GEN ER AL TER M S
AN D CO N DITIO N S
GR O U P PLU S
GR O U P PER SO N AL ACCIDEN T
IN SU R AN CE
General terms and conditions
Grou p Plu s Grou p Accident Insu rance v ersion 2010/ 01
Y ou will find ou r Glob al Priv acy Policy on h ttp:/ / www.aig.com/ nl-priv acy b eleid (a copy can also b e ob tained b y mail or b y ph one).
1/ 13
GEN ER AL TER M S AN D CO N DITIO N S
GR O U P PLU S
GR O U P ACCIDEN T IN SU R AN CE
Article
Description
Page
1
DEF IN ITIO N S
3
2
GEN ER AL CO N DITIO N S
5
3
PER SO N AL ACCIDEN T
8
CLAU SES SH EET TER R O R ISM CO V ER
11
General terms and conditions
Grou p Plu s Grou p Accident Insu rance v ersion 2010/ 01
Y ou will find ou r Glob al Priv acy Policy on h ttp:/ / www.aig.com/ nl-priv acy b eleid (a copy can also b e ob tained b y mail or b y ph one).
2/ 13
A R T ICLE 1 – D E F IN IT IO N S
In th is policy th e following terms sh all h av e th e following meanings:
1 .1
Co m p an y
AIG Eu rope Limited, N eth erlands.
1 .2
P o lic y h o ld e r
Th e person wh o h as tak en ou t th is insu rance with th e Company and wh o is named as su ch in th e policy
sch edu le.
1 .3
T h e In su r e d
Th e person wh ose interest is protected b y th e insu rance and wh o is named as su ch in th e policy sch edu le.
1 .4
P ar tn e r
Th e spou se or th e person liv ing for du rab le time with th e Insu red (for at least 1 y ear at th e time of th e
Accident).
1 .5
Ch ild r e n
U nmarried ch ildren of th e Insu red, aged u nder 27 y ears, eith er residing with h im/ h er or liv ing away from
h ome for edu cation pu rposes.
1 .6
B e n e fic iar ie s
Ev ery person wh o is designated as su ch in th e policy ; in th e ab sence th ereof:
In th e ev ent of death : th e spou se of th e Insu red, or h is/ h er legally registered Partner; in th e ab sence
of su ch : th e legal h eirs with th e ex clu sion of th e state.
In all oth er cases: th e Insu red.
1 .7
A c ts o f w ar
Ex ceptional circu mstances su ch as armed conflict, civ il war, reb ellion, civ il u nrest, riots a mu tiny . Th ese
six ty pes of acts of war, as well as th e definitions th ereof, form part of th e tex t dated 2 N ov emb er 1981
th at th e V erb ond v an V erz ek eraars with in Th e N eth erlands (Du tch Association of Insu rers) deposited with
th e District Cou rt of Th e H agu e in Th e N eth erlands, and wh ich , as su ch , forms part of th is insu rance.
1 .8
A c c id e n t
An ev ent wh ereb y th e Insu red, independently of h is/ h er will, is su ddenly stru ck b y ex ternal v iolence
affecting h im/ h er, on accou nt of wh ich h e/ sh e is b odily inju red in an instant, wh ich may or may not resu lt
in death , prov ided th e natu re and location of th e inju ry or th e cau se of death can b e medically
estab lish ed, th e inju ry was not inflicted intentionally b y th e Insu red, and th e inju ry is not th e resu lt of a
disease. It is ex pressly stipu lated th at inju ry , as a direct conseq u ence of a disease, sh all not b e considered
an Accident itself.
Accident sh all also b e tak en to mean:
a.
Th e conseq u ences of incorrect medical treatment, wou nd infection or b lood poisoning directly
related to an insu red Accident;
b.
Inju ry resu lting from lawfu l self-defence, rescu e or attempted rescu e of h u man b eings, animals or
property in jeopardy ;
c.
Th e acu te and u nintentional ingestion of solid, liq u id and/ or gaseou s su b stances wh ich are
detrimental to a person’s h ealth ;
d.
Animal b ites and insect b ites;
e.
Spraining, wrench ing, dislocating, straining or tearing of a mu scle, tendon, ligament
or capsu le;
General terms and conditions
Grou p Plu s Grou p Accident Insu rance v ersion 2010/ 01
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f.
g.
h.
i.
j.
Ex h au stion and h ardsh ip wh en isolated from th e ou tside world du e to a disaster (flood,
sh ipwreck , emergency landing, collapse, and su ch lik e), ex ceptional weath er conditions, frostb ite,
h eatstrok e, u nintentional drowning, u nintentional su ffocation (not as a resu lt of an illness),
ligh tning, su nstrok e;
B acterial poisoning resu lting from an u nintentional fall into a solid or liq u id
su b stance;
Cowpox , anth rax , foot and mou th disease, scab ies, trich oph y th on and b ov ine
b ru cellosis (B ang’s disease);
Lu mb ago (b ack ach e), inflammation of th e tendon (tendov aginitis crepitans), wh iplash
(cou p de fou et), tennis elb ow (epicondy litis h u meri), slipped disk and h ernia,
prov ided th ey h av e b een su rgically rectified;
An Accident th at was cau sed b y an illness, oth er th an a mental illness or a
psy ch ological disorder.
