Coverage Details: Please refer to Part I of the schedule for
the coverage applicable as
per your plan along with the sum
insured and deductibles
In the event of a contingency which
shall result in a claim under the Policy, the Insured shall
immediately contact ICICI Lombard 24hr Help Line number -1800 2666 or
email at ihealthcare@icicilombard.com
Customer can send claim documents at
ICICI LOMBARD
GENERAL INSURANCE COMPANY LIMITED
ICICI Bank Tower, Plot No.
12,
Financial District, Nanakram Guda, Gachibowli,
Hyderabad,
Andhra Pradesh, Pin Code-500032
ICICI Lombard General Insurance
Company Ltd. Group Travel Insurance
PART II OF THE
SCHEDULE
DEFINITIONS
For the
purposes of this Policy and endorsements, if any, the terms mentioned
below shall have the meaning set forth:
“Accident” means a
sudden, unforeseen and involuntary event caused by external, visible
and violent means.
“Alternative treatments” are forms of treatments other
than treatment "Allopathy" or "modem medicine"
and includes Ayurveda, Unani, Sidha and Homeopathy in the Indian
context.
“Any One Illness” shall mean continuous Period of
illness and it includes relapse within 45 days from the date of last
consultation with the Hospital/Nursing Home where treatment may have
been taken
“Baggage and Personal Effects” means luggage and
personal possessions, whether belonging to and/or in the lawful
custody of the Insured during the Trip.
“Burglary” means any theft following upon actual,
forcible and violent entry of and / or exit from the premises or
rented vehicle with intent to commit a felony and includes
housebreaking.
“Cashless Facility” means a facility extended by the
insurer to the insured where the payment, of the cost of treatment
undergone by the insured in accordance with the policy terms and
conditions, are directly made to the network provider by the insurer
to the extent pre-authorization approved.
“Checked-In Baggage” means the baggage entrusted by the
Insured and accepted by a Common Carrier for transportation for which
a baggage receipt is issued to the Insured by the Common Carrier.
This shall exclude all the items that are carried/ transported under
a contract of affreightment.
“City of Residence of the Insured” shall mean and
include any city, town or village in which the Place of Residence of
the Insured is currently located.
“Chronic Illness” means any Illness that is long-lasting
and / or permanent Illness. Long-lasting in relation to the above
shall mean any Illness lasting for more than 3 months.
“Company” means the ICICI Lombard General Insurance
Company Limited.
“Common Carrier” means any commercial public airline,
railway, bus transport, or water borne vessel (which shall include
ocean going and / or coastal vessels and / or vessels engaged for
official or personal purposes), operating under license issued by the
appropriate authority for transportation of passengers and / or
cargo.
“Condition Precedent” shall mean a policy term or
condition upon which the Insurer's
liability under the policy is
conditional upon.
ICICI Lombard General Insurance Company Ltd.
Group Travel Insurance
“Contents” (i) in so far
as it relates to the household, shall mean and include electronic
equipments, household appliances, furniture, kitchen utensils,
fixtures, fittings and interior decorations, belonging to the Insured
and/or his family, ordinarily residing with him, or for which the
Insured is legally responsible and which are solely used for personal
purposes. The term shall exclude cash and/or currency and/or cheques,
documents/ papers and all other items not coming within the purview
of the categories of items more specifically listed herein.
(ii) in so far as it relates to Checked-In Baggage, shall
mean and include any and all items other than Valuables contained in
the Checked in Baggage.
“Deductible” is a cost-sharing
requirement under a health insurance policy that provides that the
insurer will not be liable for a specified rupee amount in case of
indemnity policies and for a specified number of days/hours in case
of hospital cash policies which will apply before any benefits are
payable by the insurer. A deductible does not reduce the Sum
Insured.
“Emergency” shall mean a medical condition arising
out of any Illness contracted by the Insured declared by the Medical
Practitioner attending on the Insured where immediate treatment is
required to save the life of the Insured.
“Family” shall mean and include the Insured Person’s
spouse, children (including adopted and step children), brother(s),
sister(s) and parent(s).
In relation to the Trip Cancellation
and Interruption Cover, “Family” would mean and include the
Insured’s lawful spouse and children, including step children and
children legally adopted by the Insured and parents of the Insured.
“Financial emergency” shall mean a situation faced by
the Insured of total or near total non-availability with him / her of
Money needed for his / her prosecuting his / her next schedule of
activities and more particularly prosecuting his / her further Trip,
solely caused by an accidental loss of Money and / or travelers
cheques and / or credit cards. The term shall not include cases where
immediate financial support would be available to him / her from any
alternative source on request. The term shall not also mean any
emergency situation encountered by the Insured by causes other than
total or near total loss of Money and/or loss of all travelers’
cheques and/or credit cards issued in favour of the Insured. The term
shall exclude all situations where a Financial Emergency is not felt
as an immediate and instantaneous development and/or consequence at
the place of loss of Money and / or traveler’s cheques and / or
credit card.
“Geographical Scope of Cover” shall mean the
country(ies) or geographical boundaries in which the coverage under
the Policy is valid.
“Hijack” means any unlawful seizure or exercise of
control, by force or violence or threat of force or violence and with
wrongful intent, of Common Carrier in which the Insured is traveling.
“Hospital” A hospital means any institution established
for in-patient care and day care treatment of illness and/or injuries
and which has been registered as a hospital with the local
authorities and complies with all minimum criteria as under:
--has
qualified nursing staff under its employment round the clock;
--has
qualified medical practitioner(s) in charge round the clock;
--has
a fully equipped operation theatre of its own where surgical
procedures are carried out;
--maintains daily records of
patients and makes these accessible to the insurance company’s
authorized personnel.
“Hospitalization admission in a Hospital for a minimum period of
24 In patient Care consecutive hours except for specified procedures/
treatments, where such admission
could be for a period of less
than 24consecutive hours.
“Illness” mean a sickness or a disease or pathological
condition leading to the
impairment of normal physiological
function which manifests itself during the Policy Period and requires
medical treatment.
a. Acute condition - Acute condition is a
disease, illness or injury that is likely to respond quickly to
treatment which aims to return the person to his or her state of
health immediately before suffering the disease/illness/injury which
leads to full recovery.
b. Chronic condition - A chronic
condition is defined as a disease, illness, or injury that has one or
more of the following characteristics:—it needs ongoing or
long-term monitoring through consultations, examinations, check-ups,
and / or tests—it needs ongoing or long-term control or relief of
symptoms— it requires your rehabilitation or for you to be
specially trained to cope with it—it continues indefinitely—it
comes back or is likely to come back.
“Immediate Family
Member” shall mean an Insured's lawful spouse; children including
stepchildren and children legally adopted by the Insured; siblings;
parents; parents-in-law; legal guardian; ward; step-parents.
“Injury” means accidental physical bodily harm excluding
illness or disease solely and directly caused by external, violent
and visible and evident means which is verified and certified by a
Medical Practitioner. .
“Inpatient care” means treatment for
which the insured person has to stay in a hospital
for more than
24 hours for a covered event.
“Inpatient Treatment” means any medical treatment
rendered to the Insured at a Hospital in connection with any Injury
or Illness resulting in Hospitalization.
“Intensive care unit” means an identified section, ward
or wing of a hospital which is under the constant supervision of a
dedicated medical practitioner(s), and which is specially equipped
for the continuous monitoring and treatment of patients who are in a
critical condition, or require life support facilities and where the
level of care and supervision is considerably more sophisticated and
intensive than in the ordinary and other wards.
“Insured (s)”/ “Insured Person (s)” shall mean the
person(s) whose name(s) are specifically appearing under Point 2 in
Part I of the Schedule to this Policy.
“Maternity expenses” shall include—(a). medical
treatment expenses traceable to childbirth ( including complicated
deliveries and caesarean sections incurred during
hospitalization).(b). expenses towards lawful medical termination of
pregnancy during the policy period.
“Medical Advice” Any consultation or advice from a
Medical Practitioner including the issue o f any prescription or
repeat prescription.
“Medical Expenses” means those expenses that an Insured Person has necessarily and actually incurred for medical treatment on account of Illness or Accident on the advice of a Medical Practitioner, as long as these are no more than would have been payable if the Insured Person had not been insured and no more than other hospitals or doctors in the same locality would have charged for the same medical treatment.
“Medically necessary” treatment is defined as any treatment,
tests, medication, or stay in hospital or part of a stay in hospital
which
- is required for the medical management of the illness or
injury suffered by the insured;
- must not exceed the level of
care necessary to provide safe, adequate and appropriate medical care
in scope, duration, or intensity;
- must have been prescribed by
a medical practitioner,
- must conform to the professional
standards widely accepted in international medical practice or by the
medical community in India.
“Medical Practitioner” means a person who holds a degree of a recognised institute and is registered or licensed by recognised Medical Council of India or of the respective States of India, or of similar Medical Council of the Country at the place of Accident (as applicable as per the Geographical Scope of Cover) and acting within the scope of the license or registration granted to him/her. The term Medical Practitioner would include physician, specialist, anaesthetist and surgeon but would exclude the Insured Person and person who is an Immediate Family Member of the Insured Person. The term
“Medical Practitioner” specifically excludes persons practicing in non-allopathic fields.
“Missed Flight” shall mean the failure of the Insured to travel by a flight being part of the Trip as per Part I of the Schedule.
“Money” shall mean and include coins, currency notes, traveler’s cheques and credit cards / debit cards, and shall not include any form of cheques, banker’s cheques, bank pay orders or demand drafts.
"Network Provider” means hospitals or health care providers
enlisted by an insurer or by a TPA and insurer together to provide
medical services to an insured on payment by a cashless
facility.
Nominee – means the person(s) nominated by the
Insured Person to receive the benefits under this Policy payable on
the death of the Insured Person caused by an Accident. For the
purpose of avoidance of doubt it is clarified that if the Insured
Person is a minor, his legal guardian shall appoint the Nominee.
“Non- Network” Any hospital, day care centre or other provider that is not part o f the network.
“Notification of claim” is the process of notifying a claim to the insurer or TPA by specifying the timelines as well as the address / telephone number to which it should be notified.
“Outpatient Treatment or OPD” means the medical treatment
taken by the Insured Person in a Hospital on the written advice of a
Medical Practitioner without
Hospitalization, including the
medical treatment availed of in an emergency room of a Hospital.
“Period of Insurance” with reference to the Multi Trip Policy shall mean the period from commencement of insurance cover to the end of the insurance cover or full utilization of the maximum number of travel days covered under the Policy as mentioned in Part I of the Schedule to the Policy, whichever is earlier. “Period of Insurance” with reference to the Single Trip policy shall mean the period from commencement of insurance cover to the end of the insurance cover or actual Trip Duration, whichever is less.
“Place of Destination” means the destination place where the journey of the Insured, forming part of the Trip, is scheduled to be concluded through a Common Carrier.
“Place of Origin” means the starting point / place from where the Insured’s Trip is scheduled to be undertaken through a Common Carrier.
“Place of Residence of the Insured” means the dwellings the Insured is normally residing in currently, and declared as the residential address of the Insured in Part I of the Schedule.
“Pre-Existing Illness” shall mean and include any condition,
ailment or injury or related condition(s) for which you had signs or
symptoms, and / or were diagnosed, and / or received medical advice /
treatment within 48 months to prior to the first policy issued by the
insurer..
Complications arising from such pre-existing disease
will be considered part of that Pre-Existing Illness.
“Policy” means the policy booklet along with the schedule,
extensions and any applicable endorsement. The Policy contains
details of the extent of cover available to the Insured Person, the
exclusions from the cover and the terms and conditions of the
Policy.
Policyholder – means the person(s) or the entity named
in Part I of the Schedule to this Policy who executed the Policy
Schedule and is (are) responsible for payment of premium(s) on behalf
of the Insured Person or otherwise.
“Qualified nurse” is a person who holds a valid registration from the Nursing Council of India or the Nursing Council of any state in India.
“Renewal” defines the terms on which the contract of insurance can be renewed on mutual consent with a provision of grace period for treating the renewal continuous for the purpose o f all waiting periods.
“Room Rent” means the amount charged by a hospital for the occupancy of a bed on per day (24 hours) basis and shall include associated medical expenses.
“Subrogation” shall mean the right o f the insurer to assume the rights o f the insured person to recover expenses paid out under the policy that may be recovered from any other source.
“Surgery or Surgical Procedure” means manual and / or
operative procedure (s) required for treatment of an illness or
injury, correction of deformities and defects, diagnosis and
cure
of diseases, relief of suffering or prolongation of life, performed
in a hospital or day care centre by a medical practitioner
“Sum Insured” means the maximum amount of coverage in respect of the claims during the Period of Insurance in connection with each of the items of coverage, as specified in Part I of the Schedule to this Policy.
“Third Party Administrator” means such person or persons as may be appointed by the Company from time to time to provide assistance to the Insured in terms of this Policy.
“Traveling Companion” means the means the Insured Person(s) traveling as named in Part I of the Schedule traveling with the Insured during the Trip, provided that, the Insured and such individual(s) are traveling to the same destination on the same dates. For the purpose of this definition, any individual(s) forming part of a group traveling on a tour arranged by a travel agent or a tour leader is not considered as Traveling Companion, unless the individual(s) is an Immediate Family as defined herein.
“Trip” shall mean the journey(s) undertaken by the Insured
from the City of Residence or the Place of Origin and return back to
the City of Residence or the Place of Origin or the Place of
Destination during the Period of Insurance. Single Trip shall mean
and include a Trip undertaken by the Insured from the City of
Residence or the Place of Origin on or after the date of commencement
of the insurance cover and return to the City of Residence or the
Place of Origin or the Place of Destination, as the case may be, on
or before the expiry of the insurance cover. Multi Trip shall mean
and include one or more Single Trips during the Period of
Insurance.
The Trip shall be deemed to be completed on the Date
of Expiry of Insurance as specified in Part I of the Schedule,
provided further that for a Multi Trip Policy, the Multi Trip shall
be deemed to be completed on the completion of the last Single Trip
undertaken as part of the Multi Trip or expiry of cover whichever is
earlier.
“Trip Duration” means the time period commencing from the date when the Insured travels out of the City of Residence or Place of Origin and ending on the date of return to the City of Residence and/or Place of Origin and includes both days.
“Unproven/Experimental treatment” is treatment, including drug Experimental therapy, which is based on established medical practice in India, is treatment experimental or unproven. These treatments are excluded under the policy.
“Valuables” shall mean and include photographic, audio, video, computer and any other electronic equipment, telecommunications and electrical equipment, telescopes, binoculars, antiques, watches, jewelry and gems, furs and articles made of precious stones and metals.
SCOPE OF COVER
The Company hereby agrees,
subject to the terms, exclusions and conditions herein contained or
otherwise expressed herein, to pay to the Insured a sum as
compensation for any loss or damage as described under different
Sections hereunder but not exceeding the Sum Insured as applicable to
the respective Sections as specified in Part I of the Schedule to the
Policy.
The Deductible as indicated against each Section in the Part I of
the Schedule shall be borne by the Insured in respect of each claim
or series of claims arising out of one event.
Eligibility
Conditions
The product would be offered to India
residents and between age bands from 1 year upto 70 years with a
lifelong renewal option. Note: Age refers to the number of completed
years as on the start date of the Policy.
Policy Tenure- The
policy tenure would be for a period of 1 year only
Terms
of Renewal
a. The Policy can be renewed under the then
prevailing Group Travel Insurance product or its nearest substitute
(in case the Group Travel Insurance product is withdrawn by the
Company) approved by IRDA.
b. This policy shall ordinarily be
renewable except on grounds of fraud, moral hazard or
misrepresentation or non-cooperation by the insured
BENEFIT
1- HOSPITALIZATION EXPENSES FOR INJURY
The Company shall
indemnify the Insured for the expenses reasonably incurred by the
Insured for Hospitalization and medical treatment, taken on account
of any Injury sustained by the Insured whilst on a Trip during the
Period of Insurance, subject to the overall liability of the Company
not exceeding the Sum Insured for the coverage as mentioned in Part I
of the Schedule hereto.
Provided that the treatment for such
Injury shall commence anytime during the Period of Insurance
immediately after diagnosis of such Injury, and in no case beyond the
expiry of 30 days from the date of return to the City of Residence or
Place of Origin.
The Company shall reimburse the following
Hospitalization expenses for:
1. Accommodation, board and
nursing expenses;
2. Test and / or examination charges;
3.
Physician’s fees;
4. Cost of medicines provided by the
Hospital / purchased from a registered pharmacy other than the
Hospital.
5. External medical appliances as prescribed by a
registered Medical Practitioner as necessary and essential as part of
the treatment on actuals.
