Whereas the Insured named in the schedule hereto has applied in writing on the proposal signed by or on behalf of the insured which the Insured has agreed shall be deemed to be of a promissory nature and effect and the basis of this contract and which is to be deemed incorporated herein has applied to Old Mutual (hereinafter called the Company) for the insurance hereinafter contained and has paid or agreed to pay the Company the sum designated as first premium in the Schedule hereto as the premium and consideration for the said insurance for the period set-forth in the said Schedule.
Now therefore this policy witnesses that the Company hereby agrees subject to the prior payment of the premium as consideration and to the terms, provisions, exceptions and conditions contained herein or endorsed hereon (hereinafter collectively referred to as the terms of the policy) to insure the Insured during the said period or during any further period for which the Company may agree to renew the insurance upon the basis of and in conformity with the table of compensation contained in the Schedule hereto against the event of bodily injury caused by violent, accidental, external and visible means which injury shall solely and independently of any other cause result in the insured’s death or disablement and subject to the terms as aforesaid the Company hereby binds itself to pay to the Insured or in the event of the insured’s death to the insured’s legal personal representatives the sum or the sums of money as provided in the said Schedule provided always that such bodily injury is sustained during the period covered by the policy or during any period for which the Company may agree to renew the policy and that no waiver of any of the terms of this policy shall be valid unless made in writing and signed by an authorised officer of the Company.
GEOGRAPHICAL AREA:
Kenya, but extended to worldwide for travel purposes for a period of up to three (3) months in any one period.
EXCEPTIONS
Except in so far as the Company shall by endorsement hereon have agreed to the contrary, this policy does not insure against:
Death or disablement directly or indirectly proximately or remotely occasioned by contributed to by or traceable to or arising out of or in connection with war invasions act of foreign enemy hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, mutiny military or usurped power.
Death or disablement caused by or consequent upon suicide or attempted suicide whether felonious or not, wilful self injury, breach of law on the part of the Insured, voluntary wilful or negligent exposure of the Insured to needless peril (except for the purpose of saving human life), indulgence in drink, narcotics or drugs not prescribed by a qualified medical practitioner, failure to obtain medical advice and act upon the same, insanity or venereal disease.
Death or disablement caused by or consequent upon participation in wild beast or big-game hunting, climbing and mountaineering (using ropes), winter sports, racing (other than on foot), polo, football (other than as an amateur), motor cycling (excluding motor cycles under 250cc), aqualag diving, parachuting, boxing, soccer, polo, water skiing jumping, water boating, professional wrestling and martial arts, show jumping, yachting outside territorial waters.
Death or disablement where the Insured is a female resulting directly or indirectly from pregnancy or childbirth.
Death or disablement occurring whilst the Insured is engaged in aviation except as a passenger on a recognised airline operating on regular scheduled air routes or in any chartered aircraft duly licensed as a recognised carrier.
Death or disablement arising out of serving in the armed forces of any country or international authority, whether in peace or war.
Death or disablement arising out of driving or riding as a passenger in or on:
7.1 Any vehicle engaged in any race, speed testing or endurance test; or
7.2 Any vehicle used for acrobatic or stunt driving; or
7.3 For smashing, such as in “demolition derby”; or
7.4 For any other purpose except transportation.
Death or disablement caused by earthquake, atmospheric, geological or climatic conditions or any other naturally deteriorating cause or condition.
Any riot, strike or public disorder or any act or activity which is calculated or directed to bring about a riot, strike or public disorder.
Public
Political risks exclusion
The following shall be excluded from this agreement:
Any loss or damage occasioned by or through or in consequence, directly or indirectly, of any of the following occurrences, namely:10.1 War, invasion, act of foreign enemy, hostilities or warlike operations (whether war be declared or not), civil war.
10.2 Abandonment and/or permanent or temporary dispossession resulting from detention, confiscation, seizure, restraint, commandeering, nationalisation, appropriation, destruction or requisition by order of any government de jure or de facto or by any public authority.
10.3 Mutiny, civil commotion, military rising, insurrection, rebellion, revolution, military or usurped power, martial law or state of siege or any of the events or causes which determine the proclamation or maintenance of martial law or state of siege.
10.4 Any riot, strike or public disorder or any act or activity which is calculated or directed to bring about a riot, strike or public disorder.
10.5 Any act which is calculated or directed to bring about loss or damage in order to further any political aim, objective or cause, or to bring about any social or economic change, or in protest against any state or Government, or any political or local authority, or for the purpose of imposing fear in the public or any section thereof.
