Driver Personal Accident PLUS (A) / (C) Policy Document

For all intents and purposes where there is a conflict or ambiguity as to the meaning in the Bahasa Malaysia provisions of any part of the contract, it is hereby agreed that the English version of the Contract shall prevail.

WHEREAS the insured described in the Schedule hereto, (hereinafter called the “Insured”) has applied to PACIFIC & ORIENT INSURANCE CO. BERHAD (hereinafter called the “Company”) for the insurance hereinbelow set out (hereinafter called the “Insurance”) by a proposal and declaration (dated as stated in the said Schedule). In consideration of the payment of the premium stated in the said Schedule for such insurance, the Company agrees to provide the insurance and the particulars set out in the abovestated proposal and declaration (the particulars of which the insured hereby declares are true and/or valid) shall be the basis of this contract and is deemed to be incorporated herein.

NOW THIS POLICY WITNESSETH that if, during the period of Insurance stated in the Schedule hereto or during any further period for which the Company may accept payment for the renewal of this Policy, the Covered Person and/or any other person under their employment shall sustain any bodily injury caused solely and directly by violent accidental external and visible means hereto and being the sole and direct cause of the Covered Person’s death or disablement (hereinafter referred to as the “Bodily Injury” and the whole as the “Accident” respectively), then the Company will, subject to compliance with the procedures, terms, provisions, conditions, clauses and/or endorsements contained herein, pay to the insured or, in the event of the death of the Insured, to the Insured’s legal personal representatives or such beneficiary of beneficiaries as may be hereinafter stipulated, the sums of money set forth in the Schedule.

Consumer Insurance Contracts

This Policy is issued in consideration of the payment of premium as specified in the Policy Schedule and pursuant to the answers given in Your Proposal Form (or when you applied for this insurance) and any other disclosures made by you between the time of submission of your Proposal Form (or when you applied for this insurance) and the time this contract is entered into. The answers and any other disclosures given by you shall form part of this contract of insurance between you and us. However, in the event of any pre-contractual misrepresentation made in relation to your answers or in any disclosures given by you, only the remedies in Schedule 9 of the Financial Services Act 2013 will apply. This Policy reflects the terms and conditions of the contract of insurance as agreed between you and us.  

PREVIOUS DISABILITY

• If as a consequence of the Accident the Covered Person shall sustain an injury and if such injury has been or shall be aggravated by any disability and/or condition which existed before the accident occurred (hereinafter referred to as the “condition”) the amount of any compensation payable shall be the amount that the Company, at its sole and absolute, discretion considers would have been payable if such condition had not existed and the bodily injury had not been so aggravated. 

BENEFIT LIMITS

• Benefit limits stated in accordance with the Plan Type selected in the Policy Schedule. 

GENERAL

• The benefits are payable in addition to all other policies. 
• Payment will be made whether the driver is negligent or not. 

The Covered Person(s) age shall not be less than 16 years and not more than 65 years of age.

a) Covered Persons shall be the named person or the authorised insured person. 

The insurance with respect to the following hazards shall not apply:- 

1) To injuries and death caused directly or indirectly, wholly or partly due to the accident :-

a) By bacterial infections except septicaemia related directly to the Injury; 

b) By any other kind of diseases and/or allergic reactions including but not limited to those caused by insects or mosquito bites; 

c) While the driver is under the influence of liquor or drugs (unless administered under the order of a qualified medical practitioner and which does not affect his ability to drive);

d) While the insured person is in a state of insanity or mentally impaired for any reason whatsoever; 

e) While the vehicle is used or being used for illegal and/or criminal, business, pursuits, purpose and/or objectives or in attempt thereof;

f) While the vehicle is used as an unlisensed common carrier or without the insured’s permission; 

2) To suicide or any attempt thereat (sane or insane)

3) To injuries and death occasioned by war, invasion, act of foreign enemy, hostilities or wartime operations (whether war be declared or not), civil war, rebellion, revolution, military or usurped power, guerilla or urban guerilla activities, act of terrorism, martial law, or state of siege.

4) To injuries and death occasioned while the vehicle is used for racing, road rally, pacemaking, speed testing or use for any purpose in connection with motor trade. 

5) This insurance does not cover death, injury of a Covered Person or provide any indemnity against liability attributable directly or indirectly to HIV (Human Immunodeficiency Virus) and/or HIV related illness including but not limited to AIDS (Acquired Immune Deficiency Syndrome) and/or any mutant derivatives or variation thereof. 

Benefit Limits Per Person

Optional Coverage (as printed in policy schedule)

SECTION 1 – ACCIDENTAL DEATH (LOSS OF LIFE) 

When injury results in death (loss of life) of the Covered Person, 12 months from the date of the accident, the Company will pay 100% of the Sum Insured. 

