TABLE OF CONTENTS TERMS AND CONDITIONS OF TRAVEL INSURANCE R100/2011

Transcription

1 TRAVEL INSURANCE

2 TABLE OF CONTENTS TERMS AND CONDITIONS OF TRAVEL INSURANCE R100/ Key Terms and Definitions Validity of Insurance Start and End of Trip Extent of Insurance Cover MedicalTreatment Expenses Death Disability Trip Failure Measures Applied after Loss Event Luggage Insurance Measures Taken after Luggage-Related Loss Event Disclosure of Information Exclusions Payment of Insurance Indemnity Jurisdiction Transfer of Claim Notices /8

3 TERMS AND CONDITIONS OF TRAVEL INSURANCE R100/2011 Effective as of Unofficial translation. In case of a dispute refer to household insurance terms and conditions in Estonian R100/2011 3/8

4 This document forms part of the insurance contract entered into with the Estonian branch of AB Lietuvos draudimas (hereinafter PZU*). In matters not regulated hereunder, the Parties to the insurance contract shall be governed by the Law of Obligations Act and other legislation. 1. Key Terms and Definitions 1.1. Insurer is the Estonian branch of AB Lietuvos draudimas (hereinafter PZU*) Insured person shall be the person specified in the policy, who has a permanent residence in Estonia Period of insurance shall be a period of time specified in the insurance policy, during which insurance is in effect. If the return from a trip is delayed due to weather conditions or technical failure of the means of transport, the period of insurance shall extend once by maximum 48 hours Sum insured shall be a money amount which is the maximum amount payable by PZU during the period of insurance. Any insurance indemnity paid shall reduce the sum insured Limit of indemnity shall be a money amount which is the maximum amount payable by PZU per each insured event and per each insured person. If several insured persons sustain damage or a number of insured events occurs simultaneously, PZU shall indemnify the amount which does not exceed the sum insured Assistance centre is the insurer's cooperation partner Coris International (phone , coris@corisriga.lv), which shall arrange for the handling of insured events outside Estonia when necessary Trip shall be a temporary stay of the insured person outside the country of his/her residence. 2. Validity of Insurance 2.1. Geographical Scope Insurance shall be valid on the territory outside the Republic of Estonia, which is specified in the policy In respect of the insured events provided for in clauses 8.1 and 8.3 of these insurance terms and conditions the geographical scope shall also include the Republic of Estonia if the specified insured event has occurred in the Republic of Estonia Term of Contract The insurance contract shall come into force as of payment of the insurance premium. The insurance contract shall be in force within the period of insurance specified in the insurance policy The insurance contract shall terminate at on the last day of the period of insurance Insurance cover and the insurer's liability shall commence at of the day specified in the policy, but not before the insured has crossed the border of the Republic of Estonia, except for the events specified in clauses 8.1 and Limitations of Validity Insurance shall not extend to competitive sport or related training Insurance shall not cover physical paid employment Insurance shall not cover engaging in risky hobbies. Risky hobbies shall be parachuting, hang gliding, gliding, hot air ballooning, alpine skiing outside the marked courses, downhill skiing, diving, white water rafting, mountain, rock or wall climbing, bungee jumping, and any kind of motor sport Insurance shall not apply to air, ship or rail accidents with regard to the performance of duties by airplane, ship or train crews and persons related to the activity concerning the trip. 3. Start and End of Trip 3.1. The starting point of a trip shall be a port, airport, bus or train station or a border point through which the insured person directly leaves or intends to leave the Republic of Estonia A trip shall be deemed to have been completed when the insured person crosses the border of the Republic of Estonia upon return. 4. Extent of Insurance Cover 4.1. The Insurer shall indemnify for: medical treatment expenses of the insured person, incl. dental first aid costs, transportation to the nearest hospital, transportation of the sick person to Estonia; funeral expenses of the deceased abroad or transportation of the deceased to Estonia; invalidity benefit if the insured person becomes disabled as a result of an accident; death benefit if the insured person dies as a result of an accident; damage resulting from the cancellation, interruption or delay of the trip; damage to luggage, incl. damage resulted from the delay of luggage, breaking or loss of luggage during transportation, theft or robbery of luggage The limits of indemnities for each insured event shall be specified in the insurance policy. 5. MedicalTreatment Expenses 5.1. Illness Expenses for the treatment of an illness started during the trip shall be indemnified, taking into account the restrictions provided in clause Only expenses of medical treatment provided abroad shall be indemnified for a period of 30 treatment days In case of chronic diseases only first aid expenses shall be indemnified in the event of an unexpected acute condition of the disease which is dangerous to life. If it was possible to forecast the acute condition of the disease, no indemnification shall be paid Accident Treatment expenses in case of an accident occurred during the trip shall be indemnified, taking into account the restrictions provided in clause An accident shall be a bodily injury of the insured person involuntarily sustained due to an external impact, as well as drowning, heat stroke, sunstroke, freezing, trauma caused by sudden change in the ambient pressure, gas or poisoning caused by any other substance that has accidentally entered the system. An accident shall also be any injury of the insured person involuntarily sustained due to an abrupt movement, which has been medically treated within 7 days as of sustaining the injury The following shall not be deemed an accident, and no indemnity shall be paid if an injury or health disorder has occurred as a result of: *PZU is a trademark used in Estonia by the Estonian branch of AB Lietuvos draudimas. AB Lietuvos draudimas is a Lithuanian non-life insurance company that is part of the international PZU Group. 4/8

