Policy Wording
Europea Limited
www.europea.co.uk
Member of the Primary Group
Personal Accident Insurance
659 1. In consideration of the payment of the required premium(s)
and subject to the terms, conditions and exclusions herein
defined, Underwriters agree with the Assured, to the extent
and in the manner herein provided, that if the Insured Person
sustains Bodily Injury as herein defined, Underwriters will pay
to the Assured, or to the Assured's Executors or
Administrators (if any) the amount of compensation applicable
and all as more fully defined in the Schedule of
Compensation attached hereto and which shall form an
integral part of this policy.
Europea Limited
www.europea.co.uk
Member of the Primary Group EPA2004
Definitions
2. DEFINITIONS: In this insurance,
2.1 "Accidental Death" shall mean the death of the Insured
Person from Bodily Injury.
2.2 "Permanent Total Disablement" and "Permanently Totally
Disabled" shall mean complete and total physical inability of
the Insured Person arising from Bodily Injury which entirely
prevents the Insured Person from attending to any business
or occupation of any and every kind and which either lasts for
twelve continuous months and at the end of such time there is
no hope of recovery, or is as and when Underwriters’
determine that the Insured Person is Permanently Totally
Disabled, whichever is the earlier occurrence.
2.3 "Loss of or loss of use of a limb(s)" means loss by
physical separation of a hand at or above the wrist or of a foot
at or above the ankle and includes total and irrecoverable
loss of use of hand, arm or leg. "Loss of or loss of use of an
eye or both eyes" means the total and irrecoverable loss of
sight of one or both eyes.
2.4 "Temporary Total Disablement" and "Temporarily Totally
Disabled" shall mean disablement of the Insured Person
arising from Bodily Injury which entirely prevents the Insured
Person from attending to his usual occupation as stated in the
Schedule. In the event of Bodily Injury during the period of
insurance then the Underwriters, after the excess period, as
specified in the Schedule, will pay to the Insured Person the
weekly benefit as specified in the Schedule.
2.5 "Accident" shall mean a sudden, unexpected, unusual,
specific event which occurs at an identifiable time and place.
2.6 "Bodily Injury" shall mean identifiable physical injury which
is caused by an Accident, which occurs during the period of
this insurance and which solely and independently of any
other cause, (except Illness directly resulting from, or medical
or surgical treatment rendered necessary by such Bodily
Injury), occasions the death or disablement of the Insured
Person within twelve months from the date of the Accident.
2.7 "Insured Person" shall mean the person upon whom the
defined risk is operative and whose name appears in the
Schedule herein.
2.8 "Assured" shall mean the third party effecting the
insurance on behalf of the Insured Person and as specified in
the Schedule if applicable. Where there is no Assured and
this insurance is issued direct to an Insured Person, all
references to "Assured" in this insurance shall be deemed to
be references to "Insured Person" and this insurance shall
operate accordingly.
2.9 "Excess" shall mean the number of days stated in the
schedule of compensation herein at the beginning of each
and every period of Temporary Total Disablement for which
no benefit is payable. If any Temporary Total Disablement
arising from the same Bodily Injury reoccurs within 180 days
of recovery then no Excess shall apply.
2.10 "Maximum Benefit Period" shall mean the maximum
number of weeks in respect of all Bodily Injury and Illness
causing Temporary Total Disablement for which benefit shall
be payable by Underwriters.
2.11 "Underwriters" shall mean the various insurers and/or
syndicates at Lloyd's of London participating in this contract.
2.12 "Pre-existing Condition" shall mean any incapacity
otherwise covered by this insurance and due wholly or partly
to any illness or injury or any related condition either which
existed or was foreseeable prior to the commencement of this
insurance or as disclosed in the Proposal Form.