1 .9
P e r m an e n t D isab le m e n t
Permanent total or partial loss or disab lement of any part of th e b ody or organ (or part th ereof).
1 .1 0
Lo ss o f a lim b
In th e ev ent of a leg or lower limb :
a.
Loss b y permanent ph y sical sev erance of a foot at or ab ov e th e ank le, or
b.
Permanent and complete loss of th e u se of a complete foot or a complete
leg.
In th e ev ent of an arm or u pper limb :
a.
Loss b y permanent ph y sical sev erance of th e fou r fingers at or ab ov e th e
metacarpoph alangeal joints (wh ere th e fingers are attach ed to th e palm of
th e h and), or
b.
permanent and complete loss of a complete arm or h and.
1 .1 1
Lo ss o f sig h t
Permanent and complete loss of sigh t: a) in b oth ey es, and b ) in one ey e if th e v ision after
correction is 1/ 20 or less on th e Snellen scale.
1 .1 2
P ar ap le g ia
Permanent and complete paraly sis of th e two lower limb s, b ladder and rectu m.
1 .1 3
Q u ad r ip le g ia
Permanent and complete paraly sis of th e two u pper limb s and th e two lower limb s.
1 .1 4
A n n u al salar y
Annu al salary sh all b e tak en to mean:
a.
F or th e su m insu red: th e Insu red wages as declared to th e tax au th orities, ov er a
period of twelv e month s immediately prior to th e Accident. If th e employ ment did not last a fu ll
period of twelv e month s, it will b e dedu ced as if th e employ ment h ad ex isted du ring th e period
referred to.
b.
F or th e calcu lation of th e premiu m: th e Insu red total annu al earnings as to b e declared to th e tax
au th orities.
1 .1 5
A c c u m u latio n lim it
Th e total max imu m amou nt th at th e Company sh all pay u nder th is and oth er accident insu rance policies
issu ed b y th e Company in th e name of th e Policy h older for ph y sical inju ries su ffered b y all th e Insu red in
th e ev ent of an Accident or a series of accidents, cau sed b y or as a resu lt of th e same cau se, ev ent or
circu mstance.
General terms and conditions
Grou p Plu s Grou p Accident Insu rance v ersion 2010/ 01
Y ou will find ou r Glob al Priv acy Policy on h ttp:/ / www.aig.com/ nl-priv acy b eleid (a copy can also b e ob tained b y mail or b y ph one).
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Th e conseq u ent redu ction of liab ility in v iew of th is Accu mu lation limit sh all b e made proportionally to th e
su ms insu red for each Insu red.
1 .1 6
H o sp ital
An institu tion for th e medical treatment of b edridden patients, wh ich h as:
diagnostic and su rgical facilities;
a nu rsing staff 24 h ou rs a day ;
is u nder th e su perv ision of ph y sicians and
is not a nu rsing h ome, a rest h ome, an old people’s h ome or a psy ch iatric institu tion (also for
b eh av iou ral disorders), sanatoriu m or clinic for th e treatment of alcoh ol or dru gs addicts; ev en wh en
th ese facilities are at th e same location.
1 .1 7
Co m p e te n t p h y sic ian
A medical practitioner wh o gradu ated from a medical facu lty listed in th e ‘Directory of M edical Sch ools of
th e W orld H ealth O rganisation’, wh o h olds a license issu ed b y th e medical au th orities of th e cou ntry
wh ere h e practices and wh o practices medicine with in th e framework of h is applicab le license and
training.
A R T ICLE 2 - G E N E R A L CO N D IT IO N S
2.1
D e sc r ip tio n o f th e c o v e r
Th is insu rance policy sh all prov ide cov er for accidents occu rring du ring th e term of th e insu rance and
falling with in th e limitations describ ed in th is policy .
2.2
T e r r ito r ial sc o p e
W orldwide.
2.3
P e r io d o f in su r an c e an d te r m in atio n o f th e in su r an c e
Th e insu rance policy sh all tak e effect on th e date stated in th e policy sch edu le and continu e for a fix ed
period of 12 month s, u nless specified oth erwise. Th e policy sh all b e tacitly renewed each time for a period
of 12 month s or for a period as specified oth erwise, u nless th e Company or th e Policy h older cancels th e
insu rance b y registered letter at least 2 month s b efore th e end of su ch period.
2.4
P ay m e n t o f p r e m iu m s
Th e premiu m is du e on th e premiu m du e date as stated in th e policy sch edu le.
If th e Policy h older h as not paid th e premiu m in th e prescrib ed manner, h e sh all b e in defau lt b y operation
of law with ou t fu rth er notice of defau lt or with ou t ju dicial interv ention. After th e premiu m du e date th e
Policy h older will b e giv en an opportu nity once to pay th e premiu m with in a term of 14 day s.
