Contractors' Accident & Sickness Insurance

Transcription

1 Contractors' Accident & Sickness Insurance Arranged by: Qdos Broker & Underwriting Services Limited Underwritten by: Maiden Life Försäkrings AB Scheme 10UK01

2 Contractors' Accident & Sickness Insurance Policy Wording This Policy has been arranged by Qdos Broker & Underwriting Services Limited on behalf of: Maiden Life Försäkrings AB. Registered Office: Maiden Life & General, Klarabergsviadukten 70, Box 70396, Stockholm, Sweden (registered number ). Qdos Broker & Underwriting Services Limited is authorised and regulated by the Financial Conduct Authority. This can be checked on the FCA register by visiting the FCA website at or by contacting them on Maiden Life Försäkrings AB is authorised and regulated by the Finansinspektionen of Sweden. This can be checked by visiting or contacting them on Maiden Life Försäkrings AB is authorised in the United Kingdom under the European Union Freedom of Services Regulations by the Financial Conduct Authority (Firm Reference Number ). You can check this by visiting or contacting them on Your Policy and Schedule combine to form this insurance contract. 1. Introduction This document sets out the cover Your policy provides. Please read this document alongside Your policy Schedule so that You know exactly what You are insured for, and keep it in a safe place so that You can refer to it easily if You need to. If You do not understand any part of the policy, please phone Qdos Broker & Underwriting Services Limited on Benefits The benefits payable under this policy are; Up to 12 Monthly payments, after a 30 day excess, due to Accident, Sickness or Injury. (subject to below terms and conditions) Accidental Death. A cash lump sum of 25,000 paid to the estate of the Insured Person in the event of their death as a result of an accident. Terminal Illness cover. In the event of a claim occurring due to a terminal illness, the Excess Period will be waived and You can start claiming from the date Your Doctor advises You are terminally ill. 3. Eligibility You may take out this policy if You are a Limited Company, Limited Liability Partnership or Public Limited Company with Your registered address within the United Kingdom. One policy can cover one named individual who is Employed by or a Director of Your company. The Insured Person is required to be; resident in the UK over 18 years old at the start of the policy, under 64 years old at the start of the policy, Employed by or a Director of the policy holders Company Working under a contract providing service only to businesses required to adhere to UK HSE standards. We are unable to provide cover under this policy if the Insured Person is

3 Working in an off shore installation, unless noted in Your policy Schedule. Participating in any kind of flying other than as a fare paying passenger; A member of any armed forces, whether full time or reserves; Working underground or underwater; Working with explosives. This applies throughout the lifetime of the policy. If the Insured Person s role changes and You have concerns that the above may apply, please contact a member of Qdos on Definitions Accidental Death Annual Review Date Bodily Injury Consultant Disabled / Disability Doctor Elective Surgical Procedure Employed; Employment Means a Bodily Injury occurring during the Period of Insurance which is the direct result of accidental, external, violent and visible means and which solely and independently of any other cause results in a claim for Your death. This does not include any sickness, disease, bacterial or viral infection (unless this is a direct result of an accidental injury), naturally occurring condition or degenerative process or the result of any gradually operating cause. Qdos will contact You every year at the anniversary of Your start date to discuss continuation of Your policy and any changes that may have occurred since taking it out. A physical injury which is caused by an accident (including illness directly arising from that physical injury), which results in the death or Disability of the Insured Person within 12 months of the date of the accident Means a medical specialist, other than the Insured Person, their Partner or any of their relatives, who is a member of a College and recognised by that College to be a Consultant. Means the Insured Person has a medical condition certified by a Doctor or Consultant as preventing them from doing their normal work or any similar work which they would otherwise be reasonably able to do given their experience, education or training and they are not doing any other work for payment or reward. A medical practitioner registered with the General Medical Council and working in the United Kingdom. This must not be the Insured Person, a relative or close friend of the Insured Person or an employee of the policy holder A procedure which is not medically necessary to maintain the quality of life of the Insured Person, and is carried out solely at the request of the Insured Person, including beauty and cosmetic treatments. Meaning that at the time of claim You are currently working under a contract for a defined period of time.