10.6 The act of any lawfully established authority in controlling, preventing, suppressing or in any other way dealing with any occurrence referred to in clauses 10.4 and 10.5 above.
10.7 Plundering, looting, war pillage in connection with riots and/or civil commotion.
For the purposes of clauses 10.4, 10.5 and 10.6, any loss or damage occasioned directly by a labour disturbance, lock-out or strike shall not be excluded.
In any action, suit or other proceeding in which the Insurer alleges that by reason of these provisions any loss or damage is not covered by this agreement, the burden of proving that such loss or damage is covered shall be upon the Insured.
Terrorism exclusion
Notwithstanding any provision to the contrary within this policy or any endorsement thereto, this Insurance agreement does not cover any liability, loss, damage or expense of whatsoever nature directly or indirectly caused by, resulting from, happening through or in connection with any act of terrorism, regardless of any other cause contributing concurrently or in any other consequence to the loss, damage or expense.
For the purpose of this exclusion, terrorism means an act of violence or an act dangerous to human life, tangible or intangible property or infrastructure with the intention or effect to influence any government or to put the public or any section of the public in fear.
In any action suit or other proceedings where the Insurer alleges that by reason of this definition a loss, damage or expense is not covered by this policy, the burden of proving that such a loss, damage or expense is covered shall be upon the Insured.
CONDITIONS
Claims Procedure
Notice of any accident with full particulars and medical certificates must be given to the Company as soon as possible and in any case within thirty days from its occurrence and in default thereof (unless the delay is explained to the reasonable satisfaction of the Company) and satisfactory proof as required by the Company at the expense of the Insured or his legal personal representatives of the cause of death or injury as the case may be no claim in respect of that accident will be admitted. The Company shall in no circumstances be under any liability hereunder in respect of any accident unless notice thereof be given to the Company within twelve calendar months from its occurrence. And in case the accident shall not prove immediately fatal the Insured must be attended to by a duly qualified and registered medical practitioner and must at his own expense within seven days after receipt of demand post to the Company a full written report by such medical practitioner setting forth the facts of the case and the extent of disablement. The Insured further shall when required by the Company submit himself/ herself to be examined by the medical or other officer of the Company and shall at all times send by post at his own expense within seven days after receipt of demand all such further evidence and information by certificates declarations or otherwise as may be from time to time required in order to ascertain and prove the nature and extent of the injuries; and in case of death there must be delivered to the Company a certificate from the medical attendant of the Insured stating as fully as possible the nature extent and duration of the injuries the cause of death and all such other information and evidence as the Company may require or consider necessary to satisfy itself of its liability and the identity of the Insured and of the title of the claimant. In case of death of the Insured the Company shall have the right to have a post mortem examination made at its own expense.
Claims Discharge
Any receipt of discharge which the Insured may grant to the Company for compensation under this policy shall be deemed a final and complete discharge of all claims in respect of all and every injury, complication or contingency (including death) resulting to the Insured in consequence of the same accident whether resulting before or after the date of such receipt or discharge and in no case shall any claim be competent for a second payment in respect of any results or effects whatsoever (including death) of the same accident. No sum payable under this policy shall carry interest.
Notification of Change
The Insured shall give notice to the Company of any change of name, address, occupation, beneficiary, intermediary or any other material changes immediately after such change.
Renewal and Cancellation
The Company shall not be bound to send any notice of the renewal premiums becoming due or to accept any renewal of this policy. The company may cancel this policy by sending seven days notice by registered letter to the insured at his last known address and in such event will return to the Insured the premium paid less the pro rata portion thereof for the period the policy has been in force. This policy may also be terminated at the request of the Insured by giving a seven day notice to that effect to the Company and the Insured shall be entitled to a return of premium less the pro-rata portion thereof for the period the Policy has been in force at the Company’s short period rates. In the event that a claim shall have been made under the policy, there shall be no refund of premium upon cancellation.
Age Limit
This policy does not cover persons under the age of eighteen years and shall not be continued at all after the end of the year of insurance during which the Insured attains the age of seventy-five years.
