GROUP PERSONAL ACCIDENT INSURANCE POLICY TERMS SUMMARY 1 P a g e
Personal Accident Insurance Policy Important Notice YourCover Pty Ltd trading as ROOBYX (YCR) gives notice that this contract has been effected under a binding authority agreement, given to YCR by certain Underwriters at Lloyd s. YCR has entered into the binding authority agreement as an agent of the Underwriters and not an agent of the Insured. A commission is payable by Underwriters to YCR 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; 3. The limits of liability referred to in the Policy. Subject to the terms, conditions, exclusions and limitations contained in this Policy, this Policy provides cover for Disablement caused by Injury only and Benefits are payable in the circumstances set out in the Policy. The particular cover which applies to you and selected by the Insured is referred to in the Schedule and forms part of this Policy. Important Definitions This policy has important definitions which apply: ACCIDENT means a sudden, unexpected, unusual, specific, external event which occurs at an identifiable time and place during the Period of Insurance. COMPLETE FRACTURE means a fracture in which the bone is broken completely across and no connection is left between the pieces. EMPLOYEE means an individual who works part-time or full-time under a contract of employment, whether oral or written, express or implied, and has recognised rights and duties. FINGERS, THUMBS OR TOES mean the digits of a Hand or Foot. FOOT means the entire foot below the ankle. GIG ECONOMY a way of working based on having temporary jobs and/or doing separate pieces of work, each paid separately, as an Independent Contractor and not an Employee via a platform that is an established and registered entity under the Corporations Act in Australia. HAIRLINE FRACTURE means mere cracks in the bone. HAND means the entire hand below the wrist. INDEPENDENT CONTRACTOR means a person who contracts to do work for another person according to his or her own processes and methods; the contractor is not subject to another's control except for what is specified in a mutually binding agreement for a specific job. 2 P a g e
INJURY means bodily Injury to the Insured Person resulting from an Accident during the Operative Time while this policy is in force which, solely and independently of any other cause (except illness directly resulting from, or medical or surgical treatment rendered necessary by such injury) 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: 1. Any consequences of an Injury which are ordinarily described as being a disease, including but not limited to any congenital condition, heart condition, stroke or any form of cancer; 2. A Pre-Existing Condition; 3. Any degenerative or gradual onset condition. INSURED means the organisation named as the Insured in the policy Schedule who acquired this insurance. INSURER means certain Underwriters at Lloyd s. LONG DISTANCE OR HEAVY HAULAGE DELIVERY means to a delivery destination outside a 250 kilometre radius from home base or which requires an overnight stay and/or where the vehicle requires a HR, HC or MC class licence. LOSS OF SIGHT means the permanent and total loss of sight which we will consider as having happened: in both eyes, if your name is added to the Register of Blind Persons on the authority of a fullyqualified ophthalmic specialist; or in one eye if, after correction, the degree of sight you have left is 3/60 or less on the Snellen scale. LOSS OF USE means loss of, by physical severance, or total and Permanent loss of the effective use of the part of the body referred to in the Table of Benefits. MEDICAL PRACTITIONER means a person legally qualified and registered to practice medicine in Australia and who is a person other than the Insured, their relatives, business partners, shareholders or employees. Chiropractors, Physiotherapists and alternative therapy providers are not regarded as a Medical Practitioner. ON-DEMAND WORKER means an individual person who derives any Income through personal exertion whilst working as an Independent Contractor and not an Employee in the Gig Economy within Australia. OPERATIVE TIME means only while performing duties directly allocated to you by the Insured, including direct travel to and from your home and the location of the work, and for which premium is paid. OTHER FRACTURE means any fracture other than a Complete Fracture, Hairline Fracture or Simple Fracture. PARAPLEGIA means the permanent and total paralysis of the two lower limbs, bladder and rectum. PERIOD OF INSURANCE means the period stated in the Schedule. PERMANENT means lasting at least twelve (12) consecutive months, and at the end of that time being beyond hope of improvement 3 P a g e
TOTAL DISABLEMENT means disablement which entirely prevents you from engaging in any occupation or employment for which you are suited by reason of education, training, experience, or skill. PRE-EXISTING CONDITION means a medical condition, injury or defect which you were aware of (whether diagnosed or not) or had sought treatment for the condition or the symptoms of the condition in the twelve months prior to the inception of your Policy. QUADRIPLEGIA means the permanent and entire paralysis of both legs and both arms. ROOBYX PLATFORM means the online platform at www.roobyx.com where this insurance is marketed and administered. SCHEDULE includes any current Schedule or renewal or variation of this Policy. SIMPLE FRACTURE means a fracture in which there is a basic and uncomplicated break in the bone and which in the opinion of a Medical Practitioner requires minimal and uncomplicated medical treatment. YCR means YourCover Pty Ltd trading as ROOBYX, ABN 35 169 038 466, AFS Licence No. 461299; Level 5, 320 Adelaide Street, Brisbane, QLD 4000, Australia. YOU/YOUR/INSURED PERSON is the person(s) named in the Schedule as the Insured Person(s). WE/OUR/US means certain Underwriters at Lloyd s. Extent of Cover If, as a result solely and directly of Injury, you suffer any of the Insured Events set out in the Table of Benefits we will pay you the compensation set out in that Table. However, all Insured Events including disablement must occur within twelve (12) months of the Injury. 4 P a g e
