal Organs - category two Spleen, Gallbladder and Pancreas Period of Insurance Means the period of Your Associated Motor Policy which runs concurrent with this policy and does not exceed 12 months. Permanent Total Disablement Means physical disablement caused other than by Loss 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 gainful 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 described in the schedule of Your Associated Motor Policy as the Start Date. 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.co.uk and/ or the underwriters. You, Your, Policyholder The person who has taken out the Associated Motor Policy and who is named in the schedule. Section 2. Eligibility 1. You are eligible for this insurance cover if: a. You are aged 17 or over and under 80 at the Start Date; and b. You are living permanently in the UK for at least 40 weeks in any one year and throughout the Period of Insurance; or up to a minimum of 26 weeks if extended European cover is purchased with Your Associated Motor Policy; and c. You have an Associated Motor Policy; and d. You have agreed to pay the Premium (including insurance premium tax) 2. Other individuals named in the schedule of Your Associated Motor Policy will be eligible for cover if they are: a. aged 17 or over and under 80 at the Start Date; and b. living permanently in the UK for at least 40 weeks in any one year and Page 6

9 Personal Injury Cover Policy Document throughout the Period of Insurance; or up to a minimum of 26 weeks if extended European cover is purchased with Your Associated Motor Policy Section 3. Benefits The Benefits table below should be read in conjunction with Section 1 Meaning of Words. You 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 Personal Injury Plus Item 1 Death 40,000 80,000 Item 2 Item 3 Permanent Total Disablement A, Loss of Sight in both eyes 50, ,000 50, ,000 B, Loss of Sight in one eye 15,000 30,000 Item 4 A, Loss of Hearing in both ears B, Loss of Hearing in one ear 25,000 50,000 10,000 20,000 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 both Feet 25,000 50,000 B, One Hand or one Foot 12,500 25,000 Item 8 A, Both Thumbs 7,000 15,000 B, One Thumb 3,500 7,000 Item 9 A, More than one Finger 5,000 10,000 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 Item 11 A, More than one Toe (excluding big Toes) B, One other Toe (excluding big Toes) 1,000 2, ,000 Item 12 A, Internal Organs category one B, Internal Organs category two 10,000 20,000 2,500 5,000 Page 7

10 Description Benefit Payable ( ) Personal Injury Personal Injury Plus Item 13 Burns 5,000 10,000 Item 14 Fractures to: A, the Pelvis, Arm, Leg, Skull, Vertebrae, Jaw, Knee, Hand or Facial Bones excl. Nose B, the Foot, Shoulder blade, Elbow, Sternum, Wrist, Ankle, Collar Bone or Coccyx 1,000 2, ,000 C, any other body part Item 15 Hospital Cash daily benefit Maximum Policy Benefit 50, ,000 Page 8 In relation to the Benefits table above: 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. 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 for the first 24 hour period You are in Hospital. For any further period in Hospital, payment will only be made once You are discharged and We have received a completed claim form and hospital discharge form. 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 pre-existing condition. Section 4. Maximum Policy Benefit 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 cover has been selected. 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

11 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. the Insured Person being under the influence of, or being affected by alcohol or drugs, other than drugs taken under the direction of a qualified medical practitioner 2. Suffered after age 80 years. 3. Use of vehicles other than private motor vehicles or light vans as detailed in Your Associated Motor Policy. 4. For any injury not specifically listed in the Benefits table (Section 3. Benefits) 5. Where You are already claiming under another Personal Injury or Personal Injury Plus policy with Us arising from the same motoring Accident (this does not include the claims paid under the Person Injury section of the Extra Cover section of Your Associated Motor Policy). Section 6. When does the cover end? 1. This cover ends automatically as soon as one of the following happens: a. You reach the age of 81 years b. You do not pay a Premium when due c. The day and time Your Associated Motor Policy ends d. the date on which the maximum benefit has been paid in accordance with Section 4 e. You die f. 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: a. when they reach 81 years old b. 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 misrepresent material facts about any Insured Persons Section 7. Cancellation Rights a. Your Cancellation Rights You may cancel this product and receive a full refund, subject to You not making a claim, if You inform us within 14 days from receipt of the confirmation letter or . Should You cancel outside the 14 day cancellation period, additional charges, including a 5 cancellation fee will apply for the time on cover. Please contact EUI Limited (trading as elephant.co.uk) 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.) Page 9

12 Page 10 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. Your cover may be cancelled by Us by giving you 7 days notice in writing. This will be done if your Associated Motor Policy is cancelled. 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 aim 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: quality@elephant.co.uk Fax: (calls to 0871 numbers are charged at 8p per minute plus network extras) 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 South Quay Plaza 183 Marsh Wall 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 complaint.info@financialombudsman.org.uk Section 11. Providers and Suppliers This policy is arranged and administered by EUI Limited (FSA 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 are authorised and regulated by the Financial Services Authority. Admiral

13 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 should EUI Limited be unable to meet their 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, 7th Floor, Lloyds Chambers, Portsoken Street, London, E1 8BN. Tel: or Page 11

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16 This booklet is made from recycled paper. ELAN