Arbitration
All differences arising out of this policy shall be referred to the decision of an arbitrator to be appointed in writing by the parties in difference or if they cannot agree upon a single arbitrator to the decision of two arbitrators one to be appointed in writing by each of the parties within one calendar month after having been required in writing so to do by either of the parties or in case the Arbitrators do not agree of an umpire appointed in writing by the arbitrators before entering upon the reference. The umpire shall sit with the arbitrators and preside at their meetings and the making of an award shall be a condition precedent to any right of action against the Company. If the Company shall disclaim liability to the Insured for any claim hereunder and such claim shall not within twelve calendar months from the date of such disclaimer have been referred to arbitration under the provisions herein contained then the claim shall for all purposes be deemed to have been abandoned and shall not thereafter be recoverable hereunder.
Observance
The due observance and fulfilment of the terms of this policy insofar as they relate to anything to be done or not to be done by the Insured and the truth of the statements and answers in the proposal shall be conditions precedent to any liability of the Company to make any payment under this policy.
EXTENSIVE CLAUSES
DISAPPEARANCE
It is hereby declared and agreed that if the Insured disappears during the period of insurance and the body is not found within 12 months after the disappearance and sufficient evidence is produced to the Company which leads the Company to the inevitable conclusion that the insured (or the Insured Person) has sustained bodily injury and that such bodily injury has resulted in death in cases as described in the policy then the Company shall forthwith pay the death benefit under the insurance provided that the party to whom the death benefit is paid shall sign an undertaking to refund such sum on demand should the Insured (or the Insured Person) subsequently be found to be living.
RIOT & STRIKES EXTENSION
It is hereby declared and agreed that the within policy is extended to cover losses or expenses caused by or resulting from riots, strikes and civil commotion. Consequently the words ‘riot’, ‘strike’ and ‘civil commotion’ are deemed to be deleted from exception 9 of the policy.
AIR FARES FOR TREATMENT
It is hereby declared and agreed that the sum insured under medical expenses shall extend to include the cost of any air fares incurred solely for the purpose of transporting the insured person to a place outside Kenya for medical treatment provided that the insured person’s medical practitioner certifies that this is necessary and the Medical Expenses Limit in respect of the insured person allow. In any case the cost of such fares and all other medical expenses shall be taken into account in determining the total medical expenses.
EXPOSURE
In consideration of the premium paid hereon, it is hereby declared and agreed that, subject otherwise to the terms, limitations and conditions, this policy covers claims arising out of bodily injury caused by exposure to the elements as the result of an accident covered hereunder.
MOTOR CYCLING
Notwithstanding anything contained herein to the contrary, it is hereby declared and agreed that the insurance provided by this policy applies to bodily injury as herein defined sustained in connection with the use of a motorcycle or motor scooter provided that the cubic capacity does not exceed 250cc and other than while the insured is engaged in speed trials or racing of any kind.
TRUSTEE CLAUSE
In the event of any claim becoming payable under this Insurance all benefit are payable to the insured who shall hold such benefit paid in trust for the lives assured and which shall constitute a valid discharge.
Public
CASH AND CARRY
“Pursuant to the deletion of Section 156 sub-section (2) of the Insurance Act Cap. 487, you are required to pay your premium on or before the commencement of cover. Please note that the Company shall only assume risk upon receipt of the full premium”.
BASIS OF CONTRACT
It is hereby declared and agreed that the insured not having completed the insurer’s formal printed proposal form for this class of business but having proposed to the insurers by means of a Risk Note, wherever within Policy makes references to proposal and or declaration, these terms shall be deemed to include the terms agreed on at the time of making quotations for the said class of business. In the event of a conflict in terms between the Broker’s risk note and the agreed on quotations, the latter shall prevail. Subject to the Terms of the Provisos conditions and exclusions of the policy.
SANCTIONS CLAUSE
“The [Insurer] shall not be deemed to provide cover and the [Insurer]shall not be liable to pay any claim or provide any benefit under this policy to the extent that the provision of such coverage, payment of such claim or provision of such benefit would expose the [Insurer], its parent, subsidiary or affiliate entities and organizations, including any director, officer, employee, or agent to any sanction, prohibition or restriction implemented pursuant to resolutions of the United Nations or the trade and economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America.”
CANCELLATION CLAUSE
The Company may cancel this Policy by sending fourteen (14) days’ notice by registered letter or email to the Insured at his last known address and in such event will return to the Insured the premium paid less the pro rata portion thereof for the time during the current Period of Insurance the Policy has been in force or the Policy may be cancelled at any time by the Insured and provided no claim has arisen during the current Period of Insurance, the insured shall be entitled to the difference (if any) between the premium paid and the premium calculated at the Company’s Short Period rates for the time during the current Period of Insurance the Policy has been in force.