6. Rehabilitation and/or physiotherapy
expenses;
7. Should the Insured decide to avail the treatment
for said Injury in the City of Residence or Place of Origin , the
Company shall compensate the Insured for the expenses incurred under
various items of expenses mentioned herein above, and also for the
cost of return journey incurred by the Insured for self as also for
an accompanying attendant from the place of Injury to the City of
Residence or Place of Origin by the Common Carrier through which the
Trip was initially undertaken, subject however to the overall
liability of the Company not exceeding the amount had the treatment
been taken at the place where the Injury was suffered in the opinion
of the Third Party Administrator or the Sum Insured, whichever is
less.
However the Company shall not be liable for the first Rs.
500 (for Geographical scope of cover within India)/ US$ 100 (for
Geographical scope of cover outside India) or such a
deductible
amount as mentioned against this benefit in Part I of the Schedule to
this Policy, in respect of each and every claim admissible under this
benefit.
EXTENSIONS TO HOSPITAIZATION EXPENSES COVER FOR INJURY (SUBJECT TO
SPECIFIC ACCEPTANCE BY THE COMPANY AND ON INCORPORATION IN THE PART I
OF THE SCHEDULE ACCORDINGLY)
EXTENSION I – OUTPATIENT
TREATMENT EXPENSES FOR INJURY
The Company shall indemnify the
Insured for the Outpatient Treatment expenses reasonably incurred by
the Insured, under Benefit 1, on account of any Injury sustained
whilst on a Trip during the Period of Insurance, but not exceeding
the Sum Insured for the coverage as mentioned in Part I of the
Schedule hereto.
However, the Deductible amount mentioned under
Benefit 1 as mentioned in Part I of the Schedule to this Policy shall
be applicable.
EXTENSION II – DAILY ALLOWANCE IN CASE OF
HOSPITALIZATION ARISING OUT OF INJURY
In the event of
Hospitalization of the Insured due to an Injury sustained within the
Period of Insurance whilst on a Trip, the Company shall pay to the
Insured a daily compensation as specified in Part I of the Schedule,
subject to the maximum liability of the Company in respect of all
claims coming under Benefit I - Hospitalization Expenses for Injury
during the Period of Insurance together with the amount payable
hereunder, if any, not exceeding the Sum Insured specified in Part I
of the Schedule to this Policy. The Hospitalization should be for a
period of more than 24 consecutive hours or such time as specified in
Part I of the Schedule to this Policy.
EXCLUSIONS APPLICABLE TO
BENEFIT 1 AND EXTENSIONS THEREIN -:
The Company shall not be
liable to make any payment towards expenses incurred by the Insured
in connection with or in respect of:
1. Treatment for any dental
Illness / Injury.
2. Beauty and / or cosmetic treatment and/or
reconstructive plastic surgery in any form or manner.
3. Rest or
recuperation at a spa or health resort, sanatorium, convalescence
home or similar institution.
4. Mental or psychiatric
disorders.
5. Pregnancy, childbirth and any consequences
thereto.
6. Prostheses/ prosthetics (artificial limbs) etc.
7.
Test and / or examination of any kind not consistent with or
incidental to the diagnosis and treatment of any Illness or Injury
either in a Hospital or for Outpatient Treatment .
8.
Self-inflicted Illness or Injury.
9. Any Injury and/or Illness
sustained or contracted
a. Whilst the Insured is under the
influence of intoxicating liquor / drugs;
b. Whilst the Insured
is engaging in aviation / ballooning / while mounting into or
dismounting from or traveling in any balloon or aircraft other than
as a passenger (fare paying or other wise);
c. Directly or
indirectly occasioned by, happening through or in consequence of war,
invasion, act of foreign enemy, hostilities (whether was be declared
or not), civil war, rebellion, revolution, insurrection or military
or usurped power;
d. Directly or indirectly caused by or
contributed by:
i. Ionizing radiation or contamination by
radioactivity from any nuclear fuel or from any nuclear waste from
the combustion of nuclear fuel;
ii. The radioactive, toxic,
explosive or other hazardous properties of any explosive nuclear
assembly or nuclear component thereof.
CLAIMS PROCEDURE
In
the event of the Insured sustaining any Injury necessitating a
treatment rendered as Emergency, he / she shall provide the
particulars of insurance cover as also the details of the Third Party
Administrator to the Hospital and / or the Medical Practitioner while
simultaneously reporting the contingency / claim to the Third Party
Administrator as provided in the Claims Procedure –
General.
Documents to be submitted in support of the claim:
1.
Medical reports and discharge summary issued by the Hospital or
prescriptions and medical report from the Medical Practitioner
furnishing the name of the Insured, period of treatment and details
of treatment rendered.
2. Bills / receipts for:
a. Charges
paid towards Hospital accommodation, nursing facilities and other
medical services rendered;
b. Fees paid to the medical
practitioner, special nursing charges, etc.
c. Charges incurred
towards any and all test and / or examinations rendered in connection
with the treatment.
d. Charges incurred towards medicines or
drugs purchased from a registered pharmacy other than the Hospital
duly supported by the prescriptions of the Medical Practitioner
attending to the Insured.
3. And any other document as may be
appropriately applicable for the claims preferred under this section
of the Policy
In respect of all claims payable hereunder, the
Company may effect settlement either in the form of cashless
treatment facility or by reimbursement of the amount of claim to the
Insured, at its sole discretion.
BENEFIT 2- EMERGENCY
HOSPITALIZATION EXPENSES FOR ILLNESS
The Company shall indemnify
the Insured for expenses reasonably incurred for Hospitalization and
medical treatment taken on account of any Illness contracted whilst
on a Trip during the Period of Insurance, subject to the overall
liability of the Company not exceeding the Sum Insured for the
coverage as mentioned in Part I of the Schedule hereto.
Provided
that the treatment for such Illness shall commence anytime during the
Period of Insurance immediately after diagnosis of such Illness, and
in no case beyond the expiry of 30 days from the date of return to
the City of Residence or Place of Origin.
The Company shall
reimburse the following inpatient medical expenses for:
a.
Accommodation, board and nursing expenses;
b. Test and / or
examination charges;
c. Physician’s fees;
d. Cost of
medicines provided by the Hospital / purchased from a registered
pharmacy other than the Hospital.
e. External medical appliances
as prescribed by a registered Medical Practitioner as necessary and
essential as part of the treatment on actuals.
f. Rehabilitation
and/or physiotherapy expenses.
However the Company shall not be
liable for the first Rs. 500 (for Geographical scope of cover within
India)/ US$ 100 (for Geographical scope of cover outside India) or
such a deductible amount as mentioned against this benefit in Part I
of the Schedule to this Policy, in respect of each and every claim
admissible under this benefit.
Should the Insured decide to
avail the treatment for said Injury in the City of Residence or Place
of Origin , the Company shall compensate the Insured for the expenses
incurred under various items of expenses mentioned herein above, and
also for the cost of return journey incurred by the Insured for self
as also for an accompanying attendant from the place of Illness to
the City of Residence or Place of Origin by the Common Carrier
through which the Trip was initially undertaken, subject however to
the overall liability of the Company not exceeding the amount had the
treatment been taken at the place where the Injury was suffered in
the opinion of the Third Party Administrator or the Sum Insured,
whichever is less.
EXTENSION I – OUTPATIENT TREATMENT EXPENSES
FOR ILLNESS
The Company shall indemnify the Insured for the
Outpatient Treatment expenses reasonably incurred by the Insured,
under Benefit 1, on account of any Illness contracted whilst on a
Trip during the Period of Insurance, but not exceeding the Sum
Insured for the coverage as mentioned in Part I of the Schedule
hereto.
Provided further that the Company’s liability per
Illness shall not exceed 30% of the maximum liability stated in the
Part I of the Schedule with respect to an Outpatient Treatment and
further provided that the Deductible amount mentioned under Benefit 2
as mentioned in Part I of the Schedule to this Policy shall be
applicable.
EXTENSION II – PRE-EXISTING ILLNESS EXTENSION
This
extension is not covered in the policy.
EXTENSION III – DAILY
ALLOWANCE IN CASE OF HOSPITALIZATION ARISING OUT OF ILLNESS
In
the event of Hospitalization of the Insured due to an Illness
contracted within the Period of Insurance whilst on a Trip, the
Company shall pay to the Insured a daily compensation as specified in
Part I of the Schedule, subject to the maximum liability of the
Company in respect of all claims coming under Benefit 2 – Emergency
Hospitalization Expenses for Illness during the Period of Insurance
together with the amount payable hereunder, if any, not exceeding the
Sum Insured specified in Part I of the Schedule to this Policy. The
Hospitalization should be for a period of more than 24 consecutive
hours or such time as mentioned in specified in Part I of the
Schedule to this policy to avail of this Benefit
EXCLUSIONS
APPLICABLE TO BENEFIT 2 AND EXTENSIONS THEREIN -:
The Company
shall not be liable to make any payment towards expenses incurred by
the Insured in connection with or in respect of:
1. Any
treatment of a Pre-Existing Illness, unless covered specifically
under Extension II – Pre-existing Illness Extension of the cover –
Emergency Hospitalization Expenses for Illness and if covered so,
beyond what is provided for under the said Extension.
2.
Treatment of orthopedic, degenerative, or oncological diseases unless
covered specifically under Extension II – Pre-existing Illness
Extension of the cover – Emergency Hospitalization Expenses for
Illness and if covered so, beyond what is provided for under the said
Extension .
3. Treatment for any dental Illness / Injury.
4.
Beauty and / or cosmetic treatment and/or reconstructive plastic
surgery in any form or manner.
5. Rest or recuperation at a spa
or health resort, sanatorium, convalescence home or similar
institution.
6. Mental or psychiatric disorders.
7.
Pregnancy, childbirth and any consequences unless covered
specifically under Extension II – Pre-existing Illness Extension of
the cover – Emergency Hospitalization Expenses for Illness and if
covered so, beyond what is provided for under the said Extension.
8.
Prostheses/ prosthetics (artificial limbs) etc.
9. Test and / or
examination of any kind not consistent with or incidental to the
diagnosis and treatment of any Illness or Injury either in a Hospital
or as an outpatient.
10. Self-inflicted Illness or Injury.
11.
Any Injury and/or Illness sustained or contracted
a. Whilst the
Insured is under the influence of intoxicating liquor / drugs;
b.
Whilst the Insured is engaging in aviation / ballooning / while
mounting into or dismounting from or traveling in any balloon or
aircraft other than as a passenger (fare paying or other wise);
c.
Directly or indirectly occasioned by, happening through or in
consequence of war, invasion, act of foreign enemy, hostilities
(whether was be declared or not), civil war, rebellion, revolution,
insurrection or military or usurped power;
d. Directly or
indirectly caused by or contributed by:
i. Ionizing radiation or
contamination by radioactivity from any nuclear fuel or from any
nuclear waste from the combustion of nuclear fuel;
ii. The
radioactive, toxic, explosive or other hazardous properties of any
explosive nuclear assembly or nuclear component thereof.
CLAIMS
PROCEDURE:
In the event of the Insured contracting any Illness
necessitating a treatment rendered as Emergency, he / she shall
provide the particulars of insurance cover as also the details of the
Third Party Administrator to the Hospital and / or the Medical
Practitioner while simultaneously reporting the contingency / claim
to the Third Party Administrator as provided in the Claims Procedure
– General.
Documents to be submitted in support of the
claim:
1. Medical reports and discharge summary issued by the
Hospital or prescriptions and medical report from the Medical
Practitioner furnishing the name of the Insured, period of treatment
and details of treatment rendered.
2. Bills / receipts for:
i.
Charges paid towards Hospital accommodation, nursing facilities and
other medical services rendered;
ii. Fees paid to the Medical
Practitioner, special nursing charges, etc.
iii. Charges
incurred towards any and all test and / or examinations rendered in
connection with the treatment.
iv. Charges incurred towards
medicines or drugs purchased from a registered pharmacy other than
the Hospital duly supported by the prescriptions of the Medical
Practitioner attending to the Insured.
In respect of all claims
payable hereunder, the Company may effect settlement either in the
form of cashless treatment facility or by reimbursement of the amount
of claim to the Insured, at its sole discretion.
BENEFIT 3 -
REPATRIATION OF REMAINS
In the unfortunate event of the death of
the Insured whilst on a Trip during the Period of Insurance, the
Company shall, reimburse the Nominee the costs of transporting the
remains of the deceased Insured back to the City of Residence or
Place of Origin or, up to an equivalent amount, for a local burial or
cremation in the place where the death shall occur, provided that the
Company’s liability does not exceed the liability mentioned in Part
I of the Schedule
EXCLUSIONS APPLICABLE TO BENEFIT 3-
REPATRIATION OF REMAINS
The Company shall not be liable for:
1.
Payment of compensation in respect of death:
a. arising from
intentional self Injury / suicide / attempted suicide;
b. whilst
the Insured is under the influence of intoxicating liquor / drugs;
c.
whilst engaging in aviation / ballooning / while mounting into or
dismounting from or traveling in any balloon or aircraft other than
as a passenger (fare paying or other wise);
d. directly or
indirectly occasioned by, happening through or in consequence of war,
invasion, act of foreign enemy, hostilities (whether war be declared
or not), civil war, rebellion, revolution, insurrection or military
or usurped power;
e. directly or indirectly caused by or
contributed by:
i. Ionizing radiation or contamination by
radioactivity from any nuclear fuel or from any nuclear waste from
the combustion of nuclear fuel;
ii. The radioactive, toxic,
explosive or other hazardous properties of any explosive nuclear
assembly or nuclear component thereof.
CLAIMS
PROCEDURE:
In event of a contingency resulting in the
death of the Insured, his / her representatives shall immediately
report the same to the Third Party Administrator and submit the
claims form furnishing the complete details of the death of the
Insured to the Third Party Administrator.
Documents to be
submitted in support of the claim:
1. Photocopy of the death
certificate providing the details of the place, date and time, and
the circumstances and cause of the death (photocopy of the postmortem
certificate wherever required by the Third Party Administrator),
issued by the appropriate authority where the contingency has
arisen.
2. Proof for expenses incurred towards disposal of the
mortal remains.
3. In case of transportation of the body of the
deceased to the City of Residence or Place of Origin , the receipt
for expenses incurred towards preparation and packing of the mortal
remains of the deceased and also for the transportation of the mortal
remains of the deceased to the City of Residence or Place of
Origin.
BENEFIT 4 – MEDICAL EVACUATION
The Company shall
indemnify the Insured for the cost incurred for an ambulance or any
other Emergency transportation and evacuation services, including
necessary medical care en-route, reasonably incurred forming part of
the treatment for any Illness contracted or Injury sustained whilst
on Trip during the Period of Insurance. These transportation expenses
would be limited to transporting the Insured from the place of loss
to the nearest appropriate medical facility or to the Place of Origin
or to the City of Residence of the Insured, whichever is nearer.
Provided that the Company’s liability does not exceed the liability
mentioned in Part I of the Schedule hereto.
Provided that such
cost are certified and authorized by the Third Party Administrator of
the Company and/or the Company.
However the Company shall not be
liable for the first Rs. 500 (for Geographical scope of cover within
India)/ US$ 100 (for Geographical scope of cover outside India) or
such a deductible amount as mentioned against this benefit in Part I
of the Schedule to this Policy, in respect of each and every claim
admissible under this benefit.
EXCLUSIONS APPLICABLE TO BENEFIT
4 – MEDICAL EVACUATION:
The Company shall not be liable to
make any payment towards expenses incurred by the Insured in
connection with or in respect of:
1. Expenses related to a
Pre-Existing Illness, unless covered specifically under Additional
Covers: Extension II – Pre-existing Illness Extension of the cover
– Emergency Hospitalization Expenses for Illness and if covered so,
beyond what is provided for under the said Additional Cover.
2.
Expenses related to orthopedic, degenerative, or oncological diseases
unless covered specifically under Additional Covers: Extension II –
Pre-existing Illness Extension of the cover – Emergency
Hospitalization Expenses for Illness and if covered so, beyond what
is provided for under the said Additional Cover.
3. Expenses
related to any dental Illness / Injury.
4. Expenses related to
beauty and / or cosmetic treatment and/or reconstructive plastic
surgery in any form or manner.
5. Expenses related to mental or
psychiatric disorders.
6. Expenses related to pregnancy,
childbirth and any consequences unless covered specifically under
Additional Covers: Extension II – Pre-existing Illness Extension of
the Emergency Hospitalization Expenses for Illness cover and if
covered so, beyond what is provided for under the said Additional
Cover.
7. Expenses related to self-inflicted Illness or
Injury.
8. Any Injury and/or Illness sustained or contracted
a.
Whilst the Insured is under the influence of intoxicating liquor /
drugs;
b. Whilst the Insured is engaging in aviation /
ballooning / while mounting into or dismounting from or traveling in
any balloon or aircraft other than as a passenger (fare paying or
other wise);
c. Directly or indirectly occasioned by, happening
through or in consequence of war, invasion, act of foreign enemy,
hostilities (whether was be declared or not), civil war, rebellion,
revolution, insurrection or military or usurped power;
d.
