GROUP PERSONAL ACCIDENT POLICY WHEREAS the Insured described in the Schedule hereto following the profession or occupation stated in the Schedule being desirous of insuring the Persons described in the Schedule (hereinafter called the "Lives Insured") in the manner hereinafter mentioned with the Company described in the Schedule has made a proposal and signed a declaration dated as stated in the Schedule which proposal and declaration together with any other statements in writing relating to this insurance it is agreed shall be the basis of the contract for the insurance hereby intended to be made and incorporated herein and has paid to the Company the premium stated in the Schedule as a consideration for the Insurance for the period stated therein. NOW THIS POLICY OF INSURANCE WITNESSES that if during the Period of Insurance any of the Lives Insured shall suffer Death or Loss or Disablement which is solely and directly occasioned by accidental bodily injury, the Company will subject to the terms provisos exclusions and conditions of and endorsed on this Poli (which terms provisos exclusions and conditions shall so far as the nature of them respectively will permit be deemed conditions precedent to the right to recover under this Policy) pay to the Insured the sum or sums of money specified in the Table of Benefits allocated to the said Life Insured in the Schedule and the receipt of the Insured shall in all respects be an effective discharge to the Company. DUTY OF DISCLOSURE Where the lif e Insured has applied for this Insurance wholly for purposes unrelated to Life lnsured's trade, business or profession, Life Insured had a duty to take reasonable care not to make a misrepresentation in answering the questions in the Proposal Form (or when Life Insured applied for this insurance). Life Insured should have answered the questions fully and accurately. Failure to have taken reasonable care in answering the questions may result in avoidance of Life lnsured's contract insurance, refusal or reduction of claim(s), change of terms and termination of contract of insurance in accordance with remedies in Schedule 9 of the Financial Services Act 2013. Life Insured was also required to disclose any other matter that Life Insured knew to be relevant to The Company's decision in accepting the risks and determining the rates and terms to be applied. Life Insured also have a duty to tell The Company immediately if at any time after Lif e insured's contract of insurance has been entered into, varied or renewed with The Company any of the information given in the Proposal Form ( or when Life Insured applied for this insurance ) is inaccurate or has changed. TABLE OF BENEFITS Death or Loss or Disablement solely and directly occasioned by accidental bodily injury which injury shall solely and independently of any other cause result in: Benefit A Benefit B DEATH occurring within twelve calendar months of bodily injury as aforesaid. PERMANENT DISABLEMENT occurring within twelve calendar months of bodily inju as aforesaid. The percentages are as stated under Benefit B Coverage. Benefit C. 1 TEMPORARY TOTAL DISABLEMENT temporarily from engaging i n or giving attention to the Life lnsured's profession or occupation. Compensation for such disablement at the rate or necessitate Benefit C. 2 TEMPORARY PARTIAL DISABLEMENT temporarily from engaging in or giving attention to the Life lnsured's profession or occupation. Compensation for such disablement at the rate of or necessitate. Benefit D Benefit E MEDICAL AND SURGICAL TREATMENT for such injury subject to a limit in respect of any one accident. HOSPITAL INCOME OTHER BENEFITS 1. BURIAL OR CREMATION ALLOWANCE OF RM2000/- shall be payable to the lnsured's next-of-kin or legal personal representative in the event of Benefit A is payable. As specified in the Schedule 2. IN THE EVENT OF DEATH REPATRIATION EXPENSES of up to RMS000/- shall be payable to reimburse the actual necessa and reasonable expenses incurred for the transportation of the mortal remains from the place where such death occur to the 1 (Grp-PA/PW 0918
Transcript
GROUP PERSONAL ACCIDENT POLICY
WHEREAS the Insured described in the Schedule hereto following the profession or occupation stated in the Schedule being desirous
of insuring the Persons described in the Schedule (hereinafter called the "Lives Insured") in the manner hereinafter mentioned with
the Company described in the Schedule has made a proposal and signed a declaration dated as stated in the Schedule which proposal
and declaration together with any other statements in writing relating to this insurance it is agreed shall be the basis of the contract
for the insurance hereby intended to be made and incorporated herein and has paid to the Company the premium stated in the
Schedule as a consideration for the Insurance for the period stated therein.