4 Excess Period The period of time after the accident when no benefit is payable for Disability, as shown in the policy schedule. Hazardous Pursuits a) Any Extreme, Action, Aggro, Freestyle and Adventure sports which have high level of inherent danger involving speed, height, high physical exertion or specialised gear. E.g.: Bungee jumping, Parkour, mountain biking; b) Any aerial sport including and not limited to Gliding, parascending, skydiving; c) Any competitive motor related sports either on land or water; d) Any underwater activity at depths greater than 10m or underwater activities which include ice, caves or wrecks; e) Any sport where the Insured Person receive payment for taking part, or any record attempt; f) Any activity in open seas; g) Any mountaineering or climbing activities including and not limited to canyoning, ice climbing, Ski-mountaineering; Insured Person Insurer Monthly or Annual Premium Normal Pregnancy The person named in the policy Schedule Maiden Life Försäkrings AB. The premium You pay to Us each month/year for the cover as specified in the policy Schedule. Common symptoms of pregnancy which do not pose any significant threat to the health of the mother or baby. This includes childbirth, delivery by Caesarean section or any other medically assisted delivery which may not be classified as a pregnancy complication. Claims will cease after the first 6 weeks of maternity Leave. Offshore Installations a) any installation in the sea or tidal waters which is intended for underwater exploitation of mineral resources or exploration with a view to such exploitation; b) any installation in the sea or tidal waters which is intended for the storage or recovery of gas; c) any pipe or system of pipes in the sea or tidal waters; or d) any installation which is intended to provide accommodation for persons who work on or from the locations specified in a), b) or c) above. Own Occupation Partner Means the occupation that the Insured Person carries out at the time they become Disabled. If their occupation has changed due to returning to Work after Maternity/Paternity Leave of longer than 39 weeks it will be based on the occupation taken up by them on their return to Work The Insured Person s Spouse, their civil Partner (as defined in Section 1 of the civil Partnership act 2004) or the person (whether or not same sex) with whom they are permanently cohabiting in a relationship equivalent to marriage (including same sex couple act 2013)

5 Period Of Insurance Policy Holder Pre-Existing Condition Schedule Start Date Terrorism Terminal Illness Termination Date We, Us, Our You, Your The period during which cover under this policy is in force. The Limited Company, Limited Liability Partnership or Public Limited Company which has taken out this contract of insurance A pre-existing condition means any sickness, condition or injury, whether diagnosed or not, that the Insured Person was aware of at the policy start date, or any sickness, condition or injury causing them to see or arrange to see a Doctor during the 12 months prior to the policy start date. A claim originating from a pre-existing condition within the duration of this policy, regardless of when the claim occurs, would not be paid. The document accompanying this policy which confirms the benefit period, policy Start Date, expiry date, Annual Review Date, Excess Period, and monthly benefit which You have applied for and for which we have accepted. The date on which cover first commenced noted on Your policy Schedule. Any act or acts including (but not limited to): a) the use or threat of force and/ or violence, and; b) harm or damage to life or property; caused or occasioned by any person(s), or group of persons, in whole or part for political, religious, ideological or similar purposes. An illness where the Insured Person has received a diagnosis, confirmed in writing, that their life expectancy is less than 18 months from the time of diagnosis. Means the earliest of the following to occur; a) The Insured Person dies; or b) The Insured Person retires from work or reach the age 65, whichever is the earlier; or c) The Insured Person stops residing in the United Kingdom d) You default on Your premium e) You cancel this policy f) The Insured Person ceases to be Employed by the Policy Holder or ceases to be a Director of the Policy Holder g) We cancel the contract h) We have paid 12 monthly payments in respect of the Insured Person. The Insurer Maiden Life Försäkrings AB. The policyholder named in the policy schedule.