Directly or indirectly caused by or contributed by:
i. Ionizing
radiation or contamination by radioactivity from any nuclear fuel or
from any nuclear waste from the combustion of nuclear fuel;
ii.
The radioactive, toxic, explosive or other hazardous properties of
any explosive nuclear assembly or nuclear component thereof.
CLAIMS
PROCEDURE:
In event of circumstances leading to Medical
Evacuation of the Insured Person, his / her representatives shall
immediately report the same to the Third Party Administrator/ Company
and submit the claims form furnishing the complete details alongwith
the supporting documentation.
Documents to be submitted in
support of the claim:
1. Medical reports and transportation
details issued by the evacuation agency, prescriptions and medical
report by the attending Medical Practitioner furnishing the name of
the Insured and details of treatment rendered alongwith the statement
confirm the necessity of evacuation.
2. Proof for expenses
incurred towards the above.
3. Any other document as required by
the Company/ TPA on a case to case basis.
BENEFIT 5 - DENTAL
TREATMENT
The Company shall compensate the Insured for the
reasonable medical expenses incurred in connection with any Injury or
Illness to his/her natural tooth or teeth during the Trip but not
exceeding the Sum Insured for the coverage as mentioned in Part I of
the Schedule hereto.
However the Company shall not be liable for
the first Rs. 500 (for Geographical scope of cover within India)/ US$
100 (for Geographical scope of cover outside India) or such a
deductible amount as mentioned against this benefit in Part I of the
Schedule to this Policy, in respect of each and every claim
admissible under this benefit.
EXCLUSIONS APPLICABLE TO BENEFIT
5 - DENTAL TREATMENT:
The Company shall not be liable to make
any payment towards expenses incurred by the Insured in connection
with or in respect of:
1. Any treatment of a Pre-Existing
Illness;
2. Treatment of orthopedic, degenerative or oncological
diseases;
3. Beauty and / or cosmetic treatment and/or
reconstructive plastic surgery in any form or manner;
4. Rest or
recuperation at a spa or health resort, sanatorium, convalescence
home or similar institution.
CLAIMS PROCEDURE:
Claims
provisions applicable to Benefit 5– Dental Treatment
In event
of the Insured contracting any Illness / sustaining any Injury
necessitating a treatment in Hospital he / she shall render the
particulars of insurance cover as also the details of the Third Party
Administrator to the service provider (rendering the treatment) while
simultaneously reporting the contingency / claim to the Third Party
Administrator as provided in the Claims Procedure –
General.
Documents to be submitted in support of the claim:
1.
Medical reports and discharge summary issued by the Hospital
furnishing the name of the Insured, period of treatment, details of
treatment rendered.
2. Bills / receipts for:
i. Charges
paid towards Hospital accommodation, nursing facilities and other
medical services rendered;
ii. Fees paid to the Medical
Practitioner, special nursing charges, etc.
iii. Charges
incurred towards any and all test and / or examinations rendered in
connection with the treatment.
iv. Charges incurred towards
medicines / drugs supplied by the Hospital or purchased from a
registered pharmacy other than the Hospital duly supported by the
prescriptions of the Medical Practitioner attending to the
Insured.
3. And any other document as may be appropriately
applicable for the claims preferred under this section of the
Policy
In respect of all claims payable hereunder, the Company
may effect settlement either in the form of cashless treatment
facility or by reimbursement of the amount of claim to the Insured,
at its sole discretion.
BENEFIT 6- LOSS OF CHECKED IN
BAGGAGE
The Company shall pay the Insured for the sum as
mentioned against this Benefit 6 in Part I of the Schedule to the
Policy for value of the Checked-In Baggage lost whilst in custody of
the Common Carrier during the Trip covered hereunder. The coverage
shall commence from the time the Checked-In Baggage is entrusted to
the Common Carrier and a receipt obtained, and shall terminate on
delivery by the Common Carrier against surrender of the receipt at
the Place of Destination/ City of Residence, as the case may be
provided that the cover shall in no case exist beyond the point of
delivery by the Common Carrier at the arrival terminal / exit gate.
The cover shall be available only if the entire Checked-In Baggage is
permanently lost by the Common Carrier.
The liability of the
Company in so far as it relates to a single Checked-In Baggage being
part of more than one Checked-In Baggage attached to the ticket of
the Insured, shall be restricted to 50% of the Sum Insured specified
in the Part I of the Schedule of the Policy. The compensation will
not exceed the Sum Insured for the coverage as mentioned in Part I of
the Schedule hereto.
The cover shall be applicable individually
and independently in case of Trip involving multi destinations
en-route.
EXCLUSIONS APPLICABLE TO BENEFIT 6 - LOSS OF
CHECKED-IN BAGGAGE:
The Company shall not be liable for any loss
in connection with the following:
1. Valuables
2. Any
partial loss or partial damage of Contents of the Checked-In
Baggage.
3. Losses arising from any delay, detention,
confiscation by customs officials or other public authorities.
4.
Loss due to damage to the Checked-In Baggage.
5. Loss of the
Checked-In Baggage sent in advance or souvenirs and articles mailed
or shipped separately.
In event the lost Checked-In Baggage is
subsequently delivered to the Insured, the Insured shall refund in
full the sum paid by the Company hereunder, provided that, the
Company shall separately consider the Insured’s eligibility for
recovery of claim under the Benefit 7 - Delay of Checked-In Baggage
under the Policy.
CLAIMS PROCEDURE:
Claims provisions
applicable to Benefit 6 – Loss of Checked-In Baggage:
In event
the Insured not getting delivery of one or more Checked-In Baggage
attached to the ticket for the travel being part of the Trip against
surrender of the ticket, the Insured shall hold back the ticket and
report to the Common Carrier of the non-delivery (or short delivery
of one or more Checked-In Baggage while simultaneously reporting to
the Third Party Administrator as provided in the Claims Procedure –
General.
Documents to be submitted in support of the
claim
Statement of claim furnishing the details of items
contained in the Checked-In Baggage.
Property irregularity
report issued by the Common Carrier.
Voucher of the Common
Carrier for the compensation paid for the non-delivery / short
delivery of the Checked-In Baggage.
Copies of correspondence
exchanged, if any, with the Common Carrier in connection with the
non-delivery / short delivery of the Checked-In Baggage.And any other
document as may be appropriately applicable for the claims preferred
under this section of the Policy
In case of compensation from
the Common Carrier having been received after payment of the claim by
the Company hereunder, the Insured shall repay to the Company such
amount in excess of his / her loss after taking into account the
benefit amount received from the Company and that received from the
Common Carrier.
In case the undelivered Checked-In Baggage is
subsequently traced by the Common Carrier and offered for delivery to
the Insured, the Insured shall take delivery of the Checked-In
Baggage and refund the amount paid by the Company hereunder. In case
of delivery of part of the Checked-In Baggage, the amount paid by the
Company attributable to such Checked-In Baggage shall be refunded by
the Insured to the Company.
BENEFIT 7 - DELAY OF CHECKED IN
BAGGAGE
The Company shall pay the Insured for the sum as
specified for the coverage in the Schedule I of the Policy as a fixed
allowance in case the Insured shall encounter a delay in receipt of
the Checked-In Baggage beyond the period as specified in the Part I
of the Schedule from the scheduled / expected time of delivery by the
Common Carrier.
Provided that such allowance for the Delay of
Checked-in Baggage shall be paid only in event the delay is for more
than 6 Hours (for Geographical scope of cover within India)/ 12 Hours
(for Geographical scope of cover outside India) or the number of
hours stated against the benefit as Deductible in the Part I of the
Schedule to the Policy.
For the purpose of this benefit, delay
shall be considered to be the time lapsed from the actual time of
arrival of the Common Carrier and the receipt of the Checked-In
Baggage by the Insured.
The cover shall be applicable
individually and independently in case of Trip involving multi
destinations en-route, provided that, in event of more than one
incident of delay of Checked-in Baggage during the Trip, the
Company’s overall liability shall be limited to loss suffered for
two such incidents of delay of Checked-In Baggage.
EXCLUSIONS
APPLICABLE TO BENEFIT 7 - DELAY OF CHECKED-IN BAGGAGE:
No
payment shall be made by the Company in connection with the
following:
1. In case the period of delay does not exceed the
time specified in Part I of the Policy.
2. Any delay for part of
total Checked-In Baggage in relation to the ticket of the Insured for
the Trip covered under this Policy.
3. Delay in delivery of the
Checked-In Baggage arising out of and resulting from detention /
confiscation by the Common Carrier / customs / government agencies /
other agencies.
4. Delay attributable to damage to Checked-In
Baggage warranting an examined delivery by the Common Carrier.
CLAIMS
PROCEDURE:
Claims provisions applicable to Benefit 7 – Delay
of Checked-In Baggage
In event the entire Checked-In Baggage
attached to the ticket of the Insured for the travel being part of
the Trip covered hereunder, not being received as per schedule
resulting in a delay of delivery, the Insured shall immediately
report to the Common Carrier of the fact and also of the details of
the Checked-In Baggage while simultaneously reporting to the Third
Party Administrator as provided in the Claims Procedure –
General.
Documents to be submitted in support of the claim
1.
Property irregularity report stating the scheduled time of delivery
and actual time of delivery of the Checked-In Baggage issued by the
Common Carrier;
2. Voucher of the Common Carrier for the
compensation paid for the delay in delivery of the Checked-In
Baggage;
3. Copies of correspondence exchanged, if any, with the
Common Carrier in connection with the delay in delivery of the
Checked-In Baggage.
4. And any other document as may be
appropriately applicable for the claims preferred under this section
of the Policy
BENEFIT 8 - PERSONAL ACCIDENT
The Company
shall compensate the Insured as per table of benefits hereunder in
case the Insured shall meet with death or incur total or partial
permanent disability arising out of and consequent upon an Injury
encountered at any time during the Period of Insurance.
The
Company’s maximum liability in respect of any one Accident or all
Accidents resulting in death of or Injury to the Insured during the
Period of Insurance shall not exceed the Sum Insured specified in the
Part I of the Schedule of the policy.
EXCLUSIONS APPLICABLE TO
BENEFIT 8 - PERSONAL ACCIDENT
The Company shall not be liable
for:
2. Compensation for death or Injury under more than one of
the categories of Benefits as specified below in respect of any one
Accident / series of Accidents arising out of one event.
3.
Amounts related to medical expenses;
4. Payment of compensation
in respect of death or disability:
a. arising from intentional
self Injury / suicide / attempted suicide;
b. whilst the Insured
is under the influence of intoxicating liquor / drugs;
c. whilst
engaging in aviation / ballooning / while mounting into or
dismounting from or traveling in any balloon or aircraft other than
as a passenger (fare paying or other wise);
d. directly or
indirectly occasioned by, happening through or in consequence of war,
invasion, act of foreign enemy, hostilities (whether war be declared
or not), civil war, rebellion, revolution, insurrection or military
or usurped power;
e. directly or indirectly caused by or
contributed by:
i. Ionizing radiation or contamination by
radioactivity from any nuclear fuel or from any nuclear waste from
the combustion of nuclear fuel;
ii. The radioactive, toxic,
explosive or other hazardous properties of any explosive nuclear
assembly or nuclear component thereof.
BASIS OF ASSESSMENT OF
CLAIM
The benefit payable to or on behalf of the Insured will be
as per the following categories:
Categories of benefits
1.
Death:
The Sum Insured as stated in Part I of the Schedule if
the death of the Insured shall result within a period of twelve
months from the date of the Injury, and if such Injury shall be the
sole and direct cause of the death of the Insured.
2. Permanent
Total Disablement (PTD):
If such Injury shall, within twelve
months of its occurrence, be the sole and direct cause of the total
and irrecoverable loss of:
Sight of both eyes, or actual loss by
physical separation of two entire hands or two entire feet, or one
entire hand and one entire foot, or loss of sight of one eye and loss
of one entire hand or one entire foot, then the Sum Insured stated in
the Part I of the Schedule hereto shall be payable;
Loss of use
of two hands or two feet, or of one hand and one foot, or of loss of
sight of one eye and loss of use of one hand or one foot, then the
Sum Insured stated in Part I of the Schedule hereto shall be
payable;
Note:
(i) Physical separation of a hand or foot
means separation of hand at or above the wrist, and of foot at or
above the ankle.
(ii) Loss of Use - means the total paralysis of
one or more limb, or loss of hearing or loss of vision which is
certified in writing by a Medical Practitioner to be permanent,
complete and irreversible.
(iii) If an Injury shall, as a direct
consequence thereof, immediately, permanently, totally and
absolutely, disable the Insured from engaging in and being occupied
with or giving attention to any employment or occupation of any
description whatsoever, then a lump sum equal to hundred percent
(100%) of the Sum Insured stated in Part I of the Schedule hereto
shall be payable.
3. Permanent Partial Disablement (PPD):
If
an Injury shall, within twelve calendar months of its occurrence, be
the sole and direct cause of the total and/or partial irrecoverable
loss of use or the actual loss by physical separation of the body
parts as per the following table, then the percentage as specified
hereunder of the Sum Insured as stated in Part I of the Schedule
shall be payable:
Percentage of Capital Sum Insured
Loss of
Use/ Physical Separation:
One entire hand 50
One entire
foot 50
Loss of one eye/ vision of one eye 50
Loss of toes
– all 20
Great both phalanges 5
Great – one phalanx
2
Other than great if more than one toe lost each 1
Loss of
hearing – both ears 75
Loss of hearing one ear 30
Loss of
four fingers and thumb of one hand 40
Loss of four fingers
35
Loss of thumb - both phalanges 25
- one phalanx 10
Loss
of Index finger - three phalanges 10
- two phalanges 8
-
one phalanx 4
Loss of middle finger - three phalanges 6
-
two phalanges 4
- one phalanx 2
Loss of ring finger - three
phalanges 5
- two phalanges 4
- one phalanx 2
Loss of
little finger - three phalanges 4
- two phalanges 3
- one
phalanx 2
Loss of metacarpus - first or second (additional) 3
-
third, fourth or fifth (additional) 2
Any other permanent
partial disablement - This shall be based upon opinion and assessment
of the Medical Practitioner as to the extent of disability.
SPECIAL
CONDITIONS APPLICABLE TO BENEFIT 8 - PERSONAL ACCIDENT
1. Upon
happening of any event, which is likely to give rise to a claim under
this Benefit 8, the Insured or his/her representative shall give
written notice with full particulars immediately to the Company or
the Third Party Administrator.
2. The Insured or his/her
representative shall arrange for immediate treatment of the Insured
in a Hospital and produce all such records of treatment to the
Company in support of the claim.
3. Any claim for death of the
Insured shall be duly supported by a death certificate issued by the
Hospital in the city of Accident or City of Residence or Place of
Origin , as the case may be. Post mortem certificate if required by
the Company shall also be submitted.
4. The claim for permanent
total or partial disability shall be duly supported by the disability
certificate issued by the Hospital / Medical Practitioner specifying
the nature of disability and the percentage of disablement.
5.
In case of death, written notice must be given before internment or
cremation within one calendar month after the death, unless
reasonable cause for delay is shown. In event of loss of sight or
amputation of limbs or any part thereof, written notice must be given
within one calendar month after such loss of sight or amputation.
6.
No claim for death or disability under this Policy shall be
considered unless death or disability results within 12 months from
the date of the Accident that led to the death or disability. To this
extent the certificate obtained from the Medical Practitioner shall
clearly relate the death / disability to the Accident in
question.
CLAIMS PROCEDURE:
Claims provisions applicable to
Benefit 8 – Personal Accident
In event of the Insured meeting
with death or disability arising out of an Injury caused in an
Accident taking place any time during the Period of Insurance,
immediate written notice thereof shall be sent to the Third Party
Administrator by or on behalf of the
Insured furnishing details
of the Accident. If the Accident shall take place in a public place
or premises, report shall be made to the authorities having
jurisdiction over the place of Accident, and also to the police
having jurisdiction over the place of Accident.
Documents to be
submitted in support of the claim:
i. Medical reports giving the
details of the Accident, nature of Injury and the extent of
disability.
ii. In case of death of the Insured, death
certificate issued by the Medical Practitioner who attended on the
Insured.
iii. Postmortem certificate to be produced if required
by the Third Party Administrator. Police report in original in case
the Accident shall have taken place in a public place or
premises.
iv. Medical Practitioner’s certificate in case of
Injury (in case of Permanent Partial Disablement/ Permanent Total
Disablement) stating the reasons and the extent of the
Injury.