If th e Policy h older does not pay th e premiu m, or does not pay th e premiu m in time, no cov er sh all b e
prov ided for ev ents occu rring as from th e fifteenth day of th e date on wh ich th e Company sent th e
Policy h older a written demand for pay ment after th e du e date and pay ment h ad not b een made. Th e
Policy h older sh all remain ob liged to pay th e premiu m.
N o cov er sh all b e prov ided u nder th is policy for ev ents th at took place du ring th e period in wh ich th e
insu rance was interru pted.
2.5
Ch an g e o f r isk /in c r e ase d r isk
If th e Policy h older ch anges h is b u siness activ ities in relation to th e activ ities h e specified at th e start of th e
policy , h e sh all immediately notify th e Company th ereof.
If su ch ch ange inv olv es an increased risk , th e Company reserv es th e righ t to amend th e premiu m and
th e conditions of insu rance. Th e Policy h older sh all h av e th e righ t to reject th e amended premiu m and
conditions of insu rance and to cancel th e policy with in 60 day s of th e date on wh ich h e was informed of
th e ch ange.
General terms and conditions
Grou p Plu s Grou p Accident Insu rance v ersion 2010/ 01
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2.6
Ch an g e o f p r e m iu m an d /o r c o n d itio n s
Th e Company sh all h av e th e righ t to ch ange th e premiu m and/ or conditions of certain insu rance produ cts
en b loc. If th is policy b elongs to su ch a grou p of produ cts, th e Company sh all h av e th e righ t to ch ange th e
premiu m and/ or conditions of th is policy in accordance with th at ch ange and to do so with effect from a
date to b e determined b y th e Company .
Th e Company sh all inform th e Policy h older in writing of th e ch ange(s) at least 2 month s b efore th e date
wh en th e ch ange(s) will tak e effect. Th e Policy h older sh all b e deemed to h av e accepted th is u nless h e
cancels th e agreement with in 1 month after notification of th e ch ange(s).
Th e Policy h older sh all not h av e th e righ t to cancel th e policy if th e ch ange inv olv es a redu ction of th e
premiu m and/ or an ex tension of th e cov er.
2.7
Can c e llatio n in th e e v e n t o f ac ts o f w ar
Th e Company and th e Policy h older may cancel any cov er for Acts of war with in th e meaning of article 1.7
of th ese terms and conditions, if su ch risk is manifested or if th is is ab ou t to h appen, su b ject to sev en day s'
notice.
2.8
T r an sfe r
Th e policy cannot b e transferred u nless agreed u pon oth erwise in writing with th e Company .
2.9
P e r io d o f lim itatio n
A claim against th e Company to mak e a pay ment sh all lapse b y th e passage of th ree y ears after th e start
of th e day following th e day on wh ich th e person entitled to pay ment b ecame aware of th e pay ment b eing
du e and pay ab le.
Th e period of limitation sh all b e interru pted b y a written notification wh ereb y a claim to pay ment is made.
A new period of limitation sh all commence with th e start of th e day following th e day on wh ich th e
Company eith er ack nowledges th e claim or u namb igu ou sly annou nces b y registered letter th at it h as
rejected th e claim, stating u namb igu ou sly th at in th e ev ent of rejection th e claim sh all lapse b y th e
passage of six month s.
2.1 0
A d d r e ss
All notifications to th e Policy h older with regard to th is insu rance policy mu st b e effected in writing and mu st
b e sent b y th e Company to th e Policy h older’s last k nown address.
2.1 1
P e r so n al D ata
Personal data (h ereinafter th e “ Data” ) will b e collected and processed b y th e Company in accordance with
th e Code of condu ct for th e processing of personal data b y financial institu tions (“ Code of Condu ct” ). Th e
Company is th e controller responsib le for th e processing of th ese Data and th e processing is notified to th e
Personal Data Protection Commission. Th e Data will b e processed for th e pu rpose of th e u se of th e
serv ices prov ided b y th e Company , inclu ding risk assessment, contract management, claims h andling and
crime prev ention (su ch as frau d) as well as to allow th e Company to fu lfill its legal ob ligations. In
connection with th e Company ’s activ ities and for th e pu rpose of good serv ice, th e Company may transfer
th ese Data to oth er companies of th e grou p of companies it b elongs to, to su b contractors or to partners.
Th ese companies, su b contractors or partners may b e located in cou ntries ou tside th e Eu ropean Economic
Area th at do not necessarily offer th e same lev el of protection as Th e N eth erlands. W ith regard to th ese
transfers, th e Company will tak e precau tionary measu res to ensu re th e protection of Data in th ese
cou ntries as well as possib le. U nless th e data su b ject ob jects h ereto, th e Data can b e u sed b y th e
Company for mark eting pu rposes. According to th e Code of Condu ct, th e data su b ject is entitled to
access, ammend or oppose (for a reasonab le cau se) to th e processing of Data. To ex ercise th ese righ ts,
th e data su b ject can contact AIG at any time in writing at K .P. v an der M andelelaan 50, 3062 M B
R otterdam. F or fu rth er information on th e mech anisms for processing y ou r Data b y AIG, y ou will find
AIG’s complete Glob al Priv acy policy on h ttp:/ / www.aig.com/ nl-priv acy b eleid.
