Professional Documents
Culture Documents
PA Policy Wording V3
PA Policy Wording V3
PA Policy Wording V3
Welcome
Thank you for choosing to purchase your personal accident
insurance from Zurich.
We have 140 years experience of protecting our customers against the unexpected,
and we pride ourselves on providing high quality insurance solutions in more than
170 countries.
Zurich has been serving customers in the Middle East for over 25 years. Our
commitment to the region has seen us develop our business in Oman, Kuwait,
Lebanon, Bahrain and the UAE.
As a Zurich customer, youll benefit from being with one of the leading and most
secure financial services groups in the world. Our global expertise combined with
our regional understanding means that you can be sure you will benefit from
products and services tailored to your individual needs.
We hope you are happy with the your policy and look forward to having the
opportunity to be your preferred insurance provider for many years to come.
Contents
Making a claim............................................................................................................ 5
Personal accident insurance cover................................................................................ 6
Part 1: Definitions........................................................................................................ 7
Part 2: Important information...................................................................................... 9
Part 3: Benefits and covers.........................................................................................10
Part 4: General exclusions...........................................................................................14
Part 5: General conditions..........................................................................................17
Part 6: General provisions...........................................................................................18
Part 7: Our complaints procedure...............................................................................24
Making a claim
Please notify us within thirty days of any occurrence likely to give rise to a claim.
If you wish to make a claim, please contact us on:
claims.me@zurich.com
Bronze
Silver
Gold
Platinum
Accidental Death
100,000
250,000
500,000
1,000,000
Accidental Death
(common carrier)
Permanent Partial
Disablement
Permanent Total
Disablement
500,000
1,250,000
2,500,000
5,000,000
110,000
275,000
550,000
1,100,000
110,000
275,000
550,000
1,100,000
Bronze
Silver
Gold
Platinum
Accidental Death
100,000
250,000
500,000
1,000,000
Accidental Death
(common carrier)
Permanent Partial
Disablement
Permanent Total
Disablement
500,000
1,250,000
2,500,000
5,000,000
110,000
275,000
550,000
1,100,000
110,000
275,000
550,000
1,100,000
Benefit
Bronze
Silver
Gold
Platinum
Accidental Death
100,000
250,000
500,000
1,000,000
Accidental Death
(common carrier)
Permanent Partial
Disablement
Permanent Total
Disablement
500,000
1,250,000
2,500,000
5,000,000
110,000
275,000
550,000
1,100,000
110,000
275,000
550,000
1,100,000
Family
Part 1: Denitions
Certain words have specic meanings when they appear in this policy.
These meanings are shown below or in the section where they apply.
They are printed in bold type. Any other words not appearing in the
denition section will follow the English language denition:
Accident a sudden, unforeseen and unusual specic event that happens
unexpectedly caused solely and directly by violent, external and visible means
which occur at an identiable time and place resulting in injury and which is
the sole and direct cause of accidental death or disablement.
Accidental death loss of life due to an accident as determined by a
physician/medical practitioner.
Beneciary The person or persons nominated by the insured person as stated
on the policy schedule, if not mentioned then the beneciary will be the legal
heirs of the insured person.
Children/child Biological off-springs, legally adopted or fostered children of the
insured person who are not in full-time employment, unmarried, not pregnant,
without children, primarily dependent on the insured person for support and who
are between the ages of three (3) months and eighteen (18) years. Or under twenty
three (23) years of age if a full time student
Close relative Spouse, parent, parent-in-law, grandparent, son or daughter,
son or daughter-in-law, brother or sister, brother or sister-in-law, grandchild,
legal guardian, children or anc(e) of the insured person.
Country of residence Your normal place of residence or dwelling in the
United Arab Emirates of which you are a citizen or hold a valid resident status as
of the time of the policy issuance.
Excess The rst amount of any claim for which you are responsible to pay for
any one event. Or the amount we will subtract from any covered loss that we pay.
Or the time period during which any claim will not be paid. If claims are made under
two or more covers, for loss or damage caused by the same insured incidence at the
same time, excess shall apply for each section as stated in the policy schedule.
Family The insured person, spouse and unlimited dependent children.
Injury Bodily injury sustained in an accident directly and independently of all
other causes.
Insurance period The date specied in your policy schedule.
limited to aircraft, bus, coach, ferry, hovercraft, hydrofoil, ship, train, tram or
underground train.
Quadriplegia Permanent loss of use of both arms and both legs.
Spouse A person who has a legitimate marital contract to the insured person as
recognized by United Arab Emirates laws between the ages of eighteen (18) years
and seventy (70) years.
Sum insured Maximum amount payable under each cover of the policy schedule
as set to be payable by the policys terms and conditions.