BENEFIT 9- PERSONAL LIABILITY
The Company shall
indemnify the Insured against legal liability for Injury or property
damage to third parties occasioning on account of an Accident
occurring anytime during the Period of Insurance under the Policy for
which claims shall be made on the Insured by the third parties during
the Period of Insurance or within 60 days from the Date of Expiry of
Insurance as specified in Part I of the Schedule . The Company shall
also indemnify the Insured towards the cost of defense incurred with
the consent of the Company, provided that the Company’s overall
liability, including the cost of defense for all claims during the
Period of Insurance shall not exceed the Sum Insured specified in the
Schedule I of the Policy.
EXCLUSIONS APPLICABLE TO BENEFIT 9-
PERSONAL LIABILITY
The Company shall not be liable for the
following:
1. Legal liability of the Insured in relation to any
professional services rendered by him / her.
2. Liability for
Injury or damage of any kind whilst the Insured is engaged in his /
her business activities or in course of business activities by the
Insured.
3. Liability assumed by the Insured by an agreement /
contract which would not have attached in the absence of such
agreement / contract.
4. Liability arising out of any acts of
god, earthquake, earth-tremor, volcanic eruption, flood, storm,
tempest, typhoon, hurricane, tornado, cyclone or other similar acts
or convulsions of nature and atmospheric disturbances.
5.
Liability arising from intentional or willful acts or negligence on
part of the Insured or illegal acts.
6. Fines / penalties /
punitive / exemplary damages of any kind.
7. Directly or
indirectly occasioned by, happening through or in consequence of war,
invasion, act of foreign enemy, hostilities (whether was be declared
or not), civil war, rebellion, revolution, insurrection or military
or unsurped power.
8. Directly or indirectly caused by or
contributed by:
a. Ionizing radiation or contamination by
radioactivity from any nuclear fuel or from any nuclear waste from
the combustion of nuclear fuel
b. The radioactive, toxic,
explosive or other hazardous properties of any explosive nuclear
assembly or nuclear component thereof.
9. Liability arising from
the use of any motor vehicle unless it involves rented road transport
vehicles that is used by the Insured for personal transportation
only.
ICICI Lombard General Insurance Company Ltd. Group Travel
Insurance
Page 23 of 55
10. Any liability, which is the
subject matter of specific insurance elsewhere.
11. Liability
arising through personnel engaged by the Insured for either business
/ personal purposes of any kind.
12. Any personal liability of
the Insured towards his/her Family, relations and Traveling
Companions, whether personal or official.
13. Liability
resulting from transmission of an Illness or disease by the
Insured.
14. Liability arising out of all personal injuries such
as libel, slander, false arrest, wrongful eviction, wrongful
detention, defamation, etc., and mental Injury, anguish, or shock
resulting therefrom.
15. Liability arising out of any
infringement of intellectual property rights such as copyright,
patent, trademark, registered designs and trade secrets.
16.
Liability arising from the possession of animals, birds, reptiles,
insects, etc. and their byproducts like skin, hair, feathers, horns,
fur, ivory, bones, eggs, etc.
17. Liability arising from the
ownership or possession of vehicles, aircrafts, water crafts, or
activities of the Insured involving parachuting, hang-gliding, hot
air ballooning or use of firearms.
18. Liability arising from
insanity, the use of any alcohol/ drugs (except as medically
prescribed) or drug addiction.
19. Liability arising from any
supply of goods or services on the part of the Insured.
20.
Liability arising from any ownership or occupation of land or
buildings other than the occupation of any temporary residence.
TERMS
AND CONDITIONS APPLICABLE TO BENEFIT 9- PERSONAL LIABILITY:
1.
The Insured shall give written notice to the Company as soon as
reasonably practicable of any claims made against the Insured (or any
specific event or circumstances that may give rise to a claim being
made against the Insured) that shall become the subject of indemnity
under this Benefit and shall give all such additional information as
the Company may require. Every claim, writ, summons or process and
all documents relating to the claim/ event shall be forwarded to the
Company immediately on receipt by the Insured.
2. No admission,
offer promise or payment shall be made or given by or on behalf of
the Insured without the written consent of the Company.
3. The
Company will have the right but in no case the obligation, to take
over and conduct in the name of the Insured the defense of any claims
and will have full discretion in the conduct of any proceedings and
in the settlement of any claim and having taken over the defense of
any claim in relinquishing the same. All amounts expended by the
Company in the defense, settlement and/or payment of any claim, will
correspondingly reduce the limits of indemnity specified in the
Schedule of the Policy.
4. In the event the Company, in its sole
discretion, chooses to exercise its right pursuant to this condition,
no action taken by the Company in the exercise of such right will
serve to modify or expand in any manner, the Company’s liability or
obligations under this Benefit 9 beyond what the Company’s
liability or obligations would have been had it not exercised its
rights under this condition.
5. The Insured shall give all such
information and assistance as the Company may reasonably require.
6.
The Insured shall give notice as soon as reasonably practicable of
any fact, event or circumstance which materially changes the
information supplied to the Company at the time when this Policy was
effected and the Company may amend the terms of this Policy.
ICICI
Lombard General Insurance Company Ltd. Group Travel Insurance
Page
24 of 55
7. The terms and exclusions of this Benefit 9 (and any
phrase or word contained therein) shall be interpreted in accordance
with the Indian Law.
CLAIMS PROCEDURE:
Claims provisions
applicable to Benefit 9 – Personal Liability
1. In the event
of a contingency resulting in or likely to result in a liability on
the part of the Insured towards Injury or property damage to third
parties, the Insured shall immediately report the event to the Third
Party Administrator of the Company and furnish details of the
circumstances that gave rise to the liability.
2. The Insured
shall not settle or offer for settlement or enter into a compromise
with the claimant or any other person without the consent and a
written approval by the Third Party Administrator or the Company.
3.
The Insured shall, in the event of the contingency resulting in
liability taking place in any of the public places or the roads,
he/she shall immediately report the matter to the police.
Documents
to be submitted in support of the claim
1. Statement of claim
furnishing particulars of the event leading to the liability
2.
Photocopy of the police report wherever reported
3. And any
other document as may be appropriately applicable for the claims
preferred under this section of the Policy
The Company shall
have the right to defend the case or enter into compromise or take
such steps as may be required to bring the claim to a close, provided
however that such steps taken by the Company shall not affect the
Insured’s right of claim under the Policy, subject to Point (3)
under Terms and Conditions applicable to Benefit 9- Personal
Liability.
BENEFIT 10 - HIJACK DISTRESS COMPENSATION
The
Company shall compensate the Insured at the rate per day as specified
in the Part I of the Schedule of the Policy in case the Common
Carrier in which the Insured is traveling as a passenger during Trip
shall be subject of Hijack, and that the Common Carrier with all the
passengers thereon is held captive by the hijackers. Compensation
shall be payable under this Benefit 10 provided that the Hijack is
for more than 12 hours or for a period more than as specified in Part
I of the Schedule of the Policy.
The Company’s liability shall
be restricted for the period for which the Common Carrier with the
passengers including the Insured is held captive in excess of the
period as specified in Part I of the Schedule of the Policy and in no
case shall exceed the maximum number of days specified in the Part I
of the Schedule of the Policy. Should the Insured be released by the
hijackers in advance of the total release of the Common Carrier and
all the passengers therein the Company’s liability shall not extend
beyond the time of release of the Insured by the hijackers.
Should
death of the Insured occur during the period for which the Common
Carrier with the passengers is held captive by the hijackers, such
death of the Insured shall be considered as a valid claim under
Benefit 8 – Personal Accident under the provision
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applicable to the death of the Insured. Such
compensation for death shall be independent of the Insured’s
eligibility for claim under this Benefit 10.
EXCLUSIONS
APPLICABLE TO BENEFIT 10 - HIJACK DISTRESS COMPENSATION
The
Company shall not be liable for any claim under this Policy if the
Insured shall be involved as either principal or accessory in the
Hijack.
CLAIMS PROCEDURE:
Claims provisions applicable to
Benefit 10 – Hijack Distress Compensation
In the unfortunate
event of the Insured being held captive along with other passengers
of the Common Carrier which shall be the subject of a Hijack, the
Insured shall contact the Third Party Administrator of the Company
immediately after he / she is released from captivity.
The
Insured shall immediately thereafter send a statement of claim
furnishing details, namely the date and time of Hijack, the date and
time of release of the Insured, together with a brief narration of
the circumstances of the Hijack.
In the unfortunate incident of
the death of the Insured whilst under captivity of the hijackers,
solely attributable to an Injury caused by or circumstances created
by the hijackers, the nominee/representative of the Insured shall
furnish to the Third Party Administrator the details of the Hijack
and the resultant death of the Insured.
The statement of claim
in both the cases above shall be accompanied by a certificate of
Hijack from the Common Carrier furnishing details of travel by the
Insured, the fact of his / her being held captive and confirmation of
death, if death shall occur.
BENEFIT 11 - FINANCIAL EMERGENCY
ALLOWANCE
In the event of the Insured facing a Financial
Emergency as a result of and consequent upon the accidental loss of
Money held by him / her, at any time during the Trip covered under
the Policy the Company shall pay a sum as a fixed allowance as
specified in the Part I of the Schedule. In order that the Insured
shall be entitled for this benefit amount, he / she shall disclose
all such details as may be required by the Third Party Administrator
or Company and shall furnish such documents as may be required to
evidence the loss declared by him / her.
Should it come to
notice at a later date after payment of compensation by the Company
to the Insured that the declaration of the Insured in connection with
the Financial Emergency is false / unsubstantiated; the Company shall
be entitled to recover the sum paid hereunder in addition to
retaining its right of action against the Insured for damages.
The
Company’s liability under this Benefit 11 shall not be for more
than one incident of Financial Emergency during the whole Period of
Insurance hereunder, irrespective of whether the Policy is Single
Trip Policy of Multi-trip Policy.
The Company shall not be
liable for Financial Emergency arising out of any actions on part of
the Insured such as wager, lottery, gambling, betting, etc.
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TERMS AND CONDITIONS APPLICABLE TO BENEFIT 11 –
FINANCIAL EMERGENCY ASSISTANCE
No claim shall be admitted under
the Policy unless a complaint is lodged with the police and copy of
the first information report is furnished to the Company.
No
claim shall be payable under this Benefit for Financial Emergency
occurring after return of the Insured to the City of Residence or
Place of Origin of the Insured.
In event the Insured traces or
recovers the lost Money which is the subject matter of claim
hereunder, either in part or in full, any time before a settlement of
claim is made by the Company the state of the Financial Emergency
shall be deemed to be extinct and no claim shall lie against the
Company. Further in the event of the Company having made settlement
of the claim prior to such discovery of the lost Money the Insured
shall repay to the Company the total amount of settlement made by the
Company.
CLAIMS PROCEDURE:
Claims provisions applicable to
Benefit 11 – Financial Emergency Assistance
1. The Insured
shall report to the Company / Third Party Administrator immediately
after becoming aware of the accidental loss of Money that triggers a
Financial Emergency.
2. The Insured shall also report to the
police authorities having jurisdiction at the place of loss,
immediately and in any case not exceeding 24 hours from the time the
loss was detected and shall make available to the Company a copy of
the first information report of the police immediately thereafter.
3.
Along with the report of his / her claim, the Insured shall declare
that there was no other source for him / her in and around the place
where the contingency has arisen from where he / she would have
secured monitory support to avert a Financial emergency.
4. The
Insured shall also confirm that in spite of all his / her efforts to
trace the lost Money he / she was unsuccessful.
BENEFIT 12 -
TRIP CANCELLATION AND INTERRUPTION
The Company shall indemnify
the Insured for the financial loss incurred by the Insured arising
out of cancellation of the Trip (whether wholly or in part) solely
attributable to and / or arising out of:
Earthquake;
Storm,
flood, inundation, cyclone, tempest, fog (optional
cover)1
Terrorism;
provided that, the named perils
hereinabove shall take place at or in the vicinity of the City of
Residence or Place of Origin or Place of Destination or any
intermediate place which is involved in or related to the Insured’s
Trip; and
Personal contingencies like death or imminent death,
or emergency Hospitalization treatment necessitated to the Insured or
Insured's Immediate Family due to an unforeseen Illness or
Injury.
Subject to the maximum liability of the Company as
stated in Part I of Schedule, the Company shall pay to the
Insured:
1. Official cancellation charges;
1 Covered on
payment of additional premium
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2. Actual
additional transportation expenses incurred to return to the City of
Residence or Place of Origin , provided that, the additional expenses
are for alternative travel arrangement of the same class and / or
type and by the most direct route;
The Company’s liability
under this Benefit shall be limited to the difference between the
actual charges incurred for the return journey from the place of
cancellation to the City of Residence or Place of Origin of the
Insured and the amounts obtained towards refund towards the
unfulfilled / unfinished portion of the Trip.
However the
Company shall not be liable for the first Rs. 500 (for Geographical
scope of cover within India)/ US$ 100 (for Geographical scope of
cover outside India) in respect of each and every claim admissible
under this benefit.
ADDITIONAL COVER (SUBJECT TO SPECIFIC
ACCEPTANCE BY THE COMPANY AND ON INCORPORATION IN THE PART I OF THE
SCHEDULE ACCORDINGLY)
EXTENSION I – REIMBURSEMENT OF COST OF
TRANSPORTATION
In the event of cancellation of part of the Trip
of the Insured covered hereunder, that necessitates the Insured’s
return back to the City of Residence of the Insured before completion
of the Trip, and for which compensation to the Insured for the
cancellation charges and the additional transportation expenses are
paid under Benefit 12 – Trip Cancellation & Interruption, the
Company shall reimburse the cost of airfare as actually incurred by
the Insured to resume the Trip from the City of Residence of the
Insured to the place where the trip was interrupted, subject to the
maximum Sum Insured specified in Part I of the Schedule
EXCLUSIONS
APPLICABLE TO BENEFIT 12 – TRIP CANCELLATION AND INTERRUPTION
The
Company shall not be liable for any loss caused by and/or
attributable to the following:
1. Directly or indirectly
occasioned by, happening through or in consequence of war, invasion,
act of foreign enemy, hostilities (whether was be declared or not),
civil war, rebellion, revolution, insurrection or military or usurped
power;
2. Directly or indirectly caused by or contributed by:
a.
Ionizing radiation or contamination by radioactivity from any nuclear
fuel or from any nuclear waste from the combustion of nuclear fuel
b.
The radioactive, toxic, explosive or other hazardous properties of
any explosive nuclear assembly or nuclear component thereof.
3.
Cancellation of the Trip either wholly or in part done at the
instance of the Common Carrier or by the travel agent;
4.
Cancellations of the Trip either wholly or in part done at the
instance of the authority governing the Common Carrier or the
government;
5. Any circumstances other than those that are
directly attributable to the perils as stated above.
CLAIMS
PROCEDURE:
Claims provisions applicable to Benefit 12 – Trip
Cancellation & Interruption
In event of any of the
contingencies covered hereunder occurring either at the City of
Residence or Place of Origin or at any intermediate place any time
after the commencement of the Trip and before termination of the
same, resulting in the interruption of the scheduled travel being
part of the Trip necessitating cancellation of
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55
the Trip, immediate notice thereof shall be given by the
Insured to the Third Party Administrator of Company.
Documents
to be submitted in support of the claim:
1. In case of
cancellation of the Trip either in the City of Residence or Place of
Origin or any other intermediate place forming part of the Trip by
the Common Carrier solely resulting from contingencies namely
earthquake, storm, flood, inundation, cyclone, tempest &
terrorism, fog (if specifically covered) duly completed claims form
to be accompanied by:
a. Confirmation of cancellation of the
Trip from the Common Carrier detailing the circumstances of
cancellation;
b. Original used ticket issued by the Common
Carrier indicating the cost the ticket and receipt for the refund of
the fare of the Common Carrier towards the cancelled portion of the
Trip, the cancellation charges retained;
c. Original bill and a
receipt / letter obtained from the hotel and / or guest house and /
or any other paid residential accommodation (available for fee)
indicating the amount paid for the accommodation, the refund given
and the cancellation charges retained, wherever such accommodation
has be arranged at the place of cancellation of the Trip;
d.
Used ticket issued by the Common Carrier in original for return
journey from the place of cancellation to the City of Residence or
Place of Origin of the Insured which indicate the cost of the tickets
together with the receipts for the refunds obtained towards the
unfulfilled portion of the Trip.
2. In case the cancellation of
the Trip shall result because of personal contingencies covered
hereunder or a decision taken at the instance of the Insured arising
out of the contingencies namely earthquake, storm, flood, inundation,
cyclone, tempest & terrorism, fog (if specifically covered) the
duly completed claims form to be accompanied by:
a. A
declaration from the Insured furnishing the circumstances that
compelled him / her to cancel the Trip;
b. Medical evidence as
may be required by the Third Party Administrator in case of the
cancellation of the Trip arising out of personal contingencies of the
Insured or his / her Immediate Family;
c. Receipt for the refund
of the fare of the Common Carrier towards the cancelled portion of
the Trip indicating the cancellation charges retained;
d.