5 a) damage caused by chronic (not occurred during the trip) disease or physical disability of the insured person; b) conditions caused by a medicinal product, alcohol or any other narcotic or intoxicating substance consumed by the insured person; c) biting into a tooth or denture Medical treatment expenses of injuries sustained as a result of an accident during a trip abroad shall be indemnified for a period up to 90 treatment days If the injury caused by accident has been materially affected by an independent disease or injury that has manifested before the start of the trip independent of the accident, the indemnity shall be paid only to the extent which is determined to have been caused by this accident Medical Treatment Expenses Medical treatment expenses shall include the following: a) expenses for the analysis and treatment provided or prescribed by a doctor as necessary; b) technical aids prescribed by a doctor, the purchase of which has been previously approved by PZU in a format which can be reproduced in writing; c) justified expenses of the transportation of the sick person and transportation of the sick person to Estonia accepted by the insurer, and unavoidable justified expenses of a possible accompanying person; d) expenses necessary and justified for the repair of the hearing aid or denture broken in the accident or purchase of new ones; e) dental first aid required for the elimination of the centre of pain The following shall not be included in medical treatment expenses: a) expenses for spa treatment or travel to a treatment facility specified as trip and back; b) expenses of vaccination and medical examination which are related to the events specified in clause 5.2; c) expenses of medical assistance related to pregnancy and childbirth, except for emergency care after an accident; d) expenses for the treatment of oncologic diseases; e) expenses for the treatment of sexually transmitted diseases, AIDS-related treatment expenses; f) expenses for the treatment of an infection caused by insect or tick bite or sting or any complications thereof Based on an invoice, the part of medical treatment expenses, which is not subject to indemnification under any current legislation, shall be indemnified The insurer may reduce the indemnity or refuse to pay the indemnity if: a) the insured person knowingly uses travel insurance in order to avoid treatment or similar expenses in Estonia; b) the insured person uses medical treatment services for a longer period than justified from the standpoint of treatment and optimality of expenses No indemnity shall be paid if medical treatment expenses have been caused by a disease resulting from taking medical measures The total limit of indemnification for medical treatment expenses shall be specified in the policy. 6. Death 6.1. Should the insured person die during a trip, the justified costs of repatriation of the deceased to Estonia or expenses of funeral or cremation carried out abroad (except for funeral repast and expenses related to the travel of the next of kin) shall be indemnified In case of death of the insured person as a result of the accident the successors to the insured person or any person specified by the insured person shall be paid a death benefit. The benefit shall be paid if the insured person dies as a result of the accident occurred during the trip within one year as of the day of the accident. 7. Disability 7.1. If the insured person becomes disabled as a result of an accident, an invalidity benefit shall be paid Disability shall be determined and indemnified pro rata to the percentage of the loss of the capacity for work occurred as a result of the accident, which is determined according to the procedure provided for by legislation The insured person shall have the right to receive the invalidity benefit if the degree of invalidity caused by accident is at least 10%. If the degree of invalidity caused by accident is at least 60%, the entire invalidity benefit agreed upon shall be paid (taking into account the provisions of clause 7.2) The invalidity benefit shall be paid as a single benefit. 8. Trip Failure 8.1. Cancellation of Trip The cancellation of a trip shall be a situation where a booked and paid for or purchased trip does not take place To receive indemnity, the following shall have happened immediately before the trip, which is the reason for the cancellation of the trip: a) sudden and acute illness, severe injury or death of the insured person; b) sudden and acute illness, severe injury or death of the insured person's travel companion jointly with whom the trip has been booked and paid, a spouse/life partner or child of the insured person; c) sudden dangerous condition or death of the insured person's parent, grandparent, sister, brother, mother-in-law, father-in-law, daughter-in-law, sonin-law; d) damage caused to the household property of the insured person if it has resulted from a crime against property, fire or natural disaster and due to which fact the personal presence of the insured person is unavoidably necessary In case of cancellation of a trip, the expenses to the operator arising from the obligation of the policyholder or insured person pursuant to the terms of the trip shall be indemnified No insurance indemnity shall be paid for the cancellation of a trip if: a) the insurance premium has been paid later than three days before the reason for the cancellation of the trip has emerged; b) the reason for the possible cancellation of the trip has emerged before the travel documents have been prepared; 5/8