We/us/our/ours Zurich Insurance Middle East S.A.L.
Eligibility
To be eligible for this insurance:
You must be a valid resident of the United Arab Emirates; and
have a valid business, employment or residency visa in the United Arab Emirates;
Age limit
You must be between the ages of eighteen (18) years and seventy (70) years at the
commencement date of this policy.
Chosen plan
There are four (4) available plans to choose from and your policy schedule will show
the plan you have chosen.
You may elect to extend your plan to include your spouse or your family as per
the terms, conditions and limits set forth in this policy and provided the premium is
paid for the appropriate extension and we agree to accept it.
Geographical areas
Unless specically mentioned in the schedule, your cover does not apply to Iraq
and Afghanistan and in countries where war has been declared or after it has
been recognized as a war zone by the United Nations.
Policy information
If you require information or advice on any aspect of this policy please
contact us on 0800 ZURICH (987 424)
Compensation Table
Events
1. Accidental death or accidental death
(public common carrier)
2. Permanent total disablement
A. Permanent paraplegia, quadriplegia or incurable
paralysis of all limbs
3. Permanent partial disablement
A. Permanent total loss of sight of both eyes
B. Permanent total loss of sight of one eye
C. Loss of or the permanent total loss of use of two limbs
D. Loss of or the permanent total loss of use of one limb
(i) Right hand
(ii) Left hand
(iii) One foot
E. Loss of speech and hearing
F. Permanent total loss of hearing in
(i) both ears
(ii) one ear
G.
Loss of speech
H. Loss of or the permanent total loss of use of four ngers
and thumb of
(i) Right hand
(ii) Left hand
I. Loss of or the permanent total loss of use of four ngers of
(i) Right hand
(ii) Left Hand
J. Loss of or the permanent total loss of use of one thumb
(i) both right joints
(ii) one right joint
(iii) both left joints
(iv) one left joint
K. Loss of or the permanent total loss of use of ngers
(i) three right joints
(ii) two right joints
(iii) one right joint
Percentage of
maximum benets
100%
100%
100%
100%
25%
100%
70%
50%
70%
100%
75%
15%
50%
70%
50%
40%
30%
30%
15%
20%
10%
15%
10%
7.50%
10%
7.50%
5%
20%
7.50%
5%
2%
Such percentage
of the lump sum
amount as we in our
absolute discretion
shall determine and
being in our opinion
not inconsistent with
the compensation
provided under Event
3. Event 4 is limited
to 75% of the
maximum amount
shown in the policy
schedule.
All covers and benets provided under this policy will be subject to the following
provisions and limitations:
Should more than one (1) of the covers occur from the same accident and/or injury,
the total indemnity payable shall be computed by adding the indemnity payable
corresponding to each cover with 100% as the highest compensation payable.
No indemnity will be paid under any circumstances for more than one of the losses
payable for section A or section B.
The insurance for any insured person under this policy shall terminate upon the
occurrence of any compensation for which total indemnity is 100% payable, but
such termination shall be without prejudice to any claim originating out of the
accident causing such loss.
When a limb or organ which had been partially disabled prior to an injury covered
under this policy and which becomes totally disabled as a result of such injury, the
6. Insanity, mental or nervous disorders including, but not limited to, anxiety
disorders, eating disorders, psychotic disorders, affective disorders, personality
disorders, substance use disorders, somatoform disorders, dissociate disorders,
psychosexual disorders, adjustment disorders, organic mental disorders, mental
retardation and autism;
7. (a)
(b) alcohol abuse, alcoholism, substance abuse, solvent abuse, drug abuse or
addictive conditions of any kind;
(c) an insured person being under the inuence of alcohol with more than the
legal limit of alcohol in his/her blood or breath;
8. Any condition resulting from pregnancy, childbirth or miscarriage, abortion,
pre-natal care as well as post-natal care and other complications arising
therefrom, venereal disease, services and supplies related to the diagnosis or
treatment of infertility or other problems related to inability to conceive a child;
birth control, including surgical procedures and devices;
9. Congenital anomalies and conditions arising out of or resulting there from,
and hernia;
10. Air travel where the insured person is acting as pilot or part of the aircraft crew
other than as a fare-paying passenger on a regular scheduled airline or licensed
chartered aircraft;
11. Flying in any aircraft owned, leased or operated by or on behalf of an insured
person or close relative;
12. Engaging in any kind of occupational activities underground or aerial
photography; handling or requiring the use of explosives; naval, military or
airforce service or operations or armed force services (including being in service
or on duty with or undergoing training with any military or police force, or militia
or paramilitary organization);
13. Any Injury, illness, death, loss, expense or other liability attributable to HIV
(Human Immunodeficiency Virus) and/or HIV-related illness including AIDS and/or
any mutant derivative or variations thereof however caused or however named;
14. Any sexually transmitted or transmissible disease, or infection or virus of any sort
emanating from a sexually transmitted or transmissible disease;
or benet to any insured or other party to the extent that such cover, payment,
service, benet and/or any business or activity of the insured would violate any
applicable trade or economic sanctions law or regulation.