Table of Benefits The percentage shown against Item 1 is of your chosen Accidental Death Benefit shown in the Schedule. The percentage shown against Items 2 to 18 are of your chosen Accidental Permanent Disablement Benefit shown in the Schedule. The compensation being a percentage of the Sum Insured stated in the Schedule. Injury resulting directly in: - Insured Event Schedule # Percentage Death 1. 100% Permanent Total Disablement 2. 100% Permanent and incurable paralysis of all limbs 3. 100% Permanent Total Loss of Sight of both eyes 4. 100% Permanent Total Loss of Sight of one eye 5. 100% Permanent Total Loss of Use of two limbs 6. 100% Permanent Total Loss of Use of one limb 7. 100% Permanent and incurable insanity 8. 100% Permanent Total Loss of hearing in a. both ears 9a. 80% b. one ear 9b. 20% Permanent Total Loss of four fingers and thumb of either hand 10. 80% Permanent Total Loss of the lens of one eye 11. 60% Permanent Total Loss of Use of four fingers of either hand 12. 50% Third degree burns and/or resultant disfigurement which covers more than 40% of the entire external body 13. 50% Permanent Total Loss of Use of one thumb of either hand both joints 14a. 30% one joint 14b. 15% Permanent Total Loss of Use of fingers of either hand a. three joints 15a. 10% b. two joints 15b. 7.5% c. one joint 15c. 5% Permanent Total Loss of Use of toes of either foot a. all - one foot 16a. 15% b. great - both joints 16b. 5% c. great one joint 16c. 3% d. other than great, each toe 16d. 1% Fractured leg or patella with established non-union 17. 10% Shortening of leg by at least 5cm 18. 7.5% 5 P a g e
Additional Benefits 1 Exposure If as a result of an Injury occurring during the Operative Time within the Period of Insurance you are exposed to the elements and suffer from any of the Insured Events set out in the Table of Benefits as a direct result of that exposure, we will pay compensations accordingly. 2 Disappearance If you disappear following the disappearance, sinking or wrecking during the Operative Time within the Period of Insurance of a conveyance in which you were then travelling and your body has not been found within one (1) year after the date of disappearance, we will pay a compensation on the assumption that you died as a result of an Injury at the time of the disappearance, sinking or wrecking of the conveyance provided that the person or persons to whom such sum is paid shall sign an undertaking to refund such sum to us if you are subsequently found to be living. 3 Injury Resulting in Fractured Bones Insured Events Benefit Amount The following Event(s) which have been diagnosed within 3 months from the date of the Accident The compensation being a percentage of the Sum Insured stated in the Schedule. Injury resulting directly in: - Complete Fracture of neck, spine or skull 19. 100% Hip. 20. 75% Other Fracture of jaw, pelvis, leg, ankle or knee, 21. 50% Cheekbone, shoulder or Hairline Fracture of neck, skull or spine. 22. 40% Other Fracture of arm, elbow, wrist or ribs (per rib) 23. 30% Simple Fracture of jaw, pelvis, leg, ankle or knee 24. 25% Nose or collarbone, 25. 25% Simple Fracture of arm, elbow, wrist or ribs (per rib) 26. 25% Finger (per Finger), Thumb (per Thumb), Foot, Hand or Toe (per Toe) 27. 10% 6 P a g e
General Conditions & Limitations 1. Compensation shall not be payable for more than one of the Insured Events 1-18 in respect of the same Injury, in which case the highest compensations will be payable. 2. The maximum benefit payable for any one (1) Injury resulting in fractured bones under Insured Events 19--27 shall be the amount shown in the Schedule. 3. No further compensation will be payable under this Policy and all cover under this Policy will cease if You become entitled under this Policy to the payment of a Sum Insured being 100% of the Sum Insured stated in the Schedule under Insured Events 1-18. 4. No compensations are payable unless as soon as possible after the happening of any Injury you obtain and follow medical advice from a Medical Practitioner. 5. 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. 6. 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. 7. The benefits of this policy depend on you 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 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. 8. 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. 9. We may request a progressive claim form be completed by your attending physician or specialist. 10. This Policy may be cancelled by you at any time by giving us written notice. 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. 11. All cover for You under this Policy shall cease upon your attaining the age of sixty-five (65) unless otherwise indicated on the Schedule. 12. All compensations shall be paid to you, or in the case of your death, to your legal personal representative. 13. Any claim or benefit paid under this policy will be paid in the same currency as premium quoted. 7 P a g e
