Principal conditions of accident insurance in accordance with the Rules of voluntary accident insurance №210.1/1
- The rights and obligations and responsibilities of the parties for non-fulfillment or improper fulfillment of the Insurance Contract.
1.1. During the term of the Insurance Contract, Insurance Policyholder / Insured Person is entitled to:
1.1.1. receive insurance benefits in the manner and amount prescribed by the Insurance Contract;
1.1.2. contact the Insurer with reasonable claims in case if insurer refuses to make an insurance settlement payment;
1.1.3. appoint a person (hereinafter Beneficiary) to obtain the insurance sum in case of death of Insurance Policyholder / Insured Person due to an accident, and change this person before insured event.
1.2 Insurance Policyholder / Insured Person shall:
1.2.1. comply with all conditions of the Insurance Contract;
1.2.2. take measures to prevent and reduce damage caused in the result of an accident;
1.2.3. not later than five (5) working days from the date of accident, which subsequently can be qualified as insurance, notify the Insurer.
1.3. The Insurer is entitled to:
1.3.1. check information reported by notified Insurance Policyholder / Insured Person;
1.3.2. refuse to pay in case of:
– deliberate actions of the Insurance Policyholder or the person, for the benefit of to whom the Insurance Contract is concluded, are aimed at the occurrence of the insured event;
– commission of an intentional crime that led to the insured event by Insurance Policyholder or the person, for the benefit of to whom the Insurance Contract is concluded;
– deliberate submission of false information by Insurance Policyholder / Insured Person about the object of insurance or the fact of the insured event;
– Other cases envisaged by the legislation of Ukraine.
1.4. The Insurer shall:
1.4.1. familiarize the Insurance Policyholder with the conditions and the Rules of insurance.
1.5. The Insured Person hereunder acquires the rights and the obligations of the Insurance Policyholder.
1.6. Parties are responsible in accordance with insurance regulations and laws of Ukraine for non-fulfillment or improper fulfillment of the Insurance Contract. For late payment of the insurance due to the fault of the Insurer, Insurance Policyholder is paid the penalty in the amount of double rate of the National Bank of Ukraine effective during the period for which the penalty is paid and calculated from the amount of late payment.
- The order of changes and termination of the Insurance Contract
2.1. The Insurance Contract shall be terminated in case of:
– expiration of Contract validity period;
– fulfillment of obligations by the Insurer to the Insurance Policyholder in full;
– death of the Insurance Policyholder / Insured Person;
– failure by the Insurance Policyholder to pay insurance payments within deadlines the established by the Contract;
– liquidation of the Insurer in accordance with the legislation of Ukraine;
– judicial decision on the recognition of Insurance Contract invalid.
The Insurance Contract can be terminated unilaterally by the request of the Insurance Policyholder or Insurer.
Either party shall notify the other about the intention of early termination of the Contract not later than 30 calendar days before the date of termination.
In case of early termination of the Contract at the request of the Insurance Policyholder, the Insurer returns the insurance payments to the Insurance Policyholder for the period remaining before the end of the Contract validity, inclusive of case conducting, determined when calculating the insurance rate (30%), actual payments of insurance sums, which were made under this Contract.
Changes to the Contact are made with the consent of the Insurance Policyholder and the Insurer by concluding additional contracts to the current Contract, which are its integral parts upon signature.
- Reasons for denial to make insurance payments
The Insurer is not liable and does not make payments in case of death, disability, temporary incapacity of the Insurance Policyholder / Insured Person or traumatic injuries if they are directly or indirectly related to:
– deliberate actions or gross negligence by the Insurance Policyholder / Insured Person or Beneficiary or Heir;
– intentional infliction bodily injury to him/herself by Insurance Policyholder / Insured Person;
– suicide or suicide attempt, except when the Insured Person was brought to such state by illegal actions of third parties;
– driving of means of land or water transport by Insurance Policyholder / Insured Person without corresponding license or appropriate category, and assigning of driving of transport by Insurance Policyholder / Insured Person to a person who is in a state of alcoholic, narcotic or toxic intoxication, does not have driver’s license or appropriate category ;
– flights on any aircraft, except when the Insurance Policyholder / Insured Person is flying as a passenger in civil aircraft, whose owner has a license for passenger transportation;
– participation in sports classes, trainings, competitions and other occupations related to increased risk for life and health, except when additional fare is paid, as stipulated in the “Special Conditions” of the Contract;
– service in the armed forces and military units;
– force majeure circumstances (war, military operation, their consequences, public unrest, revolution, rebellion, uprising, civil unrest, strikes, acts of terrorism, extraordinary, special or military situations announced by the government bodies in accordance with law, natural disasters, radioactive, chemical or bacteriological contamination, effect of ionizing radiation);
– diseases of various kinds, self-treatment, adverse effects of therapeutic and diagnostic procedures.
The loss of employability is not an insurance case and therefore does not have the basis for payment.
Sudden deterioration of the health of people due to food poisoning, epidemics and other diseases is not considered the insured event.
The Insurer is not liable and does not perform insurance payments in cases when Insured Person was under the influence of alcohol, drugs and other substances that can cause intoxication at the time of accident, except for taking these substances as a result of illegal actions of third parties in the form of coercion or threat to life.
- The terms of the insurance payments
4.1. Insurance payment is made based on insurance act of Insurer, application of Insurance Policyholder / Insured Person and the following documents:
– Insurance Contract;
– documents confirming the insured event (original or copies, certified by relevant medical institutions or authorized representative of Insurer):
– medical certificate (or certificates) signed by the responsible person and sealed by medical institution, certificate of incapacity for work from medical institution with the appropriate stamp including the name of patient, accurate diagnosis, date of application for medical help, duration of treatment;
– act of accident at work detailing the reasons that caused the insured event, signed by the director or the representative of a company at which the Insured Person works, by another responsible person or act of accident outside work (form НT) in case of non work-related accident;
– documents issued by medical-social expert commission (MSEC), confirming the disability group;
– X-ray pictures, conclusion of laboratory and instrumental methods of diagnostics, and other documents at the Insurer’s request, if necessary for the decision making.
– in case of death of the Insurance Policyholder / Insured Person due to an accident – death certificate of the Insurance Policyholder / Insured Person; autopsy protocol, or act of forensic medical expert examination;
– documents of succession (for heirs);
– passport and identification number of the person who receives the insurance payment.
4.2. Insurance payment is made only in the territory of Ukraine in the national currency of Ukraine (UAH) in the following amounts:
– in case of death of the Insurance Policyholder / Insured Person due to an accident that took place during the Insurance Contract validity – 100% of the insured sum;
– in the case of primary disability of the Insurance Policyholder / Insured Person due to an accident that took place during the Insurance Contract validity: 50% of the insured sum – for the third group of disability, 75% of the insured sum – for the second group of disability, 100% of the insured sum – for the first group of disability;
– in the case of traumatic injuries and functional disturbances due to an accident – according to the “Table of amount of insurance payments for accident insurance” (Annex №1 to Regulations №210.1/1 “Voluntary Accident Insurance”),
4.3. At the occurrence of an insured event and presence of all the necessary documents, the Insurer makes decision to pay within 15 working days or refuse to pay within 5 working days of the day of receipt of the last document and makes payment within the insured sum within 15 working days after the decision is made.
- Procedure for dispute resolution
Disputes concerning this Contract shall be resolved by negotiation, if it is impossible – by judicial procedure.
