p
INSURANCE TERMS
INSURANCE
th
of 1 January 2014
AND
CONDITIONS
OF
TRAVEL
Article 1 – Basic provisions
1.1.
TRAVEL INSURANCE is private personal insurance against
loss and damage related to travelling. The General Insurance
Terms and Conditions of Individual Insurance, as well as the
Conditions of Insurance Related to Travelling defined in the
insurance contract apply to this insurance.
1.2.
An insurance contract is entered into for a period stipulated in
the insurance contract in accordance with the principles given
by the insurer.
1.3.
Insurance contracts also include assistance services governed
by the Conditions of Assistance Services Provision.
Article 2 – Insurance alternatives
2.1.
The insurance can be taken out to cover the insured’s trips and
stays abroad with territorial effectiveness for:
a) area E covering all the states in the entire territory of
Europe, including the Mediterranean islands and the Canary
Islands, Israel, Cyprus, Morocco, Tunisia, Turkey and the
European part of Russia up to the Urals and the river Ural,
or;
b) area S covering all the states and territories around the
world;
or the insurance can be taken out to cover the insured’s stay in
the source country with territorial effectiveness for:
c) area T covering the territory of the Czech Republic.
2.1.1.
The insured’s stay onboard of an aircraft or a seafaring vessel,
if the source and/or destination country is a country other than
the source country or the insured’s homeland, is also
considered the insured’s stay abroad.
2.1.2.
The insured’s stay in the transit zone of an airport or a port,
regardless of whether or not it is located in area E in which the
insured’s flight or cruise was interrupted, if the source and
destination countries of the flight or cruise is an area E country
or the source country, is also considered the insured’s stay
abroad.
2.1.3.
The insured’s stay in a means of transport moving in the
territory of the source country, if it transports the insured abroad
and back as a service included in a foreign tour, is also
considered the insured’s stay abroad.
2.2.
The insurance can be arranged:
a) for one trip or stay of the insured, or;
b) for repeated trips of the insured abroad for the period of one
year.
2.3.
The insurance for one trip or stay can be taken out for one
person or a group of persons named in the insurance contract.
2.4.
The insurance for repeated trips abroad applies to an unlimited
number of foreign trips that are taken over the course of one
year from the day of the insurance period beginning, and start
and end in the source country, and the individual length of
which does not exceed 42 days. For longer trips, the insurance
only applies to the first 42 days of the trip. The insurance for
repeated trips cannot be arranged with territorial effectiveness
for area T.
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
2.4.1.
The insurance for repeated trips can be arranged as:
a) personal non-transferable insurance for one person;
b) insurance for two people - this insurance covers two fellow
travellers named in the insurance contract, or possibly the
first insured person travelling separately (the person listed
first in the insurance contract); if the second insured travels
on her/his own, s/he can be insured only if the policyholder
– before the trip starts – provably informs the insurer of the
insurance contract number, the name and surname and the
birth certificate number of the second insured, the
destination country, the date when the trip abroad starts and
presumably ends, whereas the insurance only applies to the
second insured person for the period of this trip;
c) family insurance – the insurance covers a family travelling
together the members of which are named in the insurance
contract, whereas no more than two can be of full legal age
and the other insured persons can only be children up to the
age of 17 years inclusive, but the number of them is not
limited; the children are insured is they travel together with
at least one insured person of full legal age;
d) corporate transferable insurance for one person – the
insurance covers one person and is transferable among
employees of the policyholder’s company who are aged
from 18 to 69 years provided that the policyholder - before
the trip starts - provably informs the insurer of the name, the
surname and the birth certificate number of the insured, the
destination country and the date when the trip abroad starts
and presumably ends.
2.5.
The insurance can be taken out in alternatives for tourist, sports
or business type of trip.
2.5.1.
The sports type must be taken out if any sports activities within
the meaning of art. 6.2. of the Conditions of insurance related to
travelling are planned to be carried out. The insurance for the
sports type of trips also applies to activities falling within the
tourist type of trips.
2.5.2.
If the purpose of the trip is performance of a business or similar
activity in return for remuneration, the business type trip must
be arranged. The insurance covering a business type trip also
applies to activities falling within the sports and tourist types of
trips.
2.5.3.
The type of trip cannot be selected for the insurance covering
repeated trips; this insurance is always taken out to cover the
scope of the sports type trip and it also applies to activities
falling within the business and tourist types of trips.
2.6.
The insurance can be arranged in limit class A or B. If the
insurance is taken out for the insured’s stay in the source
contract (area T), the insurance is arranged in limit class B.
Limit classes determine sums insured or insurance indemnity
limits.
Article 3 – Insured risks and options
3.1.
The insurance contract with territorial effectiveness of insurance
for areas E and S always includes indemnity insurance covering
medical expenses according to the CLV clause.
3.2.
The insurance contract can include the following optional
insurance:
luggage indemnity insurance according to the CPZ clause;
tour cancellation indemnity insurance according to the CSZ
clause – only in insurance for one trip or stay;
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Strana 1 ze 18
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damage liability indemnity insurance according to the COO
clause;
accident insurance of the agreed sum combined with
insurance against death due to injury according to the CUS
clause, against permanent consequences of injury
according to the CTN clause and against damage due to
injury according to the CPU clause;
3.3.
To policyholder shall pay the single premium stipulated in the
insurance contract as the price of all insurance policies included
in the insurance contract.
Article 4 – Insurance contract formation
4.1.
The insurance contract is entered into in the mode of
concluding an insurance contract on behalf of the insurer, or in
the mode of concluding a short-term insurance contract (shorter
than 1 year) via an electronic means of communication.
4.2.
For the insurance covering one trip or stay, the policyholder
must state the required commencement and end of the
insurance effectiveness abroad, or the commencement and end
of her/his stay in the source country.
4.2.1.
The tour cancellation insurance according to the CSZ clause
can only be taken out no later than within 3 days following the
final settlement of the tour price and no later than within 15
days before the insured starts using the services included in the
tour. The effectiveness of the tour cancellation insurance arises
at the moment of entering into the insurance contract.
4.3.
For the insurance covering repeated trips abroad, the
policyholder must state the required commencement of the
period for which s/he applies for the insurance covering
repeated trips.
Article 5 – Cancellation of insurance
5.1.
The tour cancellation insurance according to the CSZ clause –
apart from the cases defined in the NOZ (New Civil Code) – is
cancelled on the day, stated by the insured in the insurance
contract, on which the effectiveness of the insurance abroad, or
the stay in the source country, starts.
5.2.
Any other insurance covering the stay in the source country is
cancelled upon expiry of the end of the insurance effectiveness
stipulated in the insurance contract.
5.3.
Any other insurance covering trips and stays abroad – apart
from the cases defined in the NOZ – is (differently from the
NOZ) also cancelled in the following situations:
termination of the trip and stay abroad;
withdrawal of consent to sensitive data processing
(art. 2.8.3. of the Conditions of insurance related to
travelling);
5.4.
If the insured, owing to the insured event from the medical
expenses insurance according to the CLV clause, becomes –
from the medical point of view – unable to return to the source
country, or to the homeland of the insured, before the end of the
insurance period stipulated in the insurance contract, the end of
effectiveness of the medical expenses insurance according to
the CLV clause is automatically extended until the moment:
a) when the insured returns or is transferred to the source
country or her/his homeland, or;
b) when the insured deliberately refuses to return or does not
return to the source country or her/his homeland as soon as
her/his state of health allows it.
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
Article 6 – Insurance indemnity
6.1.
Medical expenses insurance
6.1.1.
If the insured event from the medical expenses insurance
according to the CLV clause occurs, the insurer will provide the
beneficiary with insurance indemnity in the amount of the cost
of the necessary care and treatment directly related to the
insured event. Insurance indemnity includes the cost of the
necessary examinations, diagnosis, treatment, surgery and
related expenses, medicines prescribed by a doctor, hospital
stay in a multibed room with usual equipment, and medical aids
prescribed by a doctor.
6.1.2.
Insurance indemnity also includes reimbursement for the
necessary cost of the insured’s transport:
a) to a healthcare facility;
b) between healthcare facilities;
c) from a healthcare facility to the place of the insured’s
temporary stay abroad;
d) back to the source country or homeland of the insured.
6.1.3.
Insurance indemnity also includes reimbursement for the cost of
the chartered transport or taxi services abroad used to take the
insured to and from medical checkups during her/his treatment
if it was impossible to use a means of public transport.
6.1.4.
If the insured is transported back to her/his homeland, the
insurer shall cover the cost only up to the amount which it would
be obliged to pay for transport to the source country.
6.1.5.
If the insured is transported back to the source country or
her/his homeland, the insurer shall – in justified cases – cover
the cost of transport of another person accompanying the
insured.
6.1.6.
If the insured dies, the insurer shall provide insurance indemnity
in the amount of the cost necessary for temporary storage
and/or cremation abroad, and repatriation of the insured’s
remains back to the source country or homeland.
6.1.7.
If the insured’s corpse is repatriated to the insured’s homeland,
the insurer shall cover the cost only up to the amount which it
would be obliged to pay for repatriation to the source country.
6.1.8.
Insurance indemnity also includes reimbursement for the cost of
telephone calls made by the insured or the insured’s
accompaniment from abroad, but only the calls to assistance
services if they relate to the insured event. The fee for an
itemized telephone bill is not covered by the insurance
indemnity.
6.1.9.
The provision of article 5.1.1. d) of the Conditions of insurance
related to travelling shall not be applied to the medical
expenses insurance according to the CLV clause unless the
insured was directly involved in the terrorist attack or another.
6.1.10.
Insurance indemnity does not include the cost of the necessary
medical care for the insured covered by the public health
insurance.
6.1.11.
The amount of insurance indemnity is limited by the limit class
stipulated in the insurance contract.
Soubor_PP_CP_01012014
Strana 2 ze 18
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Limit
class
A
B
Total limit
of which:
dental treatment
Total limit
of which:
dental treatment
Area E
(in CZK)
3,000,000
Area S
(in CZK)
3,000,000
7,500
5,000,000
7,500
5,000,000
7,500
7,500
The limit given for dental treatment applies to one insured
person and one insured event. The total limit applies to one
insured person and all insured events occurring in the
insurance period.
6.2.
Luggage insurance
6.2.1.
If an insured event from the luggage insurance according to the
CPZ clause occurs, the insurer shall provide the beneficiary
with insurance indemnity in the amount of the proved damage
occurred.