NOW THIS POLICY OF INSURANCE WITNESSES that if during the Period of Insurance any of the Lives Insured shall suffer Death or
Loss or Disablement which is solely and directly occasioned by accidental bodily injury, the Company will subject to the terms
provisos exclusions and conditions of and endorsed on this Policy (which terms provisos exclusions and conditions shall so far as the
nature of them respectively will permit be deemed conditions precedent to the right to recover under this Policy) pay to the Insured
the sum or sums of money specified in the Table of Benefits allocated to the said Life Insured in the Schedule and the receipt of the
Insured shall in all respects be an effective discharge to the Company.
DUTY OF DISCLOSURE
Where the life Insured has applied for this Insurance wholly for purposes unrelated to Life lnsured's trade, business or profession, Life
Insured had a duty to take reasonable care not to make a misrepresentation in answering the questions in the Proposal Form (or
when Life Insured applied for this insurance). Life Insured should have answered the questions fully and accurately. Failure to have
taken reasonable care in answering the questions may result in avoidance of Life lnsured's contract insurance, refusal or reduction of
claim(s), change of terms and termination of contract of insurance in accordance with remedies in Schedule 9 of the Financial
Services Act 2013. Life Insured was also required to disclose any other matter that Life Insured knew to be relevant to The Company's
decision in accepting the risks and determining the rates and terms to be applied.
Life Insured also have a duty to tell The Company immediately if at any time after Life insured's contract of insurance has been
entered into, varied or renewed with The Company any of the information given in the Proposal Form ( or when Life Insured applied
for this insurance ) is inaccurate or has changed.
TABLE OF BENEFITS
Death or Loss or Disablement solely and directly occasioned by accidental bodily injury which injury shall solely and independently
of any other cause result in:
Benefit A
Benefit B
DEATH occurring within twelve calendar months of bodily injury as aforesaid.
PERMANENT DISABLEMENT occurring within twelve calendar months of bodily injury as aforesaid.
The percentages are as stated under Benefit B Coverage.
Benefit C. 1 TEMPORARY TOTAL DISABLEMENT temporarily from engaging in or giving attention to the Life
lnsured's profession or occupation. Compensation for such disablement at the rate or necessitate
Benefit C. 2 TEMPORARY PARTIAL DISABLEMENT temporarily from engaging in or giving attention to the Life
lnsured's profession or occupation. Compensation for such disablement at the rate of or necessitate.
Benefit D
Benefit E
MEDICAL AND SURGICAL TREATMENT for such injury subject to a limit in respect of any one accident.
HOSPITAL INCOME
OTHER BENEFITS
1. BURIAL OR CREMATION ALLOWANCE OF RM2000/- shall be payable to the lnsured's next-of-kin or legal personal
representative in the event of Benefit A is payable.
As
specified
in the
Schedule
2. IN THE EVENT OF DEATH REPATRIATION EXPENSES of up to RMS000/- shall be payable to reimburse the actual necessary
and reasonable expenses incurred for the transportation of the mortal remains from the place where such death occur to the
1
(Grp-PA/PW 0918
first point of entry into country of residence.
3. HOSPITALISATION ALLOWANCE OF RMS00/-per accident shall be payable to the Insured for hospital confinement exceeding
14 days provided Benefit C is payable.
4. AUTOMATIC INCREASE OF RMS00/-IN MEDICAL EXPENSES in the event of the Life Insured being confined as an in-patient in a
hospital provided Benefit D is payable.
In the event that Life Insured is covered under more than one Personal Accident policy Issued by the Company it is hereby declared
that the subsequent policy/policies will not be entitled to the additional Benefits as mentioned above.
Payment of Benefit A shall not preclude payment under this Memo.
PROVISOS
1. Compensation in respect of the above shall be payable only when the claim have been proved to the satisfaction of the
Company
2. Compensation under Benefits (C.1) and (C.2) is payable only if such bodily injury shall, within twenty days from the date of
accident, wholly or partly and continuously disable and prevent the Life Insured from performing his occupation. For the
purpose of this Policy, Temporary Total Disablement shall mean that the Life Insured is rendered completely incapable of
attending to any part of his ordinary profession, business or occupation and T emporary Partial Disablement shall mean
that the Life Insured is capable of attending to some portion of his profession, business or occupation.
