THE NEW INDIA ASSURANCE COMPANY LIMITED
Regd. & H.O. :New India Assurance Building , 87,M.G. Road,
Fort , MUMBAI - 400 001

PERSONAL PACKAGE INSURANCE POLICY FOR EXECUTIVES / BUSINESSMEN
( EXECUTIVE / ADHIKARI SURAKSHA KAVACH )

WHEREAS the insured named in the Schedule hereto has made to New India
Assurance Company Limited (hereinafter called “the Company”) a proposal and
declaration which shall be the basis of this contract and be deemed to be incorporated herein for the insurance hereinafter contained and has paid the premium stated herein.

The Company hereby agrees subject to the terms and conditions contained herein or endorsed or otherwise expressed hereon that if the Insured shall sustain LOSS or DAMAGE or INCUR LIABILITY or shall sustain BODILY INJURY by accident or shall at any time during the period of insurance or any subsequent renewal in respect of which premium has been paid to the Company the Company will pay to the Insured the value, at the time of happening of such LOSS, of the property so lost or the amount of such damage or the amount of liability incurred or the benefits specified herein but not exceeding in any one period of insurance in respect of each of the several items specified herein the sum set opposite thereto respectively.

GENERAL CONDITIONS
1. Notice : Every notice and communication to the Company required by this policy
shall be in writing to the office of the Company through which this Insurance is
effected .
2. Mis-description : This Policy shall be void and all premium paid hereon shall be
forfeited to the Company in the event of misrepresentation misdescription or nondisclosure
of any material particular.
3. Reasonable Care : The Insured shall take all reasonable steps to safeguard the
property insured against any loss or damage.
4. Cancellation : The Company may at any time by seven days notice in writing
cancel this Policy, in which case the Company shall return to the Insured a
proportion of the last premium corresponding to the unexpired period of insurance.
This Policy may also be terminated at any time at the request of the Insured in
which case the Company will retain the premium for the period this policy has
been in force at the short period scale as described below.
Period of risk retained |
Upto one month | 25% of the annual rate premium
Upto three months | 50% of the annual rate premium
Upto six months | 75% of the annual rate premium
Exceeding six months | Full annual rate
5. Claims Procedure :
i) The Insured shall upon the occurrence of any event giving rise or likely to give
rise to a claim under this Policy :
a) in the event of theft lodge forthwith a complaint with the Police and take all
practicable steps to apprehend the guilty person or persons and to
recover the property lost.
b) give immediate notice thereof to the Company and shall within Fourteen
(14) days thereafter furnish to the Company at his own expenses detailed
particulars of the amount of the loss or damage together with such
explanations and evidence to substantiate the claim as the Company may
reasonably require.
ii) In the event of a claim under Personal Accident Section under this policy,
immediate written notice shall be given by Insured or his legal representative,
but in no case later than one month after occurrence of the injury. All
certificates, information and evidences whether from a Medical Attendant or
otherwise required by the Company shall be furnished at the expenses of
insured or his legal representative/ assignee and shall be in such form and of
such nature as the Company may prescribe. The Insured person must
immediately after the occurrence of an accident which may be the subject of a
claim hereunder obtain medical treatment failing which the Company will not
be liable for the consequence thereof.
iii
)
The Insured shall upon the occurrence of any event giving rise or likely to
give rise to a claim under the Policy give immediate notice thereof to the
Company and shall forward to the Company forthwith every written notice or
information of any verbal notice of claim and shall send to the Company any
writ, summons or other legal process issued or commenced against the
Insured and shall give all necessary information and assistance to enable the
Company to settle or resist any claim or to institute proceedings. The Insured
shall not incur any expenses in making good any claim without the written
consent of the Company and shall not negotiate pay settle admit or repudiate
any claim without such consent.
6. Contribution : In the event of any loss, damage, liability or expenses covered by
this Policy there shall be any other insurance covering the same loss, damage,
liability or expenses whether effected by the Insured or not, this Policy shall pay
only so much of the excess of such loss, damage, liability or expenses as is not
recoverable under such other insurance, subject always to the limitations of this
Policy.
7. Fraud : If any claim under this Policy shall be in any respect fraudulent or if any
fraudulent means or device are used by the Insured or any one acting on the
Insured’s behalf to obtain any benefit under this Policy, all benefits under the
Policy shall be forfeited.
8. Indemnity : The Company may at its option reinstate, replace or repair the
property or premises lost or damage or any part thereof instead of paying the
amount of loss or damage or may join with any other insurer in so doing but 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
chosen to reinstate such property as it was at the time of occurrence of such loss
or damage not more than the Sum Insured by the Company thereon .
9. Average : If the property hereby insured shall at the time of any loss or damage
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
ratable proportion of the loss or damage accordingly. Every item, if more than one
of the
Policy shall be separately subject to this condition .
10. Arbitration : If any 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 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 disinterested persons as arbitrators of whom one shall be
appointed in writing by each of the parties within two calendar months after
having been required so to do in writing by the other party in accordance with the
provisions of the Arbitration Act 1940 as amended from time to time and for the
time being in force. In case either party shall refuse or fail to appoint arbitrator
within two calendar months after receipt of notice in writing requiring an
appointment, the other party shall be at liberty to appoint sole arbitrator, and in
case of disagreement between the arbitrators, the difference shall be referred to
the decision of an umpire who shall have been appointed by them in writing
before entering on the reference and who shall sit with the arbitrators and preside
at their meetings .
It is clearly agreed and understood that no difference or dispute shall be referable
to arbitration as herein before 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 or umpire of the amount of the loss or damage shall be first
obtained.
It is also hereby further expressly agreed and declared that if the Company shall
disclaim liability to the insured for any claim hereunder and such claim shall not
within 12 calendar months from the date of such disclaimer have been made the
subject matter of a suit in a court of law, then the claim shall for all purpose be
deemed to have been abandoned and shall not thereinafter be recoverable
hereunder.