General terms and conditions
Grou p Plu s Grou p Accident Insu rance v ersion 2010/ 01
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2.1 2
G o v e r n in g law an d c o m p lain ts
Du tch law sh all apply to th is insu rance, u nless stated oth erwise in th e policy sch edu le.
Complaints and dispu tes relating to b rok erage serv ices, th e effecting and th e performance of th e
insu rance contract may b e su b mitted to th e management of AIG Eu rope Limited, N eth erlands, PO B ox
8606, 3009 AP R otterdam, Th e N eth erlands.
If th e Policy h older, th e Insu red and/ or th e B eneficiary (ies) are not satisfied with th e decision of th e
Company , th e K lach teninstitu u t F inancië le Dienstv erlening, PO B ox 93257, 2509 AG Th e H agu e, Th e
N eth erlands, tel. + 31 (0)70 33 38 999 may b e contacted.
If th e Policy h older, th e Insu red and/ or th e B eneficiary (ies) do not wish to av ail th emselv es of th is possib ility
or are not satisfied with th e treatment or ou tcome th ereof, th ey may su b mit th e dispu te to th e competent
cou rt.
2.1 3
A g e lim it
As soon as th e Insu red h as reach ed th e age of 85, th e insu red amou nts, in th e ev ent of death or
Permanent Disab lement as a conseq u ence of an Accident, sh all b e decreased b y 50% or u p to €
100.00,00, depending on wh ich amou nt is th e lowest.
2.1 4
N o tific atio n
Th e Policy h older, th e Insu red and/ or B eneficiary (ies) sh all b e ob liged:
a) In th e e v e n t o f d e ath :
to notify th e Company as soon as possib le of th e Accident, b u t alway s with in 48 h ou rs after th e
Accident h as occu rred;
to prov ide all th e information req u ired b y th e Company ;
to giv e th e ph y sician and/ or au th oriz ed person/ persons designated b y th e Company ev ery
opportu nity to inv estigate th e cau se of death ;
if deemed necessary , to allow au topsy .
b ) In all o th e r c ase s:
to inform th e Company as soon as possib le of th e Accident, b u t alway s with in 90 day s after th e
Accident h as occu rred;
to prov ide all th e information req u ired b y th e Company ;
to u ndergo medical treatment as soon as possib le and to continu e th is treatment;
to h av e oneself ex amined b y a ph y sician designated b y th e Company . Th e costs related to th is
ex amination sh all b e b orne b y th e Company .
2.1 5
F r au d
If th e Policy h older and/ or th e person entitled to pay ment fail(s) to comply with an ob ligation
specified, with th e intention to mislead th e Company , or do(es) not prov ide th e Company with all th e
information and docu ments th at th e latter req u ires to assess its ob ligation to pay , th e righ t to pay ment
sh all lapse, u nless su ch deception does not ju stify th e lapsing of th e righ t to pay ment. Th e person(s)
(Policy h older and/ or th e person entitled to pay ment) wh o h as/ h av e perpetrated su ch deception, sh all also
compensate th e Company for th e loss or damage incu rred as a resu lt of th is situ ation. Th e Company may
also dedu ct su ch damage from a pay ment if it concerns th e person entitled to pay ment.
2.1 6
In te r e st o n p ay m e n ts
U nless oth erwise prov ided, th e Company sh all not pay interest on pay ments to b e made.
General terms and conditions
Grou p Plu s Grou p Accident Insu rance v ersion 2010/ 01
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2.1 7
O b lig atio n s an d stip u latio n s
Th e Policy h older, th e Insu red and/ or th e B eneficiary (ies) sh all comply with th e ob ligations and stipu lations
set ou t in th e policy . If th e Policy h older, th e Insu red Person and/ or th e B eneficiary (ies) fail to do so, th e
Company may dedu ct any loss it incu rs as a resu lt of th is from th e claim.
2.1 8
D e v iatio n N H T -c lau se
W ith regard to an Accident wh ich is th e resu lt of terrorism, th e stipu lations and restrictions mentioned in
th e Clau ses Sh eet Terrorism Cov er enclosed apply . If th e pay ment to wh ich th e Insu red or B eneficiary is
entitled u pon application of th is clau ses sh eet is lower th an th e pay ment to wh ich h e/ sh e wou ld b e entitled
in accordance with th e stipu lations and accu mu lation limits of th is insu rance, sh ou ld th e restrictions u nder
th e enclosed clau ses sh eet not apply , th en, in th e ev ent of death or permanent disab ility as a resu lt of an
Accident as a resu lt of terrorism, as describ ed in th is clau se sh eet, th e cov er offered will b e su pplemented
to th e accu mu lation limits apply ing to th is insu rance.
A R T ICLE 3 - P E R S O N A L A CCID E N T
3.1
D e ath
If th e Insu red dies with in two y ears of an Accident, as a direct and sole conseq u ence of th at
Accident, th e su m insu red stated in th e policy sch edu le sh all b e paid.
Pay ment sh all b e made as soon as th e inv estigation b y th e Company into th e Accident, th e cau se of death
and th e connection b etween th e two h as b een completed.