Europea Limited
www.europea.co.uk
Member of the Primary Group EPA2004
Conditions
3. CONDITIONS: The following are general conditions and
are precedent to Underwriters' liability to pay compensation
under this insurance:
3.1 Notice must be given to Underwriters as soon as
reasonably practicable of any Accident which causes or may
cause disablement or Bodily Injury within the meaning of this
insurance, and the Insured Person must, as early as possible,
place himself under the care of a duly qualified independent
medical practitioner. Notice must be given to Underwriters as
soon as reasonably practicable in the event of death of the
Insured Person resulting or alleged to result from an Accident.
3.2 It is a condition precedent to Underwriters' liability to pay
compensation to the Assured or his representatives, that all
medical records, notes and correspondence referring to the
subject of a claim or a related Pre-existing Condition shall be
made available on request to any medical adviser appointed
by or on behalf of Underwriters and that such medical adviser
or advisers shall, for the purposes of reviewing the claim, be
allowed so often as may be deemed necessary to make
examination of the Insured Person.
3.3 Underwriters at their own expense shall have the right
and opportunity to examine the Insured Person whose Bodily
Injury is the basis of a claim when and as often as they may
reasonably require during the pendancy of a claim hereunder
and to make an autopsy in case of death, where it is not
forbidden by law.
3.4 Any claim made under this insurance in respect of
Permanent Total Disablement shall be subject to the approval
of two independent medical referees, one to be appointed by
the Insured Person and one by Underwriters. In the event of
the aforesaid independent medical referees being unable to
concur, in their opinion that the Insured Person is
Permanently Totally Disabled, a third independent medical
referee will be appointed by them and his decision shall be
final and binding upon all parties. Underwriters or the Insured
Person reserve the right at their own discretion to apply this
same procedure in respect of any Temporary Total
Disablement claim made hereunder.
3.5 Benefit(s) 1 to 4 of the Schedule of Compensation are
only insured where there is an amount inserted against them
in the Schedule of Compensation. Where benefit(s) are not
insured, the words "Not Insured" are inserted.
Notwithstanding the benefits insured in the Schedule of
Compensation the following limitations shall apply:
3.5.1 Compensation shall not be payable under more than
one of items 1 or 2 of the Schedule of Compensation.
3.5.2 Benefit 4 may be payable in addition to benefit 1
however payment of benefit will cease upon the death of the
Insured Person.
3.5.3a Benefit 4 may be payable in addition to, but not
concurrently with, benefit 2.
3.5.3b Benefit 4 may be payable in addition to benefits 3
3.5.4 Benefit 4 payable for a fractional part of a week will be
indemnified on the basis of one-seventh of the applicable
weekly benefit for each day of disablement for which
Underwriters are liable.
3.5.5 From the date at which the Insured Person is
determined to be Permanently Totally Disabled, benefit 4 will
cease with effect from that date.
3.5.6 The total sum payable under items 1 or 2 or 3 in respect
of one or more claims shall not exceed in all the largest
benefit under any one of the items 1 or 2 or 3 contained in the
Schedule of Compensation.
3.6 This insurance contract shall be governed by and shall be
construed in accordance with English law and shall be subject
to the jurisdiction of the Courts of England and Wales. Any
enquiry or complaint should be addressed in the first instance
to Europea Ltd. If you are not satisfied with the way a
complaint has been dealt with, you may ask the Complaints
and Advisory Department, Lloyd's, One Lime Street, London
EC3M 7HA to review your case without prejudice to your
rights in law.
3.7 This certificate of insurance, including any endorsement
and attachment and application, if any, constitutes the entire
contract. No change in this certificate of insurance shall be
valid until approved by Europea Ltd. and unless such
approval has been endorsed hereon or attached hereto. No
person has authority to change this certificate of insurance or
any of its terms or conditions, other than authorised
signatories of Europea Ltd.
3.8 Any fraud, concealment, or deliberate mis-statement
either in the application on which this insurance is based or in
relation to any other matter affecting this insurance or in
connection with the making of any claim hereunder shall
render this insurance null and void and all claims hereunder
shall be forfeited.