11. Observation of Terms and Conditions : The due observance and fulfillment of the
terms, conditions and endorsements of this Policy in so far as they relate to
anything to be done or compiled with by the insured shall be a condition
precedent to any liability of the Company to make any payment under this Policy.
12. Interest / Penalty : No sum payable under this Policy shall carry any interest or
penalty.
13. Geographical Scope : The Geographical Scope of this Policy will be India except
for Section - I ( Portable Computers), Section VI (Personal Accident), Section - IV
(Baggage Insurance).
GENERAL EXCEPTIONS
This Company shall not be liable in respect of :
1. Loss, damage, liability or expenses, whether direct or indirect occasioned by
happening through or arising from any consequence of war, invasion, act of
foreign enemy, hostilities (whether war be declared or not) civil war, rebellion,
revolution, insurrection military or usurped power or civil commotion or loot or
pilferage in connection therewith.
2. Loss or damage caused by depreciation or wear and tear.
3. Consequential loss of any kind or description.
4. a) Loss or damage directly or indirectly caused by or arising from or in
consequence of or contributed to by nuclear weapons material.
b) This insurance does not cover loss or damage directly or indirectly caused
by or arising from or in consequence of or contributed to by ionising
radiations or contamination by radioactivity from any nuclear fuel or from any
nuclear waste from the combustion of nuclear fuel. For the purpose of this
Condition 4(b) only combustion shall include any self- sustaining process of
nuclear fission.
5 Loss or damage caused by Terrorism and sabotage activities.
SECTION I LAP TOP
SCOPE OF COVER
The Company will indemnify the Insured in the event of any unforseen sudden physical
loss or damage due to any cause other than those specifically excluded to portable
computer specified in the schedule and belonging to the Insured and in personal
custody of insured, whilst anywhere in the world for the purpose of business or
profession .
SPECIAL EXCLUSION TO SECTION I
The Company will not be liable for :
a) 10% (Ten percent ) of the claim amount subject to a minimum of Rs. 5,000/- (Five
Thousand Only) for each and every occurrence of damage .
b) Damage caused by any faults or defects existing at the time of commencement of
present insurance within the knowledge of insured or his representatives whether
such faults or defects were known to the Company or not .
c) Damage due to or consequent upon wear and tear, gradual deterioration,
atmospheric or climatic conditions rust, corrosion, moth vermin or insect .
d) Any costs incurred in connection with the elimination of functional failures unless
such failures were caused by an indemnifiable damage .
e) Any cost incurred in connection with the maintenance of the insured items such
exclusions will also apply to parts exchanged in course of such maintenance
operations .
f) Damage to rented or hired equipment for which the owner is responsible either by
law or under a lease and / or maintenance agreement .
g) Damage due to defects of design material or workmanship or otherwise for which
manufacturer or supplier of the insured items is responsible either by law or under
contract or any amount recoverable under the terms of the Maintenance Agreement
.
h) aesthetic defects, such as scratches on painted, polished or enamelled surfaces .
PROVISIONS APPLYING TO SECTION I :
1. SUM INSURED :
It is a requirement of this insurance that the Sum Insured shall be equal to the Cost of
replacement of the insured property by new property of the same kind and same
capacity, which shall mean its replacement cost including freight , dues and customs
duties, if any.
2. BASIS OF INDEMNITY :
(a) In cases where damage to an insured item can be repaired the Company will
pay expenses necessarily incurred to restore the damaged machine to its former state
of serviceability plus the cost of dismantling and re-erection incurred for the purpose of
effecting the repairs as well as ordinary freight to and from a repair shop, customs
duties and dues if any, to the extent such expenses have been included in the Sum
Insured, if the repairs are executed at a workshop owned by the Insured, the Company
will pay the cost of materials and wages incurred for the purpose of the repairs plus a
reasonable percentage to cover overhead charges .
No deduction shall be made for depreciation in respect of parts replaced, except those
with limited life, but the value of any salvage will be taken into account . If the cost of
repairs as detailed herein above equals or exceeds the actual value of the machinery
insured immediately before the occurrence of the damage, the settlement shall be
made on the basis provided for in (b) below .
(b) In cases where an insured item is destroyed - the Company will pay the actual
value of the item immediately before the occurrence of the loss, including costs for
ordinary freight , erection and customs duties if any, provided such expenses have
been included in the sum insured, such actual value to be calculated by deducting
proper depreciation from the replacement value of the item . The company will also
pay any normal charges for the dismantling of the machinery destroyed , but the
salvage will be taken into account .
Any extra charges incurred for overtime, night-work , work on public holidays, express
freight are covered by this insurance only if especially agreed to in writing .
The cost of any alterations, improvements or overhauls shall not be recoverable under
this policy .
The cost of any provisional repairs will be borne by the Company if such repairs
constitute part of the final repairs, and do not increase the total repair expenses .
If the sum insured is less than the amount required to be insured as per Provision-I
hereinabove, the Company will pay only in such proportion as the sum insured bears
to the amount required to be insured. Every item if more than one shall be subject to
this condition separately.
The Company will make payments only after being satisfied by production of the
necessary bills and documents, that the repairs have been effected or replacement
have taken place, as the case may be
WARRANTY
It is warranted that the Maintenance Agreement in force at the inception of this Policy
is maintained during the currency of this policy no variation in the terms of the
Agreement shall be made without the written consent of the Company being obtained.
For the purpose of this warranty the word Maintenance shall mean the following :
(i) Safety checks
(ii) Preventive maintenance
(iii) Rectification of loss or damage or faults arising from normal operation as well
as from aging.
SECTION II - CELLULAR PHONE
The Company will indemnify the insured for the loss of or damage to cellular phone by
theft and burglary, fire, lightning, explosion, malicious or accidental damage due to
external means, earthquakes, flood, storm, electrical and mechanical breakdown.