6.2.2.
If the insured thing is damaged, the difference between the
usual price of the insured thing immediately before the insured
event and the usual price of usable remains of the insured thing
after the insured event is considered the proved damage.
6.2.3.
The insurance is arranged with financial participation of CZK
500 for each insured per one insured event.
6.2.4.
The insurance is arranged with insurance indemnity limit of CZK
15,000 for each insured per one insured event. The sum of
indemnities provided to one insured for all insured events
occurring in the period of the insurance effectiveness can
amount to a double of the insurance indemnity limit at most.
6.2.5.
The insurance indemnity limit for one thing is CZK 10,000.
6.2.6.
For each child aged up to 17 years inclusive who travels
together with an adult and is named in the insurance contract,
the insurance is arranged with the insurance indemnity limit of
CZK 5,000 for one insured event.
6.3.
Tour cancellation insurance
6.3.1.
If an insured event from the tour cancellation insurance
according to the CSZ clause occurs, the insurer shall provide
the beneficiary with insurance indemnity in the amount of the
actual tour cancellation fees expended in consequence of the
insured event, provably paid for cancellation of the insured’s
ordered tour, but only after it has been verified that the insured
did not take part in the tour; however, up to the stipulated
insurance indemnity limit.
6.3.2.
Insurance indemnity includes the actual tour cancellation fees
paid by no more than one other insured fellow traveller to whom
no insured event occurred and who could have otherwise taken
part in the tour. The limitation of the number of other insured
fellow travellers does not apply to the following persons: the
spouse, children, parents, grandparents, siblings and the
registered partner of the insured.
6.3.3.
Insurance indemnity does not include any increase in the tour
cancellation fees caused by breach of the obligation under art.
CSZ.5. of the Conditions of insurance related to travelling (late
cancellation of the tour).
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
6.3.4.
The insurance is arranged with 20% financial participation of the
insurance indemnity.
6.3.5.
Insurance indemnity is limited according to the area stipulated
in the insurance contract:
a) for areas E and T – arranged with limit of CZK 12,500,
b) for area S – arranged with limit of CZK 25,000
for each insured person per one insured event.
6.4.
Damage liability insurance
6.4.1.
If an insured event from the damage liability insurance
according to the COO clause occurs, the insurer shall provide
the beneficiary with insurance indemnity in the amount of the
damage proved.
6.4.2.
The insurer provides insurance indemnity to the beneficiary only
in money.
6.4.3.
The insurance indemnity is arranged with insurance indemnity
limits for one insured person for the entire insurance period:
for damage to health
CZK 2,000,000,
for damage to a thing
CZK 1,000,000,
for other damage
CZK 500,000.
6.5.
Accident insurance
6.5.1.
Sums insured are determined depending on limit classes as
follows:
a) limit class A:
For adults aged 18 years and above: the sum insured
against death due to injury is CZK 100,000; CZK 200,000
against permanent consequences of injury and CZK 20,000
against damage due to injury. For children aged up to 17
years inclusive: the sum insured against death due to injury
is CZK 20,000; CZK 100,000 against permanent
consequences of injury and CZK 20,000 against damage
due to injury.
b) limit class B:
For adults aged 18 year and above: the sum insured against
death due to injury is CZK 200,000; CZK 400,000 against
permanent consequences of injury and CZK 40,000 against
damage due to injury. For children aged up to 17 years
inclusive: the sum insured against death due to injury is
CZK
40,000;
CZK
200,000
against
permanent
consequences of injury and CZK 40,000 against damage
due to injury.
6.5.2.
Indemnity for death due to injury
a) If an insured event from the insurance against the insured’s
death due to injury according to the CUS clause occurs, the
insurer shall provide the beneficiary with one-off indemnity
in the amount of the stipulated sum insured against death
due to injury.
b) If an insured event from the insurance against the insured’s
death due to injury occurs and the insurer has already
indemnified for permanent consequences of this injury, the
insurer shall pay out only the potential difference between
the sum insured against death due to injury and the sum
already paid out.
6.5.3.
Indemnity for permanent consequences of injury
a) If an insured event from the insurance against permanent
consequences of injury according to the CTN clause occurs,
the insurer shall provide the insured with one-off indemnity
in the amount of a percentage of the sum insured
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Strana 3 ze 18
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corresponding for individual damage according to the TN
Classification with the scope of permanent consequences.
b) If the TN Classification specifies a percentage range, the
amount of indemnity shall be determined so that it matches
the nature and extent of the damage caused by the injury
within the given range.
c) The amount of indemnity is determined by the insurer on the
basis of a medical report on the examination of the insured’s
state of health by the healthcare provider designated by the
insurer.
6.5.4.
Indemnity for damage due to injury
a) If an insured event from the insurance against damage due
to injury according to the CPU occurs, the insurer shall
provide the insured with one-off insurance indemnity in the
amount of a percentage of the sum insured determined
according to the PU Classification for the relevant damage.
CONDITIONS OF ASSISTANCE SERVICE PROVISION
country or the insured’s homeland unless otherwise agreed
upon between the insurer and the bereaved.
A.3.
Above-standard assistance services (provided only under limit
class B)
a) Legal assistance:
If, following a road traffic accident or owing to any
inappropriate administrative complications, the insured is
detained, taken into custody, imprisoned, or at risk that such
a thing happens, the assistance company designates a legal
representative and the insurer covers the cost of legal
assistance, however, up to the insurance indemnity limit
arranged for legal assistance at most.
b) Visit by a relative:
If the insured is hospitalised and her/his health condition
prevents her/his transfer back to the source country or
her/his homeland and if s/he must stay at hospital longer
than ten days, the assistance company arranges a return
ticket (fare to and from the place) for one close relative of
the insured (spouse, children, parents, grandparents,
siblings) so that s/he can see the insured, however, up to
the insurance indemnity limit stipulated for the visit by the
relative at most. The insurer shall only cover the travel
expenses; the cost of accommodation and any other cost
are not covered.
c) Substitute employee:
If the insurance for the business type trip is arranged and
the insured is transferred or repatriated within the meaning
of art. A.2. h) or i), the insurer shall cover the fare for the
substitute employee, replacing the insured person and
taking the insured’s mission over, to the place from which
the insured was repatriated, however, up to the insurance
indemnity limit stipulated for the substitute employee at most
and provided that this service is required immediately after
the appointed doctor decided about the repatriation of the
insured within the meaning of art. A.2. h) or i).
A.4.
Article A – Assistance services
A.1.
The insured is provided with assistance services in the case of
a loss event, emergency or distress. Assistance services are
procured by the assistance company which is a contractual
partner of the insurer. The call centre operators of the
assistance company can speak Czech and other languages
and are available 24 hours a day.
A.1.1.
The assistance service provider is
the company
AXA ASSISTANCE CZ, s. r. o., Hvězdova 1689/2a, 140 62
Prague 4. To use assistance services, call 272 10 10 11.
A.2.
Basic assistance services (provided under both limit classes
A and B) for the medical expenses insurance
The assistance company:
a) provides medical advice and information to insured persons
who become ill or whose state of health becomes critical
while staying abroad,
b) recommends to the insured which doctor or medical
specialist s/he should call, which hospital or healthcare
facility in the particular place s/he should contact, etc.,
c) when hospitalisation is necessary, guarantees the payment
for services or provides an advance payment and takes care
of the financial settlement with the hospital without the
insured taking part in it (in accordance with art. CLV.9. f) of
the Conditions of insurance related to travelling),
d) in the case of hospitalisation stays in touch with the insured
and the persons depending on the insured, or possibly with
other involved persons, and the assistance company’s
medical team maintains communication with the doctors
who provide medical care to the insured,
e) ensures that locally unavailable medicines and medical
materials are sent to the insured,
f) if the insured’s health condition so requires, the assistance
company organises transport of the insured to the nearest
hospital where s/he will be provided with appropriate health
care, qualified accompaniment inclusive,
g) if a child aged less than nine years is hospitalised, the
insurer shall cover the cost of accommodation of one parent
accompanying the child abroad directly in the healthcare
facility (or hotel) up to the limit for accommodation of the
accompanying person,
h) if the insured’s health condition so requires, the assistance
company organises transfer of the insured from abroad to a
hospital in the source country or the insured’s homeland,
and if the insured’s health condition so requires, it arranges
qualified accompaniment during the transfer,
i) if the insured dies, the assistance company organises
repatriation of the insured’s remains to a relevant facility in
the source country or in the insured’s homeland; or as the
case may be, if agreed upon with the relatives, it organises
cremation abroad and transport of the urn to the source
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
Area E
(in CZK)
Limit
class
A
B
accommodation of the
accompanying person
per night
total
accommodation of the
accompanying person
per night
total
legal assistance
visit by a relative
substitute employee
Soubor_PP_CP_01012014
Area S
(in CZK)
2,000
12,000
25,000
25,000
2,000
12,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
25,000
Strana 4 ze 18
p
GENERAL INSURANCE TERMS AND CONDITIONS OF
INDIVIDUAL INSURANCE
as of 01/01/2014
Article 1 – Opening and general provisions
1.1.
This private insurance (hereinafter referred to as “the
insurance”), provided by Komerční pojišťovna, a. s., company
registration number 63998017, registered address: Karolinská
1/650, 186 00 Prague 8 (hereinafter referred to as "the
insurer"), is regulated especially by Act No. 89/2012 Coll., the
Civil Code (hereinafter referred to as “the NOZ”) and by the
insurance contract of which these insurance terms and
conditions form an integral part. If the insurance also includes
assistance services, the conditions of providing these
assistance services also form an integral part to the insurance
contract.
1.2.
This insurance, as well as the rights and duties arising from it,
follow the legislation of the Czech Republic (hereinafter referred
to
as
“the
CR“). In case of any legal disputes, the courts of the Czech
Republic are the relevant courts of law.
1.3.
The Czech language is the language of communication.
1.4.
All amounts and payments related to the insurance are written
and paid in the currency valid in the territory of the CR.
1.5.
The effectiveness of the insurance is not restricted by the
territory, unless the insurance contract stipulates otherwise.
1.6.
Legal actions the content of which causes no inception, change,
cancellation of the insurance, or assertion of the right to
insurance indemnity, do not have to be made in writing if they
are taken in a form enabling to capture the content.
1.7.