6 c) the insurance premium has been paid after the occurrence of the events specified in clause Interruption of Trip The interruption of a trip shall be the interruption of a trip already started and return to Estonia A trip shall be deemed to have started as of the moment the insured person leaves his/her home or place of work using regular means of transport in order to reach a port, airport, bus or train station To receive indemnity, the following shall have happened during the trip, which is the reason for the interruption of the trip: a) sudden and acute illness, severe injury or death of the insured person, his/her spouse/life partner or child; b) sudden dangerous condition or death of the insured person's parent, grandparent, sister, brother, mother-in-law, father-in-law, daughter-in-law, sonin-law; c) damage caused to the household property of the insured person if it has resulted from a crime against property, fire or natural disaster and due to which fact the personal presence of the insured person is unavoidably necessary In case of interruption of a trip the insured person shall be indemnified for any justified additional travel and accommodation expenses No insurance indemnity shall be paid for the interruption of a trip if: a) the insurance premium has been paid later than three days before the reason for the possible interruption of the trip has emerged; b) the reason of the possible interruption of the trip has emerged before the travel documents have been prepared; c) the insurance premium has been paid after the occurrence of the events specified in clause Being Late for Trip Being late for a trip shall be a situation where the insured person is late to the starting or transit point of the trip using regular means of transport. Regular means of transport shall be a public means of transport operating according to a predetermined timetable along a fixed route (except for hydrofoil) The starting point of a trip shall be a port, airport, train or bus station through which the insured person leaves the Republic of Estonia The transit point of a trip shall be a port, airport, train or bus station in a foreign country, which the insured person uses to continue the trip Any expenses incurred due to being late at the starting or transit point of a trip shall be indemnified if the regular means of transport by which the insured person intended to travel or travelled to the starting or transit point of the trip is late due to: a) traffic accident; b) technical failure of the means of transport; c) weather conditions preventing the means of transport from operating according to the schedule (incl. ash clouds); d) crime, and trip ticket reservations cannot be changed pursuant to the travel conditions Also, such expenses shall be indemnified, which are incurred due to being late to the starting or transit point of the trip if the insured person is involved in a traffic accident on his/her way to the starting point of the trip, riding a vehicle he/she uses (the traffic accident shall be duly reported to the police) No expenses shall be indemnified under insurance if: a) the insured person is late to the starting or transit point of a trip because he/she has failed to start for the trip sufficiently early considering the travel schedule and conditions prevailing before the trip (traffic conditions, weather conditions, time of the year): b) being late is caused by the activities of public authorities; c) being late is caused due to inadequate work organisation of the transport company, computer error or employee's error; d) interval between the arrival at the transit point and departure of the following means of transport planned by the tour operator does not comply with the minimum period requirement With regard to being late, any justified additional expenses incurred in order to catch or continue the trip shall be indemnified. If the trip of the insured person requires transfers, the following shall be indemnified: a) expenses incurred due to being late from one means of transport to another; b) additional expenses required for the use of an alternative means of transport; c) justified additional accommodation costs Expenses not subject to refund by the tour operator, transport company, hotel or any other person or authority shall be indemnified. 9. Measures Applied after Loss Event 9.1. PZU shall be notified of an insured event, and an application regarding loss shall be filed with PZU within one month as of completion of the trip. If the policyholder violates the specified obligation, PZU shall be released from the performance obligation In case of a loss event the insured person shall do the following in order to receive insurance indemnity: consult a doctor. It is allowed to consult any doctor with respective professional qualifications and holding a respective licence or a lisenced health care institution; obtain from the doctor a document confirming the diagnosis. The policyholder shall provide the insurer with such medical diagnosis which is of importance in the clarification of the loss event and indemnity claim; the insurer's doctor has the right to make inquiries to respective authorities and persons in order to verify circumstances related to treatment; file a written application regarding loss with the insurer (also in case treatment has not been paid for in cash). This shall be considered as claim for insurance indemnity; if this is an offence, the event shall be reported to the local police and the investigation of the circumstances of the event shall be enabled. A police certificate shall be submitted to the insurer; obtain a certificate from the transport company in case of the cancellation, interruption or delay of the trip, which includes the reason therefor If the policyholder fails to perform the obligations specified in clause 9.2 or provides false information affecting the clarification of the circumstances of the loss event, 6/8