Receipt / letter obtained from the hotel and / or guest house and /
or any other residential accommodation (available for a fee)
indicating the cancellation charges retained, wherever such
accommodation has be arranged at the place of cancellation of the
Trip;
e. Used ticket issued by the Common Carrier or boarding
pass, as the case may be, in original for return journey from the
place of cancellation to the City of Residence or Place of Origin of
the Insured together with the receipts for the refunds obtained
towards the unfulfilled portion of the Trip.
3. In case the
cancellation charges either for the Trip or part of it or in relation
to the accommodation in a hotel / guest house / other residential
accommodation is waived to the advantage of the Insured subsequent to
any settlement of claim under this Benefit, the Insured shall
forthwith return the sum paid by the Company to the extent of such
waiver.
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4. And any other document as
may be appropriately applicable for the claims preferred under this
section of the Policy
BENEFIT 13 - TRIP DELAY
The Company
shall reimburse the Insured for the expenses incurred subject to the
sum as specified in Part I of the Schedule if the departure of the
Insured shall be delayed, at any place forming part of the Trip,
solely arising out of and consequent upon any of the contingencies
specified hereunder:
1. Earthquake
2. Floods, rains, storm,
cyclone, tempest, fog (optional cover)2
3. Terrorism
provided
that, the named perils hereinabove shall take place at and in the
vicinity of the City of Residence or Place of Origin or Place of
Destination or any intermediate place which is involved in or related
to the Insured’s Trip; and
4. Cancellation or rescheduling of
flights done at the instance of the Common Carrier that causes
delay;
For the purpose of this Policy, reasonable expenses shall
mean any expenses for meals and lodging which were necessarily
incurred by the Insured as the result of delay arising out of and
consequent upon the above mentioned contingencies and which were not
provided by the Common Carrier or any other party free of
charge.
Compensation shall be payable under this Benefit 13
provided that the Trip is delayed for more than 6 hours (for
Geographical scope of cover within India)/ 8 Hours (for Geographical
scope of cover outside India) or for the period as mentioned against
the Benefit in Part I of the Schedule to the Policy.
EXCLUSIONS
APPLICABLE TO BENEFIT 13 – TRIP DELAY
No claim shall be
payable by the Company in case of delay:
1. Arising out of
contingencies other than those specifically named herein above;
2.
Directly or indirectly occasioned by, happening through or in
consequence of war, invasion, act of foreign enemy, hostilities
(whether was be declared or not), civil war, rebellion, revolution,
insurrection or military or usurped power;
3. Directly or
indirectly caused by or contributed by:
a. Ionizing radiation or
contamination by radioactivity from any nuclear fuel or from any
nuclear waste from the combustion of nuclear fuel
b. The
radioactive, toxic, explosive or other hazardous properties of any
explosive nuclear assembly or nuclear component thereof.
TERMS
AND CONDITIONS APPLICABLE TO BENEFIT 13 – TRIP DELAY
1. On the
happening of the contingency covered under this Benefit 13, resulting
in the Insured’s decision to delay the departure, immediate notice
thereof shall be given to the Company.
2 Covered on payment of
additional premium
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2. The Insured shall
look for immediate alternative arrangements for prosecuting the
journey as scheduled so as to minimize the delay arising out of the
contingency.
CLAIMS PROCEDURE:
Claims provisions applicable
to Benefit 13 – Trip Delay
In the event of any of the
contingencies covered hereunder occurring at any place forming part
of the Trip, at any time after the commencement of the Trip and
before termination of the same, resulting in the delay of the
scheduled travel being part of the Trip, immediate notice thereof
shall be given by the Insured to the Third Party Administrator of
Company.
Documents to be submitted in support of the claim:
In
case of delay of the Trip, at any place forming part of the Trip, by
the Common Carrier solely resulting from contingencies namely
earthquake, storm, flood, inundation, cyclone, tempest &
terrorism, fog (if specifically covered) duly completed claims form
to be accompanied by, confirmation of delay of the Trip from the
Common Carrier detailing the circumstances of delay.And any other
document as may be appropriately applicable for the claims preferred
under this section of the Policy.
BENEFIT 14 - MISSED (FLIGHT)
CONNECTIONS
The Company shall pay an amount as mentioned in Part
I of the Schedule per day or part thereof in case of failure of the
Insured to access the connecting flight/ connecting journey by the
Common Carrier as per schedule any time during the Trip, arising out
of and consequent upon the delayed arrival of the earlier flight/
Common Carrier caused by reasons beyond the control of the Insured,
provided that, no claim shall be payable hereunder incase such delay
is foreseen by the Insured or that the Insured could have reasonably
become aware of such delay in advance.
The Company shall also
pay the official cancellation charges, if any, incurred by the
Insured resulting from cancellation by the Insured of the ticket in
relation to the Missed Flight as also reimburse the additional cost
of transportation to prosecute the journey originally scheduled to
have been covered by the Missed Flight, provided that, such
additional cost shall be in relation to the scheduled destination and
not to any different destination and provided that the additional
cost shall be for tickets of the same class and / or type as of the
Missed Flight.
Provided also that the Company shall be liable
under this Benefit only in event of Missed Flight/ connecting journey
by the Common Carrier caused solely by the delay of the flight/ delay
of Common Carrier in which the Insured is traveling immediately prior
to the Missed Flight.
The Company’s overall liability for
claims of all occurrences of Missed Flight/ connecting journey by the
Common Carrier during the Period of Insurance shall not exceed the
Sum Insured specified in the Part I of the Schedule.
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However the Company shall not be liable for the first
Rs. 500 (for Geographical scope of cover within India)/ US$ 100 (for
Geographical scope of cover outside India) in respect of each and
every claim admissible under this benefit.
EXCLUSIONS APPLICABLE
TO BENEFIT 14 – MISSED (FLIGHT) CONNECTION
No claim shall be
payable by the Company:
1. If the time gap between the scheduled
arrival of the previous flight and the scheduled departure of the
next flight (Missed Flight) shall be less than 3 hours.
2.
Towards expenses incurred for any temporary stay in the port of delay
not exceeding 3 hours from the time of delayed arrival of the earlier
flight to the departure of the rescheduled flight, provided that,
this exclusion shall not apply in respect of the Company reimbursing
the cancellation charges of the Missed Flight and the additional cost
of transportation in relation to the rescheduled flight.
3. If
the missing of the flight is the result of:
a. Any deviation
from the originally scheduled route done at the instance of the
Insured for reasons whatsoever;
b. Any advance intimation given
to the Insured of a possible delay of the flight that might lead to
missing of connecting flights.
c. Any circumstances other than
those directly attributable to the delay of the earlier flight beyond
the control of the Insured.
TERMS AND CONDITIONS APPLICABLE TO
BENEFIT 14 – MISSED (FLIGHT) CONNECTION
1. The Insured shall
endeavor to take all timely steps to ensure avoidance of missing a
flight even in case of delays of the arrival of the earlier
flight.
2. In case of missing flight, when Insured shall look
for alternative flights for prosecuting the scheduled journey, he /
she shall ensure minimum additional cost and earliest departure in
selecting the alternative flight. While submitting the claim the
Insured shall also furnish the Company of the efforts taken by him in
choosing the alternative.
3. In order to minimize the claim
under this Policy, the Insured shall also take all efforts to see
that the cancellation charges are either waived or reduced to the
minimum level by the Common Carrier and / or the authorities of the
hotel / guest house / any other residential accommodation.
4.
While preferring the claim, the Insured shall declare that he / she
has not been compensated by the Common Carrier or any other agency
concerned in connection with delay of the flight that led to the
situation of missing flight.
CLAIMS PROCEDURE:
Claims
provisions applicable to Benefit 14 – Missed (Flight)
Connections
In the event of any flight wherein the Insured shall
travel in connection with part of his/her Trip shall arrive at the
intended destination with a delay because of circumstances beyond the
control of the Insured, resulting in the Insured missing the ongoing
journey to the next Place of Destination being part of the Trip, he /
she shall report to the Third Party Administrator such delay
furnishing the details of the flights, the scheduled arrival to the
place of delay, actual time of arrival and consequently the period of
delay.
Documents to be submitted in support of the claim:
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1. The confirmation from the Common Carrier of the
delayed flight as to the expected time of arrival and the actual time
of arrival at the port of delay together with the reasons for
delay.
2. Unused ticket for the Missed Flight with an
endorsement of the Common Carrier of cancellation of the same.
3.
Certificate from the Common Carrier of the Missed Flight that the
fare for the part of the Trip covered by the Missed Flight is
forfeited in full or in part together with the amount of
forfeiture.
4. Original used ticket obtained afresh towards the
alternative flight for the part of the Trip covered by the Missed
Flight indicating the amount paid as fare.
5. And any other
document as may be appropriately applicable for the claims preferred
under this section of the Policy
In the event of the forfeited
amount by the Common Carrier for the Missed Flight being refunded /
returned to the Insured, subsequent to any payment under this
section, the Insured shall return the amount so refunded in
full.
BENEFIT 15 - FIRE AND ALLIED PERILS (HOME BUILDING &
CONTENTS)
IN CONSIDERATION OF the Insured named in the Schedule
hereto having paid to the ICICI Lombard General Insurance Company
Limited (hereinafter called the Company) the full premium mentioned
in the said schedule, the Company agrees, (Subject to the Conditions
and Exclusions contained herein or endorsed or otherwise expressed
hereon) that if after payment of the premium the Property Insured
described in the said Schedule or any part of such Property be
destroyed or damaged by any of the perils specified hereunder during
the period of insurance named in the said schedule or of any
subsequent period in respect of which the Insured shall have paid and
the Company shall have accepted the premium required for the renewal
of the policy, the Company shall pay to the Insured the value of the
Property at the time of the happening of its destruction or the
amount of such damage or at its option reinstate or replace such
property or any part thereof:
1. Fire
Excluding destruction
or damage caused to the property Insured by
a. Its own
fermentation, natural heating or spontaneous combustion.
b. Its
undergoing any heating or drying process.
c. Burning of property
Insured by order of any Public Authority.
2. Lightning
3.
Explosion/Implosion
Excluding loss, destruction of or damage
a.
To boilers (other than domestic boilers), economizers or other
vessels, machinery or apparatus( in which steam is generated) or
their contents resulting from their own explosion/implosion,
b.
Caused by centrifugal forces.
4. Aircraft Damage
Loss,
Destruction or damage caused by Aircraft, other aerial or space
devices and articles dropped therefrom excluding those caused by
pressure waves.
5. Riot, Strike and Malicious Damage
Loss
of or visible physical damage or destruction by external violent
means directly caused to the property Insured but excluding those
caused by
a. Total or partial cessation of work or the
retardation or interruption or cessation of any process or operations
or omissions of any kind.
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b.
Permanent or temporary dispossession resulting from confiscation,
commandeering, requisition or destruction by order of the Government
or any lawfully constituted Authority.
c. Permanent or temporary
dispossession of any building or plant or unit of machinery resulting
from the unlawful occupation by any person of such building or plant
or unit or machinery or prevention of access to the same.
d.
Burglary, housebreaking, theft, larceny or any such attempt or any
omission of any kind of any person (whether or not such act is
committed in the course of a disturbance of public peace) in any
malicious act.
e. If the Company alleges that the loss/damage is
not caused by any malicious act, the burden of proving the contrary
shall be upon the Insured.
Terrorism Damage Exclusion
Warranty:
Notwithstanding any provision to the contrary within
this insurance it is agreed that this insurance excludes loss, damage
cost or expense of whatsoever nature directly or indirectly caused
by, resulting from or in connection with any act of terrorism
regardless of any other cause or event contributing concurrently or
in any other sequence to the loss.
For the purpose of this
endorsement an act of terrorism means an act, including but not
limited to the use of force or violence and / or the threat thereof,
of any person or group(s) of persons whether acting alone or on
behalf of or in connection with any organisation(s) or government(s),
committed for political, religious, ideological or similar purpose
including the intention to influence any government and/or to put the
public, or any section of the public in fear.
The warranty also
excludes loss, damage, cost or expenses of whatsoever nature directly
or indirectly caused by, resulting from or in connection with any
action taken in controlling, preventing, suppressing or in any way
relating to action taken in respect of any act of terrorism.
If
the Company alleges that by reason of this exclusion, any loss,
damage, cost or expenses is not covered by this insurance the burden
of proving the contrary shall be upon the Insured.
In the event
any portion of this endorsement is found to be invalid or
unenforceable, the remainder shall remain in full force and
effect.
6. Storm, Cyclone, Typhoon, Tempest, Hurricane, Tornado,
Flood and Inundation
Loss, destruction or damage directly caused
by Storm, Cyclone, Typhoon, Tempest, Hurricane, Tornado, Flood or
Inundation excluding those resulting from earthquake, Volcanic
eruption or other convulsions of nature. (Wherever earthquake cover
is given as an “add on cover” the words “excluding those
resulting from earthquake” shall stand deleted).
7. Impact
Damage
Loss of or visible physical damage or destruction caused
to the property Insured due to impact by any Rail/ Road vehicle or
animal by direct contact not belonging to or owned by
a. The
Insured or any occupier of the premises or
b. Their employees
while acting in the course of their employment
8. Subsidence and
Landslide including Rock slide
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Loss,
destruction or damage directly caused by Subsidence of part of the
site on which the property stands or Land slide/ Rock slide
excluding:
a. The normal cracking, settlement or bedding down of
new structures
b. The settlement or movement of made up
ground
c. Coastal or river erosion
d. Defective design or
workmanship or use of defective materials
e. Demolition,
construction, structural alterations or repair of any property of
ground works or excavations.
9. Bursting and/or overflowing of
Water Tanks, Apparatus and Pipes
10. Missile Testing
operations
11. Leakage from Automatic Sprinkler
Installations
Excluding loss, destruction or damage caused by
a.
Repairs or alterations to the buildings or premises.
b. Repairs,
Removal or Extension of the Sprinkler Installation.
c. Defects
in construction known to the Insured.
12. Bush Fire
Excluding
loss destruction or damage caused by Forest Fire.
PROVIDED that
the liability of the Company shall in no case exceed in respect of
each item the Sum expressed in the said Schedule to be Insured
thereon or in the whole the total Sum Insured hereby or such other
Sum or sums as may be substituted therefor by memorandum hereon or
attached hereto signed by or on behalf of the Company.
13.
Earthquake (Fire and Shock)
Earthquake (Fire and Shock)
Endorsement: It is hereby agreed and declared that notwithstanding
anything stated in the printed exclusions of this policy to the
contrary, this Insurance is extended to cover loss or damage
(including loss or damage by fire) to any of the property insured by
this policy, occasioned by or through or in consequence of earthquake
including flood or overflow of the sea, lakes, reservoirs and rivers
and/or landslide / rockslide resulting therefrom.
Provided
always that all the conditions of this policy shall apply (except in
so far as they may be hereby expressly varied) and that any reference
therein to loss or damage by fire shall be deemed to apply also to
loss or damage directly caused by any of the perils which this
insurance extends to include by virtue of this endorsement.
(A)
GENERAL EXCLUSIONS
1. This Policy does not cover (not applicable
to policies covering dwellings)
a. The first 5% of each and
every claim subject to a minimum of Rs.10,000 in respect of each and
every loss arising out of “Act of God perils” such as Lightning,
STFI, Subsidence, Landslide and Rock slide covered under the
policy
b. The first Rs.10,000 for each and every loss arising
out of other perils in respect of which the Insured is indemnified by
this policy
The Excess shall apply per event per Insured.
2.
Loss, destruction or damage caused by war, invasion, act of foreign
enemy hostilities or war like operations (whether war be declared or
not), civil war, mutiny, civil commotion assuming the proportions of
or amounting to a popular rising, military rising, rebellion,
revolution, insurrection or military or usurped power.
3. Loss,
destruction or damage directly or indirectly caused to the property
Insured by
a. Ionizing radiations or contamination by
radioactivity from any nuclear fuel or from any nuclear waste from
the combustion of nuclear fuel
ICICI Lombard General Insurance
Company Ltd. Group Travel Insurance
Page 35 of 55
b. The
radio active, toxic, explosive or other hazardous properties of any
explosive nuclear assembly or nuclear component thereof
4. Loss,
destruction or damage caused to the Insured property by pollution or
contamination excluding
a. Pollution or contamination which
itself results from a peril hereby Insured against.
b. Any peril
hereby Insured against which itself results from pollution or
contamination
5. Loss, destruction or damage to bullion or unset
precious stones, any curios or works of art for an amount exceeding
Rs. 10000/-, manuscripts, plans, drawings, securities, obligations or
documents of any kind, stamps, coins or paper Money, cheques, books
of accounts or other business books, computer systems records,
explosives unless otherwise expressly stated in the policy.