All su ms already paid ou t pu rsu ant to th is insu rance policy for Permanent Disab lement as a resu lt of th e
same Accident sh all b e dedu cted from th is pay ment.
3.2
P e r m an e n t D isab le m e n t
Th e Company sh all pay a percentage of th e insu red amou nt to th e B eneficiary as stated in th e policy
sch edu le, dependent on th e degree of Permanent Disab lement wh ich is th e resu lt of an Accident.
Th e degree of Permanent Disab lement sh all b e assessed as soon as it h as reasonab ly b een
conclu ded th at th e condition of th e Insu red is not lik ely to improv e or deteriorate, b u t not later th an two
y ears after th e Accident. Th e degree of disab lement sh all b e ex pressed in a percentage.
Th e degree and th e percentage of Permanent Disab lement sh all b e assessed on th e b asis of an
independent ex amination b y a Competent ph y sician in accordance with ob jectiv e criteria.
W h en determining th e disab lement percentage any Permanent Disab lement ex isting prior to th e Accident
sh all b e dedu cted from th is percentage.
In th e ev ent th at th e Insu red dies b efore th e percentage h as b een determined, th e Company sh all not b e
ob liged to pay any Permanent Disab lement b enefit. H owev er, if th e Insu red does not die as a resu lt of th e
Accident, th e Company sh all pay th e amou nt th at it wou ld reasonab ly h av e ex pected to pay ou t for
Permanent Disab lement h ad th e Insu red not died.
In th e ev ent of loss or disab lement of th e b elow mentioned b ody parts/ organs, th e percentages mentioned
of th e insu red amou nt h ereafter for Permanent Disab lement sh all apply :
at least one limb
loss of ey esigh t
total paraly sis
incu rab le b rain damage
loss of speech
100%
100%
100%
100%
100%
General terms and conditions
Grou p Plu s Grou p Accident Insu rance v ersion 2010/ 01
Y ou will find ou r Glob al Priv acy Policy on h ttp:/ / www.aig.com/ nl-priv acy b eleid (a copy can also b e ob tained b y mail or b y ph one).
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h earing in b oth ears
h earing in one ear
sense of tou ch or smell
a th u mb
an index finger
oth er finger
a b ig toe
oth er toe
spleen
k idney
lower jaw as a resu lt of su rgical treatment
th e b ack or spine b elow th e neck with ou t damage to th e spinal cord
th e neck or neck v erteb rae with ou t damage to th e spinal cord
100%
30%
10%
30%
20%
10%
15%
7,5%
5%
20%
30%
40%
30%
In th e ev ent of partial permanent loss or partial permanent disab ility , a proportionate part of th e
percentage stated for complete loss or total disab lement sh all b e paid ou t pro rata to th e seriou sness of
su ch loss or disab lement. Th e determination will b e effected in accordance with th e latest edition of th e
‘Gu ide to th e Ev alu ation of Permanent Impairment’ of th e American M edical Association (A.M .A.)
su pplemented with th e gu idelines of th e Du tch Specialists Associations.
In th e ev ent of loss or disab lement of any b ody parts, organs, etc. not listed ab ov e, th e percentage of
Permanent Disab lement sh all b e determined on th e b asis of an independent ex amination b y a Competent
ph y sician in accordance with ob jectiv e criteria, in accordance with th e latest edition of th e ‘Gu ide to th e
Ev alu ation of Permanent Impairment’ of th e American M edical Association (A.M .A) su pplemented b y
gu idelines from th e Du tch Specialists Associations.
In th is case th e Insu red h as th e following options:
a)
h is employ ment sh all not b e tak en into accou nt;
b)
h is employ ment and th e activ ities h e cu stomarily performed prior to th e Accident sh all b e tak en
into accou nt; su itab le employ ment th at may in all reasonab leness b e req u ired of h im sh all also
b e tak en into accou nt, h av ing regard to h is disab ilities, strength , capab ilities, edu cation and
social position.
In th e ev ent of disab lement of sev eral limb s or organs as a resu lt of one or more accidents, pay ment sh all
nev er ex ceed th e su m insu red for permanent total disab lement.
3.3
P ay m e n t o f in te r e st
If, for medical reasons, th e degree of Permanent Disab lement cannot b e estab lish ed with in a period of
730 day s of th e Accident, th e Company sh all pay th e Insu red interest of 6% per y ear on th e disab ility
b enefit to b e paid ou t later, to b e calcu lated as from th e 731st day .
3.4
A d d itio n al c o v e r ag e s
3.4 .1
P ar ap le g ia & Q u ad r ip le g ia
In th e ev ent of Paraplegia or Q u adriplegia th e following b enefit sh all b e added to th e b enefit for
Permanent Disab lement for th e Insu red:
Paraplegia
€ 25.000,00
Q u adriplegia
€ 50.000,00
3.4 .2
Ch ild r e n
In th e ev ent th at a pay ment is made for death as a resu lt of an Accident, th e amou nt to b e paid sh all b e
increased b y € 5.000,00 for each ch ild, u p to a max imu m of 10% of th e su m insu red for death as a resu lt
of an Accident.
