Personal Accident (Continental Scheme) 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 has made to the PACIFIC & ORIENT INSURANCE CO. BERHAD (hereinafter called the “Company”) a Proposal and Declaration which shall be the basis of this Contract and which is deemed to be incorporated herein and has paid or agreed to pay the Premium stated in the Schedule hereto as consideration for the insurance hereinafter contained.

NOW THIS POLICY WITNESSETH that if at any time 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 Insured Person shall sustain any Bodily Injury caused solely and directly by violent accidental external and visible means and being the sole and direct cause of an insured Person’s death or disablement as hereinafter defined, THEN the Company will pay to the Insured, or in the event of the death of the Insured Person to the Insured’s legal personal representatives, or such beneficiary or beneficiaries as may be stipulated in the Schedule of this Policy, the sum or 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.

PROVIDED ALWAYS THAT:- 

• No sum stated in the Schedule shall be payable:-

1. Under Benefits A & B unless the death or disablement as therein defined takes place within 24 months after the date of the Bodily Injury.
2. Under Benefits C and/or D in respect of any one injury for more than 104 weeks from the commencement of the disablement.
3. Until the total amount of compensation shall have been ascertained and agreed.

• The aggregate of all percentages payable in respect of any one accident shall not exceed 100%.
• The Insured shall not be entitled to compensation under more than one of the Benefits A to D in respect of any one accident except that the Insured shall be entitled to receive compensation under Benefit D for a period in succession to a period under Benefit C.
• Any sums paid under Benefits C and/or D shall be deducted from any sum becoming due under Benefits A or B.
• With the exception of Medical Expenses, as defined herein, the Company shall not be liable to make any further payment under this Policy after a claim under Benefits A or B has been admitted and becomes payable.

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.

c. TEMPORARY TOTAL DISABLEMENT from engaging in or giving attention to profession or occupation; Weekly Compensation at the rate stated under item C of the Schedule hereto shall be payable.

d. TEMPORARY PARTIAL DISABLEMENT from engaging in or giving attention or occupation; Weekly Compensation at the rate stated under item D of the Schedule hereto shall be payable.

e. MEDICAL EXPENSES necessarily and reasonably incurred and supported by receipt accounts from a medical practitioner registered under the Medical Act 1971 (but only to extent that they are not recoverable from any other source) in respect of any one occurrence for which compensation is payable under Benefits A to D of the Policy; up to but not exceeding the Sum Insured under item E of the Schedule hereto shall be payable.

Permanent total loss of use of member shall be treated as loss of member.

In the event of partial loss of any member above a proportionately lower percentage of compensation shall be payable.

In the event of Permanent Disablement by physical loss or loss of use not specified above the percentage of compensation shall be assessed in proportion to the degree of disability as compared with the cases specified without reference to the profession or occupation of the Insured.

Loss of Eye means total and irrecoverable loss of all sight rendering the Insured absolutely blind in the eye beyond remedy by surgical or other treatment.

Permanent Total Disablement means absolute disablement from engaging in or giving attention to profession or occupation of any kind.

Temporary Total Disablement means disablement from engaging in or giving attention to any portion of the Insured’s ordinary profession or occupation.

Temporary Partial Disablement means partial disablement from engaging in or giving attention to the Insured’s ordinary profession or occupation. 

This Policy does not cover (Unless the consent of the Company should have previously been obtained and recorded by endorsement thereon:-

1.Death or Disablement occasioned by or happening through:-

1. War Invasion Act of Foreign Enemy Hostilities (whether War be declared or not) Civil War Rebellion Revolution Insurrection Riot & Strike Civil Commotion Military or Usurped Power and in the event of any claim hereunder the Insured shall when so required by the Company prove that the claim arose independently of and was in no way connected with or occasioned by or contributed to by or traceable to any of the said occurrences or any consequence thereof and in default of such proof the Company shall not be liable to make any payment in respect of such a claim.
2. Self Injury Suicide or Attempted Suicide (whether felonious or not) Provoked Assault, Insanity, or the effect or influence (temporary or otherwise) of alcohol or drugs not prescribed by a qualified medical practitioner, Venereal Disease, Pregnancy or Childbirth, Hernia, Fits of any kind, Disease or Sickness of any kind, or any pre-existing physical defect or infirmity.

2. Death or Disablement occurring whilst the insured being in or upon or entering or descending from Aircraft of any kind or caused by or resulting from a descent or fall from such Aircraft except in respect of the Insured’s journeys as a ticket-holding passenger over established air routes in fully licensed standard type aircraft owned and/or operated by a recognised Air Line.