SPECIAL EXCEPTION
The Company shall not be liable in respect of :
1. Loss or damage to handset occurring outside India.
2. Loss or damage caused by misplacement.
3. Loss arising out of ordinary wear and tear.
4. Loss or damage to SIM CARD or other accessories (including antenna and flip)
unless Cellular Phone itself is damaged or stolen at the same time.
5. Loss or damage caused by the willful act of the insured, agent or members of the
Insured’s family.
6. The first Rs.1000/- of each and every claim.
SECTION III - LOSS OF CASH
SCOPE OF COVER
In the event of loss of cash due to accident or misfortune happening during the
currency of the policy when the insured is on official duty or on tour outstation, the
Company will pay to the insured the amount of such loss not exceeding the amount
stated in the schedule upto a maximum of Rs.5,000/- during the policy period.
SPECIAL EXCLUSION TO SECTION III
The Company shall not be liable for
(i) Shortage of money due to error or omission.
(ii) loss of money entrusted to any person by the insured.
(iii) loss arising from fraud or dishonesty of the insured.
(iv) the amount of loss insured by any other policy.
SPECIAL CONDITIONS
On happening of a loss, the insured shall inform the Police and shall obtain First
Information Report (FIR) as a record of proof. The Insured should also submit
documentary evidence that the money obtained was either through bank withdrawals
or from his office.
SECTION IV - BAGGAGE INSURANCE
In the event of loss or damage due to theft/ burglary/accident or misfortune whilst on
journey, anywhere in the world, the Company will indemnify the insured in respect of
such loss or damage upto the actual value at the time of happening of loss or damage
but not exceeding the Sum Insured in any one period of Insurance.
Journey
It shall mean a trip undertaken in connection with official purpose outside the city, town
or municipal limit of place where office is situated.
Baggage
It shall mean personal effects belonging to the insured which are necessary for journey
purpose and are being taken by him or her on journey or acquired during the journey.
SPECIAL EXCLUSIONS
The Company will not be liable for :
a) First Rs.500/- (five hundred only) in each and every loss or damage.
b) Damage due to confiscation or detention by custom or any other public authority.
c) Damage not reported to Police within 24 hours of discovery.
d) Damage due to cracking, scratching or breakage of lens or glass whether part of
any equipments or otherwise or of China marble, gramophone records and other
articles of a brittle or fragile nature, unless such loss or damage arises from
accident to vessel, train, vehicles or aircraft by which such property is conveyed.
e) Damage caused by moth, mildew, vermin or any process of cleaning, dyeing,
repairing or restoring to which the property is subjected.
f) Damage to any electrical machines, apparatus, fixtures or fittings ( including
wireless sets, radio, television sets and tape recorders ) arising from overrunning,
excessive pressure, short circuiting, arcing, self heating or leakage of electricity
from whatever cause (lightning included).
g) Theft from car except from car of fully enclosed saloon type having all the doors,
windows and other openings, securely locked and properly fastened.
h) Damage whilst being conveyed by any carrier under contract of affreightment.
i) Damage to money, securities, manuscripts, deeds bonds, bills of exchange,
promissory notes, stock or share certificates, stamps, business books or
documents, jewellery, watches, fur, precious metals, precious stones, gold and
silver ornaments, travel tickets, cheques and bank drafts.
j) Damage, destruction of or to articles of consumable nature.
k) Loose articles such as sticks, straps, umbrellas, sunshades, fans, deck chairs,
property in use on the voyage and/or journey or articles or clothes whilst being
worn on the person or carried about.
l) Damage or destruction caused by or arising from the leakage, spilling or exploding
of liquid oils or materials of a like nature or articles of a dangerous or damaging
nature.
SECTION V - ALL RISKS ( JEWELLERY AND VALUABLES )
The Company will indemnify the Insured in respect of loss or damage to jewellery and
Valuables caused by Accidents or Misfortune whilst anywhere in India . Provided that
the liability of the Company in respect of any one item any one period of insurance will
not exceed the sum insured set against such item in the Schedule hereto and not
exceeding in the aggregate the total sum insured hereby Provided further that where
damage to any item can be repaired the Company will pay expenses necessarily
incurred to restore the damaged item to its former state of serviceability not exceeding
the sum insured in respect of such item .
It is expressly declared and agreed that the condition of average in so far as this
section is concerned is deemed deleted .
SPECIAL EXCEPTIONS
The Company shall not be liable in respect of :
I. Loss or damage due to cracking , scratching or breakage of lens or glass whether
part of any equipment or otherwise or to china marble, gramophone records and
other articles of brittle or fragile nature unless such loss or damage arise from
accident to railway train or ship or aircraft or vehicle by which such property is
being conveyed.
II. Loss or damage caused by moth, mildew, vermin or any process of cleaning,
dyeing or restoring to which the property is subjected .
III. Loss of or damage to any electrical or electronic machine, apparatus, fixtures or
fittings (including electrical fans, electric household or domestic appliances,
wireless sets radio, tape recorders, television sets and the like) or to any portion of
electrical installation arising from or occasioned by overrunning, excessive
pressure short circuiting, arcing, self-heating or leakage of electricity from whatever
cause (lightning included)
IV. Loss or damage caused by mechanical derangement or over winding of watches
and clocks .
V. Theft from car except from car of fully enclosed saloon type having all the doors,
windows and other openings securely looked and property fastened .
VI. Loss or damage whilst being conveyed by any carrier under contract of
affreightment.
SPECIAL CONDITIONS
I. where any item insured hereunder consists of articles in pair or set the company’s
liability in respect thereof shall not exceed the value of any particular part or parts
which may be lost or damaged without reference to any special value which such
articles may have as part of such pair or set not more than a proportionate part of
the insured of the pair or set .
