Accident & Health International Underwriting Pty Ltd DRIVER PARTNER PERSONAL ACCIDENT POLICY
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1 Accident & Health International Underwriting Pty Ltd DRIVER PARTNER PERSONAL ACCIDENT POLICY This Policy has been specifically designed to provide disability income protection to Driver Partners if they have a Motor Vehicle Accident while driving as a Driver Partner. Benefits payable under this Policy will be reduced by any statutory compulsory third party insurance or other statutory compensation scheme or any law having a similar effect. This Product Disclosure Statement (PDS) contains two parts: Important information contains general information about Your Driver Partner Personal Accident insurance Policy; and The Driver Partner Personal Accident insurance Policy contains terms and conditions of Your insurance Policy. To assist You to locate specific terms in this PDS, a table of contents is provided. Please read this PDS before applying for this insurance. If We accept Your application for insurance, You will receive a Schedule that sets out details of the insurance You have taken out. If You need more information about this PDS or Your policy, please contact Your insurance adviser. Before this policy expires We will normally offer renewal by sending a renewal invitation advising the amount payable to renew this policy. It is important that You check the information shown before renewing each year to satisfy Yourself that the details are correct. YOUR PERSONAL INFORMATION AND PRIVACY As part of AHI s dealings with You, We may need to collect personal information (and sometimes sensitive information such as health information) about You. We will collect this information directly from You where possible, but there may be occasions when We collect this information from someone else. AHI will only use Your information for the purposes for which it was collected, other related purposes and as permitted or required by law. You may choose not to give Us Your information, but this may affect Our ability to provide You with insurance cover. We may share this information with other companies within Our group and third parties who provide services to Us or on Our behalf, some of which may be located outside of Australia. For more details on how We collect, store, use and disclose Your information, please read Our privacy Policy located at Alternatively, contact Us at privacy@acchealth.com.au or (02) and We will send You a copy. You should obtain a copy of this Policy and read it carefully. By applying for, using or renewing any of Our products or services, or providing Us with Your information, You agree to this information being collected, held, used and disclosed as set out in this Policy. Our privacy Policy also contains information about how You can access and seek correction of Your information, complain about a breach of the privacy law and how We will deal with Your complaint GPA Tailored PDS WRD Page 1 of 10
2 INDEX Page Product Disclosure Statement 1 Information/Definitions 3-5 Table of Benefits 5 General Conditions and Limitations 6-7 Exclusions 8-9 Governing Law and Jurisdiction 9 Notice GPA Tailored PDS WRD Page 2 of 10
3 IMPORTANT INFORMATION Accident & Health International Underwriting Pty Ltd (hereinafter called AHI) gives notice that this contract has been effected under an Authority, given to AHI by The Company. AHI has entered into the Contract as an agent of The Company and not an agent of the Insured. A commission is payable by The Company to AHI for arranging the insurance. All cover under this Policy is subject to: 1. The Payment of premium; 2. The terms and conditions contained in this Policy document and in the Schedule; and 3. The limits of liability referred to in this Policy document and in the Schedule. Subject to the terms, conditions, exclusions and limitations contained in this Policy, this Policy provides cover for the Benefits as listed in the Table of Benefits caused by Injury only and are payable in the circumstances set out in the Policy. The particular cover which applies to You and which You selected when You applied for this insurance is referred to in the Schedule which forms part of this Policy. If You are not entirely satisfied with this Policy You may cancel it by returning it to Us within twenty-one (21) days of the date of receipt. We will refund Your premium and the Policy will be treated as though it never existed. IMPORTANT DEFINITIONS For the purpose of this Policy, the following