7 the insurer may reduce the indemnity or refuse to pay the same The insured person shall have the right to address Coris International upon the occurrence of the loss event in order to obtain insurance-related information and for assistance. 10. Luggage Insurance Loss resulting from the theft, robbery, loss of, damage to the luggage and/or delay of the luggage to the transfer point or point of destination shall be indemnified. In this case the following shall serve as the basis: luggage shall be deemed to be only personal necessities and clothes the insured person has with him/her on the trip; loss of, damage to or delay of the luggage shall be deemed to be an insured event if they are not caused by the violation of diligence obligation of the insured person or luggage insurance safety requirements; delay of the luggage shall be deemed to be an insured event if: the luggage arrives at the point of destination or transfer point of the trip more than four (4) hours late; the following shall not be deemed to be luggage: precious metals and stones (incl. jewellery manufactured therefrom), works of art, unique objects and antiquities, collections, easily broken porcelain, marble, glass and ceramic objects, means of transport and vehicles and their spare parts, money, bank cards, securities and documents (except for the passport, ID card and driving licence), souvenirs, manuscripts, photographs, plans, drawings, animals, plants, seeds, medicinal products, musical instruments The following shall be indemnified under luggage insurance: the market value of the luggage prior to the insured event if it becomes unfit for use or is lost; reasonable and justified expenses of issue of the passport and other documents required to continue the trip; expenses incurred for purchasing necessary staple goods to the maximum limit of indemnity specified in the policy; the expenses specified in clauses and shall be indemnified without applying excess Luggage insurance safety requirements shall be as follows: the insured person shall ensure reasonable supervision of the luggage; items shall not be in display in a vehicle, but they must be in a locked boot; it is prohibited to leave luggage unattended at night (from to 06.00) in a vehicle or trailer; luggage shall not be given to the custody of any unauthorised person If the insured person is returned the lost luggage or part thereof after indemnification, he/she shall immediately transfer the same to the insurer or refund a respective share of insurance indemnity No damage shall be indemnified under luggage insurance, which has been caused by: normal wear and tear and scratching of the luggage; caustic, staining or flammable substances in the luggage; bad weather; use of the objects included in the luggage, incl. sports equipment; loss of or forgetting luggage The part of loss compensated or to be compensated for by the transport company shall not be indemnified under luggage insurance. 11. Measures Taken after Luggage-Related Loss Event PZU shall be notified of an insured event, and an application regarding loss shall be filed with PZU within one month as of completion of the trip. If the policyholder violates the specified obligation, PZU shall be released from the performance obligation The insured person shall limit the amount of damage as much as possible Damaged property shall be preserved until the insurer has established the amount of damage If luggage is lost or damaged during transportation, the damage shall be reported to a representative of the transport company and a report to this effect shall be obtained from the transport company In case of loss event the insured person shall take testimonies and explanations from witnesses, who know the circumstances related to the loss event A written application regarding loss shall be submitted to the insurer. This application shall be considered a claim for indemnity If luggage is stolen or robbed, the loss event shall be reported to the local police. A police certificate shall be submitted to the insurer The policyholder shall produce to the insurer the documents and information that are of importance in the clarification of the loss event and claim for indemnity If the policyholder fails to perform the obligations specified in clause 10.3 and/or 11 or provides false information affecting the clarification of the circumstances of the event of loss, the insurer may reduce the indemnity or refuse to pay the same. 12. Disclosure of Information In case of loss event, the policyholder or insured person shall submit to the insurer all the required data and documents, which prove the occurrence of the loss event and extent of loss If the data are not presented or false information is provided, the insurer shall have the right to refuse from paying indemnity or to reduce indemnity. 13. Exclusions No insurance indemnity shall be paid: to the persons who have deliberately caused a loss event; if a loss event is caused by the bankruptcy, strike or liquidation of the tour operator or transport company; if a loss event is caused by the activities of public authorities; for moral damage caused to the insured person during the trip; 7/8