II. No one article or pair of articles is deemed to be more than 10% of the sum insured
under this section unless separately specified and value stated .
SECTION VI - PERSONAL ACCIDENT
If any Insured shall during the currency of the Policy sustain anywhere in the World,
bodily injury solely and directly caused by accidental, violent , external and visible
means resulting in death or disablement within 12 (Twelve) calendar months of
occurrence of such injury as stated hereinafter, the Company shall pay to the insured
the sum or sums hereinafter set forth .
TABLE OF BENEFITS
INDIVIDUAL
PERCENTAGE OF
CAPITAL SUM INSURED (C.S.I)
1. Death
100%
2. Total and Irrecoverable loss of
i) Sight of both eyes, or of the actual
loss by physical separation of the two
entire hands or two entire feet or of
such loss of sight of one eye and such
loss of one entire hand or one entire
foot.
ii) Use of two hands or two feet, or of
one hand and one foot or of such loss
of sight of one eye and such loss of use
of one hand or one foot, without
physical separation
100%
100%
3. Total and irrecoverable loss of
i) The sight of one eye or of the actual
loss by physical separation of one
entire hand or one entire foot.
ii) Use of a hand or a foot without
physical separation
50%
50%
4. Permanent Total and Absolute disablement
disabling the insured person from
engaging in any employment or
occupation of any description
whatsoever.
100%
NOTE For the purpose of Clause 2 and Clause 3 above, physical separation of a
hand means separation at or above the wrist and of the foot at or above the ankle.
5. In such injury shall within twelve calendar months of its occurrence be the sole
and direct cause of the total and/or partial and irrecoverable loss of use or of the
actual loss by physical separation of the following, then the percentage of the
Capital Sum Insured as indicated below shall be payable :-
Percentage of
Capital Sum Insured
i) Loss of toes - all
Great - both phalanges
Great - one phalanx
Other than great, if more than one
toe lost each
20
05
02
01
ii) Loss of hearing - both ears
75
iii) Loss of hearing - one ear 30
iv) Loss of four fingers and thumb of one
hand
40
v) Loss of four fingers 35
vi) Loss of thumb - both phalanges
- on phalanx
25
10
vii) Loss of index finger
- three phalanges or
two phalanges or
one phalanx
10
viii) Loss of middle finger
- three phalanges or
two phalanges or
one phalanx
06
ix) Loss of ring finger
- three phalanges or
two phalanges or
one phalanx
05
x) Loss of little finger
- three phalanges or
two phalanges or
one phalanx
04
xi) Loss of metacarpals
- first or second
(additional) or
third, fourth or
fifth (additional)
03
xii) Any other permanent partial
disablement
Percentage as assessed by the
Panel doctor of the Company
5. Temporary total disablement of the
Insured Person following accident for
maximum of 100 weeks.
1% of C.S.I. or
Rs. 3000/- whichever
is lower per week .
For the purpose of benefits applicable, Table D will cover of above Benefit (1)
only, Table C will cover of above Benefit (1) to (4), Table B will cover of above
Benefit (1) to (5) and Table A will cover of above Benefit (1) to (6). The applicable
benefits with CSI for the same as more specifically described in the shedule will
be considered for any liability under the Policy.
6. In the event of death of the insured person due to accident as defined in the
Policy outside his / her residence, the Company shall reimburse expense incurred
for transportation of insured dead body to the place of residence subject to a
maximum of 2% (Two percent) of CSI or Rs. 2,500/- (Two Thousand Five
Hundred Only) whichever is lower .
7. Education Grant : In the event of death or permanent total disablement of the
Insured , due to accident as defined, the Policy shall pay as education grant for
the dependent children as below :
a) If the Insured person has one dependent child below the age of 25 years, an
amount equal to 10% of the CSI subject to a maximum of Rs. 5000/-.
b) If the Insured person has more than one dependent child below the age of 25
years, an amount equal to 10% of the CSI subject to maximum of Rs. 10,000/-.
The payment as above will be made along with the CSI to the same person/s who
is/are entitled to receive the CSI .
Provided that if there be any other subsisting P.A. Insurance covering the Insured
person total benefits under this policy and under all such policies, shall be limited
to a maximum of Rs. 5,000/- in case there is one dependent child and Rs. 10,000
in case there are more than one dependent child . The amount payable shall be
borne by all the policies in proportion to the original sum insured .
8. In the event of admissible claim , the Company shall also reimburse Ambulance
charges necessarily incurred for transportation of the insured to the Hospital
subject to a limit of Rs. 1,000/- (One Thousand Only) any one policy period .
SPECIAL PROVISIONS
I. Insured shall mean the insured aged between 18 years and 70 years permanently
working with the office as stated in the Schedule .
II. Temporary Total Disablement will mean the period the insured is disabled
following accident and is totally incapable from engaging in any employment or
occupation .
III. For the purpose of item 2 and 3 of table of benefits, physical separation of a
hand or foot means separation at or above wrist or at or above ankle respectively .
SPECIAL EXCLUSIONS
Provided always that :
The Company shall not be liable under this policy for :
a) Compensation under more than one of the foregoing benefits 1 to 5, in respect of
the same accident .
b) Any payment in case of more than one claim under the policy during any one
period of Insurance by which the maximum liability of the Company in that period
would exceed the sum payable under Benefit (1) of this Section .
c) Payment of compensation in respect of death , injury or Disablement from
intentional self -injury , suicide or attempted suicide, whilst under the influence of
intoxicating liquor or drugs, whilst engaging in ballooning or Aviation, whilst
mounting into, dismounting from or travelling in any Balloon or Aircraft other than
as a passenger (fare paying or otherwise) in any duty licensed standard type of
Aircraft anywhere in the world .
d) Directly or indirectly caused by venereal diseases or insanity .
e) Death or disablement resulting directly or indirectly caused by or contributed to or
aggravated or prolonged by childbirth or pregnancy or in consequence thereof .
f) Arising or resulting from the insured person committing any breach of law with
criminal intent .