important definitions apply: ACCIDENT means a sudden, external, violent, visible and specific event which occurs fortuitously and is unforeseen or unintended by the Insured Person and which occurs at an identifiable time and place. AHI means Accident & Health International Underwriting Pty Ltd, AFS Licence No , ABN , of Level 4, 33 York Street, Sydney, New South Wales, 2000, Australia. BENEFIT means the act or state of compensating, by way of indemnifying You due to an Injury by giving You an appropriate compensation as shown in the Table of Benefits. BENEFIT PERIOD means the maximum period of time for which We will pay any Weekly Accident Benefit for any one Injury irrespective of whether claims are made under the Policy or another policy held by You with Us, unless We have agreed to provide that cover in excess of this one. The relevant Benefit Period is specified in the Schedule. DEFERRAL PERIOD is the period stated in the Schedule during which no Benefits are payable for Temporary Total Disablement. DISABLEMENT means the Insured Person is wholly and continuously prevented from engaging in their occupation as a Driver Partner, and they are under the regular care of, and acting in accordance with the instructions or professional advice of a physician or medical specialist. DRIVER SERVICE PROVIDER is the company the Driver Partner is under contract to drive their Vehicle for, to pick-up and drop-off Driver Service Provider Customers. DRIVER SERVICE PROVIDER CUSTOMER means a person who is registered to validly use the Driver Service Providers digital network service which enables their transportation (including their accompanying travelling companion(s) on the same trip) and/or package collection and delivery for the Driver Service Provider Customer. DRIVER PARTNER means the Insured Person as described in the Schedule. EARNINGS means the Insured Person s gross weekly rate of pay earned as an Driver Partner exclusive of the company You drive for service fee(s) or deductions (but not deductions for goods or services voluntarily purchased by Insured Person directly from Insured Person s GPA Tailored PDS WRD Page 3 of 10
4 Driver Service Providers account) averaged over the period of 3 months prior to the date of the Disablement (with respect to which We have agreed to pay a claim under the Policy) commenced or over such shorter period that an Insured Person has continuously been permitted to engage as an Driver Partner. INJURY means bodily Injury resulting from an Accident that occurs to the Insured Person during the Period of Insurance and results in any of the Insured Events specified in the Table of Benefits within twelve (12) calendar months from the date thereof. Injury does not include: a. any consequences of an Injury which are ordinarily described as being a sickness or disease including but not limited to any congenital condition, heart condition, stroke or any form of cancer; b. an aggravation of a pre-existing Injury; c. any other Pre-Existing Condition; d. psychiatric or mental conditions; e. any degenerative condition. INSURED means the person or entity named as such in the Schedule. INSURED PERSON is the Insured Person named in the Schedule. LOSS OF means the amputation or complete severance of the body part. MOTOR VEHICLE ACCIDENT means an Accident associated with the Vehicle the Insured Person is driving, and includes when the Insured Person is assisting an Driver Service Provider Customer (or their assistance animal) before they entered the Vehicle or after they have left the Vehicle or the Insured Person was within close proximity to the Vehicle, when changing a tyre, or engaging in roadside mechanical work on the Vehicle or roadside inspection of the Vehicle, or when collecting and delivering a package for an Driver Service Provider Customer. PARAPLEGIA means Permanent total paralysis of both legs. PERMANENT in relation to disablement means disablement lasting at least twelve (12) calendar months, and at the end of that time being beyond hope of improvement. PERMANENT and TOTAL DISABLEMENT means that You are permanently prevented from ever engaging in any occupation due to Your organic injuries. Organic injuries do not include psychiatric or mental conditions. PERIOD OF INSURANCE means the period stated in the Schedule. PRE-EXISTING CONDITION means: i) In respect of Injury a condition with which the Insured Person was aware of (whether diagnosed or not) or has sought treatment prior to the inception of his or her Policy; and ii) any medical