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Cover and benefits (In accordance with the Danish Contracts Act)
INDEX
COVER AND BENEFITS
Policy conditions
Art 11 Personal accident
11.1 If the policyholder has cover for personal accident, reimbursement shall be paid by the insurance in the event of an accident that directly, and without the influence of any illness, causes the insured's death or results in loss of a limb, loss of sight, loss of extremity, or permanent total disablement.
11.1.1 An accident is defined as follows:
A fortuitous event occurring without the insured's intention which has a sudden, external and violent impact on the body, resulting in demonstrable bodily injury.
11.2 Exceptions for reimbursement:
a) any illness or pre-existing medical condition which occurs, even though the illness or condition recurs as a result of the accident or is aggravated by it,
b) any accident caused by illness,
c) any aggravated consequences of an accident due to a pre-existing condition or any unforeseen illness subsequently contracted,
d) any consequences of medical treatment not necessitated by an accident covered by the insurance,
e) if the insured is under the age of 18, compensation in case of death is limited to USD 3,000 / EUR 2,500 / CHF 4,000,
f) if the insured is over the age of 75, the compensation payable in case of death or disablement is limited to 50% of the insurance sum.
11.3 Reimbursement in case of death becomes payable at 100% of the insurance sum when an accident directly results in the insured's death within 1 year after the accident.
Unless the Company has received written instructions to the contrary, the insurance sum shall be paid to the insured's immediate family members, defined as the insured's spouse, or, if the insured leaves no spouse, the insured's children or, in the absence of any children, the insured's cohabitee, provided that such cohabitee has been registered at the same address as the insured for at least 2 years or, in the absence of a cohabitee, the insured's beneficiaries.
If reimbursement in the event of disablement was paid as a consequence of the accident, the amount of compensation payable is the amount by which the death benefit exceeds the payment already made.
11.4 Reimbursement in case of loss of a limb, loss of sight, loss of extremity, or permanent total disablement becomes payable, provided that the injury causes disablement of the insured within one year after the accident:
a) Loss of a limb shall be loss by separation or the total and irrecoverable loss of use of a hand at or above the ankle. Compensation shall be made at 100% of the insurance sum.
b) Loss of sight shall be loss of sight of one or both eyes which is certified as being complete and irrevocable by a qualified practitioner specialising in ophthalmology and approved by the Company. In case of loss of sight of one eye, reimbursement shall be made at 50% of the insurance sum. In case of loss of sight of two eyes, reimbursement shall be made at 100% of the insurance sum.
c) Loss of extremity shall be the permanent physical separation of the total and irrecoverable loss of use of a digit or part thereof or an ear, nose or genital organ or part of one of the above. Reimbursement shall be made at 25% of the insurance sum.
d) Permanent total disablement shall be disablement which inevitably and continuously prevents the insured from carrying out every aspect of his / her normal business or occupation for a period of 12 calendar months and, at the end of such period is certified by two qualified medical practitioners approved by the Company as being beyond hope of improvement. If the insured has no business or occupation, the disablement must confine him / her immediately and continuously to the house and prevent him / her from attending to his / her normal duties. Reimbursement shall be made at 100% of the insurance sum.
11.5 The insured must be receiving medical treatment and comply with the physician's instructions.
11.6 The Company is entitled to obtain information from any physician who is treating or has been treating the insured, to subject the insured to treatment by a physician chosen by the Company and, in case of death, to demand an autopsy.
| Telephone | (+34) 91 8043802 |
| Mobile | (+ 34) 609 522 300 |
| Fax | (+ 34) 91 8032484 |
| saniprof@mail.ddnet.es |