3. Death or disablement consequent upon, the insured engaging in Professional Sports, Football, Hunting, Ice Hockey, Motorcycling, Polo Playing, Racing  of  all  kinds,  Speleology,  Steeplechasing, Winter Sports, Yatching, Water-ski Jumping, Underwater Activities involving in the use of underwater breathing apparatus, Hang-Gliding, Skydiving, Parachuting, engaging in Martial Arts or Self Defence in Tournament, Competition, Demonstration or Exhibition, or using Woodworking Machinery driven by mechanical power, Timber and Logging Operations, Mounteineering.

4. Death or Disablement occasioned by or happening through

1. Ionising radiations or contamination by readioactivity from any nuclear fuel or from any nuclear waste from the combustion of nuclear fuel. Solely for the purpose of this exclusion, combustion shall include self sustaining process of nuclear fission.
2. Nuclear weapons material.

The following warranties, endorsement and clauses are not applicable unless specified in the Schedule.

5P3 FOOTBALL/RUGBY CLAUSE 

Notwithstanding anything contained herein to the contrary, it is hereby declared and agreed that this policy extends to cover death and/or disablement arising out of playing football (amateur) / rugby. 

5P12 YACHTING CLAUSE 

It is hereby declared and agreed that the insurance under this policy shall extend to include the risk of yachting.

5P27 AIDS EXCLUSION CLAUSE 

Notwithstanding anything contained herein to the contrary, it is hereby agreed and understood that this insurance does not co ver death injury illness, charges or expenses sustained by the Insured Person, attributable directly to HIV (Human Immunodeficiency Virus) and/or any HIV related illness including AIDS and/or any mutant derivatives or variation thereof.

5P31 HUNTING CLAUSE

Notwithstanding anything contained herein to the contrary, it is hereby agreed and understood that this Policy extends to cover death or disablement or any other loss expressly insured herein, sustained by the Insured Person whilst legally engaged in hunting activities as an occasional recreation.

5P33 MOTOR-CYCLE CLAUSE

Notwithstanding anything contained herein to the contrary, it is hereby agreed and understood that this policy extends to cov er death or disablement or any other loss expressly insured herein, sustained by the Insured Person whilst operating or riding a motor-cycle (whether as a rider or passenger), provided always that this extension shall not apply, whilst the Insured Person is engaged in racing, pace-making, reliability trial or speed testing.

5P37 STRIKE, RIOT AND CIVIL COMMOTION CLAUSE 

Notwithstanding anything contained herein to the contrary it is hereby agreed and understood that this Policy extends to cover death or disablement or any other loss expressly insured herein, caused by Strike, Riot and Civil Commotion provided that this extension shall not apply whilst the Insured Person is personally engaged in such activities.

1. 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 representatives of the Company shall have been issued therefor.

2.   All notices required to be given by the Insured to the Company must be in writing addressed to the nearest Local Branch or Agency of the Company and no alteration in the terms of this Policy nor any endorsement thereon, will be held valid unless the same is signed or initialled by an authorised representative of the Company.

3.    The Company shall at any time by giving seven days notice to the Insured by Registered Letter at the Insured’s address as last known to the Company be at liberty to determine and cancel    this Policy, provided that the Company shall in that event on demand return to the Insured a proportionate part of the premium corresponding to the unexpired period of insurance. This policy may be cancelled at any time by the Insured on seven days’ notice to the Company and in such event the Insured shall be entit led to a return of the premium less premium at the Company’s Short Period Rates for the time the Policy has been in force during the current period of insurance.

4. The Insured shall give immediate notice to the Company of any change of address occupation pursuits or any injury, disease, physical defect or infirmity by which the Insured has become  affected and also notice of any other Insurance (excepting Coupon or in connection with a Motor Insurance Policy) affected against acci dent or incapacity.

5.   The Company shall unless otherwise expressly provided by endorsement on this Policy be entitled to treat the Insured as the absolute owner of the Policy and shall not be bound to recognize any equitable or other claim to or interest in the Policy and the receipt of the Insured (or of the Insured’s legal personal representatives) alone shall be an effectual discharge.

6. 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 fra udulent or exaggerated or if any false declaration or statement shall be made in support thereof then in any of these cases this Policy shall be void.

7. Upon the happening of any accident likely to give rise to a claim under this Policy the Insured shall within 14 days after the happening of the 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.

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 to the Company. In the event of the death of the Insured the Company shall be entitled to have a post mortem examination at its own expense and notice shall when practicable be given to the Comp any before interment or cremation stating the time and place of any inquest appointed.

8. 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 by arbitration 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.

9. 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.

10. The insured shall not be less than 16 years of age nor more than 65 years of age.

11.  The due observance and fulfillment of the Terms, Provisions, Conditions, Clause 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. Failure to comply with any of the terms, provisions and condition in this Policy shall invalidate all claims hereunder.

12. PREMIUM WARRANTY

It is 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 proposes 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 receive such premium shall lie on the insurer.

13. 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.

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