3. The period of compensation payable under Benefits (C.1) and {C.2) either separately or together shall not exceed 104
weeks in respect of any one injury calculated from the date the Life Insured was first examined by a duly qualified Medical
Practitioner. Provided the Policy is enforced and not lapsed.
4. Compensation under Benefit (D) shall be payable only if such medical or surgical treatment is received by the Life Insured
by a qualified Medical Practitioner and must be supported by original bills/receipts subject to the limit stated whilst the policy is in force.
5. Benefits E shall only be payable for the period of hospitalization not exceeding 52 weeks and as a result of accidental
bodily injury requiring hospitalization in a registered hospital or government hospital provided that such hospitalization must
occur within 14 days of the accident. Successive periods of hospital confinement, due to the same cause, shall be considered as one
accident.
6. Where Benefit A or 100% of Benefit B becomes payable Benefits Cl or C2 or E shall cease to be paid for the same bodily injury.
7. Benefits A or B cannot be paid in aggregate under this policy.
8. Where losses smaller than 100% in respect of Benefits B becomes payable, the coverage under Benefits A and B shall be
reduced by that amount from the date of accident until the expiration of the policy.
9. Unless otherwise agreed and endorsed hereon Compensation payable in respect of Death or Disablement Occurring whilst
a number of Lives Insured are to the lnsured's knowledge travelling in the same conveyance shall be limited to a maximum
of RM3,000,000. In the event the aggregate exceeds the said amount, the Company shall settle the claims of the respective
Lives Insured on a proportionate basis.
BENEFIT B COVERAGE
PERMANENT DISABLEMENT
Description of Disablement Loss of two limbs
Loss of both hands, or of all fingers and both thumbs
Total loss of sight of both eyes
Total paralysis
Injuries resulting in being permanently bedridden
Any other injury causing permanent total disablement from gainful employment of any and every kind
Loss of arm at shoulder
Loss of arm between shoulder and elbow ...
Loss of arm at elbow
2
Percentage of the Sum Insured of Benefit B
100%
MURDER, ASSAULT OR KIDNAPPIN:G
Tihis Policy is extended to cover death or disablement proximately caused as a result of murder or any attempt thereon or kidnapping
to the Life Insured i[l Schedule, excluding death or bodily injury sustained where the Life Insured was committing or intended to
commit act therein.
NATURAL DISASTERS
This policy is extended to cover death or disablement caiused by earthquake, windstorm, flood, volcanic eruption, lightning, hurricane,
cyclone, typhoon and tidal wave.
AMATEUR SPORTS
This policy is extended to cover death or disablement arising whilst the Life Insured is engaged in indoor or outdoor sports as an
amateur except as those stated in the policy exclusions.
HIJACKING
This policy is extended to cover death or disablement arising from hijacking whether on land transit as a ticket holding passenger or
whilst travelling in an aircraft as a ticket holding passenger over establish air routes in a fully licensed standard type aircraft owned
and/or operated by a regonized air!line provided always that this extension does not apply if the event results from exclusion of this
policy.
INTOXICATION
This policy is extended to cover death or bodily injjury as a resu!lt of intoxicating by liquor except drunken driver as provided under the
law and/ or by drugs which must be prescribed by qualified registered medical practitioner.
DROWNING, GAS INHALATION, SUFFOCATION! BY SMOKE OR POISONOUS FUMES
This policy is extended to cover the Life Insured against death or disablement arising out of or res,ulting from accidental drowning, gas
inhalation, suffocation by smoke or poisonous fumes ..
NOTICE TO ALL POLICYHOLDERS/ .NOTIS KEPADA SEMUA PEMEGANG POLISI
If you have any complaints relating to this insurance policy, please contact our local branch manager or our complaints unit officer at:
Jika anda mempunya/ aduon silo berhubung dengan poflsf /nsurans ini, silo hubungi pengurus wwangan kami atau pengawol
unlt aduan di:
Or/ Atau
The following bodies who are authorised to oversee public enquiries and complaints on insurance related matters:
Pihak-pihak �ang diberi kuasa untuk mengendalikan soalon-soalan umum dan pengaduan mengenoi perkara-perkara
CUSTOMER SERVICE CENTRE (62605-U)BERJAYA SOMPO INSURANCE BERHAD Level 36, Menara Bangkok Bank105, Jalan Ampang50450 Kuala Lumpur.Tel.:03-21707300 Fax::03-21704800Email: [email protected]