condition that You have suffered from or been treated for, irrespective of whether a complete recovery has occurred, is still treated as a Pre-Existing Condition. QUADRIPLEGIA means Permanent total paralysis of all four limbs. SCHEDULE includes any current Schedule or renewal or variation of this Policy. TEMPORARY TOTAL DISABLEMENT means You are wholly and continuously prevented from engaging in Your occupation as an Driver Partner, and You are under the regular care of, and acting in accordance with, the instructions or professional advice of a physician or medical specialist. TETRAPLEGIA means Permanent total paralysis of all hands and feet. THE COMPANY means CGU Insurance Limited, ABN , AFS Licence no , of 388 George Street, Sydney, New South Wales, 2000, Australia, a company duly GPA Tailored PDS WRD Page 4 of 10
5 incorporated under the laws of Australia and registered in New South Wales, Australia. TOTAL DISABLEMENT means Disablement which entirely prevents You from engaging in any occupation or employment for the remainder of Your life. VEHICLE means the motor vehicle used by the Insured Person and accepted by Driver Service Provider for use on the Driver Service Provider s digital network. WE/OUR/US means CGU Insurance Limited. YOU/YOUR/YOURSELF in connection with the payment of premium, the General Conditions and Limitations, and receipt of Benefits means the Insured and in connection with the circumstances in which entitlement to Benefits arise means the Insured Person. EXTENT OF COVER Cover applies and We will pay the benefit that applies to the Injury or circumstance if ALL of clauses 1-5 apply at the time of the Motor Vehicle Accident AND clause 6 is subsequently satisfied. 1. You qualify for coverage within the Scope of Cover as shown in the Schedule 2. You are the driver of a Vehicle involved in a Motor Vehicle Accident. 3. An Injury or circumstance of a type listed in the Table of Benefits occurs to You. 4. The Motor Vehicle Accident was the sole contributing factor to the Injury or circumstance of a type listed in the Table of Benefits. 5. The Vehicle You were driving as per clause 2 was a Vehicle acceptable for use on Driver Service Provider s digital network and was not a motor vehicle operated by another person at the time of Injury. 6. An Injury or circumstance listed in the Table of Benefits manifests itself within twelve (12) calendar months from the date of the Motor Vehicle Accident. TABLE OF BENEFITS INJURY RESULTING IN THE FOLLOWING INSURED EVENTS MAXIMUM AMOUNT PAYABLE Death Quadriplegia / Tetraplegia / Paraplegia $250,000 $250, Loss of 2 limbs Loss of 1 limb 3 4. $250,000 $150, Permanent and Total Disablement (any occupation) 5. $250, Permanent and Total sight loss in both eyes 6. $250, Permanent and Total sight loss in one eye Burns to more than 40% of the body Injured internal organ resulting in surgery Temporary Total Disablement caused directly and solely by Injury Dental Expenses (to a maximum of) $100,000 $150,000 $5,000 (As per Schedule) $3,000 Dental Expenses Benefit We will pay (regardless of the actual dental costs involved) for loss of a tooth or teeth provided the loss of the tooth or teeth occurs within twelve (12) calendar months from the date of Injury causing the loss of permanent or second teeth caused solely by Injury that is covered by this Policy (No cover is provided for milk or first teeth, implants, dentures or dental fillings) We will pay; Loss of teeth, capping or crowning of damaged teeth with cast metal or porcelain or similar restorations, $250 per tooth. 12. Broken Bone Benefits caused directly and solely by Injury a. Neck or spine (full break) a. $5,000 b. Hip, pelvis b. $2,000 c. Skull, shoulder blade c. $2,000 d. Collar bone, upper leg d. $1, GPA Tailored PDS WRD Page 5 of 10
6 e. Upper arm, kneecap, forearm, elbow e. $500 f. Lower leg, jaw, wrist, cheek, ankle, hand, foot f. $100 g. Ribs (per rib) g. $100 h. Finger, thumb, toe (per finger, thumb or toe) h. $50 Maximum Broken Bones compensation for any one accident $5, GPA Tailored PDS WRD Page 6 of 10