If another legal regulation governing legal actions of the
policyholder, the insured or the beneficiary (hereinafter referred
to everybody as “the Client“) obliges to meet another duty or to
render assistance to the insurer in meeting the insurer’s
obligations, but the Client fails to meet her/his duty or to render
assistance within her/his legal actions, then the time period
before the fulfilment of this duty or the rendering of assistance
by the client shall be considered default of the Client.
1.8.
Unless the legal regulation specifies a special form of the power
of attorney so that it can come in force (e.g. notarial deed), the
power of attorney granted by the Client to the authorised person
has to be specific and definite, properly signed by the Client
and accepted by the authorised person. The Client’s signature
on the power of attorney must be authenticated.
1.9.
The insurance contract may stipulate the time period according
to an insurance month/year. An insurance month/year
commences on the day the number of which matches the day of
the insurance beginning specified in the insurance contract. If
there is no such day in the last month, then the insurance
month/year commences on the last day of the month.
Article 2 – Inception of insurance and changes thereto
2.1.
Insurance commences at 00:00 am on the day stipulated in the
insurance contract as at the insurance inception day.
2.2.
The process of entering into an insurance contract may follow
various modes.
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
2.2.1.
Mode of entering into an insurance contract on behalf of the
insurer
2.2.1.1.
An insurance contract draft is prepared by the insurer’s
employee, or by an insurance intermediary authorised by the
insurer, on behalf of the insurer; this person also submits the
draft to the future policyholder (insurance applicant) for
acceptance.
2.2.1.2.
Starting from the date of the draft submission, the policyholder
has 1 month to accept it, unless the draft stipulates a period
longer. In the course of this time period, the policyholder either:
a) accepts the draft by signing the original copies and
returning at least the one intended for the insurer to the
insurance intermediary, or delivering the signed original
copy directly to the insurer, or
b) accepts the draft by remitting the premium to the insurer’s
account, or
c) does not respond to the draft within the given period, or
refuses it or changes it in any other way by which the draft
is considered refused and no insurance contract is entered
into.
2.2.1.3.
If the policyholder accepts the draft by signing it or by paying
the premium, the insurer will issue and deliver, without undue
delay, a policy to the insured as a confirmation that the
insurance contract has been entered into.
2.2.2.
Mode of submitting an insurance contract draft to the insurer
2.2.2.1.
The insurance contract draft shall be prepared by an insurance
intermediary together with the future policyholder (insurance
applicant) and submitted to the insurer to examine it and accept
it, if possible.
2.2.2.2.
Starting from the date of the draft submission, the insurer has 1
month to accept it, unless the draft stipulates a period longer. In
the course of this time period, the insurer either:
a) accepts the draft by issuing and delivering a policy to the
policyholder as a confirmation of entering into the
insurance contract, or
b) does not respond to the draft within the given period by
which the draft shall be considered refused and no
insurance contract is entered into, or
c) prepares a new draft and delivers it to the policyholder.
2.2.2.3.
Unless the new draft provides otherwise, the policyholder has 1
month to accept the new draft. During this period the
policyholder:
a) accepts the new draft by signing the original copies and
returning at least the one intended for the insurer to the
insurance intermediary, or delivering the signed original
copy directly to the insurer, or
b) accepts the new draft by remitting the premium to the
insurer’s account if the new draft explicitly permits it, or
c) does not respond to the draft within the given period, or
refuses it or changes it in any other way by which the new
draft is considered refused and no insurance contract is
entered into.
2.2.2.4.
If the policyholder accepts the new draft by signing it or by
paying the premium, the insurer will issue and deliver, without
undue delay, a policy to the insured as a confirmation that the
insurance contract has been entered into.
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2.2.3.
Mode of entering into a short-term insurance contract (shorter
than 1 year) using electronic means
2.2.3.1.
The insurance contract draft is prepared, on behalf of the
insurer, using a web application on the Internet portal
(hereinafter referred to as “the electronic system“), then it is
submitted to the future policyholder (insurance applicant),
based on her/his requirements, applying means that enable the
content to be recorded.
2.2.3.2.
A time limit for accepting the draft runs for the policyholder from
the required beginning of the insurance period. If the
policyholder chooses the day of the insurance period
commencement in the period from the draft submission until the
following working day, the time limit for the draft acceptance will
nd
be extended to the 2 working day following the day of
commencement. In the course of this period, the policyholder
accepts the draft:
a) by remitting the premium to the insurer’s account, or
b) the policyholder does not pay the premium in this period of
time by which the draft is considered refused and no
insurance contract is entered into.
2.2.3.3.
If the policyholder accepts the draft by paying the premium, the
insurer will, without undue delay, issue the policy and deliver it
to the policyholder as a confirmation of entering into the
insurance contract.
2.3.
The insurer is obliged to express its opinion on the application
for a change of insurance within 3 months of the day on which
the application was delivered to the insurer. Unless the insurer
provides its opinion within this period of time, it is deemed that it
does not agree with the content of the application.
2.4.
Provisions on entering into an insurance contract apply similarly
to entering into amendments to insurance contracts.
2.5.
If the participants agree on a change of the scope of insurance
in the course of its existence, these changes come into force
at 00:00am of the day specified in the particular insurance
contract amendment.
Article 3 – Duty to answer questions truthfully
3.1.
The insurance applicant, the policyholder and the insured are
obliged to truthfully reply to the insurer’s written questions, to
provide complete information and not to conceal any substantial
piece of information, or to submit the documents necessary for
this purpose.
3.2.
The facts ascertained by the insurer from these answers may
only be used for the purposes of the insurer’s legitimate
interests and fulfilment of statutory obligations, otherwise they
may solely be used with the consent of the person whom the
information concerns.
Article 4 – Premium, method of its payment and
consequences of non-payment
4.1.
The policyholder is obliged to pay premiums for stipulated
insurance terms (periodic premium) or a single premium for the
entire insurance period (single premium).
4.2.
By this contract, the policyholder undertakes to pay premiums
to an account specified by the insurer, in the stipulated amount,
using the stipulated method, in a due and timely manner and
stating correct payment symbols.
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
4.3.
The policyholder is responsible for correct indication of payment
symbols for the payment of the premium enabling the
identification of the payment at the insurer’s account, including
the consequences related thereto.
4.4.
The insurer has the right to refuse, without undue delay, a
payment of the premium credited from an account with a
financial institution outside the CR and remitted via a provider of
postal services from abroad or made by a cash deposit.
4.5.
The periodic premium always becomes due on the first day of
the insurance term. The single premium becomes due on the
first day of the insurance period. Any premium that should
become due before entering into the insurance contract
becomes due on the day following the entering into the
insurance contract.
4.6.
The contracting parties have agreed that the insurer
accommodates its claims for premiums, starting from the oldest
one, by payment of the premium in the order in which they have
been credited to its account.
4.7.
The insurer has the right to reduce insurance indemnity by any
due premium and by any other payable claims concerning the
insurance.
4.8.
If the insurance has been cancelled, the insured becomes
obliged to return any overpayments of the premium or any
unearned premiums to the policyholder. However, the insurer
has no obligation to return to the policyholder any
overpayments of the premium or any unearned premiums up to
CZK 100 inclusive.
Article 5 – Insured event
5.1.
An insured event is an unexpected event, i.e. it cannot be
foreseen when it happens or whether it will happen at all, and it
corresponds with the definition of the insured risk as specified in
the insurance contract. Only an uncertain event occurring
independently of the insured’s or the beneficiary’s will can be
considered an insured event.
5.2.
The insured event is defined for each insurance arranged
separately. Several insured events may arise from the very
same cause simultaneously.
5.3.
The beneficiary is obliged to prove to the insurer that the
insured event, corresponding with the definition in the insurance
contract, has occurred. Once the occurrence and the scope of
the insured event have been proven, the insurer becomes
obliged to provide insurance indemnity.
5.4.
Beneficiary
5.4.1.
If the insured event occurs, the person stipulated in the
insurance contract becomes entitled to insurance indemnity. If
this person is not explicitly specified in the insurance contract,
the right to insurance indemnity arises to the insured.
5.4.2.
If the insured event is the death of the insured, the right to
insurance indemnity arises to the appointed person. If no
appointed person was designated by the policyholder, or if the
right to indemnity does arise to this person, then right to
insurance indemnity arises to the persons specified under sec.
2831 of the NOZ.
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Strana 6 z 18
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5.4.3.
The person, whose right to indemnity shall arise due to the
death of the insured person, does not acquire this right if s/he
causes the death of the insured by an intentional criminal act for
which her/his guilt will be ascertained by the court, or if she
instructs a third party to do so.
d)
even if the Client did not pick up the deposit within the
deposit period or picked it up after the expiry of the seventh
day of the deposit period;
on the day on which the item is sent back as nondeliverable due to other reasons.
Article 6 – Pledge charging a claim from an insurance
contract, assignment of a debt from an insurance contract
6.1.
If having the consent of the insured, the policyholder has the
right to assign or pledge the claims or any other rights from
insurance which can be expressed in monetary terms
(hereinafter referred to as “the rights“).
6.2.
The security interest or assignment of the claim towards the
insurer comes into effect at the moment when the policyholder
informs the insurer of this fact, or possibly when the creditor
proves the assignment of the claim, or formation of the pledge,
to the insurer.
6.3.
If the claim has been assigned, the insurer will pay insurance
indemnity to the person to whom the right has been assigned
within the scope of assignment.
6.4.
If the claim has been pledged, the insurer will pay insurance
indemnity to the person who holds the security interest and up
to the amount of the legitimate claim pledged.
6.5.
The potential positive difference between the amount of
indemnity and the amount of the legitimate claim of the creditor
or the assigned claim of the assignee, the insurer will pay this
positive difference to the beneficiary.
7.6.
The Client has the right to invoke the nullity of the contractual
presumption of delivery time set according to articles 7.4. and
7.5. only if s/he proves the existence of objective reasons that
prevented her/him from ensuring the delivery of the item,
acceptance of the item or collection of the deposited item at the
relevant post office, or resulted in the non-deliverability due to
other reasons.
7.7.
Delivering via electronic means
7.7.1.
Written documents for which no written legal form is required
can be sent by the insurer to the Client via electronic means
provided that the Client has stated her/his electronic address.
7.7.2.
The Client is obliged to notify the insurer, without undue delay,
of any change in the electronic address. Even a telephone
number that is capable of receiving short text messages (SMS)
is considered an electronic address.
7.7.3.