CUMULATIVE BONUS
Compensation payable under Table of Benefits (1), (2), (3) and (4) of the policy viz .
death, loss of limb(s) or sight and permanent Total Disablement arising out of
accidental injuries shall be increased by 5% thereof in respect of each completed year
during which the Policy shall have been in force prior to the occurrence of an accident
for which capital sum becomes payable but amount of such increase shall not exceed
50% of the capital sum insured stated in the Schedule herein .
Endorsement To Cover Medical Expenses
Endorsement No. extending insurance
under Policy No. in the name of
In consideration of the payment of an additional premium amounting to Rs. _________
it is hereby agreed and declared that notwithstanding anything in the within written
policy contained to the contrary, this insurance is extended to cover the medical
expenses necessarily incurred and expended in connection with any accident as
specified in the Policy , for which a claim is made by the Insured and admitted by the
Company .
The Company shall reimburse to the Insured an amount upto but not exceeding forty
percent of the compensation paid in settlement of a valid claim under this Policy or
10% of the relevant sum insured whichever is less . Further, it is a condition precedent
to the payment of such medical expenses that the medical attendant‘s detailed account
shall be submitted to and is approved by the Company .
PROVIDED ALWAYS THAT ;
1. This insurance shall not apply, in so far as it applies to a female to expenses
incurred in respect of any conditions arising from or traceable to any disease of the
organs of generation , malignant disease of mammary gland, pregnancy, childbirth,
abortion or miscarriage or any complications and/or sequels arising from the
foregoing, unless otherwise provided hereafter .
2. The Company shall not be liable to make any payment under this Policy in respect
of :-
I. Disease, Injury, Death or Disablement directly or indirectly due to War, Invasion,
Act or Foreign Enemy Hostilities or Warlike Operations (whether war be declared
or not) or Civil Commotion or Rebellion Military, Naval or Air Service or Breach of
Law of Hunting , steeplechasing, Revolution, Insurrection, Mutiny, engaging in
aviation other than as a passenger (fare paying or otherwise) in any licensed
Standard Type of Aircraft .
II. Circumcision or Structures or Vaccination or Innoculation or change of life or
beauty treatment of any description or dental or eye treatment or Intentional self
injury or insanity or dissipation or Nervous Breakdown (which expression shall
cover also general debility “run down” conditions and General “overhaul” ) or
venereal Disease or intemperance or the use of intoxicating drugs or liquors or any
diseases, injury, death or disablement directly or indirectly due to any one or more
of them .
Subject otherwise to the terms, exceptions, conditions and limitations of this Policy .
SECTION VII MEDICLAIM
Scope of Cover
The Company undertakes that if during the period stated in the Schedule or during the
continuance of this policy by renewal any Insured shall contract any disease or suffer
from any illness (hereinafter called DISEASE) or sustain any bodily injury through
accident (hereinafter called INJURY) and if such disease or injury shall require any
such Insured Person, upon the advice of a duly qualified Physician/Medical
Specialist/Medical Surgeon (hereinafter called SURGEON) to incur a) hospitalisation
expenses for medical/surgical treatment at any Nursing Home/Hospital in India as
herein defined (hereinafter called HOSPITAL) as an inpatient OR (b) on domiciliary
treatment in India under Domiciliary Hospitalisation Benefits as hereinafter defined, the
Company will pay to the Insured the amount of such expenses as are reasonably and
necessarily incurred in respect thereof by or on behalf of such Insured but not
exceeding the sum insured in aggregate in any one period of insurance stated in the
schedule hereto.
1.0 In the event of any claims becoming admissible under this Scheme, the
Company will pay to the insured the amount of such expenses as would
fall under different heads mentioned below, and as are reasonably and
necessarily incurred thereof by or on behalf of such Insured, but not
exceeding the Sum Insured in aggregate mentioned in the schedule
hereto.
A) Room, Boarding Expenses as provided by the hospital/nursing home.
B) Nursing Expenses
C) Surgeon, Anesthetist, Medical Practitioner, Consultant, Specialist
Fees.
D) Anesthesia, Blood, Oxygen, Operation Theatre Charges, Surgical
Appliances.
Medicines and Drugs, Diagnostic Materials and X-Ray, Dialysis,
Chemotherapy, Radiotherapy , Cost of Pacemaker, Artificial Limbs and
Cost of organs and similar expenses.
Note: Company’s liability in respect of all claims admitted during the
period of insurance shall
not exceed the Sum Insured per person mentioned in the
Schedule.
2
2.1
DEFINITIONS :
“HOSPITAL/NURSING HOME” means any institution in India established
for indoor care and treatment of sickness and injuries and which
Either
a) has been registered either as a Hospital or Nursing Home with the
local authorities and is under the supervision of a registered and qualified
Medical Practitioner.
Or
b) should comply with minimum criteria as under
I) It should have at least 15 in-patient beds
ii) fully equipped operation theater of its own wherever surgical
operations are carried out.
Iii) fully equipped nursing staff under its employment round the
clock
iv) fully qualified Doctor(s) should be in charge round the clock
NB (In class ‘C’ towns, condition of number of beds be reduced to 10)
2.1.1 The term “HOSPITAL/NURSING HOME” shall not include an
establishment which is a place of rest, a place for the aged, a place for
drug-addicts or place of alcoholics, a hotel or a similar place.
2.2 “SURGICAL OPERATION” means manual and/or operative procedures
for correction of deformities and defects, repair or injuries, diagnosis and
cure of disease, relief of suffering and prolongation of life.