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3.4 .3
R e tr ain in g c o sts
In th e ev ent th at a pay ment is made for th e Loss of a limb or th e Loss of sigh t, th e Company sh all pay th e
reasonab le costs of retraining th e Insu red to carry ou t su itab le employ ment activ ities u p to a max imu m
amou nt of € 10.000,00.
3.4 .4
R e p lac e m e n t c o sts
In th e ev ent th at a pay ment is made for death b y Accident, th e Company sh all pay u p to an
amou nt of € 10.000,00 max imu m in respect to any reasonab le costs for recru iting a replacement for th e
Insu red.
3.4 .5
H o sp italizatio n
Th e Company sh all pay th e Insu red € 50,00 for each day of inpatient treatment with a max imu m of 365
day s if th e Insu red h as b een h ospitaliz ed as a resu lt of an accidental ph y sical inju ry .
3.4 .6
Co m a
If th e Insu red is in a continu ou s u nconsciou s state as a resu lt of an Accident, th e Company sh all pay a
b enefit of € 50,00 for each day of inpatient treatment for u p to 365 day s max imu m. Th is b enefit sh all b e
paid in addition to th e h ospitaliz ation b enefit.
3.4 .7
Co sm e tic su r g e r y
If an Insu red needs cosmetic su rgery as a resu lt of an Accident, th e Company sh all pay th e costs of
cosmetic su rgery performed b y or prescrib ed b y a Competent ph y sician, u p to a max imu m of € 5.000,00
if incu rred with in a period of 730 day s after th e Accident.
3.4 .8
P sy c h o lo g ic al c o u n se llin g
If an Accident resu lts in ex pected Permanent Disab lement of more th an 50%, th e Company sh all pay th e
cost of professional psy ch ological cou nselling u p to a max imu m of € 5.000,00 prov ided th at su ch
treatment is started with in 3 month s of th e date of th e Accident, th at it is prescrib ed b y a Competent
ph y sician and th at it is connected with th e Accident.
3.4 .9
P e r so n al b e lo n g in g s
If an Accident resu lts in immediate h ospitaliz ation, th e Company sh all pay for damage to and th e costs of
lost, damaged or stolen ob jects and docu ments wh ich h ad b een b rou gh t along b y th e Insu red for h is/ h er
own u se, u p to a max imu m of € 5.000,00.
3.4 .1 0 F u n e r al e x p e n se s
In th e ev ent th at a b enefit is paid ou t for death b y Accident, th e Company sh all pay th e reasonab le costs
of th e fu neral or cremation u p to a max imu m of € 7.500,00 per Insu red.
3.4 .1 1
W h ip lash
Th e Company sh all pay a b enefit of u p to 8% max imu m of th e su m insu red stated in th e policy sch edu le
for th e conseq u ences of a cerv ical acceleration or deceleration trau ma with ou t medically ob jectified
defects.
3.4 .1 2 S e atb e lt
If th e Insu red dies as a resu lt of a road traffic accident and it h as b een estab lish ed th at h e was wearing a
seatb elt at th e time, th e b enefit to b e paid sh all b e increased b y € 5.000,00.
3.4 .1 3 Life sav e r
If a th ird party (not an Insu red or th e Policy h older) su stains ph y sical inju ry wh ile try ing to sav e th e life of an
Insu red, wh ich su b seq u ently resu lts in th e Death or Permanent Disab lement of th is th ird party with in
two y ears of th e ev ent, th e Company sh all pay th is th ird party on th e b asis of an insu red su m of €
25.000,00. Th is b enefit sh all b e paid in addition to any b enefit paid to th e Insu red.
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3.4 .1 4
H o m e m o d ific atio n s
In th e ev ent th at an Insu red su stains accidental ph y sical inju ry and as a resu lt of th is h e req u ires
modifications to h is h ome (inclu ding b u t not limited to th e installation of ramps for ex ternal and internal
wh eelch air access, internal grab rails, emergency alarm sy stem and similar aids) in order to b e ab le to
carry ou t day -to-day activ ities (su ch as wash ing, cook ing, b ath ing and dressing) and to b e ab le to fu nction
in and arou nd h is h ome, th e Company sh all pay 80% of th e additional costs of su ch adaptations u p to a
max imu m of € 5.000,00 prov ided th at su ch adaptations are made with prior written permission from th e
Company and th at th ey h av e b een approv ed b y th e attending Competent ph y sician of th e Insu red.
3.4 .1 5
P ar tn e r /c h ild
In th e ev ent of death or Permanent Disab lement as a resu lt of an Accident th e Company sh all pay an
amou nt of € 25.000,00 for each Partner or ch ild su staining ph y sical inju ry in th e same Accident as th e
Insu red.
3.4 .1 6
S c ar s
If, as a resu lt of an Accident, th e Insu red h as permanent scars in h is/ h er face, th e following percentages of
th e insu red amou nt for Permanent Disab lement as stated in th e policy sch edu le will b e paid:
Scars from 5 to 10 centimetres
Scars longer th an 10 centimetres
3.4 .1 7
5%
10%
M issin g
If an Insu red is missing and after an appropriate period of time it can reasonab ly b e assu med th at th e
Insu red h as died as a resu lt of accidental ph y sical inju ry , th e su m insu red stated in th e policy sch edu le
sh all b e paid. In th at case, th e B eneficiary sh all b e req u ired to sign an agreement stating th at if it
transpires later th at th e Insu red h as not died, any b enefits receiv ed sh all b e repaid to th e Company .