7 GENERAL CONDITIONS AND LIMITATIONS 1. Compensation shall not be payable for more than one of the Insured Events 1-7 in respect of the same Injury, in which case the highest compensation will be payable. 2. Written notice of claim must be given to Us within thirty (30) days after the occurrence of any circumstances giving rise to a claim or as soon thereafter as is reasonably possible. 3. Upon receipt of a notice of claim, We shall submit Our usual claim form for completion. We shall not be liable to make any payment under this Policy unless the claim form is properly completed and all information reasonably required by Us has been furnished at Your expense. 4. The Benefits of this Policy depend on You or any person covered by this Policy giving Us any reasonable information and help We require. This includes giving Us written statements or documents We consider relevant. We may also require You or any person covered by this Policy to attend Court to give evidence. You must help Us even when We have paid Your claim. If You do not co-operate Your payments may be suspended. 5. We may at Our own expense conduct any medical examination or examinations or arrange for an autopsy to be carried out. We may also at any time during Your claim ask for further information or appoint a person to conduct further enquiries into the nature and circumstances of the claim. 6. No action at law shall be brought to recover on this Policy prior to the expiration of sixty (60) days after Our reasonable requirements in connection with a claim have been met. No such action shall be brought after the expiration of three (3) years after the date of the Injury giving rise to the claim. No action at law or equity shall be brought or maintainable unless and until the parties have first participated in a formal mediation process before a mediator appointed by agreement or failing that by the president of the law society of that state or territory the claimant ordinarily resides. The costs of any mediator shall be borne equally by the parties. 7. This Policy may be cancelled by You at any time by giving Us written notice, in which case We shall retain a proportion of the premium calculated at a pro-rata premium for the time We were on risk. We may cancel this Policy in accordance with the provisions of the Insurance Contracts Act Upon cancellation by Us, We shall refund a proportion of the premium paid calculated by reference to the unexpired Period of Insurance. 8. All compensation shall be paid to You or, in the case of Your death, to Your legal personal representative. 9. If a sum is shown in the Schedule as being the Aggregate Limit of Liability, We shall not be liable to pay compensation under this Policy totalling in all more than the Aggregate Limit of Liability Sum Insured for all claims arising under this Policy during the Period of Insurance shown in the Schedule, including any current Schedule. 10. Weekly compensation for Temporary Total Disablement shall be limited to the Sum Insured stated in the Schedule or 85% of Your Earnings, whichever is the lesser. 11. We will pay one-seventh (1/7th) of the Weekly Accident Benefit compensation for each day of Disablement where Disablement lasts for less than a week. 12. No Weekly compensation shall be payable for Temporary Total Disablement during the Deferral Period. 13. Weekly compensation payable under this Policy will be reduced by the amount an Insured Person receives or is entitled to receive from any statutory compulsory third party compensation scheme or other statutory compensation scheme or any law having a GPA Tailored PDS WRD Page 7 of 10
8 similar effect. 14. No further compensation will be payable under this Policy and all cover under this Policy will cease if: 14.1 You become entitled to the payment of a Sum Insured being 100% of the Sum Insured stated in the Schedule; 14.2 You become entitled to the payment of Weekly Accident Benefit compensation for the maximum Benefit Period stated in the Schedule. The maximum period is fiftytwo (52) weeks from the date You first become entitled to the payment of Weekly Accident Benefit compensation except for persons aged sixty (60) years to sixty five (65) years where the Benefit Period is twenty-six (26) weeks and persons aged sixty-six (66) to seventy (70) years where the Benefit Period is thirteen (13) weeks You become entitled to both a Sum Insured as stated in the Schedule and Weekly Accident Benefit compensation and You are paid 100% of the Sum Insured stated in the Schedule and Weekly Accident Benefit compensation for the Benefit Period stated in the Schedule. 15. We may request a progress based claim form be completed by Your attending physician or specialist. 16. Any claim or Benefit paid under this Policy will be paid in Australian dollars GPA Tailored PDS WRD Page 8 of 10