SECTION 2 – PERMANENT DISABLEMENT AND (LOSS OF SIGHT)

When injury does not results in death (loss of life) the covered person within twelve (12) month from the date of the accident but does directly result in any of the following losses within the said twelve (12) months, the Company will pay for: 

PERCENTAGE OF THE SUM INSURED PER PERSON 

Loss of both hands or both feet …………………………………………………………………………………………… 100%

Loss of sight of both eyes………………………………………………………………………………...………………...… 100% 

Loss of sight of one eyes and one hand or one foot  .……………………….......................................… 100%

Total Paralysis ………………………………………………………………..........….....……………….…….………………… 100%

Loss of one hand or one foot  ………………………………………………………………………….…..………..……… 50% 

Loss of sight of one eye  …………………………………………………..…..………………...………….…….....…..…… 50% 

* Loss as above used with reference to hand or foot means complete severance through or above the wrist or ankle joint, loss of use of member and used with reference to loss of sight means the entire and irrecoverable loss of sight. 

The occurrence of any specific loss for which compensation is payable under Section 1 & 2 shall at once terminate all insurance under this Policy, but such termination shall be without prejudice to any claim originating directly out of the Accident causing such loss. 

Where more than one loss or claim arises from the Accident, the Insured or the relevant legal representatives shall only be entitled to make one claim for the Injury or death, whichever shall be the higher. The aggregate of all payments in respect of any one Accident shall not exceed the benefit limit stated in the Policy Schedule. 

1. The Policy and the schedule shall be read together as one contract and any word or expression to which a specific meaning has been attached in any part of this policy or to the schedule shall bear such specific meaning wherever it may appear. Wherever in this policy the word “Company” is used, it shall mean the company issuing it, and wherever the word “Insured” is used, it shall mean the proposer named in the proposal form. Wherever the word “Injury” is used, it shall mean bodily injuries effected as described in the insuring clause. 

2. This insurance shall not commence until the premium in full has been actually paid to and accepted by the Company and no payment in respect of any premium shall be deemed to be payment to the Company unless a valid printed form of receipt shall have been issued by a duly authorised representative of the Company. 

3. All notices required to be given by the Insured to the Company must be in writing addressed to the Company or the nearest local Branch. 

4. If the proposal or declaration of the insured is untrue in any respect or if any material fact affecting the risk be incorrectly stated therein or omitted therefrom or if this insurance or any renewal thereof shall have been obtained through any missstatment, misrepresentation or suppression or if any claim made shall be fraudulent or exaggerated or if any false declaration or statement shall be made in support thereof then, in any of these causes, this Policy shall be void and all benefits therein shall be forfeited. 

5. The Insured (or the insured’s legal personal representatives) shall, at the expense of the Insured, furnish to the Company all such certificates, information and evidence as may be required by the Company and the insured shall, whenever reasonably required to do so, submit to medical examination on behalf of the Company. In the event of the death of the insured the Company shall where it is not forbidden by law be entitled to have a post mortem examination as its own expense and notice shall, when practicable, be given to the Company as to the time and place of any inquest appointed. 

6. Upon the happening of any accident likely to give rise to a claim under this Policy, the Insured shall within thirty (30) days after the happening of such accident give notice to the Company with full particulars of the accident and injuries and shall as soon as possible procure and act on proper medical or surgical advice. Written notice by or on behalf of the Insured given to the Company with full particulars shall be deemed to be notice to the Company. Failure to give written notice within the time provided in this Condition shall not invalidate any claim provided it shall be shown not to have been reasonably possible to give such written notice and that written notice was given as soon as was reasonably possible. What is reasonable shall be determined by the Company at it’s sole discretion. The receipt of the notice with full particulars shall be condition precedent to any liability of the Company to pay the claim. 

7. The Company upon receipt of a notice of claim will furnish to the claimant such forms as are usually furnished by the Company for filing of claims and proofs of loss. 

8. All claims hereunder shall be submitted through the Insured. Affirmative proof of loss must be furnished to the Company within one hundred and eight days after the happening of such accident. if any time limitation of this policy, with respect to giving notice of claim or furnishing proof of loss, is less than that permitted by the law of the state in which the Insured resides at the time this policy is issued, such limitation is hereby extended to agree with the minimum period permitted by such law. 

9. Compensation for death of the insured is payable to the legal personal representative of the Insured. All other benefits under this policy which are payable other than to the Insured shall be payable only with the approval of the Insured and directly to the injured person or to his legal representative whose receipt shall be a full discharge of all sums payable to such person. 

10. The Company may be at liberty to cancel this Policy at any time by giving fourteen (14) days notice to the Insured by registered letter to the last known address of the Insured as appearing in the records of the Company. The said notice shall be deemed received on the fifth (5th) day after posting. The Company shall in that event return to the Insured on demand a proportionate part of the premium corresponding to the unexpired period of insurance. 