6.
Loss, destruction or damage to the stocks in Cold Storage premises
caused by change of temperature.
7. Loss, destruction or damage
to any electrical machine, apparatus, fixture, or fitting arising
from or occasioned by over-running, excessive pressure, short
circuiting, arcing, self heating or leakage of electricity from
whatever cause (lightning included) provided that this exclusion
shall apply only to the particular electrical machine, apparatus,
fixture or fitting so affected and not to other machines, apparatus,
fixtures or fittings which may be destroyed or damaged by fire so set
up.
8. Expenses necessarily incurred on
a. Architects,
Surveyors and Consulting Engineer's Fees and
b. Debris Removal
by the Insured following a loss, destruction or damage to the
Property Insured by an Insured peril in excess of 3% and 1% of the
claim amount respectively.
9. Loss of earnings, loss by delay,
loss of market or other consequential or indirect loss or damage of
any kind or description whatsoever.
10. Loss or damage by
spoilage resulting from the retardation or interruption or cessation
of any process or operation caused by operation of any of the perils
covered.
11. Loss by theft during or after the occurrence of any
Insured peril except as provided under Riot, Strike, Malicious and
Terrorism Damage cover.
12. Any Loss or damage occasioned by or
through or in consequence directly or indirectly due to Volcanic
eruption or other convulsions of nature.
13. Loss or damage to
property Insured if removed to any building or place other than in
which it is herein stated to be Insured, except machinery and
equipment temporarily removed for repairs, cleaning, renovation or
other similar purposes for a period not exceeding 60 days.
(B)
GENERAL CONDITIONS
1. THIS POLICY shall be voidable in the event
of mis-representation, mis-description or non-disclosure of any
material particular.
2. All insurances under this policy shall
cease on expiry of seven days from the date of fall or displacement
of any building or part thereof or of the whole or any part of any
range of buildings or of any structure of which such building forms
part.
PROVIDED such a fall or displacement is not caused by
Insured perils, loss or damage by which is covered by this policy or
would be covered if such building, range of buildings or structure
were Insured under this policy.
Notwithstanding the above, the
Company subject to an express notice being given as soon as possible
but not later than seven days of any such fall or displacement
may
ICICI Lombard General Insurance Company Ltd. Group Travel
Insurance
Page 36 of 55
agree to continue the insurance
subject to revised rates, terms and conditions as may be decided by
it and confirmed in writing to this effect.
3. Under any of the
following circumstances the insurance ceases to attach as regards the
property affected unless the Insured, before the occurrence of any
loss or damage, obtains the sanction of the Company signified by
endorsement upon the policy by or on behalf of the Company:-
a.
If the trade or manufacture carried on be altered, or if the nature
of the occupation of or other circumstances affecting the building
Insured or containing the Insured property be changed in such a way
as to increase the risk of loss or damage by Insured Perils.
b.
If the interest in the property passes from the Insured otherwise
than by will or operation of law.
4. This insurance does not
cover any loss or damage to property which, at the time of the
happening of such loss or damage, is Insured by or would, but for the
existence of this policy, be Insured by any marine policy or policies
except in respect of any excess beyond the amount which would have
been payable under the marine policy or policies had this insurance
not been effected.
5. This insurance may be terminated at any
time at the request of the Insured, in which case the Company will
retain the premium at customary short period rate for the time the
policy has been in force. This insurance may also at any time be
terminated at the option of the Company, on 15 days' notice to that
effect being given to the Insured, in which case the Company shall be
liable to repay on demand a rateable proportion of the premium for
the unexpired term from the date of the cancellation.
6. (i) On
the happening of any loss or damage the Insured shall forthwith give
notice thereof to the Company and shall within 15 days after the loss
or damage, or such further time as the Company may in writing allow
in that behalf, deliver to the Company
a. A claim in writing for
the loss or damage containing as particular an account as may be
reasonably practicable of all the several articles or items or
property damaged or destroyed, and of the amount of the loss or
damage thereto respectively, having regard to their value at the time
of the loss or damage not including profit of any kind.
b.
Particulars of all other insurances, if any
The Insured shall
also at all times at his own expense produce, procure and give to the
Company all such further particulars, plans, specification books,
vouchers, invoices, duplicates or copies thereof, documents,
investigation reports (internal/external), proofs and information
with respect to the claim and the origin and cause of the loss and
the circumstances under which the loss or damage occurred, and any
matter touching the liability or the amount of the liability of the
Company as may be reasonably required by or on behalf of the Company
together with a declaration on oath or in other legal form of the
truth of the claim and of any matters connected therewith.
No
claim under this policy shall be payable unless the terms of this
condition have been complied with
(ii) In no case whatsoever
shall the Company be liable for any loss or damage after the
expiration of 12 months from the happening of the loss or damage
unless the claim is the subject of pending action or arbitration; it
being expressly agreed and declared that if the Company shall
disclaim liability for any claim hereunder and such claim shall not
within 12 calendar months from the date of the disclaimer have been
made the subject matter of a suit in a court of law then the claim
shall for all purposes be deemed to have been abandoned and shall not
thereafter be recoverable hereunder.
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Insurance Company Ltd. Group Travel Insurance
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7.
On the happening of loss or damage to any of the property Insured by
this policy, the Company may
a. Enter and take and keep
possession of the building or premises where the loss or damage has
happened.
b. Take possession of or require to be delivered to it
any property of the Insured in the building or on the premises at the
time of the loss or damage.
c. Keep possession of any such
property and examine, sort, arrange, remove or otherwise deal with
the same.
d. Sell any such property or dispose of the same for
account of whom it may concern.
The powers conferred by this
condition shall be exercisable by the Company at any time until
notice in writing is given by the Insured that he makes no claim
under the policy, or if any claim is made, until such claim is
finally determined or withdrawn, and the Company shall not by any act
done in the exercise or purported exercise of its powers hereunder,
incur any liability to the Insured or diminish its rights to rely
upon any of the conditions of this policy in answer to any claim.
If
the Insured or any person on his behalf shall not comply with the
requirements of the Company or shall hinder or obstruct the Company,
in the exercise of its powers hereunder, all benefits under this
policy shall be forfeited.
The Insured shall not in any case be
entitled to abandon any property to the Company whether taken
possession of by the Company or not.
8. If the claim be in any
respect fraudulent, or if any false declaration be made or used in
support thereof or if any fraudulent means or devices are used by the
Insured or any one acting on his behalf to obtain any benefit under
the policy or if the loss or damage be occasioned by the willful act,
or with the connivance of the Insured, all benefits under this policy
shall be forfeited.
9. If the Company at its option, reinstate
or replace the property damaged or destroyed, or any part thereof,
instead of paying the amount of the loss or damage, or join with any
other Company or Insurer(s) in so doing, the Company shall not be
bound to reinstate exactly or completely but only as circumstances
permit and in reasonably sufficient manner, and in no case shall the
Company be bound to expend more in reinstatement than it would have
cost to reinstate such property as it was at the time of the
occurrence of such loss or damage nor more than the Sum Insured by
the Company thereon. If the Company so elect to reinstate or replace
any property the Insured shall at his own expense furnish the Company
with such plans, specifications, measurements, quantities and such
other particulars as the Company may require, and no acts done, or
caused to be done, by the Company with a view to reinstate or replace
shall be deemed an election by the Company to reinstate or
replace.
If in any case the Company shall be unable to reinstate
or repair the property hereby Insured, because of any municipal or
other regulations in force affecting the alignment of streets or the
construction of buildings or otherwise, the Company shall, in every
such case, only be liable to pay such Sum as would be requisite to
reinstate or repair such property if the same could lawfully be
reinstated to its former condition.
10. If the property hereby
Insured shall at the breaking out of any fire or at the commencement
of any destruction of or damage to the property by any other peril
hereby Insured against be collectively of greater value than the Sum
Insured thereon, then the Insured shall be considered as being his
own insurer for the difference and
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Insurance Company Ltd. Group Travel Insurance
Page 38 of
55
shall bear a rateable proportion of the loss accordingly.
Every item, if more than one, of the policy shall be separately
subject to this condition.
11. If at the time of any loss or
damage happening to any property hereby Insured there be any other
subsisting insurance or insurances, whether effected by the Insured
or by any other person or persons covering the same property, this
Company shall not be liable to pay or contribute more than its
rateable proportion of such loss or damage.
12. The Insured
shall at the expense of the Company do and concur in doing, and
permit to be done, all such acts and things as may be necessary or
reasonably required by the Company for the purpose of enforcing any
rights and remedies or of obtaining relief or indemnity from other
parties to which the Company shall be or would become entitled or
subrogated, upon its paying for or making good any loss or damage
under this policy, whether such acts and things shall be or become
necessary or required before or after his indemnification by the
Company.
13. If any dispute or difference shall arise as to the
quantum to be paid under this policy (liability being otherwise
admitted) such difference shall independently of all other questions
be referred to the decision of a sole arbitrator to be appointed in
writing by the parties to or if they cannot agree upon a single
arbitrator within 30 days of any party invoking arbitration, the same
shall be referred to a panel of three arbitrators, comprising of two
arbitrators, one to be appointed by each of the parties to the
dispute/difference and the third arbitrator to be appointed by such
two arbitrators and arbitration shall be conducted under and in
accordance with the provisions of the Arbitration and Conciliation
Act, 1996.
It is clearly agreed and understood that no
difference or dispute shall be referable to arbitration as
hereinbefore provided, if the Company has disputed or not accepted
liability under or in respect of this policy.
It is hereby
expressly stipulated and declared that it shall be a condition
precedent to any right of action or suit upon this policy that the
award by such arbitrator/ arbitrators of the amount of the loss or
damage shall be first obtained.
14. Every notice and other
communication to the Company required by these conditions must be
written or printed.
15. At all times during the period of
insurance of this policy the insurance cover will be maintained to
the full extent of the respective Sum Insured in consideration of
which upon the settlement of any loss under this policy, pro-rata
premium for the unexpired period from the date of such loss to the
expiry of period of insurance for the amount of such loss shall be
payable by the Insured to the Company.
The additional premium
referred above shall be deducted from the net claim amount payable
under the policy. This continuous cover to the full extent will be
available notwithstanding any previous loss for which the Company may
have paid hereunder and irrespective of the fact whether the
additional premium as mentioned above has been actually paid or not
following such loss. The intention of this condition is to ensure
continuity of the cover to the Insured subject only to the right of
the Company for deduction from the claim amount, when settled, of
pro-rata premium to be calculated from the date of loss till expiry
of the policy.
Notwithstanding what is stated above, the Sum
Insured shall stand reduced by the amount of loss in case the Insured
immediately on occurrence of the loss exercises his option not to
reinstate the Sum Insured as above.
CLAIMS PROCEDURE: SPECIAL
CLAIMS PROVISIONS APPLICABLE TO BENEFIT 15 - FIRE AND ALLIED PERILS
(HOME BUILDING & CONTENTS)
ICICI Lombard General Insurance
Company Ltd. Group Travel Insurance
Page 39 of 55
In the
event of a contingency covered under this section, occurring during
the period of insurance, resulting in loss or damage to the property
covered hereunder, the Insured shall report to the Third Party
Administrator and furnish the claims form duly completed in all
particulars. The Insured shall render all his / her corporation and
assistance to the surveyor appointed by the Company for assessment of
loss.
The Insured shall also report to the police having
jurisdiction over the place of loss and shall secure a detailed first
information report duly signed by the policy authority and forward
the same to the Company immediately thereafter.
The Insured
shall not do anything as regards to the affected property that shall
result in aggravation of loss and he shall be wholly guided by the
surveyor with regards to preserving the affected property.
Documents
to be submitted in support of the claim
1. First Information
Report
2. Panchnama
3. Investigation Report by the
Police
4. Fire Brigade Report
5. Estimate and final bills
of repairers
6. Invoices of owned articles, if required by the
Company
7. Legal opinion wherever required.
8. And any
other document as may be appropriately applicable for the claims
preferred under this section of the Policy.
BENEFIT 16 -
BURGLARY (HOME CONTENTS)
The Company hereby agrees, subject to
the terms, conditions and exclusions herein contained or otherwise
expressed herein, and subject to the maximum liability of the Company
being restricted to the Sum Insured as specified in Part I of the
Schedule during the entire period of Insurance to pay to the Insured,
at actuals, for any loss or damage sustained by the Insured caused by
Burglary and/or attempted Burglary, to the Contents of Insured’s
premises provided that the total liability of the Company for loss or
damage due to such attempted Burglary (that does not result in any
actual or physical loss of any insured item) shall not exceed
Rs.15,000/- in any one year irrespective of the number of such
incidents or occurrences.
The Company’s liability under this
Benefit shall be limited as follows:
1. In case of damage due to
attempted Burglary shall be limited to the amount actually payable
for repair or replacement of locks, damage to door, or windows, if
any.
2. For settlement of claims under this Benefit, the market
value of the jewelry, gold ornaments, silver articles and precious
stones kept in the premises of the Insured shall be considered.
Maximum value of jewellery, silver articles, precious stones covered
will be 25% of total Sum Insured as specified in Part I or 1 lakh,
whichever is lower.
3. The Company’s liability for any claim
for loss or damage shall be limited to the inherent value of the
metal or precious stones only, as the case may be, and will exclude
any additional value added thereon/attributable thereto.
4. The
Company’s liability shall be subject to a Deductible as specified
in Part I of the Schedule to the Policy, for any and all claims
arising in a particular year.
ICICI Lombard General Insurance
Company Ltd. Group Travel Insurance
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The
Company’s liability under this Benefit shall not exceed the Sum
Insured as specified in Part I of the Schedule to the
Policy.
EXCLUSIONS APPLICABLE TO BENEFIT 16 - BURGLARY (HOME
CONTENTS)
The Company shall not be liable to make any payment
under this Benefit in connection with or in respect of any expenses
whatsoever incurred by any Insured in connection with or in respect
of:
1. Loss or damage caused by direct or indirect involvement
of the Insured and/or Insured’s domestic staff in the actual or
attempted Burglary;
2. Any loss or damage to, or on account of
loss of livestock, motor vehicles, pedal cycles, Money, securities,
stamp, bullion, deeds, bonds, bills of exchange, promissory notes,
stock or share certificates, business books, manuscripts, documents
of any kind, ATM debit or credit cards (unless previously
specifically declared to, and accepted by, the Company);
3. The
loss or damage occurring while Insured’s premises is unoccupied,
for a consecutive period of more than 30 days, and if the Insured had
not previously informed the Company of the same and obtained its
written consent/approval.
4. Loss or damage to any property
illegally acquired, kept, stored, or property subject to forfeiture
in any manner whatsoever;
5. Theft without actual forcible and
violent entry and/or exit from the premises.
6. Loss or damage
directly or indirectly, proximately or remotely occasioned by or
which arises out of or in connection with riot and strike, civil
commotion, terrorist activities.
CLAIMS PROCEDURE:
Claims
provisions applicable to Benefit 16– Burglary (Home Contents)
Upon
occurrence of the event covered under this Benefit, the Insured shall
report to the Third Party Administrator and furnish the claims form
duly completed in all particulars. The Insured shall render all
cooperation and assistance to the surveyor appointed by the Company
for assessment of loss.
The Insured shall also report to the
police having jurisdiction over the place of loss and shall secure a
detailed first information report duly signed by the policy authority
and forward the same to the Third Party Administrator immediately
thereafter.
The Insured shall not do anything as regards to the
affected property / premises that shall result in aggravation of loss
and shall be wholly guided by the surveyor with regards to preserving
the affected property/ premises.
Documents to be submitted in
support of the claim:
1. The statement of claim furnishing the
details of items lost and the values thereof duly supported by
purchase bills wherever available. In the event of the purchase bills
not being available, he / she shall render such evidence as may be
required by the surveyor for the latter to arrive at the value of the
lost items.
2. First Information Report;
3.
Panchnama;
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Travel Insurance
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4. Investigation Report by
the Police;
5. Estimate and final bills of repairers;
6.
Invoices of owned articles, if required by the Company;
7. And
any other document as may be appropriately applicable for the claims
preferred under this Benefit of the Policy.
BENEFIT 17 -
COMPASSIONATE VISIT
In event of the Insured being Hospitalized
consequent upon any Injury sustained and / or Illness contracted at
any place being part of the Trip covered hereunder , other than the
City of Residence or Place of Origin and such Hospitalization shall
in the opinion of the Medical Practitioner attending on the Insured
extend beyond a period of 5 days or such period specified in the Part
I of the Schedule, the Company shall pay the sum as specified in the
Part I of the Schedule per day or part thereof for special assistance
rendered to the Insured during the period of Hospitalization by an
Immediate Family Member.