2.3 Expenses of Hospitalisation for minimum period of 24 hours are
admissible. However, this time limit is not applied to specific treatments
i.e. Dialysis, Chemotherapy, Radiotherapy , Eye Surgery, Dental Surgery,
Lithotripsy (Kidney stone removal), D&C, Tonsillectomy taken in the
Hospital/Nursing Home and the Insured is discharged on the same day;
the treatment will be considered to be taken under Hospitalisation
Benefit.
2.4 DOMICILIARY HOSPITALISATION BENEFIT MEANS:
Medical treatment for a period exceeding three days for such
illness/disease/injury which in the normal course would require care and
treatment at the hospital/nursing home but, actually taken whilst confined
at home in India under any of the following circumstances namely :-
I) The condition of the patient is such that he/she cannot be removed to
the hospital/nursing home or
II) The patient cannot be removed to hospital/nursing home for lack of
accommodation therein
Subject however that Domiciliary hospitalisation benefits shall not cover:-
I) Expenses incurred for pre and post hospital treatment and
II) Expenses incurred for treatment for any of the following diseases:
1) Asthma
2) Bronchitis
3) Chronic Nephritis and Nephrotic Syndrome.
4) Diarrhea and all type of Dysenteries including Gastroenteritis
5) Diabetes Mellitus and Insipidus
6) Epilepsy
7) Hypertension
8) Influenza, Cough and cold
9) All Psychiatric or Psychosomatic Disorders
10) Pyrexia of unknown Origin for less than 10 days
11) Tonsillitis and upper Respiratory Tract infection including
Laryngitis and pharingitis.
12) Arthritis, Gout and Rheumatism
Note When treatment such as Dialysis, Chemotherapy, Radiotherapy etc. Is
taken in the Hospital/Nursing Home and the Insured is discharged on the
same day, the treatment will be considered to be taken under
Hospitalisation benefit section.
Liability of ‘The Company’ under this clause is testified as stated in the
Schedule attached hereto.
3 ANY ONE ILLNESS
Any one illness will be deemed to 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.
Occurrence of same illness after a lapse of 45 days as stated above will
be considered as fresh illness for the purpose of this policy.
3.1 PRE-HOSPITALISATION
Relevant medical expenses incurred during period upto 30 days prior to
Hospitalisation/ Domiciliary hospitalisation on disease/illness/injury
sustained will be considered as part of claim mentioned under item
above.
3.2 POST-HOSPITALISATION
Relevant Medical expenses incurred during period upto 60 days after
Hospitalisation/Domiciliary Hospitalisation on disease/illness/injury
sustained will be considered as part of claim as mentioned under item 1.1
above.
3.3 MEDICAL PRACTITIONER means a person who holds a degree/diploma
of a recognised institution and is registered by Medical Council of
respective state of India. The term Medical Practitioner would include
Physician, Specialist and Surgeon
3.4 QUALIFIED NURSE
Means a person who holds a certificate of a recognised Nursing Council
and who is employed on recommendations of the attending medical
practitioner.
4
4.0
EXCLUSIONS :
The company shall not be liable to make any payment under this policy in
respect of any expenses whatsoever incurred by any Insured in
connection with or in respect of :-
4.1 Such disease which have been in existence at the time of proposing this
insurance. Pre-existing condition means any injury which existed prior to
the effective date of this insurance. Pre-existing condition also means any
sickness or its symptoms which existed prior to the effective date of this
insurance, whether or not the Insured had knowledge that the symptoms
were relating to the sickness. Complications arising from pre-existing
disease will be considered part of that pre-existing condition.
4.2 Any expenses on hospitalisation/domiciliary hospitalisation incurred
during first 30 days from the date of commencement of insurance cover
except in case of injury arising out of an accident.
4.3 During the first year of the operation of insurance cover, the expenses on
treatment of diseases such as Cataract, Benign Prostrate Hypertropy,
Hysterectomy for Menorrhagia, or Fibromyoma, Hernia, Hydrocele,
Congenital Internal disease, Fistula in anus, piles, Sinusitis and related
disorders are not payable. If these diseases are pre-existing at the time
of proposal they will not be covered even during subsequent period or
renewal too.
4.4 Injury/disease directly or indirectly caused by or arising from or
attributable to War invasion, Act of foreign enemy, War like operations
(whether war be declared or not)
4.5 Circumcision unless necessary for treatment of a disease not excluded
hereunder or as may be necessitated due to an accident, vaccination or
inoculation or change of life or cosmetic or aesthetic treatment of any
description, plastic surgery other than as may be necessitated due to an
accident or as part of any illness.
4.6 Cost of spectacles and contact lenses and hearing aids.
4.7 Dental treatment or surgery of any kind unless requiring hospitalisation.
4.8 Convalescence, general debility, ‘Run-down’ condition or rest cure,
Congenital , external disease or anomalies, sterility, venereal disease,
intentional self injury and use of intoxication drugs/alcohol.
4.9 All expenses arising out of any condition directly or indirectly caused to or
associated with Human T-Cell Lymphotropic Virus Type III (HTLB-III) or
lymphadenopathy Associated Virus (LAV) or the Mutants Derivative or
Variation Deficiency syndrome or any syndrome or condition of a similar
kind commonly referred to as AIDS.
4.10 Charges incurred at Hospital or Nursing Home primarily for diagnosis, XRay
or Laboratory examination not consistent with incidental to the
diagnosis and treatment of positive existence or presence of any ailment,
sickness or injury, for which confinement is required at a Hospital/Nursing
Home .
4.11 Expenses on vitamins and tonics unless forming part of treatment for
injury or disease as certified by the attending physician.
4.11.1 Injury or Disease directly or indirectly caused by or contributed to by
nuclear weapons/materials.
4.12 Treatment arising from or traceable to pregnancy, childbirth including
cesarean section.
4.13 Naturopathy Treatment
5.0 CONDITIONS
5.1 Every notice or communication to be given or made under this Policy
shall be delivered in writing at the address as shown in the Schedule.
