MORIS
Personal Injury Insurance

POLICY WORDING



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. 'LOSS OF WEEKLY INCOME' means disablement which entirely prevents you from attending to your business or occupation.

4. 'PARTIAL DISABILITY' means disablement which prevents you from attending to a substantial part of your business or occupation. (Refer to Scale of Compensation below)

5. '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.

6. 'EMERGENCY MEDICAL EXPENSES' – following an accident in your competition vehicle and or (where covered) driving to or from an event venue.
  1. The fees of a registered medical practitioner and the fees of any surgeon and other specialist to whom the registered medical referee has referred the case.
  2. The cost of medication, drugs or appliances prescribed by such medical referee, surgeon as mentioned in 6a above.
  3. Maintenance and attendance in hospital pay beds or nursing home and home nursing in bed by a qualified resident or daily nurse.
  4. The cost of emergency transport necessarily incurred in connection with events covered by this section within the country where the events occurs.
7. 'REPATRIATION'
  1. Reasonable additional travel, accommodation and repatriation expenses incurred by you (including other persons necessarily having to travel and/or remain with and/or escort you) in the event of treatment being necessarily undertaken in the Country of normal domicile on the certified instructions of a registered medical referee.
  2. The cost of the transport of your body or ashes to your Country of domicile in the event of death.

EXCEPTIONS
in respect of EMERGENCY MEDICAL EXPENSES - Medical expenses shall not cover:

1.
illness.
2.
The provision of false teeth or dentures, normal eye tests and the provision of visual aids, normal ear tests and the provision of hearing aids.
3.
Cosmetic surgery and associated treatment, unless necessitated by accidental bodily injury.
4.
The excess stated.
5.
Pregnancy and childbirth costs.
6.
The costs incurred during stays at health resorts, spas, sanatoriums, clinics, convalescent homes and similar institutions.
7.
Psycho-analytical and psycho-therapeutical treatment.
8.
Treatment performed by lawful spouse, parents or children.
9.
Treatments whereby the methods and remedies are not scientifically recognised.
10.
Birth defects or congenital illness.
11.
Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or Human Immuno- deficiency Virus (HIV) howsoever these have been acquired or may be named; Hepatitis B or venereal disease.
12.
Expenses incurred within the UK, Northern Ireland, Isle of Man and Channel Islands.



REPATRIATION Sums Insured

Repatriation expenses are limited to £5,000 any one accident.



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

1.
illness.
2.
any accident which falls outside of the Operative Time specified.
3.
war, whether war be declared or not, hostilities or any act of war or civil war;
4.
radioactive contamination;
5.
you engaging in or taking part in armed forces service or operations;
6.
you engaging in flying of any kind other than as a passenger;
7.
any suicide or attempted suicide or intentional self-injury or you being in a state of insanity;
8.
deliberate exposure to exceptional danger (except in an attempt to save human life);
9.
your own criminal act.
10.
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.
11.
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. Any person or persons acting alone or on behalf of or in connection with any organisation.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.
12.
any person or persons acting alone or on behalf of or in connection with any organisation.
13.
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.
14.
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).

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



THE INSURERS
This insurance is provided by SLE Worldwide Limited (via Motorsport Race&rally Insurance Services) who have authority to underwrite on behalf of Equity Redstar, Library House, New Road, Brentwood, Essex CM14 4GD. SLE Worldwide Limited is an AUM Group Company.


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.


EMERGENCY ASSISTANCE
CEGA Emergency 24hr Service
+44 (0)1243 621511


You must do this immediately in the case of serious medical emergency abroad where you will need to stay in hospital, have hospital treatment or change travel arrangements. If you cannot contact CEGA immediately, you must do so as soon as possible.

When calling CEGA for help, please provide the following information:
  • The insured person's name and the address they are staying at
  • The phone number you, or the insured person, are calling from
  • The name and phone number of the doctor and hospital treating you
  • The policy number (shown on your confirmation of cover) and your name
  • The nature of the emergency
Not contacting CEGA, or not following their instructions, could affect your claim. CEGA must agree, beforehand, any emergency travel expenses involving air travel.


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, 63 Mansell Street, London, E1 8AN.

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.



SCALE OF COMPENSATION

Total Disability - Your policy will pay the sum specified in the event of the following:

Total loss of sight of both eyes.
Loss of both arms or both hands.
Complete deafness of both ears, of traumatic origin.
Removal of the lower jaw.
Loss of speech.
Loss of one arm and one leg.
Loss of one arm and one foot
Loss of one hand and one foot.
Loss of one hand and one leg.
Loss of both legs.
Loss of both feet.

Partial Disability - Where you have requested this to be covered the percentage of the sum insured in respect of Partial Disability shall be as follows:


Head
Loss of osseous substance of the skull in all its thickness surface of at least 6 sq. cm.
40%
Partial removal of the lower jaw, rising section in its entirety or half of the maxillary bone.
40%
Loss of one eye.
40%

Upper Limbs
Right
Left
Loss of one arm or one hand.
60%
50%
Considerable loss of osseous substance of the arm (definite and incurable lesion).
50%
40%
Total paralysis of the upper limb (incurable lesion of the nerves).
65%
55%
Shoulder anchylosis.
40%
30%
Extensive loss of osseous substance of the two bones of the forearm (definite and incurable lesion).
40%
30%
Total paralysis of the median nerve.
45%
35%
Total paralysis of the radial nerve at the torsion cradle.
40%
35%
Amputation of four fingers including thumb.
45%
40%
Amputation of four fingers excluding thumb.
40%
35%

Lower Limbs
Amputation of thigh (upper half).
60%
Amputation of thigh (lower half) and leg.
50%
Total loss of foot (tibio-tarsal disarticulation).
45%
Partial loss of foot (sub-ankle-bone disarticulation).
40%
Partial loss of foot (medio-tarsal disarticulation).
35%
Partial loss of foot (tarso-metatarsal disarticulation).
30%
Total paralysis of lower limb (incurable nerve lesion).
60%
Anchylosis of the hip.
40%
Loss of osseous substance from thigh or both bones of the leg (incurable condition).
60%
Loss of osseous substance of the knee-pan with considerable separation of the fragments and considerable difficulty of movements in stretching the leg.
40%
Shortening of the lower limb by at least 5 cm.
30%
Total amputation of all the toes.
25%

If you are left-handed and, the percentages set out above for the various disabilities of the right upper limb and left upper limb will be transposed.

Total disabilities by accident not mentioned above shall be compensated in accordance with their seriousness as compared with that of those mentioned, your occupation not being taken into consideration.

The partial or total "functional" disablement, not specifically dealt with in Total Disability, of a limb or an organ is treated like the partial or total loss of the said limb or organ.

The total compensation payable in respect of several disablements due to the same accident is arrived at by adding together the various sums, but shall not exceed the total sum insured under Total Disability.

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