Provided that:
1. The
Hospitalization has been advised by the Medical Practitioner
attending on the Insured; and
2. The need of such assistance is
essential in the opinion of the Medical Practitioner attending on the
Insured and recommended by him / her accordingly.
The Company
shall also reimburse the cost of travel ticket incurred by the person
rendering such special assistance from and to the place of origin of
such person or the place of residence of the person.
Provided
that the daily allowance shall not be payable by the Company for the
period spent by the person rendering the special assistance for
travel to and from the Hospital.
The Company’s liability under
this Benefit 17, however, shall in respect of any one event or all
events of Hospitalization during the Period of Insurance shall not in
total exceed the Sum Insured as specified in the Part I of the
Schedule.
Exclusions Applicable to Benefit 17 – Compassionate
Visit:
The Company shall not be liable if the Insured is
hospitalized for any of the following,
1. Any treatment of a
Pre-Existing Illness
2. Treatment of orthopedic, degenerative,
or oncological diseases
3. Treatment for any dental Illness /
Injury.
4. Beauty and / or cosmetic treatment and/or
reconstructive plastic surgery in any form or manner.
5. Rest or
recuperation at a spa or health resort, sanatorium, convalescence
home or similar institution.
6. Mental or psychiatric
disorders.
7. Pregnancy, childbirth and any consequences
8.
Prostheses/ prosthetics (artificial limbs) etc.
9.
Self-inflicted Illness or Injury
10. Any Injury and/or Illness
sustained or contracted leading to Hospitalization
a. Whilst the
Insured is under the influence of intoxicating liquor / drugs;
ICICI
Lombard General Insurance Company Ltd. Group Travel Insurance
Page
42 of 55
b. Whilst the Insured is engaging in aviation /
ballooning / while mounting into or dismounting from or traveling in
any balloon or aircraft other than as a passenger (fare paying or
other wise);
c. Directly or indirectly occasioned by, happening
through or in consequence of war, invasion, act of foreign enemy,
hostilities (whether was be declared or not), civil war, rebellion,
revolution, insurrection or military or usurped power;
d.
Directly or indirectly caused by or contributed by:
i. Ionizing
radiation or contamination by radioactivity from any nuclear fuel or
from any nuclear waste from the combustion of nuclear fuel;
ii.
The radioactive, toxic, explosive or other hazardous properties of
any explosive nuclear assembly or nuclear component thereof.
TERMS
& CONDITIONS APPLICABLE TO BENEFIT 17 – COMPASSIONATE
VISIT:
The Insured shall as far as possible seek for such
special assistance from any one of his / her relatives, either at the
place of Hospitalization or any other nearest place.
It is a
condition precedent to the Company’s liability hereunder that the
need for such a special assistance and consequent visit of any one of
the Family or relative from a particular place is also approved by
the Third Party Administrator before any one of the Family or near
relatives undertakes the Trip.
CLAIMS PROCEDURE:
Claims
provisions applicable to Benefit 17 – Compassionate Visit
In
event of the Insured sustaining an Injury and / or contracting an
Illness requiring Hospitalization in the opinion of the Medical
Practitioner and further in the opinion of such Medical Practitioner
continuous presence in the form of special assistance is required to
be rendered to the Insured during the period of Hospitalization by
any of the members of the Family or near relative, immediate notice
shall be given and approval obtained from the Third Party
Administrator by the Insured before requisitioning such special
assistance.
The Insured shall endeavor wherever possible to
requisition such a special assistance from any member of the Family
or near relative from places nearer to the place of Hospitalization.
In any case, the Company’s liability shall be limited to economy
class travel by a Common Carrier applicable from and to the City of
Residence and/or the Place of Origin of the Insured to the place of
Hospitalization.
Documents to be submitted in support of the
claim:
Duly completed claims form to be supported by:
1. A
certificate from the Medical Practitioner recommending the presence
in the form of special assistance to be rendered by a member of the
Family or near relative during the entire period of Hospitalization.
Certificate to also specify the minimum period of Hospitalization.
2.
Discharge summary of the Hospital furnishing details – date of
admission, date of discharge, and the presence of the member of the
Family or near relative on all days of Hospitalization.
3.
Original ticket used for the travel to and fro by the member of the
Family or near relative.
ICICI Lombard General Insurance Company
Ltd. Group Travel Insurance
Page 43 of 55
4. And any other
document as may be appropriately applicable for the claims preferred
under this section of the Policy
GENERAL EXCLUSIONS (APPLICABLE
TO ALL BENEFITS UNDER THE POLICY):
The Company shall not liable
for any loss or damages:
1. In relation to the events occurring
prior to the Date of Commencement of Insurance or after the Date of
Expiry of Insurance as mentioned in Part I of the Schedule to this
Policy.
2. If the claim be in any respect fraudulent, or if any
false declaration be made or used in support thereof or if any
fraudulent means or devices are used by the Insured or any one acting
on his behalf to obtain any benefit under the Policy or if the loss
or damage be occasioned by the willful act, or with the connivance of
the Insured, all benefits under this Policy shall be forfeited.
3.
If the Insured:
a. Is traveling against the advice of a Medical
Practitioner;
b. Is receiving, or is on a waiting list to
receive, specified medical treatment declared in a Medical
Practitioner’s report or certificate;
c. Has received terminal
prognosis for a medical condition;
d. Is taking part in a naval,
military or air force operation;
4. In relation to events
arising:
a.out of any intentional self-Injury, suicide or
attempted suicide, intoxication by liquor or drugs.
b. due to
involvement or participation of the Insured directly or indirectly in
murder, or criminal assault or the like or any breach of law.
c.
out of mental disorder, anxiety, stress, depression, venereal disease
or any loss directly or indirectly attributable to HIV (Human Immuno
Deficiency Virus) and/or any HIV related Illness including AIDS
(Acquired Immuno Deficiency Syndrome) and/or any mutant derivative or
variations thereof howsoever caused.
5. Illness and Injury that
are results of war and warlike occurrence or invasion, acts of
foreign enemies, hostilities, civil war, rebellion, insurrection,
civil commotion assuming the proportions of or amounting to an
uprising, military or usurped power, active participation in riots,
confiscation or nationalisation or requisition of or destruction of
or damage to property by or under the order of any government or
local authority;
6. In relation to events arising from damage to
any property or any loss or expense whatsoever resulting or arising
from or any consequential loss directly or indirectly caused by or
contributed to or arising from:
a. Ionizing radiation or
contamination by radioactivity from any nuclear fuel or from any
nuclear waste from the combustion of nuclear fuel or
b. The
radioactive, toxic, explosive or other hazardous properties of any
explosive nuclear assembly or nuclear component thereof.
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Lombard General Insurance Company Ltd. Group Travel Insurance
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7. Pertaining to involvement or participation in
activities that are against local laws, rules and/ or regulations
specified by any government agency.
In so far as it relates to
the benefits numbers 1 (Hospitalization Expenses for Injury), 2
(Emergency Hospitalization Expenses for Illness), 3 (Repatriation of
Remains), 4 (Medical Evacuation), 5 (Dental Treatment), 8 (Personal
Accident), 12 (Trip Cancellation & Interruption), 13 (Trip
Delay), 17 (Compassionate Visit), any claim arising out of sporting
activities in so far as they involve the training or participation in
competitions of professional or semi-professional sports persons,
unless declared beforehand and agreed by the Company subject to
additional premium being paid and incorporated accordingly in the
Policy.
8. Alternative Treatments
GENERAL CONDITIONS
(APPLICABLE TO ALL BENEFITS UNDER THIS POLICY)
1. The insurance
under the Policy shall not attach to any Trip that shall have
commenced prior to the Date of Commencement of Insurance as specified
in Part I of the Schedule under the Policy.
2. Cancellation of
the Policy - At the request of the Policyholder, the Policy will be
cancelled any time prior to the Date of Expiry of Insurance as
specified in Part I of the Schedule to the Policy subject to the
following conditions:
a. In the event of cancellation of the
Policy, the Company shall refund the premium for the unexpired
portion of the cover as per the Company’s short period scales
mentioned in Part III of the Policy document.
b. No cancellation
of the cover pertaining to an Insured will be allowed in case the
Insured has reported a claim under any of the sections of this Policy
prior to the date of notice of cancellation and that stands admitted
by the Insurer for any amount whatsoever.
3. Deductible shown
against the respective items of cover in the schedule of the Policy
shall be applied separately for each and every claim preferred under
the respective sections.
4. The Insured shall, at all times, act
as if uninsured and shall take all steps as are necessary to avoid
occurrence of any contingency covered hereunder and to avert and / or
minimize a loss otherwise payable under the Policy.
CLAIM
PROCEDURE – GENERAL: APPLICABLE TO ALL BENEFITS UNDER THIS
POLICY
1. On facing a contingency which shall result in a claim
under any of the Sections under this Policy, immediate notice thereof
shall be given by the Insured to the Third Party Administrator
appointed by the Company, the details of which are furnished
hereunder and after furnishing to them the identity as required by
them shall get the claim registered. Failure to send such immediate
notice may prejudice the Insured’s claim under the
Policy.
Telephone Number – 1800 2666 or email
ihealthcare@icicilombard.com
ICICI Lombard General Insurance
Company Ltd. Group Travel Insurance
Page 45 of 55
2.
Documents of claim appropriate for each contingency and the
consequent loss as listed in the respective sections of this Policy
shall be forwarded to the Third Party Administrator as soon as the
Insured returns to the City of Residence or the Place of Origin of
the Insured (unless otherwise required by the Company or the Third
Party Administrator) and in no case beyond a period of 30 days from
the date of such return. In case the Trip is terminated anytime
before the completion of the Trip covered hereunder, the Insured
shall submit all the documents as soon as such termination shall take
place, and in no case beyond a period of 30 days beyond the date of
such termination. Each and every claim preferred under the policy
irrespective of the sections of cover which they relate to shall be
accompanied by original used ticket issued by the Common Carrier or
the boarding pass in original indicating the travel dates, in
relation to all the travels being part of the Trip. Submission of
documents shall be a condition precedent to admission of liability
under the Policy.
3. While simultaneously lodging a claim under
the relevant section under this Policy the Insured shall also take
all steps to recover the loss from whosoever has been responsible for
such loss caused to the Insured. The Insured shall then pursue his /
her claim with the Company for the amount in excess of what has been
recovered thereon. If the claim shall in advance of any such recovery
have been settled under this Policy, the Insured shall undertake to
repay to the credit of the Company the surplus of any amount that he
/ she recovered jointly under Policy as also from other sources. The
appropriate documents in connection with such steps taken by the
Insured vis-à-vis the agencies responsible for the loss as more
explicitly described under the respective sections shall be submitted
to the Company as an when available.
4. If at anytime during the
Period of Insurance, or anytime thereafter the Insured shall commit
any fraud or resort to fraudulent means to recover any claim under
this Policy, Insured’s right for all benefits under this Policy
shall be forfeited.
5. It is a condition under this Policy that
the Insured shall declare in detail the schedule of his / her travels
to one or more destinations until he / she returns to the City of
Residence or the Place of Origin in completion of his/ her Trip
hereunder. Failure of his / her part to declare so shall prejudice
his / her right of claim under different sections of the Policy.
6.
Claim Documentation:
Any other document(s) that the Company
requires from the Insured to process the claim and prove the
authenticity of the loss may be asked for. If these additional
documents are not submitted, then the Company will be relieved of it
liability to pay the claim. If the Third Party Administrator or the
Company request that bills/vouchers in a local language/ vernacular
be accompanied by an appropriate translation then the costs of such
translation must be borne by the Insured.
7. Obligations of the
Insured:
Claims for insurance benefits must be submitted to the
Third Party Administrator not later than one (1) month after the
completion of the treatment or
ICICI Lombard General Insurance
Company Ltd. Group Travel Insurance
Page 46 of 55
transportation
to the City of Residence, or in the event of death, after
transportation of the mortal remains/ burial.
The Insured shall
provide the Third Party Administrator on demand any information that
is required to determine the occurrence of the insurable event or the
Company's liability to pay the benefits. In particular, upon request,
proof shall be furnished of the actual commencement date of the Trip
abroad.
If requested to do so by the Third Party Administrator,
the Insured shall be obliged to undergo a medical examination by a
Medical Practitioner designated by the Third Party Administrator.
The
Third Party Administrator is authorized by the Insured to take all
measures that are suitable for loss prevention and claim
minimization, which includes the Insured's transportation back to the
City of Residence or the Place of Origin of the Insured.
The
Company shall be released from any obligation to pay insurance
benefits if any of the aforementioned obligations are breached by the
Insured.
8. Transfer and Set-off of Claims:
If the Insured
has any outstanding claims against third parties, such claims shall
be transferred in writing to the Company up to the amount for which
the reimbursement of costs is made by the Company in accordance with
the terms hereunder.
In so far as an Insured receives
compensation for costs he/she has incurred either from third parties
liable for damages or as a result of other legal circumstances, the
Company shall be entitled to set off this compensation against the
insurance benefits payable, if any.
Claims to the insurance
benefits may be neither pledged nor transferred by the Insured.
9.
No sum payable under this Policy shall carry any interest /
penalty.
Settlement/Rejection of Claim –The settlement of
claims would be done by Us within 30 days after the receipt of last
necessary documents, any rejections if done, would be provided with
proper reasons by Us. The role of the TPA (if any) would be limited
to facilitate the flow of information between You and Us.
Penal
interest provision shall be as per Regulation 9(6) of (Protection of
Policyholders’ Interests) Regulations, 2002
PART III OF
SCHEDULE
STANDARD TERMS AND CONDITIONS:
1. Incontestability
and Duty of Disclosure:
The Policy shall be null and void and no
benefit shall be payable in the event of untrue or incorrect
statements, misrepresentation, mis-description or on non-disclosure
in any material particular in the proposal form, personal statement,
declaration and connected documents, or any material information
having been withheld, or a claim being fraudulent or any fraudulent
means or devices being used by the Insured or any one acting on his
behalf to obtain any benefit under this Policy.
2. Reasonable
Care
The Insured shall take all reasonable steps to safeguard
the interests of the Insured against loss or damage that may give
rise to a claim.
ICICI Lombard General Insurance Company Ltd.
Group Travel Insurance
Page 47 of 55
3. Observance of terms
and conditions
The due observance and fulfillment of the terms,
conditions and endorsement of this Policy in so far as they relate to
anything to be done or complied with by the Insured, shall be a
condition precedent to any liability of the Company to make any
payment under this Policy.
4. Material change
The Insured
shall immediately notify the Company by fax and in writing of any
material change in the risk, and cause at his own expense such
additional precautions to be taken as circumstances may require to
ensure safe operation of the Insured items or trade or business
practices thereby containing the circumstances that may give rise to
the claim, and the Company may adjust the scope of cover and / or
premium if necessary, accordingly.
5. Records to be
maintained
The Insured shall keep an accurate record containing
all relevant particulars and shall allow the Company to inspect such
record. The Insured shall within one month after the expiry of the
Policy furnish such information as the Company may require.
6.
No constructive Notice
Any knowledge or information of any
circumstances or condition in connection with the Insured in
possession of any official of the Company shall not be the notice to
or be held to bind or prejudicially affect the Company
notwithstanding subsequent acceptance of any premium.
7. Notice
of charge etc.
The Company shall not be bound to take notice or
be affected by any notice of any trust, charge, lien, assignment or
other dealing with or relating to this Policy, but the payment by the
Company to the Insured or his legal representative of any
compensation or benefit under the Policy shall in all cases be an
effectual discharge to the Company.
8. Special Provisions
Any
special provisions subject to which this Policy has been entered into
and endorsed in the Policy or in any separate instrument shall be
deemed to be part of this Policy and shall have effect
accordingly.
9. Overriding effect of Part II of the Schedule
The
terms and conditions contained herein and in Part II of the Schedule
shall be deemed to form part of the Policy and shall be read as if
they are specifically incorporated herein; however in case of any
inconsistency of any term and condition with the scope of cover
contained in Part II of the Schedule, then the term(s) and
condition(s) contained herein shall be read mutatis mutandis with the
scope of cover/terms and conditions contained in Part II of the
Schedule and shall be deemed to be modified accordingly or superseded
in case of inconsistency being irreconcilable.
10. Duties of the
Insured on occurrence of loss
On the occurrence of any loss,
within the scope of cover under the Policy the Insured shall:
a.
Forthwith file/submit a Claim Form in accordance with 'Claim
Procedure' Clause as provided in Part II of the Schedule.
ICICI
Lombard General Insurance Company Ltd. Group Travel Insurance
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48 of 55
b. Allow the surveyor or any agent of the Company to
inspect the lost/damaged properties premises /goods or any other
material items, as per 'the Right to Inspect' Clause as provided in
this Part.
c. Assist and not hinder or prevent the Company or
any of its agents in pursuance of their duties under 'Rights of the
Company On Happening Of Loss Or Damage' Clause as provided in this
Part.
d. Not abandon the Insured property/item premises, nor
take any steps to rectify/remedy the damage before the same has been
approved by the Company or any of its agents or the Surveyor.