5.2 The premium payable under this policy shall be paid in advance. No
receipt for Premium shall be valid except on the official form of the
company signed by a duly authorised official of the company. The due
payment of premium and the observance and fulfillment of the terms
provisions, conditions and endorsements of this Policy by the Insured 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 the Policy , No waiver of any terms, provisions,
conditions and endorsement of this policy shall be valid unless made in
writing and signed by an authorised official of the Company.
5.3 Upon the happening of any event which may give rise to a claim under
this Policy notice with full particulars shall be sent to the Company within
7 days from the date of Death, Injury, Hospitalisation/Domiciliary
Hospitalisation.
5.4 Claim must be filed within 30 days from date of discharge from the
hospital.
Note: Waiver of this Condition may be considered in extreme cases of
hardship where is proved to the satisfaction of the Company that under
the circumstances in which the insured was placed it was not possible for
him or any other person to give such notice or file claim within the
prescribed time-limit.
5.5 The Insured shall obtain and furnish the Company with all original bills,
receipts and other documents upon which a claim is based and shall also
give the Company such additional information and assistance as the
Company may require in dealing with the claim.
5.6 Any medical practitioner authorised by the Company shall be allowed to
examine the Insured in case of any alleged injury or disease requiring
Hospitalisation when and so often as the same may reasonably be
required on behalf of the Company.
5.7 The Company shall not be liable to make any payment under this policy
in respect of any claim if such claim be in any manner fraudulent or
supported by any fraudulent means or device whether by the Insured or
by any other person acting on his behalf.
5.8 If at the time when any claim arises under this policy, there is in existence
any other insurance (other than Cancer Insurance Policy in collaboration
with Indian Cancer Society) whether it be effected by or on behalf of any
Insured in respect of whom the claim may have arisen covering the same
loss, liability, compensation, costs or expenses, the Company shall not be
liable to pay or contribute more than its ratable proportion of any loss,
liability, compensation, costs or expenses. The benefits under this Policy
shall be in excess of the benefits available under Cancer Insurance
Policy.
5.9 Cancellation Clause :
The Policy may be renewed by mutual consent. The Company shall not
however be bound to give notice that it is due for renewal and the
Company may at any time cancel this Policy by sending the Insured 30
days notice by registered letter at the Insured’s last known address and
in such event the Company shall refund to the Insured a pro-rata
premium for unexpired Period of Insurance. The company shall
however, remain liable for any claim which arose prior to the date of
cancellation. The Insured may at any time cancel this Policy and in such
event the Company shall allow refund of premium at Company ‘s short
period rate only (table given herebelow) provided no claim has occurred
up to the date of cancellation.
PERIOD ON RISK RATE OF PREMIUM TO BE
CHARGED
Upto one month 1/4 th of the annual rate
Upto three months 1/2 of the annual rate
Upto six months 3/4th of the annual rate
Exceeding six months Full annual rate
5.10 If any difference shall arise as to the quantum to be paid under this Policy
(liability being otherwise admitted) such difference shall be referred to
arbitration in accordance with the provisions of the Indian Arbitration Act,
1940 as amended from time to time and for the time being in force. 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.
5.11 If the Company shall disclaim liability to the Insured for any claim
hereunder and if the Insured shall not within 12 calendar months from the
date of receipt of the notice of such disclaimer notify the Company in
writing that he does not accept such disclaimer and intends to recover his
claim from the Company then the claim shall for all purposes be deemed
to have been abandoned and shall not thereafter be recoverable
hereunder.
5.12 All medical/surgical treatments under this policy shall have to be taken in
India and admissible claims thereof shall be payable in Indian currency.
6 PAYMENT OF CLAIM
All claims under this policy shall be payable in Indian currency. All
medical treatments for the purpose of this insurance will have to be taken
in India only.
7
CUMULATIVE BONUS
Sum Insured under the policy shall be progressively increased by 5% in
respect of each claim free year of insurance, subject to maximum
accumulation of 10 claim free years of insurance.
7.1
In case of a claim under the policy in respect of Insured person who has
earned the cumulative bonus, the increased percentage will be reduced
by 10% of Sum Insured at the next renewal, however basic Sum Insured
will be maintained and will not be reduced.
N.B. 1) for existing policy holders (as date of implementation) the
accrued amount of benefit of cumulative bonus will be added to the Sum
Insured, subject to maximum 10 claim free years.
2) Cumulative bonus will be lost if policy is not renewed on the date of
expiry
Waiver : In exceptional circumstances the seven days extension in period
of renewal is permissible to be entitled for cumulative bonus although the
policy is renewed only subjected to Medical Examination and exclusion of
diseases.
COST OF HEALTH CHECK UP
In addition to Cumulative Bonus, the insured shall be entitled for
reimbursement of the cost of medical check-up once at the end of block
of every four underwriting years provided there are no claims reported
during the block. The cost so reimbursable shall not exceed the amount
equal to 1% of the amount of average sum insured during the block of
four underwriting years.
IMPORTANT
For Cumulative Bonus and Health Check-up Provisions as aforesaid
Both Health Check-up and Cumulative Bonus provisions are applicable
only in respect of continuous insurance without break excepting however,
where in exceptional circumstances the break in period for a maximum of
seven days is approved as a special case subject to medical examination
and exclusion of disease during the break period.
Health Check-up benefit will be accrued after completion of four years
continuous claim free insurance.
SECTION VIII - PERSONAL LIABILITY
Personal Liability : The Company will indemnify the insured against all sums which
the insured shall become legally liable to pay .
a) As compensation in respect of accidental death or injury to any person other than
insured or his family members or any other person residing with him .
b) In respect of accidental damage to property caused by or through the fault or
negligence of insured person .
Whilst caused during performance of any act in connection with insured‘s Business or
Profession during the currency of this policy within India upto the limit of sums set in
the Schedule for any one event and for all events during the Period of Insurance .