9 EXCLUSIONS You are not covered by this Policy if, at the time of the Motor Vehicle Accident, You; 1. were not complying with any law related to the wearing of seat-belts; 2. were under the influence of alcohol or drugs or had a blood alcohol concentration in excess of the lawful limit; 3. unlawfully refused to undergo a test for alcohol or drugs; 4. did not, without reasonable excuse, remain at the scene of the Motor Vehicle Accident until police arrived or when required by law to do so; 5. intentionally committed an act to injure Yourself, or others, or damage any property; 6. were participating in, training for or practicing for a race, pace making, reliability trial or a speed or hill climbing test, or the Vehicle was being used on a race track for any purpose, or any such competitive activity; 7. were driving a Vehicle towing a heavier load or carrying more Driver Service Provider Customers than the Vehicle was designed for or was permitted to carry by law; 8. did not possess a valid driver s licence for the class of Vehicle You were driving or were not complying with any of its conditions; 9. acted maliciously; 10. receive, or are entitled to receive, in direct consequence of Your Injury, compensation (whether lump sum, periodical payment or both) under any statute providing for payment of Injury compensation (irrespective of fault), or under a contract of insurance entered into (whether by You or another) pursuant to such a statute; 11. committed any indictable offence in relation to the circumstances leading up to, at the time of or immediately after the Motor Vehicle Accident; 12. were committing a criminal or illegal act; 13. were driving an unregistered Vehicle or a Vehicle in an un-roadworthy condition; 14. do not provide to Us, at Your own expense, with corroborative evidence of the circumstances of the Motor Vehicle Accident 15. within one month of being requested. The only acceptable evidence is: a) a police report. b) an ambulance or other emergency service report. c) details of witnesses to the Motor Vehicle Accident sufficient to allow Us to identify, locate and contact them as necessary. 16. make a claim that is fraudulent. 17. the Injury or circumstance is caused by: a) war or warlike activities; b) the use, existence or escape of nuclear weapons material, or ionising radiation from, or contamination by radioactivity from, any nuclear fuel or waste from the use of nuclear fuel. We will not pay: any Benefit that, if the Benefit were paid, that payment would constitute the carrying on of a "Health Insurance Business" as defined under the Private Health Insurance Act 2007 (Cth) or any succeeding legislation to that Act or would result in a breach of the provisions of the Health Insurance Act 1973 (Cth); or GPA Tailored PDS WRD Page 9 of 10
10 for any Benefit the Insured Person has agreed not to seek compensation for from another person or organisation that are or may be liable to compensate the Insured Person for any loss that is covered by the Policy. GOVERNING LAW AND JURISDICTION This Policy shall be governed and construed in accordance with the laws of the applicable State or Territory in Australia where the Motor Vehicle Accident occurred. Any dispute under this Policy shall be resolved in accordance with the laws of the applicable State or Territory in Australia. NOTICE 1. Code of Practice CGU Insurance Limited is a signatory to the General Insurance Code of Practice developed by the Insurance Council of Australia. The aim of the code is to raise the standards of practice and service in the insurance industry. Further information is available on request. 2. Dispute Resolution We and AHI will do everything possible to provide a quality service to You. If You have any concern or complaint AHI staff are always available to listen to You and to help where they can. If, after talking to a staff member, You wish to take the matter further, AHI has a Complaints and Dispute Resolution Procedure which undertakes to provide an answer to You within fifteen (15) working days. Please contact the Disputes Resolution Manager see contact details in this Product Disclosure Statement. If You are not happy with any decision and it relates to a claim, You may take Your complaint to the Financial Ombudsman Service Limited (FOS), an independent and external dispute resolution body subject to eligibility. Access to the FOS process is free of charge to You. Please contact AHI if You would like further information about the FOS or contact: Financial Ombudsman Service Limited GPO Box 3 Melbourne VIC 3001 Telephone: info@fos.org.au Web: GPA Tailored PDS WRD Page 10 of 10
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