Clau se s S h e e t T e r r o r ism Co v e r
B y th e Du tch Terrorism R isk R einsu rance Company (N H T) (N ederlandse H erv erz ek eringsmaatsch appij v oor
Terrorismesch aden N .V .)
1.
D e fin itio n s
W h ere th ey appear in th is clau ses sh eet and th e prov isions b ased th ereu pon, th e following terms sh all,
u nless oth erwise stipu lated, b e u nderstood to mean:
1 .1
T e r r o r ism :
Any v iolent act and/ or condu ct – committed ou tside th e scope of one of th e six forms of acts of war as
referred to in article 3:38 of th e Act on F inancial Su perv ision
[W et op h et financieel toez ich t] - in th e form of an attack or a series of attack s connected togeth er in time
and intention as a resu lt wh ereof inju ry and/ or impairment of h ealth , wh eth er resu lting in death or not,
and/ or loss of or damage to property arises or any economic interest is oth erwise impaired, in wh ich case
it is lik ely th at said attack or series – wh eth er or not in any organiz ational contex t – h as b een planned
and/ or carried ou t with a v iew to effecting certain political and/ or religiou s and/ or ideological pu rposes.
1 .2
M ale v o le n t c o n tam in atio n :
Th e spreading (wh eth er activ e or not) – committed ou tside th e scope of one of th e six
forms of acts of war as referred to in article 3:38 of th e Act on F inancial Su perv ision - of germs of a
disease and/ or su b stances wh ich as a resu lt of th eir (in)direct ph y sical, b iological, radioactiv e or ch emical
effect may cau se inju ry and/ or impairment of h ealth , wh eth er resu lting in death or not, to h u mans or
animals and/ or may cau se damage to property or may oth erwise impair economic interests, in wh ich case
it is lik ely th at th e spreading (wh eth er activ e or not) – wh eth er or not in any organiz ational contex t – h as
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b een planned and/ or carried ou t with a v iew to effecting certain political and/ or religiou s and/ or
ideological pu rposes.
1 .3
P r e c au tio n ar y m e asu r e s:
Any precau tionary measu res tak en b y th e au th orities and/ or insu red parties and/ or th ird
parties in order to av ert th e imminent risk of terrorism and/ or malev olent contamination of – if su ch peril
h as manifested itself – to minimiz e th e conseq u ences th ereof.
1 .4
D u tc h T e r r o r ism R isk R e in su r an c e Co m p an y [ N e d e r lan d se H e r v e r ze k e r in g m aatsc h ap p ij
v o o r T e r r o r ism e sc h ad e n N .V .] (N H T ):
A reinsu rance company incorporated b y th e Association of Insu rers (V erb ond v an V erz ek eraars) in Th e
N eth erlands to wh ich any liab ility to pay compensation u nder any insu rance contract wh ich , for th e
insu rers au th oriz ed in th e N eth erlands, may arise eith er directly or indirectly from th e manifestation of th e
risk s referred to in Articles 1.1, 1.2, and 1.3, may b e ceded.
1 .5
In su r an c e c o n tr ac ts:
a) N on-life insu rance contracts insofar as, according to th e prov isions of Article 1:1 of th e Act on F inancial
Su perv ision u nder ‘state wh ere th e risk is situ ated’ pertains to risk s situ ated in th e N eth erlands.
b ) Life insu rance contracts insofar as th ey are entered into with a Policy h older wh ose regu lar residence is
in Th e N eth erlands, or, if th e policy h older is a legal entity , with th e estab lish ment of th e legal entity to
wh ich th e insu rance contract pertains, wh ose registered office is in Th e N eth erlands.
c) F u neral in k ind insu rance contracts insofar as th ey are entered into with a policy h older wh ose regu lar
residence is in Th e N eth erlands, or, if th e policy h older is a legal entity , with th e estab lish ment of th e legal
entity to wh ich th e insu rance contract pertains, wh ose registered office is in Th e N eth erlands.
1 .6
In su r e r s au th o r ize d in T h e N e th e r lan d s:
Life insu rers, fu neral in k ind insu rers and non-life insu rers wh o, b ased on th e Act on F inancial Su perv ision
are au th oriz ed to carry on th e insu rance b u siness in Th e N eth erlands.