Exclusions A. No compensations are payable under this Policy for any loss, claim or event: 1. Which results from any Pre-Existing Condition (as defined); 2. Which results from illness, sickness or disease. 3. Resulting from Injury which is deliberately self-inflicted or caused by you, including suicide or attempted suicide whether sane, insane or under any mental distress; 4. Which results from you engaging in: a) air travel except as a passenger in any properly licensed aircraft; b) or taking part in or training for professional sports of any kind or for any code of football; c) racing and/or time trials of any form, other than on foot; d) tasks as a bicycle courier, Long Distance or Heavy Haulage Delivery, mining activities either above or below ground, security guard either armed or unarmed; e) any activity which requires a licence, permit, qualification or formal training if such authorities have not been obtained or are not current; f) any activities at exposed heights above 5 metres; g) any activities at exposed depths below 10 metres whether underground or underwater; h) any activities involving the use of firearms, explosives, hazardous or classified dangerous chemicals or asbestos; 5. Which results from a criminal or illegal act committed by you; 6. Which results from you being under the influence of an illegal drug or there is more alcohol or drugs in your blood than the law permits for the activity you are carrying out in the state where the Injury occurs; 7. Which is attributable wholly or partly to childbirth or pregnancy or the complications of these; 8. Which results from a sexually transmitted disease, or Acquired Immune Deficiency Syndrome (AIDS) disease or Human Immunodeficiency Virus (HIV) infection; 9. Which results from you engaging in or taking part in naval, military or air force service or operations; 10. Which occurs as a result of war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power or confiscation or nationalisation or requisition or destruction of or damage to property by or under the order of any Government or Public or Local Authority; 11. Which occurs as a result of the use, existence or escape of nuclear weapons material or ionising radiation from or contamination by radioactivity from any nuclear fuel or nuclear waste from the combustion of nuclear fuel; 12. Which results from losses arising from nuclear, chemical or biological terrorism. Terrorism includes, but is not limited to, any act, preparation in respect of action or threat of action, designed to: a. influence a government or any political division within it for any purpose, and/or 8 P a g e
b. influence or intimidate the public or any section of the public with the intention of advancing a political, religious, ideological or similar purpose; B. Sanction Limitation and Exclusion Clause LMA3100 No (re)insurer shall be deemed to provide cover and no (re)insurer shall be liable to pay any claim or provide any benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose that (re)insurer to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America. Governing Law & Jurisdiction This policy shall be governed and construed in accordance with the laws of Australia. Any dispute under this policy shall be resolved in accordance with the laws of Australia. Subrogation If we make any payments under the Policy to you, then, to the extent you may have a cause of action for loss or damage against any third party in respect of the facts, matters and circumstances which gave rise to the payments being made under the Policy, then we have a right of subrogation and repayment including any claim for interest by way of an action which may be brought in the name of you against such third party. You must provide reasonable cooperation to us in pursuing any such right. If you bring a claim for loss or damage in their own name against a third party in respect of the facts, matters and circumstances which gave rise to the payments being made under this Policy, then you must include in your claim any payments which may be recoverable from the third party including a claim for interest (recoverable payments) and should you recover damages against the third party either by way of settlement or judgment then you must repay to us out of any such damages the recoverable payments which you received under this Policy. We will provide reasonable cooperation to you and your legal advisers in bringing any such action. 9 P a g e
Contact Details YourCover Pty Limited trading as ROOBYX (YCR) ABN 35 169 038 66 AFS Licence No: 461299 Phone YourCover Pty Ltd is a Lloyd s Coverholder Email 1800 ROOBYX (1800 766 299) or 07 3010 9746 (Monday to Friday from 8.30am to 5.30pm, Brisbane time, except public holidays) Fax: 07 3010 9001 info@roobyx.com (Website www.roobyx.com) Post GPO Box 111, Brisbane QLD 4001 Lloyd s General Representative in Australia Phone 02 8298 0783 Email Post idraustralia@lloyds.com Lloyd s Australia Limited Level 9, 1 O Connell Street, Sydney NSW 2000, Australia Financial Ombudsman Service (FOS Australia) Phone 1800 367 287 Email info@fos.org.au (Website www.fos.org.au) Post GPO Box 3, Melbourne VIC 3001 Office of the Australian Information Commissioner (OAIC) Phone Email 1300 363 922 (Monday to Friday from 9am to 5pm, Sydney time, except on public holidays). enquiries@oaic.gov.au (Website www.oaic.gov.au) Post GPO Box 5218, Sydney NSW 2001 10 P a g e