6 Disability If the Insured Person becomes Disabled during the period of insurance for 30 consecutive days, we will pay You the amount shown in the policy schedule for every subsequent complete 30 days that the Insured Person remains Disabled. We will continue to make payments after every complete 30 day period until the earliest of the following: a) We have paid 12 payments under a single continuous claim; b) The Insured Person fails to provide proof of their Disability; c) The Insured Person dies; d) The Insured Person reaches age 65 years of age or permanently retires; or e) The Insured Person leaves Your Employment. When paying a claim, we will consider the first day of Disability as the day that the Doctor is visited and confirms that the Insured Person is not able to work, no benefit will be paid for the period prior to visiting the Doctor. We will only pay the Disability benefit if the Insured Person remains under care of a Doctor for the duration of the claim. If the Insured person is not Disabled for a complete 30 days, we will pay You 1 / 30 th of the amount shown in the policy schedule for every complete day the Insured Person was Disabled. For the avoidance of doubt this does not include the Excess Period nor any day for which a benefit has already been paid. Exclusions We will not make a payment under any section if the cause of the death or Disability is as a result of: a) a Pre-Existing Condition; b) any matter, other than in respect of Bodily Injury, where the Insured Person has first seen or arranged to see a Doctor within 30 days following the Start Date. Please note that this exclusion will not apply if the Insured Person is able to provide medical evidence from a specialist Consultant which confirms that the symptoms that have given rise to the death or Disability were not evident prior to the Start Date. c) Normal Pregnancy; d) psychiatric illness or mental disorders, including stress and stress-related conditions, unless certified by and under the care of an appropriate specialist; e) any Elective Surgical Procedure; f) backache or related conditions, unless there is supporting medical evidence. This evidence may be a report from a specialist Consultant. In either case, an MRI, CT scan or equivalent will be needed. g) the Insured Person committing or attempting suicide, whether sane or insane, or intentionally inflicting Bodily Injury on themselves; h) the Insured Person committing a criminal act; i) alcohol or drugs which are not taken under the advice or supervision of a Doctor (this does not include drugs prescribed by a Doctor for treating drug addiction); j) the Insured Person serving on active duty as a member of the armed forces of any country (this includes as a reservist or member of the UK Territorial Army); k) participation in a Hazardous Pursuit as described in the definitions; l) whilst visiting or working on Offshore Installations unless appropriate premium has been paid;

7 m) whilst visiting or working on any Offshore Installations which does not meet UK Health & Safety Executive (HSE) standards; n) whilst in transit by air or sea to work or visit on Offshore Installations; (regardless of the level of cover taken out) o) whilst working outside the United Kingdom, European Economic Area, United States of America, Canada, Australia or New Zealand; p) the claim occurring in a country which the UK foreign and commonwealth office advises against all travel or all but essential travel. q) war (whether declared or not), invasion, an act of an enemy foreign to the nationality of the Insured Person or the country in which the act occurs, civil war, riot, rebellion, insurrection, revolution, overthrow of the legally constituted government, terrorism of any type r) Kidnap, whether a ransom is demanded or not. Annual Policy Review After You have had Your policy for a period of one year, on the anniversary date we will send You a renewal Schedule, which details Your insurance. At this time we will also offer You the opportunity to review and adjust Your sum insured according to any changes in circumstances without having to take out a new policy. Payment of premiums Premiums are payable, annually or monthly in advance by You. Please refer to Your schedule which defines Your premium terms. If Your Premium remains unpaid for 30 days after the due date Your cover under this Policy will cease. If You are in receipt of Monthly Benefit You must continue to pay Your Monthly Premium as it falls due in order to ensure continuous cover under this Policy. Your Responsibilities You must comply with the following conditions in order for Your claim to be met: In the event of Disability, You must ensure; a) The Insured Person visits a Doctor as soon as reasonably possible and that the Insured Person complies with all recommendations of that Doctor. b) If the claim is back or psychiatric related that You obtain the relevant referrals from Your GP in order to speed up Your claim process. c) You or the Insured Person must make available to the Insurer or Qdos, if requested, whatever medical or other information is required. d) We or Qdos may require the Insured Person to attend an independent medical examination. If so, the costs and expenses of this examination will be paid by Us. e) If You make a claim that is in any way fraudulent, whether the fraud is carried out by You or the Insured Person, Your cover under this policy will be treated as invalid for the entire period of insurance. We will not refund any premium You have paid and may take legal action against You or the Insured Person. f) If we pay a benefit, You or the Insured Person must allow Us to enforce their rights against any other parties which they are or may be entitled to. Payment of Claims

