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Conditions of the Policy
Benefits
- Accidental Death pays the Insured’s beneficiary the Sum Insured for death occurring within one year from the date of accident.
- Permanent Total Disablement pays the Insured the Sum Insured covered:
- For the loss of two or more limbs or both eyes.
- For permanent total disablement from gainful employment of any kind other than dismemberment, provided such disability has continued for a period of 52 weeks and it is total, continuous or permanent at the end of this period.
- Permanent Partial Disablement pays the insured a percentage of the Sum Insured covered for permanent loss of use of body parts, according to the following schedule:
- Loss of limb or one eye (70%)
- Loss of speech (50%)
- Loss of hearing – both ears (75%)
- Loss of hearing – one ear (35%)
- Loss of thumb (30%)
- Loss of Index Finger (15%)
- Loss of Middle Finger (10%)
- Loss of Ring or Little Finger (5%)
- Loss of Big Toe (10%)
- Loss of Each other toe (2%)
- Unprovoked Murder and Assault pays the beneficiary/insured up to the limit stated in the schedule in case of death or injuries resulting from unprovokedmurder or assault
- Burial Benefit (any cause including Non-Accidental Death) pays for all actual funeral expenses incurred up to the amount stated in the schedule.
- Dengue/Leptospirosis/Chikungunya Cover (Lump Sum) – The insured is Insured is indemnified at the time the Insured is diagnosed with Dengue/Leptospirosis/Chikungunya, provided that the Insured is confined at the hospital
and advised by a qualified and licensed physician to undergo medicaltreatment as direct result of animal bites. 10-day waiting period from the Effective date. There should be no signs nor symptoms of the disease should havebeen observed and that the first doctor’s consultation should not have occurred during the waiting period.
- Fire Cash Assistance – In the event that the permanent residence of the Insured Person is damaged by fire and rendered uninhabitable, the Company will pay cash assistance to the Insured Person in the amount og Php 2,500.00. In the event two or more Insured Persons who are members of the same household reside in the affected
permanent residence, this policy shall pay the total amount of Php 2,500.00 fire cash assistance only.
Compensation Limits
- The Company’s combined liability for Death, Permanent Loss or Disablement shall in no case exceed the stated limit of liability.
- The benefits for Permanent Disablement shall be paid only after one year from the happening of the accident
Age Limits
Principal: 1 to 70 years old
Dependents:
- If Single: Parents – age up to 70 years old / Siblings – 1 to 21 years old
- If Married: Spouse – age up to 70 years old / Children – 1 to 21 years old
Exceptions
- Accidental Death/ Disablement benefit will not be payable for Bodily Injury or Death caused by or resulting from:
- Self-injury, suicide or attempted suicide;
- Any bodily or mental infirmity, disease or sickness, or infection other than infection occurring because of an accidental cut or wound;
- Provoked Assault or provoked murder;
- Pre-existing conditions; unless Insured for 1 year of continuous cover.
- Motorcycling risks including pillion riding;
- Major disease outbreak (SARS, EBOLA, FLU and other dreaded diseases).
- Death or injuries resulting from the Insured’s performance of his duties in the field as a member of the Armed Forces, including escort and securityservices rendered in whatever capacity or form;
- War, Invasion, act of foreign enemy, hostilities, or warlike operations (whether declared or not), civil war, mutiny, riot, conspiracy, rebellion, revolutions,insurrection, or military or usurped power, civil commotion assuming the proportion of or amounting to a popular uprising;
- Poison, gas or fumes voluntarily taken, or any nuclear reaction, nuclear radiation or radioactive contamination and chemical or biological contamination;
- Accident occurring while the insured individual is operating or learning to operate or serving as a crew member of an aircraft or seacraft;
- Accident occurring while the Insured is engaged in any dangerous sports or hobbies
- Accident caused by the effect of alcohol or any prescribed drug on the Insured;
- Any violation or attempted violation of the law or resistance to arrest by the Insured
- Cosmetic or plastic surgery, any dental work, treatment or surgery, eye or ear examination, except to the extent that any of them is necessary for therepair of alleviation of damage to the Insured’s person caused society by Accident;
- Accident occurring while the Insured is performing his or her duties as an Acrobat, Asylum Attendant, Aviator, Boilerman, Policeman;
- Accident to any of the following persons: Divers while performing underwater activities, Fireman while performing firefighting activities; and
- Sabotage and Terrorism.
- The policy will not cover any loss of or damage to the permanent residence of the Insured resulting from fire caused by:
- Radioactive contamination and nuclear assemblies exclusion
- War, Invasion, act of foreign enemy, hostilities, or warlike operations (whether declared or not), civil war, mutiny, riot, conspiracy, rebellion, revolutions,insurrection, or military or usurped
- Existing damages
- Damages deliberately caused by the Insured or any person in connivance with the Insured.
Expiration of the Policy
- The Policy shall expire one year after inception or upon Payment of maximum benefits, whichever comes first.
- Dengue/Leptospirosis/Chikungunya Cover – Coverage is one year from the effective date. Once claim is paid, the coverage terminates. There will be a 10-day waiting period from the Effective date.
There should be no signs nor symptoms of the disease should have been observed and that the first doctor’sconsultation should not have occurred during the waiting period.
- Benefit for Fire Cash Assistance shall cease immediately upon the fall or displacement of the property or any part of it.
Notice of Claim
A claim should be reported within thirty (30) days from the date of accident.
- Disability/Death Claim:The original of the following documents must be submitted for the immediate evaluation of all claims under this Policy
- Certificate of Registration (COR)
- Affidavit or incident report
- Death Certificate
- Birth Certificate
- Marriage Contract (if married)
- Post Mortem Certificate (If necessary)
- Vital signs chart (if necessary)
- Medical Certificate (if applicable)
- Clinical Record (if necessary)
- Police/ Incident Report
- Government Issued ID with Picture of the Insured
- Such other documents as may be required
- Fire Assistance Benefit:
- BFP Certificate
- Insured’s ID with signature
- Photos of the Fire incident
- Barangay Certificate that Insured is a fire victim
Claims will be settled within ten (10) days upon submission the documents listed above.
Misrepresentation
The misrepresentation by the Insured or any person acting in connivance with the Insured on any information relating to this Policy and any claim that may bemade hereunder shall bar any recovery under this Policy.
Fraudulent Claims and Documents
If the claim be in any respect fraudulent, or if any false declaration be used in support thereof, or it any fraudulent means or devices are used by the Insured orany one acting on his/her behalf to obtain any benefit under this Policy, all benefits under this Policy shall be forfeited.
CIVIL CODE ARTICLES 1259 WAIVER CLAUSE
It is hereby declared and agreed that the provision of Article 1250 of the Civil Code of the Philippines (Republic Act No. 386) which reads:
“In case of anextraordinary inflation or deflation of the currency stipulated should supervene, the value of the currency at the time of the establishment of the obligation shallbe the basis of payment...” shall not apply in determining the extent of liability under the provisions of this policy
Disclaimer
Please be informed that there shall be no recovery hereunder if the murder or assault occurs in any of the following provinces or places: Lanao del Norte, Lanao del Sur, Maguindanao, North Cotabato, South Cotabato, Sultan Kudarat, Sulu Archipelago, Basilan, Tawi Tawi, Zamboanga del Norte, Zamboanga del Sur.
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