SUNSET CLAUSE
Insured shall notify the company of all claims promptly and not later than six (6) months whichever the earlier from the date of loss. Any claim brought and notified to the company upon expiry of the set period herein above shall not be admissible and the company shall not be under any compulsion and/or obligation under this policy to admit liability.
This clause shall be read alongside the notification clause and does not extinguish the notification clause/condition
Public
TABLE OF PERMANENT DISABILITIES
CONTINENTAL SCALE BENEFITS
The following percentages of the Principal Sum shall be payable in the event of Accidental Bodily Injury resulting in:
Loss of two limbs 100% Loss of both hands or of all fingers and both thumbs 100% Total loss of sight of both eyes 100% Total paralysis 100% Injury resulting in being permanently bedridden 100% Any other Injury causing permanent total disablement 100% Loss of arm at shoulder 100% Loss of arm between elbow and shoulder 100% Loss of arm at elbow 100% Loss of arm between wrist and elbow 100% Loss of hand at wrist 100% Loss of four fingers and thumb of one hand 50%
Public
Description of permanent disablement
Percentage of maximum benefits payable
Loss of four fingers Loss of thumb
Loss of index finger
Loss of middle finger
Loss of ring finger
Loss of little finger
Loss of metacarpals Loss of leg
Loss of toes
Eye: Loss of
Loss of hearing
40% - both phalanges 25% - one phalanx 10%
- three phalanges 10%
- two phalanges 8%
- one phalanx 4%
- three phalanges 6%
- two phalanges 4%
- one phalanx 2%
- three phalanges 5%
- two phalanges 4%
- one phalanx 2%
- three phalanges 4%
- two phalanges 3%
- one phalanx 2%
- first or second (additional) 3%
- third fourth or fifth (additional) 2%
- at hip 100% - between knee and hip 100% 100% - below knee 100% - all 15%
- great, both phalanges 5%
- great, one phalanx 2%
- other than great, if more x
- than one two lost, each 1%
- whole eye 100% - sight of 100% - sight of except perception of light 50% - lens of 50%
- both ears 75% - one ear 15%
Public
Temporary Total Disablement Hospital Cash
Medical Expenses
Artificial Appliance
Last Expense
EXCESS:
Temporary Total Disablement (A deferment period of seven (7) days)
Hospital Cash (A deferment period of three (3) days) SPECIFIC PROVISIONS
The amount specified in the Schedule.
The complete and irrecoverable loss of use of any member or members specified above shall be deemed to be loss of such member or members.
In the event of partial loss of any member or members specified above a proportionately lower percentage of compensation shall be payable.
In the event of permanent disablement by physical loss or loss of use not specified above the percentage of compensation shall be assessed in proportion to the degree of disability as compared with the cases specified without reference to the profession or occupation of the Insured.
If the Insured is left-handed the percentages relating to the right arm or right hand shall apply to the left arm and left hand respectively and the percentages relating to the left arm or left hand shall apply to the right arm and right hand respectively.
When more than one permanent disablement arises from one accident the percentages are added together but cannot exceed 100% of the Maximum Benefit stated in the Schedule of Benefits.
Funeral expenses shall become payable upon full proof in writing and or through any documentary evidence of the death of the insured.
In the event of the insured person being hospitalised for a period in excess of the three (3) days deferment period, as a result of an accident, the company will pay the hospital cash benefit up to the amount stated in the schedule.
DEFINITIONS
“Loss of Eye” shall mean total and irrecoverable loss of all sight rendering the insured person absolutely blind in that eye beyond remedy by surgical and or other treatment.
“Loss of Limb” shall mean total loss by physical severance of hand or foot.
“Permanent Total Disablement” shall mean absolute disablement from engaging in or giving attention to the insured person’s
ordinary profession or occupation.
“Temporary Total Disablement” shall mean disablement from engaging in or giving attention to any portion of the insured person’s ordinary profession or occupation.
“Medical Expense” shall mean the cost of medical, surgical or other remedial attention treatment given or prescribed by a qualified medical practitioner.
“Cost of Artificial Appliances” shall mean the cost of appliances given or prescribed by a qualified and registered member of the medical profession.
“Deferment Period” shall mean the initial period during which no benefit is payable.
“Football”shall mean rugby, soccer, football and all associated games.