8 In the event of a claim, please call a member of Our claims team on In all claims Your claims handler will only ask for evidence that is absolutely necessary in order for Us to consider Your claim. A claims form will be sent out to You for completion and we will advise You at this point if any further information is needed based on what You have told Us. All Disability claims will require a Doctor s certificate detailing the reason for the insured being incapable of working. All sickness claims will require evidence from the Insured Person s Doctor. We recommend that they take the claim form we provide them with them at their first Doctor s appointment. This will make it quicker for Us to settle Your claim. Any Accidental Death claims will require sight of the Insured Persons Death Certificate confirming the accidental nature of the death. This may include a coroner s report. Death must occur within 365 days of the accident to be able to claim. All claims (other than Accidental Death) are paid to the Policy Holder not the Insured Person. Claims will cease to be paid after the first six weeks of Maternity leave until the Insured Person returns to work. Should the Doctor decide that the Insured Person is able to return to Work but in a reduced capacity or in a different role, We will pay the difference between the benefit value and their new monthly income. We will pay any shortfall, monthly in arrears, for each full month of the remaining term as long as their claim continues to be valid. We will continue to pay the claim until the Termination date or a) The last consecutive day of the Insured Person s Disability or b) The date the Insured Person stops providing proof that they remain continuously Disabled or c) The date we have paid You a sum equivalent to the maximum benefit payments allowed in the benefit period shown in Your schedule. Should the Insured Person s Doctor confirm that they are able to go back to their original Working hours and they choose to remain on reduced hours, payments will cease to be made. If You become insolvent, enter administration or cease trading Your Policy will terminate and You will not be able to make a claim relating to any Insured Person s Disability or Accidental Death which occurs after the date of that the company ceases to trade. Claim requalification period An Excess Period will not be applied by Us in respect of a Disability claim which occurs within 3 months of a prior claim period. In this case the claim will be treated as one claim period. Cancellation You can cancel this contract at any time by giving notice by calling Qdos on or ing freelancer@qdoscontractor.com. If You cancel Your policy within 14 days of the start date we will refund all of any premiums You have paid, provided You have not made a claim under this policy. If You cancel Your cover under this policy more than 14 days after the policy start date only a pro-rata premium will be paid to those that have paid annually in advance.

9 We have the right to cancel Your contract at the renewal date of Your policy provided that we have given You 60 days notice. Policy Amendments We may need to amend the terms and conditions of this contract from time to time. This will only occur at the renewal date of Your policy. We will provide You with 30 days notice of any changes in cover. These changes can affect the premium we charge. We can only guarantee Your premium for the annual term of Your policy. Your policy currently includes an insurance premium tax of 10%. Should this tax be increased or decreased by the government we will inform You of this and Your premiums will change accordingly at the renewal date of the policy. Changes in terms and conditions will only be applied when You renew Your policy unless the changes are favourable to You or if the insurance regulators advise Us to change wordings for legal reasons. 90 days notice will be provided in advance of these changes. Complaints Customer service is very important to Us and Our aim is to give a first-class service at all times. If You have any enquiry or complaint about Your policy or claim, please write to: The Nominated Complaints Handler Qdos Broker & Underwriting Services Limited Windsor House, Troon Way Business Centre Humberstone Lane, Thurmaston, Leicestershire LE4 9HA If You are still unhappy with any issue connected with the handling of Your insurance policy, please write to: The Managing Director Maiden Life c/o Maiden Global Holdings Albion House, Valley Business Centre, Gordon Road, High Wycombe, Buckinghamshire, HP13 6EQ Customer.relations@maideniis.com If You are still unhappy or the problem has not been resolve to Your satisfaction, You may refer it to: The Financial Ombudsman Service Exchange Tower Harbour Exchange Square London E14 9GE Tel: complaint.info@financial-ombudsman.org.uk

10 If You complain, it will not affect Your legal rights. Choice of law English law will apply to the terms of this policy unless agreed otherwise. Data Protection The information that You give about You or the Insured Person, including sensitive information, will be Used by Us and Our associated companies and agents to process this insurance and handle claims. This may involve transferring the information to other countries. Steps have been taken to make sure the information is held securely. We may be asked to give Your information to the insurance regulator and public organisations (including the police) to help prevent fraud. Compensation Scheme Maiden Life Försäkrings AB is covered by the Financial Services Compensation Scheme. You may be entitled to compensation from the scheme in the unlikely event that Maiden Life Försäkrings AB cannot meet their financial responsibilities. The FSCS will meet 90% of the claim, without any upper limit. You can obtain further information about compensation scheme arrangements from the FSCS at or by phoning