AIG Insurance New Zealand Limited

Transcription

1 AIG Insurance New Zealand Limited NZRU Personal Accident Voluntary Medical Expenses & Income Protection Policy Wording

2 NZRU Personal Accident Voluntary Medical Expenses & Income Protection Policy Wording AUCKLAND The AIG Building, Level Shortland Street P O Box 1745 Auckland 1140 Freephone: Telephone: (09) Facsimile: (09) WELLINGTON Level 3, City Chambers 142 Featherston Street P O Box Wellington 6011 Telephone: (04) Facsimile: (04) This Policy is underwritten by AIG Insurance New Zealand Limited ( AIG ). This document contains Your Insurance Policy terms, Provisos, Exclusions and Conditions. It is important that You read and understand it and retain it in a safe place. Page 2 of 13

3 Policy Schedule Policy Number AG1887 Insured New Zealand Rugby Union Inc Insured Person/s Category Description 1. All registered rugby players, coaches, managers, team support (including but not limited to medical staff), administrators and referees who have selected Individual Standard Cover. 2. All registered rugby players, coaches, managers, team support (including but not limited to medical staff), administrators and referees who have selected Individual Premier Cover. 3. All registered rugby teams, including players, coaches, managers, team support (including but not limited to medical staff), administrators and referees, who have selected Team Standard Cover. 4. All registered rugby teams, including players, coaches, managers, team support (including but not limited to medical staff), administrators and referees, who have selected Team Premier Cover. Broker JLT Address for Notices C/- P O Box 11145, Wellington Policy Period From 4pm on the 30 December 2012 To 4pm on the 30 December 2013 Scope of Cover Category Scope of Cover Whilst playing in official club matches including championship or representative matches; Whilst engaged in official club activities; (c) Whilst engaged in organised training or practice for the activities as described in or above (including pre-season training); (d) Whilst undertaking uninterrupted travel directly between the activities in, or (c) above and the Insured Persons residence or place of employment; Page 3 of 13

4 (e) Whilst performing official speaking or presentation engagements for the New Zealand Rugby Union. Age Limitation Minimum age 5 years Maximum age 64 years Aggregate Limit of Liability $1,000,000 (Special Provisions - Number 5) Page 4 of 13

5 Schedule of Compensation Section 1. Medical Expenses Category The Compensation Applicable for Each Insured Person per Policy Period 1. $5, $5, $5, $5,000 Section 2. Temporary Total Disablement Category The Compensation Applicable for Each Insured Person per Policy Period 1. $ $ $ $800 In Witness Whereof, this Policy has been countersigned on Our behalf at Auckland on 01 December 2012 Group Manager Page 5 of 13

6 Contents The Policy Wording Policy Schedule Schedule of Compensation Important Policy Matters Your Duty of Disclosure Our Privacy Statement Definitions Exclusions Page Number Section 1. Medical Expenses 10 Section 2. Temporary Total Disablement 10 Special Provisions Conditions Page 6 of 13

7 Important Policy Matters This Policy covers Insured Persons as described in the Policy Schedule for Medical Expenses and Temporary Total Disablement following an Injury suffered within the Policy Period and Scope of Cover on the following terms. All cover is subject to You paying the premium We require for the Option You select, and is subject to all the terms, Provisos, Conditions and Exclusions of this Policy including the Policy Schedules. Your Duty of Disclosure Before You enter into this Contract of Insurance You have a duty to disclose to Us every matter that You know, or could reasonably be expected to know, is relevant to Our decision whether to accept the risk of the Insurance and if so on what terms. You have the same duty to disclose those matters to Us before You renew, extend, vary or reinstate this Contract. Your duty however, does not require disclosure of matters: that diminish the risk to be undertaken by Us that are of common knowledge that We know or in the ordinary course of Our business ought to know as to which compliance of Your duty is waived by Us Non-Disclosure If You fail to comply with Your duty of disclosure or make a misrepresentation, We may be entitled to reduce Our liability under the Contract in respect of a claim, or may cancel the Contract. If Your non-disclosure is fraudulent We may also have the option of avoiding the Contract from the beginning. Our Privacy Statement This Policy is issued/insured by AIG Insurance New Zealand Limited ( AIG ). AIG collects information necessary to underwrite and administer Your Policy. In the course of administering Your Policy AIG may exchange or disclose Your and the Insured Person s personal information to: (c) (d) (e) a related AIG company; contractors or third party providers providing services related to the administration of Your Policy; banks and financial institutions for the purpose of processing Your application and obtaining payment of premium; in the event of a claim - assessors, third party administrators, emergency providers, retailers, medical providers and travel carriers; Our assistance provider who will record all calls to the assistance service provided under Your Policy for quality assurance, training and verification purposes. Your Access to Personal Information AIG Insurance New Zealand Limited The AIG Building, Level 19 T PO Box 1745, Shortland Street F Auckland AIG. All rights reserved. Page 7 of 13