The insurer’s written document sent to the Client by electronic
means is considered delivered on the day following the sending
to the last known electronic address of the Client.
7.7.4.
The Client has the right to order the insurer to stop sending the
documents via electronic means any time. However, the Client
has no right to request sole delivering via electronic means from
the insurer.
Article 7 – Delivering to the Client
7.1.
Legal arrangements, announcements or any other information
(hereinafter referred to as “the written documents“) intended for
the Client can be sent by the insurer to a previously agreed
mailing address, or to the last known residence address
(hereinafter referred to as “the delivery address“) of the Client,
via a provider of postal services (hereinafter referred to as “the
post“), or delivered to the Client to her/his own hands through
the insurer’s employee or any other authorised person.
7.2.
The Client is obliged to notify the insurer of a change in the
delivery address without undue delay.
7.3.
The policyholder is obliged to ensure that s/he has a delivery
address in the territory of the CR for the entire period of the
insurance duration.
7.4.
The insurer’s written document sent to the Client by recorded
delivery (unless it is an item sent by recorded delivery with
delivery confirmation according to art. 7.5.) is considered
delivered on the seventh day following the sending of the
document.
7.5.
The insurer’s written document sent to the Client by recorded
delivery with delivery confirmation is considered delivered:
a) on the day of receipt which is written on the delivery
confirmation if it precedes the delivery day specified
according to c);
b) on the day when the Client refused to accept the delivered
item if it precedes the delivery day specified according to
c);
c) on the seventh day following the day when it was deposited
by the postman at the post office relevant for the Client,
Article 8 – Delivering to the insurer
8.1.
All written documents of the Client intended for the insurer have
to be delivered by post to the address of Komerční
pojišťovna, a. s.: Palackého 53, 586 01 Jihlava, unless it is
stipulated otherwise in the insurance contract or hereafter.
8.2.
Delivering by insurance intermediaries
8.2.1.
If the insurance contract was entered into by an insurance
intermediary, the Client may deliver written documents for the
insurer through the insurance intermediary as well.
8.2.2.
If the insurance intermediary acts on the basis of the contract
entered into with the insurer (as an agent), the item is
considered delivered on the seventh day following its provable
delivery to the intermediary.
8.2.3.
If the insurance intermediary acts on the basis of the contract
entered into with the Client (as a broker), the item is considered
delivered on the third working day after it was provably sent to
the insurer by the insurance intermediary.
8.3.
Delivering via electronic means
8.3.1.
The client can be engaged in legal negotiations and deliver their
content intended for the insurer via electronic means provided
that the execution of the particular legal act explicitly allows
that.
8.3.2.
An electronic system is such a communication tool, including an
electronic system of the third party (e.g. tool for direct banking
of Komerční banka, a.s.), enabling the recording of the Client’s
legal actions, the identification and records are made
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
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Strana 7 z 18
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systematically and sequentially and are protected against
changing.
8.3.3.
If the Client acts through such an electronic system, the item is
considered delivered to the insurer on the first working day
following its provable sending.
8.4.
Delivering via electronic means
8.4.1.
Written documents, the printed written legal form of which is not
required, can be sent by the Client to the insurer via electronic
means using provided electronic addresses.
8.4.2.
The Client’s written document sent to the insurer by electronic
means is considered delivered on the day following the sending
to the electronic address of the insurer.
Article 9 – Personal data processing
9.1.
Processing of personal data in connection with the insurance
contract
9.1.1.
The Client’s personal data, within the meaning of section 4a) of
Act No. 101/2000 Coll. governing the personal data protection
(hereinafter referred to as “the ZOOU“) – except for the
sensitive ones – provided by the Client to the insurer in relation
to entering into the insurance contract, or which the insurer
obtained in any other legal way, or created by processing the
data obtained in this way, will be processed by the insurer, or by
the administrator entrusted by the insurer, in compliance with
the ZOOU, in order to be used within the subject-matter of the
insurer’s business, i.e. for processes directly or indirectly related
to insurance or reinsurance activities. Within the meaning of
section 27 of the ZOOU, the insurer has the right to transfer the
insured’s personal data to other states for the purposes of
reinsurance. The insurer will process the Client’s personal data
in the given way and in the scope stipulated in the insurance
contract, for the period necessary to ensure all the rights and
duties arising from the insurance obligation relationship.
9.1.2.
The insurer has the right to process the personal data of the
Client to the given extent and for the given purpose even
without the express consent of these persons.
9.2.
Consent to sharing the data within the group
9.2.1.
The Client grants in the insurance contract her/his consent that
her/his personal data – if s/he is a natural person – or its
personal data – if it is a legal person – can be processed by the
insurer and any other Administrator, and mutually shared
between them for the purposes of improving the quality of care
for the Client, performance of Marketing activities, informing of
other Administrators about the solvency and credibility of the
Client and analysing this data. The Client agrees that the
Administrator can process the personal data about her/him
(natural person) or it (legal person) for the purposes and in the
scope specified above for the period from the granting of this
consent until 4 years have expired of the end of the last
contractual or any other legal relationship with any of the
Administrators.
9.2.2.
The consent of the Client, according to art. 9.2.1., is effective
only in relation to the Client who has entered with the insurer
into the contract or amendment to the existing contract of which
these insurance terms and conditions form an integral part, and
no sooner than on the day on which these insurance terms and
conditions come into effect, or who additionally grants her/his
consent to the existing contractual relationship. For the Client
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
who has signed, refused to sign or withdrawn such consent
previously, the legal status of the consent granted, refused or
withdrawn shall remain unaffected by the change in the
insurance terms and conditions.
9.2.3.
This consent to the data processing, granted principally in
compliance with current Acts No. 277/2009 Coll., governing the
insurance business, the NOZ, No. 480/2004 Coll., governing
certain services of an information society, and the ZOOU, is
voluntary and the Client has the right to withdraw it in relation to
any of the Administrators any time. The withdrawal of the
consent must be made in writing. The provision of personal data
is voluntary unless the generally binding legal regulation
stipulates otherwise.
9.3.
The Client is obliged to inform the insurer of any change in the
processed personal data without undue delay.
9.4.
The Client’s personal data is processed to such an extent in
which the Client has provided them or the policyholder has
provided them on the Client’s behalf in relation to:
a) application for a contractual or any other legal relationship,
b) any contractual or any other legal relationship concluded
between her/him and the Administrator, or
c) which the Administrator collected otherwise and processes
in compliance with current legislation for the following
purposes:
i) purposes included within the consent of the insured,
ii) negotiations on the contractual relationship,
iii) fulfilment of the contract,
iv) protection of vital interests of the Client,
v) authorised disclosure of personal data,
vi) protection of the rights of the Administrator, recipient or
other persons involved,
vii) archiving kept as required by the law,
viii) offering of deals or services,
ix) provision of the name, surname and address of the
Client for the purpose of offering deals and services in
compliance with the generally binding legislation.
9.5.
If the Client so requests in writing, s/he has the right, in
compliance with current legislation, to receive from the insurer
information on the personal data processed about her/him, the
purpose and nature of the personal data processed, on the
recipients of such data and on the Administrators. The Client is
further entitled to demand from the insurer a correction of the
personal data if s/he ascertains that the data processed by any
of the Administrators does not correspond with reality. If the
Client ascertains or suspects that the Administrator processes
her/his personal data in violation of the protection of private and
personal life, s/he has the right to request an explanation from
the insurer, or more precisely has right to request that the
insurer remedies such defects. Regardless of previous
provisions of this Article, the Client has the right to contact the
Office for Personal Data Protection and request the
Administrator to take remedial action.
9.6.
For the purposes of this article, the following is understood:
Administrator – Insurance Company, Société Générale SA,
B 552 120 222, a company founded and existing according
to the law of the French Republic, residing at: 29, Boulevard
Haussmann, 75009 Paris (SG), Members of FSKB, Persons
controlled by SG and Investiční kapitálová společnost KB,
a. s., company registration number 60196769;
Marketing activities – activities the purpose of which is to
inform Clients about products and services of the
Administrator, to present offers to order, to mediate or
Soubor_PP_CP_01012014
Strana 8 z 18
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procure these products and services, and to evaluate the
data relevant for these purposes, including via email;
Members of the Financial Group of the Bank (Members of
FSKB), especially Komerční banka, a. s., company
registration number (IČ) 45317054 (Bank); Modrá pyramida
stavební spořitelna, a. s., company registration number
(IČ) 60192852; KB Penzijní společnost, a. s., company
registration
number
(IČ) 61860018;
ESSOX s. r. o.,
company registration number (IČ) 26764652, , and other
entities in which the Bank has or will acquire an equity
interest of a direct or indirect share in their registered
capital;
Entities controlled by SG – entities which SG controls and
which, at the same time, either (i) have or acquire an equity
interest in entities with their registered office in the Czech
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
Republic consisting of a direct or indirect share in their
registered capital, or (ii) have their registered office in the
Czech Republic. If such an entity is an FSKB member, this
entity is listed in the specification of FSKB Members;
Personal Data – name, surname, address, date of birth,
birth certificate number, connection details, financial
standing and credibility of the Client – natural person, no
sensitive personal data;
Data on legal entity – the identification data of the Client - legal
person, especially: business name, place of business/company
address, company registration number (IČ), date of foundation,
type of business, contact details, information about the solvency
and reliability of the Client.
Soubor_PP_CP_01012014
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CONDITIONS OF INSURANCE RELATED TO TRAVELLING
st
as of 1 January 2014
Article 1 – Insured person
1.1.
The person named in the insurance contract is the insured
person.
Article 2 – Sensitive data processing
2.1.
The insurer has the right to ascertain the state of health of the
insured as well as other information about the insured when
providing assistance services during the insurance existence or
when paying out insurance indemnity.
2.2.
By using the assistance services or exercising the right to
insurance indemnity by the insured the insurer becomes entitled
to require reports on the insured’s state of health from the
healthcare facilities in which the insured is treated, was treated
or is registered.
2.3.
At the insurer’s request, the insured, or the beneficiary, is
obliged to procure at her/his own expense the necessary
medical documentation required by the insurer.
2.4.
The insurer can ask the insured to undergo examinations (or
more precisely, examination at the provider of healthcare
services designated by the insurer. The insurer does not
reimburse for the cost of the insured’s transport.
2.5.
The insurer’s right to ascertain and investigate the insured’s
state of health shall mainly be used when handling a claim –
even after the death of the insured.