3.9 The Insured Person is deemed to have made a recovery
when he is able to perform his duties and related activities
associated with his usual occupation as specified in the
Schedule.
3.10 If the Insured Person shall engage in any occupation,
sport, pastime or activity in which greater risk may be incurred
than in the usual occupation stated in the Schedule without
first notifying Europea Ltd. and obtaining their written
agreement on behalf of Underwriters (and subject to the
payment of any additional premium as the Underwriters may
reasonably require as the consideration for such agreement),
then no claim shall be payable in respect of any Bodily Injury
arising out of or in the course of such occupation, sport,
pastime or activity.
3.11 Words in the masculine gender shall include the
feminine.
3.12 The Insured Person shall at all times take reasonable
precautions to prevent accidents, loss, destruction or
damage.
3.13. On the happening of any event likely to give rise to a
claim the Insured Person shall
(a) provide written notice to the Underwriters’ appointed
claims administrator as soon as reasonably practical and
provide all particulars and evidence documentary and
otherwise at the expense of the Insured Person and do all
such things as the Underwriters may reasonably require.
(b) when required the Insured Person shall submit to medical
examination on behalf of the Underwriters at the Insured
Person's expense in respect of any alleged Bodily Injury.
3.14 All certificates, information and evidence to support a
claim shall be provided at the expense of the Insured Person
and shall be in a form as required by the Underwriters and/or
their appointed claims administrator. The Insured Person
shall as often as required submit to medical examination at
the expense of the Underwriters. The Underwriters shall in
the event of the death of the Insured Person be entitled to
have a post-mortem examination at their own expense, where
it is not forbidden by law.
3.15.1 If at the time any claim arises there is any other
insurance covering the same loss, the Underwriters shall not
be liable to pay or contribute more than its rateable proportion
of any such claim and costs and expenses in connection
therewith.
3.15.2 This insurance may be cancelled by the Assured at any
time by written notice or surrender of the policy. 30 days
written notice must be given to Europea Ltd. Any premium
due for time on risk will be calculated either on a pro-rata or
short rate basis, as deemed appropriate by Europea Ltd.
3.16. If the circumstances in which this Insurance was
entered into shall be materially altered without the written
consent of the Underwriters being obtained thereto this cover
shall be voidable.
3.17. The due observance and fulfilment of the terms,
conditions and limitations of this cover insofar as they relate
to anything to be done or complied with by the Insured
Person and the truth of the statements and answers in the
said Application shall be conditions precedent to any liability
of the Underwriters to make any payment under this
insurance The Assured must inform Europea Ltd. as soon as
reasonably practicable of any change of risk relating to the
Insured Person including change of residence, usual
occupation (as stated in the Schedule attached hereto) or
immediately upon ceasing to be employed or upon retirement.
3.18. If any claim under this insurance shall be in any respect
fraudulent or if any fraudulent means or devices are used by
the Insured Person or anyone acting on his behalf to obtain
any benefit under this cover all benefit thereunder shall be
forfeited.
3.19. Notwithstanding the fact that insurance has only been
requested for one or a number of sections of the policy, the
policy wording must still be read as a whole.
3.20 Third Parties: The only parties to this contract are the
Assured and us. No other person, including the Insured
Person, has any right under the contracts (Rights of Third
Parties) Act 1999 to enforce this Policy or any part of it.
3.21. Sharing of Your Personal Information: Your details may
be shared with other similar organisations in the following
circumstances: -
1. For the purposes of obtaining quotations, indications of
terms, amendment of terms or advice of an insurance
nature, including policy renewals,
2. The sharing of information with other insurance
companies, underwriters, brokers or similar organisations
for the purpose of the detection of fraud or
misrepresentation of facts.