5. Age Limit
The insurance shall apply to an insured person who is eighteen (18) years to
seventy (70) years of age on the commencement date of this policy. When a
family policy is issued, the children must be aged between three (3) months and
eighteen (18) years, Or under twenty three (23) years of age if a full time student
6. Misstatement of Age
If the insured persons age has been misstated, the premium difference would be
returned or charged according to the correct age. In the event that the insured
persons age has been misstated and if, according to the correct age, the coverage
provided by this policy would not have become effective, or would have ceased
prior to the acceptance of each premium or premiums, then our liability during the
period that the insured person is not eligible for coverage shall be limited to the
refund of all premiums paid for the period covered by this policy.
7. Liability
We shall not be liable or responsible for: a) the negligence, wrongful acts and/or
omissions of any legal and/or health care professional or any other person or
persons or legal entity that provide direct or indirect service to the insured
person; b) The failure of any agent or broker to explain adequately the terms,
conditions, endorsements, terminations and exclusions of this policy.
8. Notice of Claims
Written notice of claim must be given to us within thirty (30) days of the date of
the incident causing such loss. In the event of accidental death, immediate
notice thereof must be given to us by the insured persons legal representative.
9. Proof of Loss
Written proof of loss must be furnished to us within thirty (30) days from our
receipt of the claim form provided by us. Failure to furnish such proof within the
time required shall not invalidate any claims if it was not reasonably practicable to
give proof within such time, provided that such proof is furnished as soon as
reasonably practicable, and in no event later than ninety (90) days from the time
when such proof is otherwise required. All certicates, information and evidence
in such form and of such nature and within such time as we may reasonably
require shall be furnished without expense to us.
10. Medical Examination
We shall be entitled in the case of non-fatal injury to call for examination by a
medical referee appointed by us whenever required and in the event of death to
have a post-mortem examination at our expense.
termination has been given, a grace period will be granted for the payment of
any premium falling due after the rst premium, subject to the terms of General
Provision 19 Grace Period. We shall not be liable for any claim arising under
this policy that occurs prior to receipt of the premium. We shall not be obliged to
accept premium tendered to us or to any intermediary after such date, but may
do so at our discretion. We reserve the right to ask for proof of payment of
premium at any time. Such proof must be to our satisfaction.
19. Grace Period
We will allow the insured person one calendar month for the payment of each
premium falling due after the rst premium. During this period we will keep this
policy in force. The insured person shall be liable to pay us the premium for the
period the policy continues in force. If any claims occur during this period, the
outstanding balance must be paid to us in full before we settle the claim.
If after this period the premium remains unpaid, this policy will lapse at the end
of the grace period.
In the event the plan offered to the insured person under the policy for which
the Annual Premium has been paid in advance is cancelled by the insured
person or us, the unearned premium shall be refunded on a pro-rata basis for
the balance of the months of cover due under the plan.
23. Termination of Coverage
Coverage under this policy shall automatically terminate at the earliest of the
dates specied below:
(i) the premium due date when any or any part of the premium pertaining to
this policy is not paid within the grace period (General Provision 19
Grace Period and General Provision 18 Premium Payments);
(ii) the date when the insured person exceeds the age limit as stated in the
policy schedule;
(iii) upon the insured persons request, termination of coverage will be
effective on the date specied in the written notice received by us, provided
that fteen (15) days notice of cancellation is given;
(iv) subject to the above General Provision 13 Misrepresentation;
(v) the date the policy expires on the expiry date;
(vi) the date the insured person is no longer eligible within the classication of
insured persons
24. Governing Law and Jurisdiction
This policy shall be governed by and construed in accordance with the laws of
the United Arab Emirates. All disputes arising hereunder shall be referred to the
exclusive jurisdiction of the courts of the United Arab Emirates.
25. Language
This policy has been written in both the English and Arabic languages. In the event
of any discrepancy in interpreting this policy, the Arabic language will prevail.
26. Statement of Purpose for Collection of Personal Data
All the personal information collected or held by us, howsoever obtained, may
be used by us or disclosed to any individual or organization within or outside
United Arab Emirates for the following purposes: (1) to assess and service this
policy, (2) to process the direct debit authorization or credit card payment, (3) to
provide marketing material for us or our associated companies and (4) to
conduct insurance claims or analysis.
84
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:
claims.me@zurich.com
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