If
the Insured does not comply with the provisions of this Clause or
other obligations cast upon the Insured under this Policy, in terms
of the other clauses referred to herein or in terms of the other
clauses in any of the Policy documents, all benefits under the Policy
shall be forfeited, at the option of the Company.
11. Rights of
the Company on happening of loss or damage
On the happening of
loss or damage, or circumstances that have given rise to a claim
under this Policy, the Company may:
a. Enter and/or take
possession of the insured property, where the loss or damage has
happened
b. Take possession of or require to be delivered to it
any property of the Insured in the building or on the premises at the
time of the loss or damage
c. Keep possession of any such
property and examine, sort, arrange, remove or other wise deal with
the same; and,
d. Sell any such property or dispose of the same
for account of whom it may concern. The powers conferred by this
condition shall be exercisable by the Company at any time until
notice in writing is given by the Insured that he makes no claim
under the Policy, or if any claim is made, until such claim is
finally determined or withdrawn. The Company shall not by any act
done in the exercise or purported exercise of its powers hereunder
incur any liability to the Insured or diminish its rights to rely
upon any of the conditions of this Policy in answer to any claim.
If
the Insured or any person on his behalf shall not comply with the
requirement of the Company, or shall hinder or obstruct the Company
in the exercise of the powers hereunder, all benefits under the
Policy shall be forfeited at the option of the Company.
12.
Right to inspect
If required by the Company, an
agent/representative of the Company including a loss assessor or a
Surveyor appointed in that behalf shall in case of any loss or any
circumstances that have given rise to the claim to the Insured be
permitted at all reasonable times to examine into the circumstances
of such loss. The Insured shall on being required so to do by the
Company produce all books of accounts, receipts, documents relating
to or containing entries relating to the loss or such circumstance in
his possession and furnish copies of or extracts from such of them as
may be required by the Company so far as they relate to such claims
or will in any way assist the Company to ascertain in the correctness
thereof or the liability of the Company under the Policy.
13.
Position after a claim
The Insured shall not be entitled to
abandon any insured item/property whether the Company has taken
possession of the same or not. As from the day of receipt of the
claim amount by the Insured as determined by the Company to be fit
and proper, the
ICICI Lombard General Insurance Company Ltd.
Group Travel Insurance
Page 49 of 55
Sum Insured for the
remainder of the Period of Insurance shall stand reduced by the
amount of the compensation.
14. Indemnity
The Company may
at its option, if applicable reinstate, replace or repair the
property or premises lost or damaged or any part thereof instead of
paying the amount of loss or damage or may join with any other
insurer in so doing. The Company shall not be bound to reinstate
exactly or completely but only as circumstances permit and in
reasonably sufficient manner. In no case shall the Company be bound
to expend more in reinstatement than it would have cost to reinstate
such property as it was at the time of the occurrence of such loss or
damage and in any event not more than the Sum Insured thereon.
If
in any case the Company shall be unable to reinstate or repair the
Insured property/item hereby Insured, because of any law or other
regulations in force affecting Insured property or otherwise, the
Company shall, in every such case, only be liable to pay such Sum as
would be requisite under the Policy.
15. Subrogation
In the
event of payment under this Policy, the Company shall be subrogated
to all the Insured's rights or recovery thereof against any person or
organisation, and the Insured shall execute and deliver instruments
and papers necessary to secure such rights.
The Insured and any
claimant under this Policy shall at the expense of the Company do and
concur in doing and permit to be done, all such acts and things as
may be necessary or required by the Company, before or after
Insured's indemnification, in enforcing or endorsing any rights or
remedies, or of obtaining relief or indemnity, to which the Company
shall be or would become entitled or subrogated.
16. Condition
of Average
If the insured property be collectively of greater
value than the Sum Insured thereon, then the Insured shall be
considered as being his own insurer for the difference, and shall
bear a rateable proportion of the loss or damage accordingly. Every
item, if more than one in the Policy, shall be separately subject to
this condition.
17. Contribution
If at the time when any
Claim arises under this Policy, there is any other insurance which
covers (or would but for the existence of this Policy) and the amount
to be claimed exceeds the sum insured under a single policy after
considering the deductibles or co-pay, in the same Claim (in whole or
in part), then We shall not be liable to pay or contribute more than
Our rateable proportion of any Claim.
However, this condition
shall not be applicable for all the benefit based covers under the
Policy, as applicable.
18. Fraudulent claims
If any claim
is in any respect fraudulent, or if any false statement, or
declaration is made or used in support thereof, or if any fraudulent
means or devices are used by the Insured or anyone acting on his/her
behalf to obtain any benefit under this Policy, or if a claim is made
and rejected and no court action or suit is commenced within twelve
months after such rejection or, in case of arbitration taking place
as provided therein, within twelve (12) calendar months after the
Arbitrator or Arbitrators have made their award, all benefits under
this Policy shall be forfeited.
ICICI Lombard General Insurance
Company Ltd. Group Travel Insurance
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19.
Cancellation/termination
(a) Disclosure to information norm
The
Policy shall be void and all premium paid hereon shall be forfeited
to the Company, in the event of misrepresentation, mis-description or
non-disclosure of any material fact.
(b) You may cancel this
Policy by giving Us 15 days written notice and in such case We shall
refund premium on short term basis for the unexpired Policy Period as
per the rates, provided no claim has been payable on Your behalf
under the Policy.
PERIOD ON RISK RATE OF PREMIUM REFUNDED
Up
to 1 month 75% of premium
Up to 3 months 50% of premium
Up
to 6 months 25% of premium
Exceeding six months Nil
20.
Policy Disputes
Any dispute concerning the interpretation of the
terms, conditions, limitations and/or exclusions contained herein is
understood and agreed to by both the Insured and the Company to be
subject to Indian Law. Each party agrees to submit to the exclusive
jurisdiction of the High Court of Mumbai and to comply with all
requirements necessary to give such Court the jurisdiction. All
matters arising hereunder shall be determined in accordance with the
law and practice of such Court.
21. Arbitration clause
If
any dispute or difference shall arise as to the quantum to be paid
under this Policy (liability being otherwise admitted) such
difference shall independently of all other questions be referred to
the decision of a sole arbitrator to be appointed in writing by the
parties to the dispute/difference, or if they cannot agree upon a
single arbitrator within 30 days of any party invoking arbitration,
the same shall be referred to a panel of three arbitrators,
comprising of two arbitrators, one to be appointed by each of the
parties to the dispute/difference and the third arbitrator to be
appointed by such two arbitrators. Arbitration shall be conducted
under and in accordance with the provisions of the Arbitration and
Conciliation Act, 1996.
It is clearly agreed and understood that
no difference or dispute shall be referable to arbitration, as
hereinbefore provided, if the Company has disputed or not accepted
liability under or in respect of this Policy.
It is hereby
expressly stipulated and declared that it shall be a condition
precedent to any right of action or suit upon this Policy that the
award by such arbitrator/arbitrators of the amount of the loss or
damage shall be first obtained.
22. Renewal notice
a) We
shall ordinarily renew the policy except on grounds of moral hazard,
misrepresentation or fraud or non cooperation by the Insured. We
shall not be bound to give notice that the renewal premium is due.
Every renewal premium (which shall be paid and accepted in respect of
this Policy) shall be so paid and accepted upon the distinct
understanding that no alteration has taken place in the facts
contained in the proposal or declaration herein before mentioned and
that nothing is known to You that may result to enhance Our risk
under the guarantee hereby given. Any change in the risk will be
intimated by You to Us. Nothing
ICICI Lombard General Insurance
Company Ltd. Group Travel Insurance
Page 51 of 55
herein or
otherwise shall affect Our right to impose any additional terms and
conditions on renewal or restrict any renewal terms as to premium or
otherwise.
b) The Policy may be renewed by mutual consent and in
such event the renewal premium shall be paid to Us on or before the
date of expiry of the Policy and in no case later than Grace Period
of 30 days from the expiry of the Policy.
23. The Standard list
of Excluded Items would be as per the Guidelines on Standardisation
dated February 20, 2013.. In case of any variation, such specific
list would be annexed along with the policy documents.
Sl
No
List of Expenses Generally Excluded ("Non-Medical")
in Hospital Indemnity Policy
SUGGESTIONS (Payable/Non
Payable)
24. Notices
Any notice, direction or instruction
given under this Policy shall be in writing and delivered by hand,
post, or facsimile to
In case of the Insured, at the address
specified in Part I of the Schedule.
In case of the
Company:
ICICI Lombard House, 414, Veer Savarkar Marg, Near
Siddhi Vinayak Temple,
Prabhadevi, Mumbai 400 025.
Notice
and instructions will be deemed served 7 days after posting or
immediately upon receipt in the case of hand delivery, facsimile or
e-mail.
25. Customer Service
If at any time the Insured
requires any clarification or assistance, the Insured may contact the
offices of the Company at the address specified, during normal
business hours.
26. Free Look Up period- You would be given a
period of 15 days (Free Look Period) from the date of receipt of the
Policy to review its terms and conditions. Where the Policy Holder
disagrees to any of the terms or conditions of the Policy, he has the
option to return the Policy stating the reasons for his objection,
when he shall be entitled to a refund of the premium paid, subject
only to a deduction of the expenses incurred by Us on medical
examination of the Insured Person(s) and the stamp duty charges. In
case the request for cancellation comes 30 days after the Policy
Period start date, pro-rata refund of premium would be paid to
You
27. Grievances
In case the Insured is aggrieved in any
way, the Insured may contact the Company at the specified address,
during normal business hours.
If the issue still remains
unresolved, Insured may, subject to vested jurisdiction, approach
Insurance Ombudsman for the redressal of his/ her grievance.
ICICI
Lombard General Insurance Company Ltd. Group Travel Insurance
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The details of Insurance Ombudsman are available
below:
CONTACT DETAILS
JURISDICTION
AHMEDABAD Office
of the Insurance Ombudsman, 2nd floor, Ambica House, Near C.U. Shah
College, 5, Navyug Colony, Ashram Road, Ahmedabad – 380 014 Tel.:-
079-27546150/139 Fax:- 079-27546142
Email:-bimalokpal.ahmedabad@gbic.co.in
State of Gujarat and
Union Territories of Dadra & Nagar Haveli and Daman and
Diu.
BENGALURU
Office of the Insurance Ombudsman, Jeevan
Soudha Building, PID No.57-27-N-19, Ground Floor, 19/19, 24th Main
Road,
JP Nagar, 1st Phase, Bengaluru-560 078. Tel.:-
080-26652048 / 26652049 Email:-
bimalokpal.bengaluru@gbic.co.in
Karnataka.
BHOPAL Office of
the Insurance Ombudsman, Janak Vihar Complex, 2nd Floor, 6, Malviya
Nagar, Opp.Airtel Office, Near New Market, Bhopal – 462 033. Tel.:-
0755-2769200/201/202 Fax:- 0755-2769203 Email:-
bimalokpalbhopal@gbic.co.in
States of Madhya Pradesh and
Chattisgarh.
BHUBANESHWAR Office of the Insurance Ombudsman, 62,
Forest park, Bhubneshwar – 751 009. Tel.:- 0674-2596461 / 2596455
Fax:- 0674-2596429 Email:-bimalokpal.bhubaneswar@gbic.co.in
State
of Orissa.
CHANDIGARH Office of the Insurance Ombudsman, S.C.O.
No. 101, 102 & 103, 2nd Floor, Batra Building, Sector 17 – D,
Chandigarh – 160 017. Tel.:- 0172-2706196/5861 / 2706468
States
of Punjab, Haryana, Himachal Pradesh, Jammu & Kashmir and Union
territory of Chandigarh.
ICICI Lombard General Insurance Company
Ltd. Group Travel Insurance
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Fax:-
0172-2708274 Email:- bimalokpal.chandigarh@gbic.co.in
CHENNAI
Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor,
453 (old 312), Anna Salai, Teynampet, CHENNAI – 600 018. Tel.:-
044-24333668 / 24335284 Fax:- 044-24333664 Email:-
bimalokpal.chennai@gbic.co.in
State of Tamil Nadu and Union
Territories - Pondicherry Town and Karaikal (which are part of Union
Territory of Pondicherry).
DELHI Office of the Insurance
Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New
Delhi – 110 002. Tel.:- 011-23239611/7539/7532 Fax:- 011-23230858
Email:- bimalokpal.delhi@gbic.co.in
State of Delhi
KOCHI
Office of the Insurance Ombudsman, 2nd floor, Pulinat Building, Opp.
Cochin Shipyard,
M.G. Road, Ernakulum - 682 015. Tel.:-
0484-2358759/2359338 Fax:- 0484-2359336 Email:-
bimalokpal.ernakulum@gbic.co.in
Kerala, Lakshadweep, Mahe-a part
of Pondicherry
GUWAHATI Office of the Insurance Ombudsman,
'Jeevan Nivesh’, 5th Floor, Nr. Panbazar over bridge, S.S. Road,
Guwahati – 781001(ASSAM). Tel.:- 0361- 2132204 / 2132205 Fax:-
0361-2732937 Email:- bimalokpal.guwahati@gbic.co.in
States of
Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and
Tripura.
HYDERABAD Office of the Insurance Ombudsman, 6-2-46,
1st floor, "Moin Court" Lane Opp. Saleem Function Palace,
A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004. Tel.:-
040-65504123/23312122 Fax:- 040-23376599 Email:-
bimalokpal.hyderabad@gbic.co.in
States of Andhra Pradesh,
Telangana and Union Territory of Yanam - a part of the Union
Territory of Pondicherry.
ICICI Lombard General Insurance
Company Ltd. Group Travel Insurance
Page 54 of 55
JAIPUR
Office
of the Insurance Ombudsman, Jeevan Nidhi-II Bldg.,
Ground
Floor,
Bhawani Singh Marg,
Jaipur - 302005. Tel.:-
0141-2740363 Email:- bimalokpal.jaipur@gbic.co.in
State of
Rajasthan.
KOLKATA Office of the Insurance Ombudsman, Hindustan
Building Annexe, 4th floor, 4, CR Avenue, Kolkata - 700 072. Tel.:-
033-22124339 / 22124340 Fax:- 033-22124341 Email:-
bimalokpal.kolkata@gbic.co.in
States of West Bengal, Bihar,
Sikkim and Union Territories of Andaman and Nicobar Islands.
LUCKNOW
Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan,
Phase-II, Nawal Kishore Road, Hazratganj, Lucknow-226 001. Tel.:-
0522-2231330 / 2231331 Fax:- 0522-2231310. Email:-
bimalokpal.lucknow@gbic.co.in
District of Uttar Pradesh:
Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad,
Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur, Varansi,
Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur,
Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi,
Kaushambi, Balrampur, Basti, Ambedkarnagar, Sulanpur, Maharajganj,
Santkabirnagar, Azamgarh, Kaushinagar, Gorkhpur, Deoria, Mau,
Chandauli, Ballia, Sidharathnagar.
MUMBAI Office of the
Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road,
Santacruz (W), Mumbai - 400 054. Tel.:- 022-26106928/360/889 Fax:-
022-26106052 Email:- bimalokpal.mumbai@gbic.co.in
States of Goa,
Mumbai Metropolitan Region excluding Navi Mumbai & Thane.
NOIDA
Office of the Insurance Ombudsman, Bhagwan Sahai Palace, 4th Floor,
Main Road, Naya Bans, Sector-15,
States of Uttaranchal and the
following Districts of Uttar Pradesh:. Agra, Aligarh, Bagpat,
Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kanooj,
ICICI
Lombard General Insurance Company Ltd. Group Travel Insurance
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Gautam Budh Nagar, Noida Email:-
bimalokpal.noida@gbic.co.in
Mainpuri, Mathura, Meerut,
Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad,
Firozabad, Gautam Budh Nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur,
Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar,
Saharanpur.
PATNA Office of the Insurance Ombudsman, 1st Floor,
Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur, Patna - 800
006. Email:- bimalokpal.patna@gbic.co.in
States of Bihar and
Jharkhand.
PUNE Office of the Insurance Ombudsman, Jeevan
Darshan Building, 3rd Floor, CTS Nos. 195 to 198, NC Kelkar Road,
Narayan Peth, Pune - 411 030 Tel: 020 -32341320 Email:-
bimalokpal.pune@gbic.co.in
States of Maharashtra, Area of Navi
Mumbai and Thane excluding Mumbai Metropolitan Region.
The
updated details of Insurance Ombudsman are also available on IRDA
website: www.irdaindia.org, on the website of General Insurance
Council: www.generalinsurancecouncil.org.in, website of the company
www.icicilombard.com or from any of the offices of the Company