8 You may gain access to or request correction of Your and the Insured Person s personal information by writing to: The Privacy Manager AIG Insurance New Zealand Limited The AIG Building, Level 19 PO Box 1745, Shortland Street Auckland 1140 New Zealand While access to this personal information may generally be provided free of charge, We reserve the right to charge for access requests in some limited circumstances. Consent acknowledgement By completing the application form (including any associated form) and paying the premium, You consent to the use of Your and the Insured Person s personal information stated in the privacy statement above. Definitions 1. Inception Date means the first date that this Policy came into force. 2. Income means (i) As regards to a salaried Insured Person, the average gross weekly Income earned from personal exertion before personal deductions and Income tax, but excluding bonuses, commissions, overtime payments and other allowances; or (ii) As regards to a T.E.C. (ie total employee cost) or salary packaged Insured Person, the average gross weekly value of the salary package earned from personal exertion (including, but not limited to wages, and/or salary, motor vehicle and/or travelling allowances, club subscriptions and fees, housing loan or rental subsidy, clothing or meal allowances) before personal deductions and Income tax, but excluding bonuses, commissions, overtime payments and other allowances; or (iii) As regards to a self employed Insured Person, the average gross weekly Income earned from personal exertion after the deduction of all business expenses necessarily incurred in earning that Income; all derived during the 12 calendar months period immediately preceding the Injury giving rise to the claim under this Policy. 3. Injury means a bodily injury to an Insured Person resulting from an accident caused by violent, external and visible means and occurring solely and directly and independently of any other cause including any pre-existing physical or congenital condition, provided the Injury occurs on or after the Insured Person s Inception Date of Individual Insurance, and results in Medical Expenses or Temporary Total Disablement within 12 calendar months from the date of such Injury. 4. Insured Person(s) means any person(s) who come within the description of the Insured Persons appearing in the Policy Schedule, who are nominated by You from time to time for insurance under this Policy and with respect to whom premium has been paid or agreed to be paid. 5. Medical Expenses means expenses in excess of ACC subsidies that are borne by the Insured Person to a duly qualified and registered medical practitioner, physician, surgeon, nurse, hospital and/or ambulance service for: medical, surgical, X-ray, hospital or nursing treatment including the cost of medical supplies and ambulance hire; or remedial treatments following surgery required for the treatment of an Injury; Page 8 of 13