2.6.
The period when it is temporarily rendered impossible to
ascertain and investigate the insured’s state of health owing to
reasons on the part of the insured, her/his healthcare provider
or the beneficiary is considered default of the creditor even if
the situation was not the creditor’s fault.
2.7.
The information obtained by the insurer when ascertaining the
state of health may only be used to meet the insurer’s
obligations arising from the insurance contract and to ensure
the insurer’s legitimate interests, otherwise solely with the
insured’s consent.
2.8.
Consent to medical data processing in connection with the
insurance contract
2.8.1.
The insured, or the beneficiary on behalf of the insured, grants
to the insurer by exercising the entitlement to insurance
indemnity her/his consent to obtain information about her/his
state of health via the healthcare provider appointed by the
insurer and authorises all the inquired insured‘s healthcare
providers, physicians, institutions, medical establishments and
health insurance companies to provide this information to the
insurer even after the death of the insured person.
2.8.2.
The insured, or the beneficiary on behalf of the insured, hereby
grants the insurer her/his explicit consent to process the
insured’s personal data concerning her/his state of health
(sensitive data within the meaning of s. 4b of the Personal Data
Protection Act) which s/he provided to the insurer in connection
with the insurance, or which the insurer obtained in the above
described way or created by processing the data acquired in
this way. This sensitive personal data will be processed by the
insurer or an administrator entrusted by the insurer in order to
be used within the subject-matter of the insurer’s business, i.e.
for processes directly or indirectly related to insurance or
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
reinsurance activities. The insurer has the right to transfer the
sensitive data of the insured, to the necessary extent, in
accordance with the meaning of s. 27 of the Personal Data
Protection Act, to other states for the purposes of reinsurance.
2.8.3.
The granting of the consent to obtain and process sensitive
data in the scope specified above is a condition for exercising
the right to insurance indemnity. However, the insured has the
right to withdraw the granted consent any time. The withdrawal
of this consent can solely be made in writing, best sent as a
registered letter to the address of the insurer. The withdrawal of
this consent results in extinguishment of the beneficiary’s
entitlement to insurance indemnity as at the day on which the
insured withdrew her/his consent in writing, however no sooner
than as at the day on which this withdrawal was delivered to the
insurer. In this case, the insurer is entitled to premiums for the
period of the insurance duration.
2.8.4.
The situation when it is rendered impossible to ascertain and
investigate the insured’s state of health owing to reasons on the
part of the insured which seems to be of a permanent nature is
considered a withdrawal of the consent to the sensitive data
processing as at the day on which the insurer learnt of this fact.
Article 3 – Insured risks related to travelling
3.1.
Insured risks are potential causes of insured events to which
the insurance contract applies and they are explicitly specified
in the insurance contract.
3.2.
The insurer is obliged to provide insurance indemnity only if the
loss event occurring from the insured risk meets the conditions
of the insured event defined by the insurance contract and the
respective clause, and no insurance exclusion applies to it,
unless the insurance contract stipulates otherwise. The
insurance contract may limit the insured event’s occurrence
only to a specific event or a related fact (e.g. traffic accident,
temporary stay abroad, use of an assistance service, etc.).
3.3.
Injury
3.3.1.
Injury is an unexpected and sudden impact of external forces or
the insured’s own physical force independent of the insured’s
will, or unexpected, continuous and independent of the
insured’s will impact of high or low external temperatures,
gases, fumes, radiation (excluding nuclear), electricity and
poisons (excluding microbial poisons and immunotoxic
substances) causing damage to the insured’s health or the
insured’s death during the insurance period.
3.3.2.
Death by drowning, near drowning and strike of lightning are
also considered an injury provided that they occur
independently of the insured’s will.
3.3.3.
To eliminate any doubt, the following cases are not considered
injury: suicide, attempted suicide, intentional self-inflicted injury
and judgement of the declaration of the death of the person.
3.3.4.
The following is not considered an injury:
a) formation and aggravation of hernias and tumours of all
kinds and origins, of varicose ulcers, diabetic gangrenes,
formation and aggravation of aseptic inflammations of
tendon sheaths, bursitis, synovitis, epicondylitis, spinal disc
prolapse and thereto related problems, including
vertebrogennic algic syndromes – even if the listed
problems have been provoked by injury or a sudden
vascular accident;
b) mental or psychiatric disorders – even if induced by an
injury;
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Strana 10 z 18
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c)
d)
e)
f)
collapses, epileptic or other fits and spasms affecting the
whole body – unless they occur as a sole result of an
injury;
infectious diseases – even if transmitted by wounds caused
by an injury;
work-related injuries and diseases – unless they are of
injurious nature as defined in these insurance terms and
conditions;
aggravation or manifestation of a disease as a result of an
injury;
heart attacks or brain strokes.
g)
3.4.
Territories and areas
3.4.1.
In the insurance contract, the territorial effectiveness of the
insurance for a particular insured risk can be determined
depending on the insured’s homeland.
3.4.2.
The homeland of the insured means the territory of the country
in which the insured:
a) is or should be, in compliance with the local legislation, a
participant of the public health insurance, or;
b) has her/his usual residence.
3.4.3.
The source country means the territory of the Czech Republic,
unless otherwise agreed upon in the insurance contract.
3.4.4.
A place abroad means any place which is neither the insured’s
homeland nor the source country.
Article 4 – Obligations in asserting the right to insurance
indemnity for an insured event
4.1.
If a loss event occurs, (if it is a condition for the insured event’s
occurrence) the insured is obliged, without undue delay, to
notify the assistance company over the telephone from abroad
of the loss event’s occurrence; having the insured returned to
the source country or her/his homeland, s/he or the beneficiary
is obliged to prove without undue delay the occurrence of the
insured event to the insurer by submitting the relevant
documents.
4.2.
Before the settlement of the claim, the insurer has the right to
require of the insured and/or the beneficiary who is/are obliged
to meet the insurer’s requirement, the submission of originals
and, in justifiable cases, of certified copies of documents. If the
relevant document is produced in a foreign language, the
insured and/or the beneficiary is/are obliged to procure its
certified translation into the Czech language and submit it
together with the original document.
4.3.
The insurer has the right to require other documents to be
submitted if it is necessary for the proving of the insured event’s
occurrence.
4.4.
The insured is obliged to undergo, at the insurer’s request, a
medical examination at the healthcare provider appointed by
the insurer, to prove her/his identity by showing the ID or any
other valid identification document to the physician. If the
insured refuses to undergo the checkup or fails to provide the
necessary information and documents, the insurer can
proportionally reduce the insurance indemnity or, in justified
cases, even refuse to pay out the indemnity at all.
4.5.
Unless these obligations have been met, the insurer provides
no insurance indemnity, or suspends the payment until the
prescribed obligations are met.
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
Article 5 – Exclusions and limitations of insurance
indemnity
5.1.
Exclusions and limitations
5.1.1.
The insurer does not indemnify for the following loss events
occurring:
a) as a consequence of warlike
events, other armed
conflicts and national riots, including related military,
police and administrative measures,
b) as
a
consequence
of
uprisings,
insurrections,
demonstrations, strikes,
c) as a consequence of intervention of the state or official
powers,
d) as a consequence of terrorist attacks and other violent
actions with political,
social, ideological or religious
motivation,
e) as a result of nuclear energy, radiation, exhalation and
emissions,
f) as a result of vandalism,
g) as a result of the HIV (AIDS) illness, infectious venereal
disease and their consequences,
h) during a trip that the insured starts after the Ministry of
Foreign Affairs of the Czech Republic, or government
bodies of other states or important
international
organizations, announce that it is not recommended for
citizens of the Czech Republic to travel to the particular
country or region (e.g. because of a war, civil uprising,
natural hazards, epidemic etc.).
5.1.2.
The insurer is not obliged to indemnify if the loss occurred as a
result of:
a) the insured deliberately breaching legal regulations of the
country (e.g. driving a motor vehicle without the prescribed
driving licence);
b) the insured violating the public order or property or
committing a crime,
c) loss or damage events caused deliberately by the insured,
d) loss events deliberately provoked by the insured or another
person,
e) the insured participating in attempts at achieving or
exceeding a speed record or in any other activities with
similar goals,
f) intentional self-inflicted injury, suicide or attempted suicide.
5.1.3.
Unless agreed upon otherwise, the insurer does not indemnify
for losses occurring in physically demanding sports activities
and activities generally regarded as risk or adrenaline. A sports
activity also means the insured’s activity in the role of an
organiser of a sports event if it entails a physically demanding
activity (e.g. a football referee) or if the insured can be directly
endangered by the moving sports equipment (e.g. a javelin) or
the sportsman (e.g. an alpine skier).
5.1.4.
The insurer also does not indemnify for losses occurring:
a) when driving a means of transport off the road or in places
where the driving of a means of transport is forbidden,
b) during the insured’s active participation in races,
competitions or shows, or during the related preparation for
these on land, water or in the air as a driver or co-driver;
c) when flying any means, including parachute techniques
(e.g. paragliding, parasailing, skydiving), with the exception
of a plane of a regular passenger airline or a special group
flight registered with the OAG Worldwide Flight Guide (e.g.
chartered flights) and aerotaxi,
d) when performing the job of a pilot or other crew member of
aircraft or a helicopter,
e) when sailing on any vessel in the open sea (waters not
included in a solely economic zone, archipelagic waters,
Soubor_PP_CP_01012014
Strana 11 z 18
p
coastal waters, adjoining zones or inland waters of states),
excluding the vessels of the regular sea passenger
transport,
f) when diving with the use of any method or means deeper
than 30 m,
g) expeditions to places with extreme climate and natural
conditions; to remote and vast, unpopulated areas (deserts,
arctic areas, etc.),
h) during emergency situations aimed at saving the life or
finding a person in a place with extreme climatic or natural
conditions,
i) when moving and/or staying in areas more than 5,000 m
above sea level,
j) in skialpinism, snowrafting,
k) in bungee jumping, canoeing, speleology,
l) when hunting, doing herpethology actively, exercising the
game management rights,
m) when performing the activities of an explosion expert,
stuntman or beast of prey tamer,
n) when staying at dangerous workplaces, e.g. construction
sites, underwater workplaces, mines, oil production facilities
etc.
5.1.5.
The insurer has the right to adequately reduce insurance
indemnity if the insured deliberately breached her/his obligation
to avert the loss event or to avert the increase of the event’s
consequences, depending on the insured’s possibilities.