Europea Limited
www.europea.co.uk
Member of the Primary Group EPA2004
Exclusions
4. EXCLUSIONS: This insurance does not cover death or
disablement directly or indirectly arising out of or consequent
upon or contributed to by:
4.1
(i) war, invasion, act of foreign enemy, hostilities or warlike
operations (whether war be declared or not), civil war.
(ii) any act of terrorism including but not limited to the use of
force or violence and/or the threat thereof, of any person or
group(s) of persons, whether acting alone or on behalf of or in
connection with any organisation(s) or government(s),
committed for political, religious, ideological or similar
purposes including the intention to influence any government
and/or to put the public, or any section of the public in fear.
(iii) mutiny, riot, strike, military or popular rising, insurrection,
rebellion, revolution, military or usurped power.
(v) martial law or state of siege or any events or causes which
determine the proclamation or maintenance of martial law or
state of siege (hereinafter for the purposes of this Exclusion
called "the Occurrences").
Any consequence happening or arising during the existence
of abnormal conditions (whether physical or otherwise)
whether directly or indirectly proximately or remotely
occasioned by or contributed to by or traceable to or arising in
connection with any of the said Occurrences shall be deemed
to be consequences for which the Underwriters shall not be
liable except to the extent that the Insured Person shall prove
that such consequence happened independently of the
existence of such abnormal conditions. In any action suit or
other proceeding where the Underwriters allege that by
reason of this Exclusion any consequence is not covered the
burden of proving that such consequence is covered shall be
upon the Insured Person.
This exclusion shall not apply in the event of the Insured
Person sustaining Bodily Injury whilst an innocent bystander
(the "Innocent Bystander Exception"), provided always that
the Innocent Bystander Exception is subject to cancellation by
the Underwriters by giving 4 days notice by registered letter to
the Insured Person at his last known address but if the
Insured Person is in the course of a journey commenced prior
to the cancellation of the Innocent Bystander Exception then
the Innocent Bystander Exception shall remain effective for
the duration of such journey.
4.2 Radioactive contamination;
4.3 The Insured Person committing suicide or attempted
suicide or committing or attempting to commit an intentional
self injury;
4.4 The Insured Person being incapable due wholly or partly
to mental illness or emotional or behavioural conditions;
4.5 The Insured Person's deliberate exposure to exceptional
danger (except in an attempt to save human life), or the
Insured Person's own criminal act;
4.6 The Insured Person being under the influence of alcohol
exceeding those levels defined by law for the use of a motor
vehicle in the country in which the Insured Person is
domiciled;
4.7 The Insured Person being under the influence of drugs or
narcotics that are not lawfully available or which have not
been prescribed by or taken in accordance with the
instructions of an independent qualified medical practitioner;
4.8 The Insured Person's Temporary Total Disablement
arising from pregnancy, childbirth, miscarriage or abortion;
the Insured Person's Permanent Total Disablement arising
from pregnancy, childbirth, miscarriage or abortion unless
such Permanent Total Disablement is caused by a medical
complication;
4.9 The Insured Person engaging in or taking part in
(a) naval, military or air force service or operations;
(b) wintersports, other than recreational skating, curling, ski-
ing and snowboarding on-piste only, but excluding off-piste,
or heli-ski /snowboarding;
(c ) skin diving involving the aid of breathing apparatus, rock-
climbing or mountaineering normally involving the use of
ropes or guides, potholing, hang-gliding, parachuting, hunting
on horseback, or driving or riding in any kind of race.
(d) driving or riding on motor-cycles or motor-scooters over
100cc;
4.10 The Insured Person engaging in Air Travel except as a
passenger in a properly licensed multi engined aircraft being
operated by a licensed commercial air carrier or owned and
operated by a commercial concern;
4.11 Acquired Immune Deficiency Syndrome (AIDS) or AIDS
Related Complex (ARC) howsoever this Syndrome has been
acquired or maybe named;
4.12 The Insured Person committing or attempting to commit
a criminal act;
4.13 A Pre-existing Condition.
4.14 The death of the Insured Person arising from Illness;