8 if damage is caused by the fact that the insured person has committed or attempted to commit a crime; if a loss event is caused by the impact of nuclear energy based weapons or device of mass destruction; if a loss event is caused by war or armed conflict in which the insured person has participated. The restriction of liability provided for in this clause shall not apply within 14 days as of commencement of armed incidents if the insured person has started the trip already before such incidents unfolded and was unable to foresee them The insurer may refuse to pay or may reduce insurance indemnity if the loss event is caused: by gross negligence or carelessness of the insured person; if, at the time of the loss event, the insured person is under the influence of alcohol or any other intoxicating or narcotic substance and this circumstance has considerably contributed to the causing or extent of loss The insurer may refuse to pay or may reduce insurance indemnity if the policyholder or insured person has submitted incomplete or false information. 14. Payment of Insurance Indemnity The insurer shall pay indemnity under the insurance contract within 30 days as of receipt of the data and documents required for the determination of obligation of indemnification (incl. effective decision regarding pending, termination of civil, criminal or misdemeanour procedure related to the insured event or a relevant decision of the court or any other respective official) If data are considered to be insufficient only as to the amount of indemnity, the incontestable part of indemnity shall be paid within the time limit specified above. 15. Jurisdiction Any disputes arising from this insurance contract shall be settled in the Harju County Court. 16. Transfer of Claim A claim of the policyholder, insured person, beneficiary or person who has received indemnity for damages against a third party shall transfer to PZU in the extent of damage indemnified by the latter If the policyholder, insured person, beneficiary or person who has received indemnity waive their claim against the third party or their right securing such claim, PZU shall be released from the performance obligation in so far as it would have been able to claim indemnity on the basis of such claim or right If the policyholder has a claim against his/her ascendants or descendants or spouse, likewise against any other family member living with him/her, PZU shall have the rights stipulated in clauses 16.1 and 16.2 of these terms and conditions in so far as the liability of a respective person is insured or if the respective person has caused damage deliberately. 17. Notices All notices to the parties to the insurance contract submitted in the course of performing the contract shall be made in a format which can be reproduced in writing or by calling PZU at /8