5.1.6.
If the insured breached the obligations set out in the insurance
contract and legislation, or allowed the breaching of these
obligations by third parties, and if this breach affected the
occurrence or scope of the loss event, the insured has the right
to reduce insurance indemnity by the amount of the loss which
would not have occurred under normal circumstances if the
insured had fulfilled her/his obligations.
5.1.7.
If a lower premium is prescribed as a consequence of incorrect
provision of the insured’s date of birth or other data crucial for
determination of the premium, the insurer has the right to
reduce insurance indemnity by the difference between the
premium received and the premium that should have been paid.
5.1.8.
If the insured or the beneficiary frustrates the devolution of the
right to the insurer, the insurer has the right to reduce the
indemnity by the amount which it would otherwise obtain. If the
insurance indemnity has already been paid out, the insurer is
entitled to the refund up to this amount.
5.1.9.
Unless the insurance contract explicitly stipulates that it also
applies to the performance of the insured’s working activities
and if the loss event occurred in connection with the insured’s
working activities, the insurer is not obliged to provide insurance
indemnity.
5.2.
Other exclusions and limitations specific for accident insurance
5.2.1.
Apart from the cases specified above and prescribed by
legislation, the insurer has also the right to reduce indemnity
from the accident insurance by up to one half if the insured fails
to obey the request of a police officer/constable and refuses to
undergo a medical examination or a test governed by a special
regulation and aimed at ascertaining whether or not the insured
is under the influence of alcohol or any other addictive
substance.
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
5.3.
Other exclusions and limitations specific for damage liability
insurance
5.3.1.
The insurer is not obliged to indemnify from the liability
insurance in the following cases:
a) damage to any means of transport borrowed or rented or
legitimately used by the insured in return for payment (e.g.
based on a hire-purchase or lease contract),
b) damage for which the insured is obliged to compensate
her/his close persons,
c) obligations to compensate for any damage above the scope
set forth in legal regulations and assumed by the insured,
d) damage resulting from the insured’s toleration of third
parties breaching the obligations imposed on the insured,
e) damage for which legal regulations prescribe the obligation
to take out insurance of liability for damage or set forth that
the insurance will be formed on the basis of another legal
fact,
f) damage to the things used by the insured wrongfully,
g) damage caused by toxic substances, noise, vibrations or
radiation,
h) damage to environment (e.g. though pollution of water, soil,
air; damage to flora and fauna, etc.),
i) damage for which the insured did not plead the limitation of
time,
j) damage for which the insured concluded a reconciliation
agreement or agreed on judicial settlement; however, the
insurer can provide indemnity in the amount according to
other documents submitted,
k) damage occurring in relation to the consumption or
consuming of alcohol, or any other addictive substances or
agents with such a substance, or abuse or abusing of
medicines and poisoning as a consequence of consuming
solid, liquid or gaseous substances due to negligence, or
when handling these substances.
Article 6 – Insured physical and sports activities
6.1.
The insurance always applies to the following activities
performed by the insured at recreational level (excluding
participation in organised competitions and official preparation
for them):
a) hiking – general hiking and trekking on marked tourist tracks
(excluding via ferrata) up to 3,000 m above sea level;
b) cycling on public roads or marked cycleways – cycling (not
off-road cycling), artistic cycling, footbiking;
c) water sports – water aerobics, swimming, synchronised
swimming, diving (to swimming pools only) from a board 5
m above the surface at most, aquatic centre attractions
(while keeping safety conditions), water polo, recreational
sailing in small boats (excluding jet skis) not subject to
registration in the Shipping Register of the Czech Republic
or a similar register of another country, dragon boats,
canoeing (kayak, canoe), rafting, descending water currents
of WWI difficulty, fitness paddleboarding (in non-running still
water), rowing, underwater hockey and rugby, snorkelling
and free-diving no deeper than 10 m;
d) winter sports on marked tracks within operating hours or on
designated sports grounds – cross-country skiing, skiathlon,
biathlon, curling, ice stock sport, ice skating, figure skating,
ice hockey, sledge hockey, sledge riding on marked tracks
(outside ice chutes);
e) indoor and collective sports – aerobics, yoga and healthbeneficial exercise, kick-box aerobics, zumba, fitness and
bodybuilding, musclebuilding, rhythmic gymnastics, artistic
gymnastics, trampoline jumping, badminton, squash, table
tennis, showdown, basketball, bowling, boccia, floorball,
hockeyball, football, indoor football, goalball, foot tennis,
Soubor_PP_CP_01012014
Strana 12 z 18
p
American football, frisbee, fire-fighting sport, handball,
cycleball, korfbal, cricket, lacrosse, field hockey, rugby,
baseball, softball, spinning, social dancing, tchoukball,
volleyball, beach volleyball, wallyball;
f) other sports – tennis, roller skating, pool, skittles,
orienteering, radio orienteering, road running, airsoft running
(no hurdles), triathlon, quadriathlon, bigman, ironman,
skateboarding, sport fishing, golf, aerotrim, boomerang,
bungee running, bungee trampolining, footbag, Olympic
fencing (martial), fencing (classical), shooting sport
(shooting at a target using a gun), cheerleading, fly fox, high
ropes activities up to 10 m above ground, archery, paintball,
pétanque, mushing, animal riding, table football, table
hockey, board games, card competitions, bridge, chess and
chess tournaments, darts, bublik, zorbing, jugglery (diabolo,
fireshow, juggling, yoyo).
6.2.
If stipulated in the insurance contract, the insurer shall
indemnify even for damage occurred in activities performed by
the insured at the recreational or competitive level:
a) hiking – alpine hiking and trekking up to 5,000 m above sea
level (via ferrata incl.), rock climbing up to 7UIAA difficulty;
b) cycling on a rough terrain – bicross, cycling, cyclo-cross,
mountain biking;
c) water sports – yachting and leisure sailing in small vessels
which are subject to registration in the Shipping Register of
the Czech Republic or in a similar register of another
country, jet ski riding, canoeing (kayak, canoe), rafting,
descending of a water current of WWII to WWV difficulty,
speed paddleboarding (in non-running still waters),
Article CN – Clauses concerning help to people in distress
while travelling
The insurance to the extent of the following clauses can be
arranged as the insurance against loss and damage or the
insurance of the agreed sum.
Clause CLV – Medical expenses insurance
CLV.1.
The insured event is the condition of the insured endangering
her/his health or life and requiring medically necessary
provision or providing of medical care in consequence of an
injury or a sudden disease occurring in the insurance period
and in the territory of the insurance effectiveness. The insured
event lasts only for the period necessary to stabilise the
insured’s state until the moment when the insured is able to
continue her/his journey or to be transferred as a patient to the
source country or her/his homeland.
CLV.2.
For the insured event’s occurrence simultaneously applies that
the medical care is unrelated to the state of the insured’s
health, disease or injury or their consequences which the
insured suffered or of which s/he was aware during 6 months
before the commencement of the insurance, regardless of
whether or not they were treated. The limitation does not apply
th
to treatment of pregnancy complications up to the 24 week of
the pregnancy, unless it is a high-risk pregnancy diagnosed
before starting the trip.
CLV.3.
The insured event is also provision of medically necessary,
acceptable or purposeful transfer of the insured:
a) to the nearest, or approved by the assistance company,
healthcare facility, or;
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
a)
b)
d)
e)
aqualung diving up to 30 m deep, water skiing,
wakeboarding, windsurfing, kitesurfing;
winter sports - within operating hours or designated sports
grounds – downhill skiing, snowboarding, rides in a
snowpark, mogul skiing, monoski, skibobbing, speed skating
on ice, skicross, bobsleighing, sledding and skeleton
sledding in a toboggan chute, snowtubbing, snowkiting
(where permitted);
indoor and collective sports – athletics, acrobatic rock’n’roll,
martial arts and sports, aikido, boxing, judo, karate,
kickboxing – martial art, taekwondo, weightlifting, GrecoRoman wrestling;
other sports – kiteboarding, riding in a skatepark (in-line,
skateboard), mountainboarding on marked tracks, rope
jumping, buggykiting, summer camps for children and sports
training camps, in-line speed skating, powerlifting,
streetluge;
other physical and sports activities posing comparable risks
– the physical and sports activities not explicitly stated in
articles 6.1. and 6.2. a) through f) which do not pose a
higher risk of damage to the insured’s health than the
insured physical and sports activities listed above,
considering the following aspects:
the way, difficulty and time of the insured’s movement;
the quality of the sports surface or terrain;
interaction with the surroundings;
material, its processing, shape and speed of the moving
sporting tools;
the used protective aids and safety measures.
b) to a more suitable healthcare facility approved by the
assistance company, or;
c) from the healthcare facility to the place of the insured’s
temporary stay abroad approved by the assistance
company;
d) back to the source country or the homeland organised or
approved by the assistance company if the initially planned
means of transport cannot be used for the insured’s return.
CLV.4.
In the case of death of the insured, the following is considered
part of the insured event:
a) temporary storage of the insured’s remains abroad;
b) repatriation of the insured’s remains to the source country or
homeland organised or approved by the assistance
company, or;
c) cremation of the insured’s remains and subsequent
transport of the urn to the source country or homeland
approved by the assistance company.
CLV.5.
If the insured dies, the beneficiary is the person who has the
right to be handed over the insured’s remains within the
nd
meaning of the 2 paragraph of section 92 of the NOZ.
CLV.6.
The following loss events do not become insured events:
a) if the insured took the trip while on sick leave or despite
her/his physician’s disapproval, or took the trip to be cured
abroad,
b) if medical care was provided without prior consent of the
assistance company or insurer, excluding emergency
medical help aimed at averting permanent damage to the
insured’s health or imminent danger to the insured’s life,
c) if the treatment was not necessary or urgent, or if the
insured could have returned to the source country or her/his
Soubor_PP_CP_01012014
Strana 13 z 18
p
homeland as soon as the diagnosis was made or the
necessary treatment provided,
d) if s/he was treated after the day on which, according to the
doctor designated by the assistance company, the insured’s
state of health enabled her/his transfer to the source country
or homeland, if the transfer was technically possible and if
such a cost of treatment exceeds the cost of the insured’s
transfer,
e) in relation to the consumption or consuming of alcohol, or
any other addictive substances or agents with such a
substance, or abuse or abusing of medicines and poisoning
as a consequence of consuming solid, liquid or gaseous
substances due to negligence, or when handling these
substances,
f) effect of microbial poisons and immunotoxic substances,
g) in direct relation to mental diseases, depression and
nervous disorders if these are not the result of the insured
event occurring in the period of insurance and the treatment
of which is not an insured event,
CLV.7.