2
Lim itatio n o f th e c o v e r fo r th e te r r o r ism r isk
2.1
If and insofar as, su b ject to th e descriptions contained in articles 1.1, 1.2 and 1.3, and with in th e limits of
th e applicab le policy conditions, cov er is prov ided for th e conseq u ences of an ev ent wh ich is (directly or
indirectly ) related to:
· Terrorism, malev olent contamination or precau tionary measu res,
· Any act or condu ct in preparation for terrorism, malev olent contamination or
precau tionary measu res, h ereinafter to b e collectiv ely referred to as ‘th e terrorism risk ’, th e liab ility to pay
compensation on th e part of th e insu rers in respect of any su b mitted claim to indemnity and/ or b enefit,
sh all b e limited to th e amou nt of th e pay ment wh ich th e insu rer receiv es in respect of said claim u nder th e
reinsu rance of th e terrorism risk with th e N H T, in th e ev ent of an insu rance with wealth creation increased
b y th e amou nt of th e wealth creation wh ich h as b een realiz ed u nder th e insu rance in q u estion. W ith
regard to life insu rances th e amou nt of th e realiz ed wealth creation sh all b e set at th e premiu m reserv e to
b e adh ered to pu rsu ant to th e Act on F inancial Su perv ision with respect to th e insu rance in q u estion.
2.2
Th e N H T sh all prov ide reinsu rance cov er for th e aforementioned claims u p to a limit of liab ility of € 1
b illion in respect of any one calendar y ear. Th e aforementioned su m sh all b e eligib le for annu al
adju stment and sh all apply to all insu rers associated with th e N H T togeth er. Any adju stment sh all b e
annou nced in th ree national newspapers.
2.3
Contrary to th e prov isions contained in th e aforementioned paragraph s of th is article, th e
limit of indemnity u nder th is contract with respect to any insu rance pertaining to:
· loss of or damage to immov ab le property and/ or th e contents th ereof;
· conseq u ential loss du e to loss of or damage to immov ab le property and/ or th e
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contents th ereof, sh all not ex ceed EU R 75 million in respect of any one policy h older and any one insu red
location per annu m for all participating insu rers as referred to in article 1 togeth er, irrespectiv e of th e
nu mb er of policies issu ed.
F or th e application of th is paragraph insu red location sh all b e u nderstood to mean: all
ob jects insu red b y th e policy h older ex isting at th e address of premises to wh ich th e insu rance applies, as
well as all ob jects insu red b y th e policy h older located ou tside th e address of premises to wh ich th e
insu rance applies wh ose u se and/ or pu rpose is in relation to th e b u siness activ ities at th e address of
premises to wh ich th e insu rance applies. As su ch sh all in any case b e considered all ob jects insu red b y th e
policy h older wh ich are located at a distance of less th an 50 meters from each oth er and of wh ich at
least one is situ ated at th e address of premises to wh ich th e insu rance applies.
F or th e application of th is paragraph it sh all b e prov ided th at, with regard to legal entities
and companies wh ich are joined in a grou p, as referred to in Section 2 (24)(b ) of th e N eth erlands Civ il
Code, all grou p companies togeth er sh all b e regarded as one policy h older, irrespectiv e of wh ich grou p
compan(y )(ies) b elonging to th e grou p h as/ h av e tak en ou t th e polic(y )(ies).
3
P ay m e n t P r o to c o l N H T
3.1
Th e reinsu rance of th e insu rer with th e N H T sh all b e su b ject to th e Claims Settlement Protocol (h ereinafter
to b e referred to as th e Protocol). O n th e b asis of th e prov isions laid down in said protocol, th e N H T sh all
b e entitled to defer any pay ment of indemnity or th e su m insu red u ntil su ch time as th e N H T is ab le to
determine wh eth er and to wh ich ex tent it h as at its disposal su fficient financial resou rces in order to settle
in fu ll all claims for wh ich th e N H T prov ides cov er in its capacity as reinsu rer. Insofar as th e N H T is
fou nd not to h av e su fficient financial resou rces at its disposal, it sh all b e entitled in accordance with th e
prov isions in q u estion to pay a partial compensation to th e insu rer.
3.2
Th e N H T sh all, with du e regard for wh at h as b een stated in prov ision 7 of th e Protocol, b e au th oriz ed to
decide wh eth er an ev ent in connection with wh ich a claim to compensation is made sh ou ld b e considered
as a conseq u ence of th e manifestation of th e terrorism risk . Any decision tak en to th at effect and in
accordance with th e aforementioned prov ision b y th e N H T sh all b e b inding u pon th e insu rer, policy h older,
insu red parties, and th e parties entitled to compensation.
3.3
N ot u ntil th e N H T h as notified th e insu rer of th e amou nt, wh eth er as an adv ance or not, wh ich will b e paid
in respect of any one claim to compensation, sh all th e insu red or th e party entitled to th e pay ment b e
entitled to lay claim to th e pay ment as referred to in article 2.18.3 in th is respect towards th e insu rer.
3.4
Th e reinsu rance cov er b y th e N H T sh all pu rsu ant to prov ision 17 of th e Claims Settlement Protocol only
apply to claims for indemnity and/ or b enefit wh ich are reported with in two y ears after th e N H T h as
estab lish ed th at a certain ev ent or circu mstance is regarded as a manifestation of th e terrorism risk with in
th e contex t of th is Clau ses Sh eet.
N o righ ts may b e deriv ed from th is docu ment. It is for information pu rposes only . F or th e original docu ment we refer y ou to th e official Du tch
docu ment ‘Algemene v oorwaarden Grou p Plu s Collectiev e O ngev allenv erz ek ering 2010-01’.
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