9 but excluding the cost of optical treatment or dental treatment unless such treatment is necessarily incurred to sound and natural teeth and is caused by Injury. Provided that in the event of the Insured Person or You becoming entitled to a refund of all or part of such expenses from any other source We will only be liable for the excess of the amount recoverable from such other source. 6. Policy Period means the period shown in the Policy Schedule or subsequent Renewal Notice issued by Us. 7. Pre-Exisiting Medical Condition means any physical defect, condition, symptom, injury, illness or disease, diagnosed or otherwise, for which treatment, medication or advice (including investigation) has been received or prescribed by a duly qualified medical practitioner or dentist in the forty five (45) days immediately prior to the date of Injury. 8. Renewal Date means the date the Policy is due to be renewed. 9. Temporary Total Disablement means that as a result of Injury the Insured Person is wholly and continuously prevented from engaging in his or her usual occupation in New Zealand, and is under the regular care of and acting in accordance with the instructions or professional advice of a registered and legally qualified medical practitioner who is not the Insured Person or a family member. 10. Terrorist Act means any actual or threatened use of force or violence directed at or causing damage, Injury, harm or disruption, or committing of an act dangerous to human life or property, against any individual, property or government, with the stated or unstated objective of pursuing economic, ethnic, nationalistic, political, racial or religious interests, whether such interests are declared or not. Robberies or other criminal acts, primarily committed for personal gain and acts arising primarily from prior personal relationships between perpetrator(s) and victim(s) shall not be considered Terrorist Acts. Terrorism shall also include any act which is verified or recognised by the (relevant) Government as an act of terrorism. 11. War means War, whether declared or not, or any warlike activities, including use of military force by any sovereign nation to achieve economic, geographic, nationalistic, political, racial, religious or other ends. 12. We/Our/Us/Insurer means AIG Insurance New Zealand Limited 13. You/Your means the Insured named in the Policy Schedule Exclusions This Policy does not apply to any claim arising directly or indirectly out of: 1. War, civil War, invasion, insurrection, revolution, use of military power or usurpation of government or military power. 2. The Insured Person engaging in any aerial activity, except as a passenger in an aircraft licensed to carry passengers. 3. Intentional self-inflicted Injury, suicide, or criminal or illegal act of the Insured Person who is the subject of the claim. 4. The Insured Person being affected by alcohol or drugs, unless the drugs were prescribed and used as directed by a legally qualified medical practitioner. Page 9 of 13

10 5. Sexually transmitted disease or sexually transmitted infection, or Acquired Immune Deficiency Syndrome (A.I.D.S.) disease or Human Immunodeficiency Virus (H.I.V.) infection. 6. The use, release or escape of nuclear materials that directly or indirectly results in nuclear reaction or radiation or radioactive contamination; or The dispersal or application of pathogenic or poisonous biological or chemical materials; or The release of pathogenic or poisonous biological or chemical materials. 7. The intentional use of military force to intercept, prevent, or mitigate any known or suspected Terrorist Act. 8. Any Terrorist Act. 9. Any Pre Existing Medical Condition. 10. Any type of Illness, disease, infection or contagion, even contacted through an Injury. 11. Enhancement Dental Repairs Section 1. Medical Expenses If an Insured Person incurs Medical Expenses as result of an Injury which has been accepted by ACC as a valid claim and for which a registered ACC case number has been issued, We will pay the Insured Person for those expenses up to the amount shown on the Schedule of Compensation. We will also pay for costs the Insured Person incurs for remedial treatments (such as physiotherapy) in excess of any ACC subsidies where We have accepted a claim under Section 2 (Temporary Total Disablement) of this Policy. Our liability under this Section for each Insured Person is limited to the amount shown in the Schedule of Compensation for the treatment of any one Injury or for the treatment of all Injuries suffered within the Policy Period. Section 2. Temporary Total Disablement If an Insured Person suffers an Injury that directly results in their Temporary Total Disablement, We will pay the Insured Person for their loss of Income for up to 7 days from the date of Injury or to the amount shown in the Schedule of Compensation for the Option You or the Insured Person selected, whichever is the lesser. To be eligible for cover under this Section, the Insured Person must be gainfully employed within New Zealand when the Injury occurs and must be able to show that they have no sick leave entitlement from their employer for the period of their disablement. A 7 day Franchise applies to this Section. Special Provisions 1. Benefits are not payable: Under more than one of the Categories of Insured Person described in the Policy Schedule in relation to the same Insured Person and the same Injury. Page 10 of 13