The following is not explicitly considered an insured event:
a) use of curative methods and drugs generally not accepted
by the scientific community, including elimination of
consequences of using these methods,
b) operations carried out by a person without appropriate
qualification,
c) rehabilitation,
d) stay at spas, health resorts, sanatoriums and similar
facilities,
e) abortion, child birth, pregnancy tests, use or purchase of
contraception,
f) cosmetic procedures with the exception of essential plastic
surgery after an injury which occurred in the insurance
period and the treatment of which is the insured event,
g) dental treatment except for urgent treatment of natural teeth
in the case of acute toothache or after an injury which
occurred in the insurance period and the treatment of which
is the insured event,
h) provision of above standard care,
i) preventative
medical
examinations,
preventative
vaccinations, vitamins, performance enhancing drugs,
prosthetic devices and auxiliary aids (sanitary towels,
contact lenses, spectacles etc.),
j) treatment provided by the close person or the policyholder,
k) medical treatment that took place after the return to the
source country or to the insured’s homeland,
l) temporary storage of the insured’s remains and funeral in
the source country or the insured’s homeland, following the
transport of the remains from abroad.
CLV.8.
The insured event starts to have effect at the moment when the
insured’s condition endangering her/his health or life arises and
it ends on the day of the insured event’s occurrence.
The day of the insured event’s occurrence is the day on which
the insured is able to continue her/his journey thanks to
stabilisation of her/his state, or is transferred as a patient to the
source country or her/his homeland, or on the day on which the
insured dies abroad.
CLV.9.
The insured is obliged:
a) if having any problems, to discuss with the attending
physician before going abroad her/his state of health
concerning the nature of the trip and to follow the doctor’s
instructions,
b) to have a sufficient amount of the medicine s/he uses
regularly,
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
c) to take reasonable care of his/her state of health, to undergo
a medical examination without any delay and to follow the
doctor’s instructions.
If an insured event occurs, the insured is obliged:
d) to use the healthcare facility and services recommended or
approved by the assistance company,
e) ensure the right to loss/damage compensation towards the
third party,
f) to cover the cost of urgent treatment abroad, in the foreign
currency up to the equivalent of CZK 3,000; the payment
and subsequent payment of the cost of urgent medical
treatment exceeding CZK 3,000 is guaranteed by the
assistance company, if possible,
g) in special cases, when asked to pay all the cost of the
urgent treatment abroad in cash, the insured pays it on the
spot,
h) to notify the insurer of the loss event within 31 days
following the insured event’s occurrence,
i) to submit to the insurer the originals of documents related to
the loss event, or the originals of copies if the original
documents were taken by the health insurance company or
a third party; but the copies must contain the health
insurance company’s or the third party’ confirmation of
having received the originals and of the amount of the cost
paid by them; to ensure, at his/her own expense, a certified
translation of these documents into Czech if not issued in
English, French, German, Russian or Spanish,
j) without undue delay to deliver to the insurer the bills sent by
a third party to the insured person’s address and not to pay
for them unless there is a risk of default on their payment,
k) to notify the insurer of all insurance coverages for the same
insured risk arranged with other insurance companies and
effective at the moment of the insured event’s occurrence,
l) to transfer any claims towards third parties (but not towards
close persons) to the insurer in writing, up to the amount of
the cost covered by the insurance contract (if the damage
was not caused deliberately or under the influence of
alcohol or other addictive substances),
m) to announce and to prove the amount paid out to her/him by
the health insurance company or a third party in connection
with the loss event – even if later.
CLV.10.
The insured event’s occurrence is proved by:
a) medical report, bill for the treatment indicating the name and
date of birth of the insured, the diagnosis, description of the
disease, list of operations, addresses of the healthcare
facility, the name and signature of the attending physician,
b) medical prescription indicating the name and date of birth of
the insured, the name and signature of the attending
physician; bill from the drugstore indicating the type of the
medicine, its price and the address of the drugstore,
c) having been injured when downhill skiing, then also a
document about professional adjustment of ski binding,
d) having been injured during working or sports activities, then
by a document about the use of protective aids, or another
prove of their use,
e) in the case of the insured’s death, by the death certificate
and medical certificate concerning the cause of death.
If the police are investigating the circumstances of the sudden
disease, injury or death of the insured, the occurrence of the
insured event is proved by police documents describing the
insured event and by the findings of the investigation.
If the insured is transferred to the source country or homeland,
s/he is obliged to give to the assistance company all the unused
travel documents which could have otherwise been used. If the
insured’s remains or urn are repatriated to the source country or
homeland, this obligation lies on the beneficiary.
Soubor_PP_CP_01012014
Strana 14 ze 18
p
CPZ clause – Luggage insurance
CPZ.1.
The subject of the insurance is travel luggage of the insured,
including the insured’s personal effects. The following is not
subject of the insurance:
a) money, cheques, stamps and vouchers, fare tickets, air
tickets, savings bankbooks, passports, driving licences and
other documents, all types of certificates and licences,
bonds, shares, deposits, certificates of deposit, investment
and similar securities;
b) jewels and jewellery, precious stones, precious metals,
collector’s items, antiquities, items of artistic or historical
value (e.g. paintings, graphic artwork, glassware, porcelain,
pottery etc.) and other valuables;
c) consumer electronics, excluding mobile phones, cameras,
binoculars, camcorders and their accessories;
d) items which were damaged, destroyed or stolen when they
were confided to the transport provider against a
confirmation, or deposited against a confirmation, and items
deposited in left luggage lockers;
e) data, sound or video recordings on any media.
CPZ.1.1.
Sporting tools and equipment for physically demanding physical
and sports activities – unless these activities are explicitly
insured by the insurance contract – and for activities generally
regarded as risky or adrenaline are not considered to be subject
of the insurance.
CPZ.1.2.
The insured’s things bought or used for business purposes are
not considered to be subject of the insurance unless the
insurance contract expressly stipulates that it also applies to
performance of the insured’s business activities.
CPZ.2.
The subject of insurance is insured against its time value (its
usual price at the moment of the insured event’s occurrence).
CPZ.3.
The insured event means the damage, destruction or loss of the
subject of insurance as a result of:
a) a natural disaster;
b) water leaking out of water mains;
c) a traffic accident with the insured as its participant; however,
the insurance applies to the loss of the subject of insurance
only if the insured was deprived, due to the injury in this
accident, of the opportunity to take care of her/his things;
d) theft, whereas the right to indemnity arises only if the
subject of insurance was stolen from a facility in which the
insured was accommodated or from a locked luggage
compartment in a closed and locked vehicle, by which the
insured travels, including the vehicle’s trailer;
e) robbery if the insured had the subject of insurance on
her/him or confided the care of the object to the close
person;
provided that it occurred in the insurance period and in the
territory of insurance effectiveness.
CPZ.3.1.
Damage means a change in the state of the subject of
insurance which can objectively be repaired, or such a change
which cannot be objectively repaired but the subject of
insurance still can be used for its original purpose.
CPZ.3.2.
Destruction means a change in the state of the subject of
insurance which cannot objectively be repaired and therefore
the subject of insurance cannot be used for its original purpose
any more.
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
CPZ.3.3.
Loss means a situation when the insured lost, independently of
her/his will, the possibility to have and use the subject of
insurance.
CPZ.3.4.
Theft means the appropriating of the subject of insurance by the
by a thief who takes the thing after having overcome the
obstacles protecting the thing against theft, i.e. the thief breaks
in and enters a closed protection area using a means other than
that provided for lawful entry, with destructive consequences or
hides in the area that protects the thing against theft and steals
the thing after the area is locked up, leaving evidentiary traces
of the theft.
CPZ.3.5.
Robbery means the appropriating of the subject of insurance by
an offender using violence or threat of violence to the insured or
another person entrusted by the insured.
CPZ.4.
The insured event does not arise if the loss event occurs as
follows:
a) breaking into a vehicle if the vehicle is parked at its
destination, or a transit place (a transit parking place is a
place of an overnight stay, not a short stopover), from
22:00 pm to 6:00 am, if the vehicle is not temporarily
supervised by its driver or any other authorised person aged
over 18;
b) theft of the subject of insurance from a tent, caravan or a
similar facility with no solid walls or ceilings (made of canvas
etc.), even if they were locked;
c) theft of the subject of insurance from unlocked luggage, or
more precisely from luggage which was cut open etc.;
d) theft of the subject of insurance in a non-destructive way,
e.g. taking it out through the bars of the facility or vehicle;
e) theft of the subject of insurance from a vehicle or its luggage
compartment when the method of entry is not discovered;
f) theft of the subject of insurance fastened on the roof rack of
a vehicle even if they are locked (except for a locked roof
box).
CPZ.5.
The day of the insured event’s occurrence is the day on which
the damage to the subject of insurance or its destruction occurs,
or when the insured discovers the loss.
CPZ.6.
In the case of a traffic accident or suspicion of a crime, the
insured is obliged, without undue delay:
a) to notify the police of the loss event;
b) if the loss incurred exceeds CZK 500, to report to the police
the information about all the things stolen, or damaged or
destroyed by the offender.
CPZ.7.
The insured event’s occurrence is proved by:
a) documents proving the loss event’s occurrence (e.g. a
document concerning the method of overcoming the
obstacles protecting the thing from thieves);
b) the list of stolen, lost or damaged things;
c) police reports (the cost of getting the police reports, including
the results of the investigation, are covered by the insured).
Article CF – Clauses of insurance against financial loss
immediately relating to travelling
The insurance to the extent of the following clauses can only be
arranged as the insurance against loss and damage.
CSZ clause – Tour cancellation insurance
CSZ.1.