11. This Policy may be cancelled at any time by the Insured on written notice to the Company and in such event, the Insured shall not be entitled to any refund of premium except under special consideration granted by Company. 

12. No assignment of interest under this Policy shall be binding upon the Company unless and until the original or a duplicate thereof is filed with and acknowledged by the Company. The Company does not assume any responsibility for the validity of an assignment. 

13. Failure to comply with any of the terms, provisions and conditions contained in this Policy shall invalidate any/or all claims made hereunder. 

14. If any difference arises as to the amount of the Company’s liability under this Policy, such difference shall independently of all questions be referred to the decision of an Arbitrator, to be appointed in writing by both parties or if they cannot agree upon a single Arbitrator, to the decision of two Arbitrators of whom one shall be appointed in writing by each of the parties within two calendar months after having been required to do so in writing by the other party and in case of disagreement between the Arbitrators the difference shall be referred to the decision of an Umpire who shall have been appointed in writing by the Arbitrators before entering on the reference, and an award shall be a condition precedent to any right of action against the Company as regards any dispute regarding the amount of the Company’s liability under this Policy.

15. If the Company shall disclaim liability to the Insured (or to the Insured’s legal personal representatives) for any claim hereunder, in no case shall the Company be liable in respect of such claim after the expiration of twelve months from the date of such disclaimer unless the claim is the subject of pending court action or arbitration.

16. Territorial Limits: Worldwide   

Where you have applied for this Insurance wholly for purposes unrelated to your trade, business or profession, you had a duty to take reasonable care not to make a misrepresentation in answering the questions in the Proposal Form (or when you applied for this insurance) i.e. you should have answered the questions fully and accurately. Failure to have taken reasonable care in answering the questions may result in avoidance of your contract of insurance, refusal or reduction of your claim(s), change of terms or termination of your contract of insurance in accordance with the remedies in Schedule 9 of the Financial Services Act 2013. You were also required to disclose any other matter that you knew to be relevant to our decision in accepting the risks and determining the rates and terms to be applied. 

You also have a duty to tell us immediately if at any time after your contract of insurance has been entered into, varied or renewed with us any of the information given in the Proposal Form (or when you applied for this insurance) is inaccurate or has changed.

5P27 – AIDS EXCLUSION CLAUSE (AIDS)

This insurance does not cover death or disablement directly or indirectly arising out of or consequent upon or contributed to by acquired immune deficiency syndrome (AIDS) or AIDS related complex (ARC) howsoever this syndrome has been acquired or may be named.

5P35 – PREMIUM WARRANTY

It is a fundamental and absolute special condition of this contact of insurance that all the premium due must be paid and received by the insurer within sixty (60) days from the inception date of this Policy / Endorsement / Renewal Certificate. If this condition is not complied with then this contract is automatically cancelled and the insurer shall be entitled to the pro rata premium for the period they have been on risk. Where the premium payable pursuant to this warranty is received by an authorised agent of the insurer, the payment shall be deemed to be received by the insurer for the purpose of this warranty and the onus of proving that the premium payable was received by a person, including an Insurance Agent, who was not authorized to receive such premium shall lie on the Insurer. 

5P69 – AGE WARRANTY (Taxi)

Warranted that the insured person(s) under this policy are between the ages of 16 to 70 years. 

5P73 – CONDITION PRECEDENT CLAUSE

The due obsevance and fulfillment of the terms, provisions, conditions, clauses and endorsement of this policy, in so far as they relate to anything to be done or complied with by the insured (or the insured’s legal personal representatives), shall be condition precedent to any liability of the company to make any payment under the policy.

5P74 – EXTENDED AGE WARRANTY

In consideration of the payment by the insured to the company of an additional premium, it is hereby agreed and declared that the insurance under this policy shall extend the age limit of the insured to 75 years.

5P75 – AGE LIMIT (16 TO 65 YEARS) WARRANTY

Warranted that the insured person(s) under this policy are between the ages of 16 to 65 years. 

5P76 – UNNAMED DRIVER WARRANTY 

It is hereby declared and agreed that the covered person under this policy will be the registered owner (Individual/Company) or any unnamed drivers of the company with valid driving licence while driving the vehicle as mentioned on the schedule. It is further understood that the unnamed drivers are subject to permanent, confirmed and probationary employees of the company only. Any temporary / part-time employees will not be covered under this policy. 

The Policyholder shall read this Policy carefully, and if any error or misdescription be found herein or if the cover were not in accordance with the wishes of the Policyholder, advice should at once be given to the Company and the Policy returned for attention. 

Disputes can be referred to: Ombudsman for Financial Services (OFS) (Formerly known as Financial Mediation Bureau) Tel No : 03-2272 2811