11 2. Proper Medical Advice Compensation shall not be payable unless as soon as possible after the happening of any Injury giving or likely to give rise to a claim, the Insured Person obtains and follows proper medical advice from a registered and legally qualified medical practitioner who is not the Insured Person or a family member. 3. Weekly Benefits Limitation For each Insured Person the Compensation payable under Section 2 (Temporary Total Disablement) is limited to the amount stated in the Policy Schedule or the Insured Person s weekly Income, whichever is the lesser. If the Insured Person is entitled to receive: (c) Weekly or periodical disability benefits under any other policy of insurance; and/or Weekly or periodical disability benefits under any Workers Compensation Act or other Statutory body having a similar effect; and/or Income earned from any other occupation; then Compensation payable under Section 2 (Temporary Total Disablement) will be reduced by the amount necessary to limit the total of all payments and/or Compensation to his or her weekly Income or the limit stated in the Policy Schedule, whichever is the lesser. 4. Recurrence of Temporary Total Disablement If an Insured Person receives Compensation under Section 2 (Temporary Total Disablement) and while this Policy is in force suffers a recurrence of Temporary Total Disablement from the same or related causes within 6 consecutive months, We will consider such disablement to be a continuation of the prior claim period. 5. Aggregate Limit of Liability Our total liability for all claims arising during any one Policy Period will not exceed the amount shown in the Policy Schedule. 6. Age Limits We will not be liable for any Event which happens to an Insured Person unless at the date of the Event they are between the ages set out in the Policy Schedule. Conditions 1. Cover This Policy provides the Insured Person(s) with Insurance cover under those Sections of the Policy selected by You and/or the Insured Person in Your and/or the Insured Person s application for this Insurance. 2. Inception Date of Individual Insurance The Insurance of any Insured Person (as specified in the Policy Schedule) will become effective on the latest of the following dates: on the commencing date of the first Policy Period set out in the Policy Schedule; Page 11 of 13

12 (c) on the date such Insured Person becomes eligible for Insurance hereunder; where a Proposal is required by Us, on the date of Our acceptance of the Insured Person s written Proposal. 3. Individual Terminations The Insurance of any Insured Person will immediately terminate on the earliest of the following dates: (c) on the date this Policy is terminated; on the date the Insured requests that such Insured Person be deleted as an Insured Person; on the date such Insured Person ceases to be eligible for Insurance hereunder. 4. Policy Renewal This Policy may be renewed with Our consent from term to term, by payment of the premium in advance at Our premium rate in force at the time of renewal. 5. Cancellation This Policy may be cancelled by You at any time by giving Us written notice, in which case We will retain the proportion of the premium calculated at Our usual short term rates for the period the Policy was in force. We may cancel this Policy by providing You with thirty one (31) days written notice sent to the address shown on the Policy Schedule. Upon cancellation of this Policy We will retain the proportion of the premium for the period the Policy was in force and refund any unused premium. (c) If the premium for this Policy is not paid within thirty one (31) days of the Inception Date, or the Renewal Date as shown on a Renewal Notice issued after the first Policy Period, the Policy may be avoided from the Inception Date or Renewal Date whichever last occurred. 6. Claims Procedure (c) Precedent to Our liability under this Policy, the Insured Person s claim must first be accepted by ACC and a registered ACC case number issued for the Injury. ACC s acceptance of the Insured Person s claim in no way implies liability by Us under this Policy. Written Notice of Claim and supporting medical evidence in the form required by Us, and proof of identity, must be given to Us within 30 days of the occurrence of any Event or as soon thereafter as is reasonably possible. Notice may be given at Our Office where the Policy was issued. We may have the Insured Person medically examined at Our expense when and as often as We may reasonably require after a claim has been made, or arrange an autopsy unless this is illegal in the country in which the autopsy is to be performed. Compensation will be paid as soon as We have investigated and verified the information supplied and satisfied Ourselves that the claim falls within the Policy. 7. New Zealand Law Page 12 of 13

13 This Policy is governed by the Laws of the New Zealand and any dispute or action in connection therewith shall be conducted and determined in New Zealand. 8. Fraudulent Claims If any claim is in any respect fraudulent or if any fraudulent means or devices are used by You or the Insured Person or anyone acting on Your or the Insured Person s behalf to obtain any benefit under this Policy then any amount payable in respect of such claim shall be forfeited. 9. Tax or Imposts Where We are, or believe We will become, liable for any tax or other imposts levied by any government, authority or body in connection with this Policy, We may reduce, vary or otherwise adjust any amounts (including but not limited to premiums, charges and benefits), under this Policy in the manner and to the extent We determine to be appropriate to take account of the tax or impost. 10. Currency All amounts shown are in New Zealand dollars. If expenses are incurred in a foreign currency, then the rate of currency exchange used to calculate the amount payable will be the rate at the time of incurring the expense or suffering a loss. This Policy has been signed on Our behalf but it shall not be binding unless the Policy Schedule is countersigned by Our Authorised Representative. For AIG Insurance New Zealand Limited Group Manager Page 13 of 13