The insured event is the occurrence of financial loss as a
consequence of premature cancellation or not starting the tour
for the below listed serious reasons, due to which the insured
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cannot start the ordered and paid tour and which arise in the
period of effectiveness of this insurance:
a) death of the insured or the insured’s close person,
b) serious acute disease, pregnancy complications up to three
months before the expected birth, medical complications or
injury of the insured if it requires hospitalisation or
permanent care, according to the attending physician’s
decision and confirmation containing the exact period of the
treatment, diagnosis of the acute disease, injury or
pregnancy complications and stating that the insured’s state
of health does not allow her/him to join the tour,
c) serious acute disease, pregnancy complications up to three
months before the expected birth, medical complications or
injury of the insured’s close person if this person needs
hospitalisation or permanent care from the insured,
according to the attending physician’s decision and
confirmation containing the exact period of the treatment,
diagnosis of acute illness, injury or pregnancy complications
and stating that the state of health of the insured’s close
person does not allow her/him to join the tour,
d) if there is a natural disaster (fire, explosion, floods,
earthquake) in the place of residence of the insured as
confirmed by local authorities which reaches an extent
endangering the health, life and property of the insured,
e) if there are any civic riots or natural disasters (earthquake,
floods, forest fires, wind storms, volcanic activity) or
epidemic in the tour destination, officially announced by the
Ministry of Foreign Affairs of the Czech Republic or any
other competent body of the Czech Republic, international
and local authorities, and if it might endanger the health, life
and property of the insured.
CSZ.2.
If the insured event from the tour cancellation insurance occurs,
the beneficiary is the person who incurred the financial loss.
CSZ.3.
The insured event does not arise if the loss event occurs as
follows:
a) as a consequences of a chronic disease, or a relapse of the
chronic disease or injury or its consequences from which the
insured or the insured’s close person suffered at the
moment of entering into the insurance contract, whereas the
need for treatment could have been foreseen before
commencing the tour,
b) in relation to the consumption or consuming of alcohol, or
any other addictive substances or agents with such a
substance, or abuse or abusing of medicines and poisoning
as a consequence of consuming solid, liquid or gaseous
substances due to negligence, or when handling these
substances,
CSZ.4.
The cancellation or not starting of the tour due to the following
reasons is not considered an insured event:
a) due to a change of travel plans and intentions, even if
independent of the insured’s will,
b) impossibility to get a visa to the destination,
c) impossibility for the insured or the close person to take
leave,
d) due to invalid travel documents.
CSZ.5.
The insured is obliged to cancel the ordered tour to the
necessary extent without undue delay if any of the situations
listed under art. CSZ.1. occurs and it is apparent that the
insured cannot take part in the tour.
CSZ.6.
The day of the insured event’s occurrence is the day on which
the sum for the tour cancellation is billed and announced to the
insured.
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
CSZ.7.
The insured event’s occurrence is proved by:
a) a receipt for the tour cancellation fee payment;
b) the travel contract;
c) documents proving the occurrence of the situations listed
under art. CSZ.1. (e.g. medical confirmation issued by the
attending physician concerning the injury, disease or other
health conditions of the insured or the close person).
If the tour is cancelled owing to the facts listed under art. CSZ.1.
and related to the insured’s close person, the insured event’s
occurrence is also proved by any document proving the relation
between the insured and the close person.
COO clause – Damage liability insurance
COO.1.
The insured event is the occurrence of the insured’s obligation
to compensate the third party for the damage occurred. For the
purposes of this insurance, damage also means the insured’s
obligation to compensate for harm. The insured event’s
occurrence is conditioned by the fact that the cause of the
damage arose in the insurance period and in the territory of the
insurance effectiveness.
COO.2.
The insurance only applies to the obligation to compensate for
the caused damage as imposed by the principles of the
insured’s civil life. Unless explicitly stipulated in the insurance
contract that it also applies to the performance of the insured’s
working activities and if the loss event occurred in connection
with performance of the insured’s working activities, the insurer
is not obliged to provide insurance indemnity.
COO.3.
The insured event does not arise if the loss event occurs as
follows:
a) due to activities relating to operation of business,
b) due to especially dangerous operation of business;
c) due to operation of the means of transports for the driving or
operation of which a special authorisation or permit is
required;
d) due to a defect of the product to be launched onto the
market;
e) to an acquired thing which should be subject to obligation of
the insured or of another person on whose behalf the
insured takes actions;
f) to a thing brought in or put off;
g) due to information or advice;
h) to a thing due to wantonness or maliciousness or the
insured.
COO.4.
The day of the insured event’s occurrence is the day on which
the damaged party exercised her/his right to damages.
COO.5.
The insured is obliged, without undue delay:
a) to inform the damaged party about her/his liability insurance;
b) to try to make a record of the damage caused and its extent;
c) if the loss event occurred under circumstances arousing a
suspicion of a crime or delict, or if the damage caused
exceeds CZK 3,000, to notify of this fact the police or other
investigative, prosecuting and adjudicating bodies;
d) to inform the insurer that criminal proceedings have been
started against the insured in connection with the loss event
and supply the insurer with information on the course and
results of these proceedings;
e) to inform the insurer that the damaged party claims her/his
right to damages before the court.
The insured is also obliged:
f) in the proceedings concerning damages for the loss event,
to follow the insurer’s instructions; in particular the insured
must not – without the insurer’s consent – pledge that s/he
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will compensate for a statute-barred claim or conclude
judicial conciliation; the insured is obliged to appeal against
any potential decision on damages in time, unless otherwise
instructed by the insurer;
g) to obtain the insurer’s consent before s/he admits or
accommodates any potential claim or its part on the basis of
her/his liability for damage.
COO.6.
The insured event’s occurrence is proved by the documents
proving the loss event’s occurrence and the amount of the loss,
e.g. police reports, medical reports, documents concerning
judicial proceedings, notification of commencement and course
of criminal proceedings.
Article CU – Clauses of accident insurance for travelling
The insurance to the extent of the following clauses can be
arranged as the insurance against loss and damage or the
insurance of the agreed sum.
CUS clause – Insurance against death due to injury
CUS.1.
The insured event is the death of the insured due to injury
occurring no later than within 1 year of the injury. The insured
event’s occurrence is also conditioned by the fact that the injury
occurred during the insurance period and in the territory of the
insurance effectiveness.
CUS.2.
The day of the insured event’s occurrence is the day on which
the insured died.
CUS.3.
The insured event’s occurrence is proved by the death
certificate and the document proving the cause of the insured’s
death, a medical confirmation that the death was caused by the
injury.
The beneficiary is also obliged to prove that the injury occurred
in the period of the insurance effectiveness and in the territory
stipulated in the insurance contract.
If the circumstances of the injury or death of the insured are
investigated by the police, then the insured event’s occurrence
shall also be substantiated by the document of the police
describing the insured event and reporting the conclusions of
their investigation, or other documents proving the causality
between the death of the insured and the injury.
CTN clause – Insurance against permanent consequences
of injury
CTN.1.
The insured event is permanent and irreversible damage to
health consisting in anatomical or functional loss of or damage
to a limb, organ or any other part of the insured’s body. The
insured event’s occurrence is also conditioned by the fact that
the injury occurred in the insurance period and in the territory of
the insurance effectiveness.
CTN.2.
The scope of permanent consequences of the injury is
assessed by the relevant percentage evaluating permanent and
irreversible damage to health after the injury in comparison to
the state before the injury. The relevant percentage is
determined according to the Classification of indemnity for
permanent consequences of injury issued by the insurer
(hereinafter referred to as “the Classification of TN“). The
Classification of TN can be inspected at the insurer’s
headquarters. The insurer may supplement and amend the
Classification of TN depending on the development of medical
science and practice.
If one injury of the insured results in several permanent
consequences, the total permanent consequences shall be
assessed by the sum of percentage shares for individual
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
permanent consequences; however up to 100 % of the total
share at most.
If the individual permanent consequences of one or several
injuries relate to the same limb, organ or their part, the insurer
will evaluate them as a whole by the percentage share specified
in the Classification of TN for anatomical or functional loss of
the relevant limb, organ or their part at most.
If the permanent consequences relate to the part of the body or
organ which has been damaged before the injury, the insurer
will reduce the indemnity by such percentage share that
corresponds with the scope of the previous damage according
to the Classification of TN.
The scope of permanent consequences of injury does not
include the consequences of diagnostic, curative and
preventative operations carried out for different reasons than to
treat the consequences of the injury.
CTN.3.
The day of the insured event’s occurrence is the day on which
the permanent consequences of the injury were stabilised,
however, no later than 3 years following the occurrence of the
injury.
CTN.4.
The insured event’s occurrence is proved by a medical
confirmation of the injury and its impact on the scope of damage
to the insured’s health.
The insured is obliged to prove by a medical report, or any other
document issued in the territory stipulated in the insurance
contract, that the injury occurred in the period of the insurance
effectiveness and in the territory stipulated in the insurance
contract.
If the circumstances of the injury are investigated by the police,
then the insured event’s occurrence shall also be substantiated
by the documents of the police describing the insured event and
reporting the conclusions of their investigation, or other
documents proving the causality between the damage to health
and the injury.
CPU clause – Insurance against damage due to injury
CPU.1.
The insured event is damage to the insured’s health due to an
injury occurring in the insurance period and in the territory of the
insurance effectiveness.
CPU.2.
The scope of damage to the insured’s health due to injury is
assessed by the relevant percentage evaluating the damage to
health by the injury compared to the state before the injury. The
relevant percentage is determined according to the
Classification of indemnity for damage to health by injury issued
by the insurer (hereinafter referred to as “the Classification of
PU“). The Classification of PU can be viewed at the insurer’s
headquarters. The insurer may supplement and amend the
Classification of PU depending on the development of medical
science and practice.
If one injury of the insured results in multiple damage, the scope
of damage shall be assessed by the sum of percentage shares
for individual cases of damage; however up to 100 % of the
total share at most.
CPU.3.
The day of the insured event’s occurrence is the day on which
the insured was injured.
CPU.4.
The insured event’s occurrence is proved by a medical
confirmation of the injury and its impact on the scope of damage
to the insured’s health.
The insured is obliged to prove by a medical report, or any other
document issued in the territory stipulated in the insurance
contract, that the injury occurred in the period of the insurance
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effectiveness and in the territory stipulated in the insurance
contract.
If the circumstances of the injury are investigated by the Police,
then the insured event’s occurrence shall also be substantiated
by the documents of the police describing the insured event and
s
Komerční pojišťovna, a. s., se sídlem:
Praha 8, Karolinská 1, čp. 650, PSČ: 186 00, IČ: 63998017
ZAPSANÁ V OBCHODNÍM REJSTŘÍKU VEDENÉM MĚSTSKÝM SOUDEM V PRAZE, ODDÍL B, VLOŽKA 3362
reporting the conclusions of their investigation, or other
documents proving the causality between the damage to health
and the injury.
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