Passengers Drivers Plan 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 person 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 subject to terms, exclusions and conditions herein contained or which may be subsequently notified to the Insured by way of an endorsement, the Company agrees that if during the period of insurance stated in the Schedule hereto or during such further period which the Company may, at the Company’s sole and absolute discretion to accept or refuse, agrees to accept the Insured and/or passenger(s), (as specified in the Schedule hereto) and/or any other person driving with the permission of the Insured (hereinafter referred to as the “Covered Persons”) shall sustain any bodily injury caused by violent accidental external and visible means while driving or riding or boarding or alighting the vehicle specified in the policy (hereinafter referred to as the “Injury” and the “Accident” respectively), and which shall solely and independently of any other cause result in his death or permanent disablement, the Company will pay to the Insured, the Insured’s legal representatives and to the relevant legal representative of the Covered Persons, the  sum or sums of money in accordance with the scale of benefits setforth herein.

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 LIMIT

• Benefits payable in respect of Medical & Surgical expenses incurred shall be limited to the:

1. Reasonable and customary charges 
2. Benefit limits stated in accordance with the Plan Type selected in the Policy Schedule.

GENERAL 

• In the event that the actual number of passengers exceed the number stated in the Schedule of the Policy, the Company’s Limit of liability per person will be proportionately reduced by the ratio of the actual number of persons in the vehicle to the total number of Covered Persons stipulated in the Schedule (hereinafter referred to as the “Proportionately Reduced Benefit”).

• The benefits are payable in addition to all other policies.

• Payment will be made whether the driver or rider is negligent or not

MOTORCYCLE 

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

• Individual Owner or Named Rider – Single Rider Policy.

Only the registered owner or the named rider is covered. If there is a named rider then the registered owner is not covered.

ALL RIDER POLICY

• All riders are covered only whilst riding the motorcycle mentioned in the Schedule. The owner can opt for an all riders’ policy even if he is above 65 years of age, however the owner will not be covered. The Pillion rider is covered under the all riders Policy, however subject to the above stated limitation, only the rider and one pillion are covered at any one time.

• Company owned – Covered Persons shall be the authorised riders of the Company

PRIVATE CAR / PRIVATE VAN / TAXI / COMMERCIAL VEHICLE

1) Covered Persons shall be the occupants of the motor vehicle as mentioned in the Schedule on an unnamed basis. The maximum number of Covered Persons are as set out hereunder:-

a. Private Car/Taxi - Driver and 4 Passengers only 

b. Private Van - Driver and 7 Passengers only. (Coverage can be extended to a maximum of driver and 11 Passengers subject to additional Premiums being paid)

c. Commercial vehicle - Driver and attendant only

2) Persons from the age of 3 to 65 are covered

3) Passengers aged between 3 to 15 are entitled to only 50% of all benefits

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

1) To injuries and death caused directly or indirectly, wholly or partly:-

1. By bacterial infections except septiceamia related directly to the Injury:-
2. By any other kind of diseases and/or allergic reactions including but not limited to those caused by insects or mosquito bites;
3. By medical or surgical treatment (except such as nessessitated by the Injury and performed within the time period provided in the policy);
4. By childbirth or miscarriage;
5. 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 or ride);
6. While the driver is in state of insanity or mentally impaired for any reason whatsoever:-
7. While the vehicle is used or being used for illegal and/or criminal, business, pursuits, purposes and/or objectives;
8. While the vehicle is used as an unlicensed common carrier or without the insured’s permission;

2) To herniation resulting from the injury. 

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

4) 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.

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

6) This insurance does not cover death, injury, illness, charges or expenses 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 mutant derivatives or variation thereof.

SECTION 1 – ACCIDENTAL DEATH (LOSS OF LIFE)

When injury results in death (loss of life) of the Covered Persons in the named vehicle within 12 months from the date of the accident, the Company will pay 100% of the Sum Insured per person, or the Proportionately Reduced Benefit where applicable, to the legal personal representative of each deceased person.

SECTION 2 – PERMANENT DISABLEMENT AND (LOSS OF SIGHT) 

When injury does not result in death (loss of life) of the driver and/or passengers in the named vehicle within twelve (12) months 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 PERSON 

*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 for any one Covered Person.

SECTION 3 – MEDICAL EXPENSES

When by reason of the Injury, the Covered Person(s) shall required treatment by a legally qualified physician or surgeon, confinement in a hospital or the employment of a licensed or qualified nurse within twelve (12) months from the date of accident, the Company will pay the actual expense incurred for such treatment, hospital charges and nurse fees upto, but not exceeding the benefit limits or the Proportionately Reduced Benefit stated in the Policy Schedule per person as a result of any one accident.

SECTION 4 – DAILY HOSPITAL INCOME

A daily Cash allowance as stated in the benefit Schedule or the Proportionately Reduced Benefit shall be payable from the second day of hospital confinement up to a maximum of 150 days per year for each Covered Person whilst the insurance is in force.

SECTION 5 – SURGICAL EXPENSES 

A surgical benefit shall be payable to an amount equal to the necessary and reasonable charges made for Surgical operations provided that such amount does not exceed the maximum benefit limits or the Proportionately Reduced Benefit under the particular plan.

SECTION 6 – BEREAVEMENT EXPENSES 

The sum stated or the Proportionately Reduced Benefit will be paid to the Covered Person’s next of kin or legal representative in the event of an accidental death of the Covered Persons involving the vehicle stipulated in the Schedule.

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.

This insurance shall not commence until the premium 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 printed form of receipt signed by a duly authorised representative of the Company shall have been issued therefor.

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. No alteration in the terms of this Policy nor any endorsement thereon, will be held valid unless the same is signed by an authorised representative of the Company.

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 misstatement, 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.

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 at 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 reasonably possible.

7. The Company upon receipt of a notice of claim will furnish to the claimant such form 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 limitations 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 the injury of such person.

10. The Company may at liberty 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 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 be entitled to a return of the premium less premium at the Short Period rates for the policy has been in force.

The following Short Period rates shall be used for this purpose:- 

Period 

Not exceeding 1 week - 12.5% of the Annual Premium 

Not exceeding 1 Month - 25.0% of the Annual Premium

Not exceeding 2 Month - 37.5% of the Annual Premium 

Not exceeding 3 Month  - 50.0% of the Annual Premium 

Not exceeding 4 Month - 62.5% of the Annual Premium 

Not exceeding 6 Month - 75.0% of the Annual Premium

Not exceeding 8 Month - 87.5% of the Annual Premium 

Exceeding 8 Month - 100.0% of the Annual Premium 

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 all claims hereunder.

14. If any difference arises as to the amount of the Company’s liability under this Policy, such difference shall independently of all other 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. PREMIUM WARRANTY 

It is a fundamental and absolute special condition of this contract of insurance that 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 authorised to received such premium shall lie on the insurer.

17. DUTY OF DISCLOSURE

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.

IMPORTANT

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.