Definitions

1. 'BODILY INJURY' means identifiable physical injury which:
   1. is caused by an Accident, and
   2. solely and independently of any other cause, (except medical or surgical treatment rendered necessary by such injury), occasions the death or disablement within twelve months from the date of the Accident.
2. 'ACCIDENT' means a sudden, unexpected, unusual, specific event which occurs during the operative time and within the Period of Insurance. Where travel to and from an event is also covered, Accident shall include:
   1. exposure resulting from a mishap to a conveyance in which the you are travelling;
   2. if you disappear during the currency of this Insurance and your body is not found within twelve months after your disappearance, and the Insurers are satisfied that you sustained Bodily Injury and that such injury resulted in death, the Insurers shall pay any death benefit, where applicable under this Insurance provided, that the person or persons to whom such sum is paid shall sign an undertaking to refund such sum to the Insurers if you are subsequently found to be living.
3. 'TOTAL DISABILITY' means disablement which entirely prevents you from attending to any business or occupation for which you are reasonably suited by training, education or experience and which lasts twelve months and at the end of that period is beyond hope of improvement.

Exclusions

This insurance does not cover death or disablement in any way caused or contributed to by:

1. loss of weekly income;
2. partial disability;
3. illness;
4. medical expenses and repatriation;
5. any accident which falls outside of the Operative Time specified;
6. war, whether war be declared or not, hostilities or any act of war or civil war;
7. radioactive contamination;
8. you engaging in or taking part in armed forces service or operations;
9. you engaging in flying of any kind other than as a passenger;
10. any suicide or attempted suicide or intentional self-injury or you being in a state of insanity;
11. deliberate exposure to exceptional danger (except in an attempt to save human life);
12. your own criminal act;
13. being under the influence of alcohol, as defined by the motor vehicle laws of the country or state of their normal domicile and / or being under the influence of drugs, unless prescribed to you by a qualified medical practitioner but excluding any drugs prescribed for the treatment of drug addiction;
14. Terrorism (including, without limitation, contemporaneous or ensuing Bodily Injury and/or Illness and/or Medical Expenses caused by fire and / or looting and / or theft.) Terrorism means any act or acts of force and / or violence for political, religious or other ends; and / or directed towards the over-throwing or influencing of the Government de jure or de facto; and / or for the purpose of putting the public or any part of the public in fear;
15. any person or persons acting alone or on behalf of or in connection with any organisation.
16. any claim and in any action, suit or other proceedings to enforce a claim under this Insurance the BURDEN OF PROVING that such claims does not fall within the Terrorism Exclusion set out above shall be upon you;
17. any person or persons acting alone or on behalf of or in connection with any organisation;
18. any amount recoverable under any state or Employers medical scheme.

Conditions

1. Unless otherwise declared and agreed by the insurers no benefit will be payable for any condition for which the you have sought advice, diagnosis, treatment or counselling or of which you were or should reasonably have been aware at inception of this Insurance or for which you have been treated at any time prior to inception.
2. Any fraud, concealment, or deliberate mis-statement either in the proposal on which this Insurance is based or in relation to any other matter affecting this Insurance or in connection with the making of any claim hereunder shall render this Insurance null and void and all claims hereunder shall be forfeited.

Cancellation

This Insurance may be cancelled by or on behalf of the insurers by 30 days notice given in writing to you at your last known address and the premium hereon shall be adjusted on the basis of the insurers receiving or retaining pro rata premium (subject to there being no claims) less 20% handling fee.

Notice shall be deemed to be duly received in the course of post if sent by pre-paid letter post properly addressed.

The Insurers

Your policy is placed 100% at Lloyd's of London with Syndicate 4000 (PEM). Head Office Address: Pembroke Managing Agency Limited, 3 Minster Court, Mincing Lane, London, EC3R 7DD.

Claims

Notice must be given to the Insurers as soon as reasonably practicable of any Accident which causes or may cause a claim within the meaning of this Insurance, and you must as early as possible seek the attention of a duly qualified medical practitioner. Notice must be given to Insurers as soon as reasonably practicable in the event of resulting or alleged to result from an Accident.

All medical records, notes and correspondence referring to the subject of a claim or a related pre-existing condition shall be made available on request to any medical adviser appointed by or on behalf of the Insurers and that such medical adviser shall, for the purpose of reviewing the claim, be allowed so often as may be deemed necessary to examine you.

You will be responsible for providing all particulars and evidence documentary and otherwise at your expense and do all such things as the Insurers may reasonably require.

All documentation, information and evidence to support a claim shall be provided at your expense and shall be in a form as required by insurers. You shall as often as required submit to medical examination at the expense of the insurers. In the event of your death the insurers shall be entitled to have a post mortem examination at their expense.

Complaints

We try our very best to promote straight forward uncomplicated insurance services, however we recognise that occasionally there may be feedback which expresses displeasure. This feedback is important to us and in the first instance we would request that you write to:

Compliance Officer, Everitt Boles Ltd, 15 St Helen's Place, London, EC3 6DE.

Upon notification of a complaint, we will enter all relevant details in our Complaints Book such as the nature of the complaint and the relevant FSA classification. We will gather together all necessary paperwork and information. We will then consider the matter in detail.

It will be our aim to address the matter immediately and we would hope to acknowledge any complaint within two working days after receipt of the complaint. If we need to carry out further internal investigations, we would hope to revert within a week. We would expect to give our final response within a month. If it appears that we need further time, we will write detailing the revised timescale and the reasons for the delay. If we are unable to resolve the issues within eight weeks, we will again write and advise you of the facilities offered by the Financial Ombudsman Service (“FOS”) and enclose their leaflet should the complainant wish to refer the matter to them.

When we have completed our research into the matter, we will write detailing our response to the complaint. There are two options here:

1. A Final Response. This is when we feel that we have answered the complaint satisfactorily. If the response is considered inadequate, the complainant may take the matter up with the FOS within six months.
2. An Offer Letter. This is where we feel that we have addressed the complaint and feel that some redress is relevant. We will then write to the complainant seeking acceptance. This will be followed by a Final Response Letter.

We will consider the matter closed when we have sent the complainant the Final Response Letter or our offer is accepted or we hear nothing within eight weeks from the date of our written response.

We are required by the FSA to report to them every six months (April – September and October – March) advising them of the number and type of all complaints received and their outcome.

The Financial Ombudsman Service are at:
South Quay Plaza
183 Marsh Wall
London
E14 9SR
Tel: 0845 080 1800

 

Law and Language

This insurance contract is written in English and is subject to English Law. All communications about it will be conducted in English.