SPECIAL PROVISIONS
i) Injury shall mean death, bodily injury, illness or disease of or to any person .
ii) Property shall mean material property.
iii) Damage means actual and/or physical damage to material property .
iV) Event shall mean one occurrence or number of occurrences arising directly or
indirectly from one source or original source .
v) Insured shall mean the insured between 18 years and 70 years of age .
Limit of Indemnity
The Company’s liability shall not exceed the sum insured mentioned in the schedule .
SPECIAL EXCLUSIONS
The Company will not be liable for :
a) The first Rs. 2,000/- in respect of Third Party Property Damage .
b) Any compensation for death of or bodily injury to any member of insured person’s
family , partners, managerial staff, contractors, employees or damage to property
belonging to or in the custody of or control of insured or insured person’s family
partner, directors managerial staff, employees and contractors employees .
c) Liability assumed by agreement unless such liability would have attached to the
insured notwithstanding such agreement .
d) Injury or Damage caused by or resulting from anything sold, supplied, installed,
erected, repaired, altered or treated and/ or due to professional advice rendered
by the Insured or by any person on behalf of the insured other than food or
beverages sold or supplied by the insured as a service the employees or visitors
for consumption in the office .
e) Accidents directly or indirectly caused by, traceable to or arising out of the
ownership, possession or the custody by or on behalf of insured of animals,
vehicles, aircrafts, ships, boats or crafts of any kind .
f) Liability arising out of loss pure financial nature such as loss of goodwill loss of
market etc.
g) a) Liability arising out of all personal injuries such as libel,slander, false arrest,
wrongful eviction and detention, deformation and mental injury arising or
shock resulting therefrom
b) Infringement of plans, copyright, patents trademark , registered design .
h) For fines, penalties, punitive or exemplary damage or any other resulting from the
multiplication of compensatory damage .
i) a) Damage to property owned, leased and hired or under hire purchase or on
loan to the insured or otherwise in the insured’s care custody and control and
control other than : the premises (or the contents thereof) temporarily
occupied by the insured for work thereon or other property temporarily in the
insured’s possession for work therein ( but no indemnity is granted for damage
to that part of the property on which the insured is working and which arises
out of such work. )
b) Employees and visitors clothing and personal effects.
j) Transportation of materials and/or hazardous/dangerous substances outside
insured’s premises.
k) Damages arising out alterations, additions, repairs or decorations to the office
premises specified in the Schedule.
PERSONAL PACKAGE INSURANCE POLICY FOR EXECUTIVES/ BUSINESSMEN
Schedule attached to policy
Agency code No. _______________
Policy No. ________________
1. Insured’s Name and address :-
___________________________________________
_____________________________________________________________________
_____________________________________________________________________
2.Business or profession of Insured
_________________________________________
____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
__
3.Address of Office Premises
______________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
__
4. Period of Insurance From _______________am/pm To
________________(midnight)
5. Total premium Rs.
_____________________________________________________
Covers operative
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Section I
1 Portable Computer/Lap Top
--------------------------------------------------------------------------------------------------------------
Description of item Yr. of make Sum Insured
MAKE SR. NO. MODEL NO.
-------------------------------------------------------------------------------------------------------------
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Rate (Two Percent) Premium Rs.______
SECTION II
Cellular Phone
-------------------------------------------------------------------------------------------------------------
Make Phone No. Handset SIM card Model MFG Sum Insured
Sr. No. No. Yr.
-------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------
Rate (2.5 Percent) Premium Rs. __________
Section I I I
Loss of cash
Sum Insured
--------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------
Rate (One Percent ) Premium Rs. _________
Section IV
Baggage Insurance
Item Description Sum Insured
--------------------------------------------------------------------------------------------------------------
1.
2.
3.
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Rate (0.75 Percent) Premium Rs. ________
Section V
All Risk
--------------------------------------------------------------------------------------------------------------
Item Description Brand / Sum Insured
identification
--------------------------------------------------------------------------------------------------------------
1. Digital Diary Rs.
2. Gold Ring / Chain Rs.
3. Spectacles Rs.
4. Goggles Rs.
5. Pen set Rs.
6. Calculator Rs.
7. Camera Rs.
8. Wristwatches Rs.
9. Others (Specify) Rs.
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Rate (One Percent) Premium Rs.__________
Section VI
(Personal Accident)
--------------------------------------------------------------------------------------------------------------
Name of Age Details of Occupation Table Sum C.B Name
Insured existing Infirmity/ opted Insured earned of
Disability Assignee
--------------------------------------------------------------------------------------------------------------
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Rate (as per guidelines) Premium Rs._______
Section VII
Mediclaim
--------------------------------------------------------------------------------------------------------------
Name of Age/ Occupation Sum Insured Domiciliary C.B Existing
Insured Sex (overall Limit) Hosp. earned Disability
Limit
(Rs. Part
of S.I. )
--------------------------------------------------------------------------------------------------------------
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In case of group proposals necessary amendments, endorsements are to be passed to
give effect for adding bonus malus provision and deleting cumulative bonus and health
check -up provisions.
Rate (as per market agreement) Premium Rs. ________
SECTION VIII
PERSONAL LIABILITY
--------------------------------------------------------------------------------------------------------------
Limit of Liability
Personal Liability Rs. 50,000/-
----------------
Premium Rs. 25 Flat
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TOTAL PREMIUM Rs.
Less: Discount for covering Rs.
4 or More sections
@ 10% (Refer Note No.4) ________
NET PREMIUM Rs.
+ 5% Service Tax Rs. ________
TOTAL Rs. ________
(To be completed by Insurance company)
SPECIAL CONDITIONS : Insurance cover herein applies to section
Nos. _____________________above
in witness whereof signed by & on behalf
of the company .
OFFICE ADDRESS FOR THE NEW INDIA ASSURANCE CO.LTD
DATE
Duly constituted Attorney