| Dive Master Insurance Consultants Ltd. Kingsbridge House, 17-23 Rectory Grove, Leigh-on-Sea ESSEX SS9 2HA England |
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IDEC |
CONDITIONS OF POLICY COVER
COVERAGE
The underwriting Company hereby agrees to indemnify the Insured or on behalf of the Insured subject to the Definitions, Provisions and Exclusions contained herein, up to the sum insured stated in the Schedule of Benefits for Accidents sustained while the Insured is engaged in Sport Diving.DEFINITIONS
1. Accident means a sudden, unexpected, unusual, specific event which occurs at an identifiable time and place.
2. Authoritative Diving Bodies means recognised national controlling organisations, or organizations affiliated to R.S.T.C. or C.M.A.S. who provide guidelines and recommendations to their membership for safe diving practices.
3. Injury means bodily injury which: (a) is caused by an Accident, and (b) solely and independently of any other cause, except illness directly resulting from, or medical or surgical treatment rendered necessary by such injury, causing the death or disablement of the Insured within twelve months of the date of the accident.
4. Claims Administrator means the designated claims administrator (Dive Master Insurance Consultants Ltd)
5. Assistance Company means the agent (CEGA Group) of the underwriting Company authorised to assist the Insured as a result of a Sport Diving Accident
6. Company shall mean certain Underwriters at Lloyd’s
7. Insured means the individual who has proposed insurance to the Company and is specified on the identification card.
8. Loss of Limb means loss or physical separation of a hand at or above the wrist or a foot at or above the ankle and includes total and irrevocable loss of use of hand, arm or leg.
9. Medical Expenses means expenses necessarily incurred by the Insured for physician services, physician ordered services, and local emergency medical transportation.
10. Sport Diving means recreational snorkelling and/or diving using standard manufacturers diving equipment when the Insured is wholly or partially immersed in water.
11. Permanent Total Disability means disability which entirely prevents the Insured from attending to any business or occupation of any and every kind to which the Insured is suited by way of training or education and lasts 365 days and at the expiration of that period is beyond hope of improvement.
12. Reasonable Transportation Costs and Accommodation Expenses means:
i) the costs to return the Insured to their Ordinary Place of Residence. This cover extends to the Insured’s immediate family (partner and children) if the Insured was accompanied by them at the time of the accident/injury if these costs are not covered by a more specific policy.
ii) the costs to repatriate the Insured’s mortal remains.
iii) Post Treatment Costs of Hotel or Accommodation when these are incurred due to medical advice not to travel or fly subsequent to a diving accident/injury if these costs are not covered by a more specific policy.
iv) Costs associated with travelling to and from a hospital or clinic more than 30 miles from your normal place of residence to obtain medical opinion or ongoing treatment after a diving accident or injury incurred under this policy.
PROVISIONS
Provided always that:
1. The Sport Diving is carried out in accordance with the guidelines and recommendations for safe diving practices as established by the Authoritative Diving Bodies.
2. No costs shall be incurred or payments made without the consent of the underwriting Company or its designated Claims Administrator. This provision may be waived when emergency care needs to be administered.
3. The total sum payable in respect of any one Accident shall not exceed the aggregate sum of €225.000,00.
4. Payments shall only be made under the sections of the Schedule of Benefits if:
a) Under section 5.I death occurs within 365 days of the date of the Accident.
b) Under section 5.II and 5.III Loss of Limbs occurs within 365 days of the date of the Accident.
c) Under section 5.IV the Insured suffers Permanent Total Disability within 365 days of the date of the Accident.
5. The Insured is under the age of 70, unless specifically accepted by us following medical examination to confirm fitness to dive.
SCHEDULE OF BENEFITS
The underwriting Company will pay up to the limits set against each section.
However, the maximum recoverable amount under this policy in the aggregate shall not exceed €225.000,00.
1. Medical Expenses € 200.000
2. Hyperbaric Treatment Costs € 200.000
3. Emergency Repatriation € 200.000
(at the option of the Company)
4. Reasonable Transportation Costs
& Accommodation Expenses € 5.000
5. Personal Accident Coverage: If during the coverage period the Insured sustains Injury/death due to a Sport Diving Accident, the following benefits will apply:
I. Death € 25.000
II. Loss of one limb or loss of one eye € 12.000
III. Loss of two limbs, two eyes or one of each € 25.000
IV. Permanent Total Disability € 25.000
TERRITORIAL LIMITS
Worldwide
EXCLUSIONS
The insurance does not provide coverage for any Accident resulting directly or indirectly from:
1. War, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power.
2. Radioactive contamination of any nature.
3. Persons aged 70 years or over who have not been specifically accepted under this insurance following medical examination to confirm fitness to dive.
4. Wilfully self-inflicted injury or illness, effects of alcohol or drugs (other than prescribed by a physician in full recognition of the Insured’s Sport Diving Activities) and/or any self exposure to unnecessary risk (unless in an attempt to save human life).
5. Any pre-existing health condition which the insured was undergoing, suffering from, recovering from or awaiting treatment for prior to Sport Diving.
6. Any mental or psychological disorder of any nature.
7. Any fraudulent, dishonest or criminal act the Insured or person(s) with whom the Insured is in collusion.
8. Any Injury/Accident not reported to the Claims Administrator or Assistance Company within 31 days of the occurrence which may give rise to a claim under this insurance.
9. Any and all Injury sustained while using a speargun or similar device when used in conjunction with an aqualung.
10. Subject always to your Authoritative Diving Bodies recommendations for safe diving practice and unless otherwise endorsed, this insurance excludes Sport Diving deeper than 50 metres on Air and 75 metres on Trimix. (unless in an attempt to save human life).
11. Neither CEGA nor certain Underwriters at Lloyd’s are responsible for the availability, quantity, quality or the results of any medical treatment provided, or for the failure of the Insured to seek medical services.
CANCELLATION
Only periods over 31 days in length can be cancelled by either party giving 7 days written notice prior to the start date. Return of premium will be calculated at pro-rata but subject to a maximum return of premium of 50%.
SUBROGATION
The underwriting Company has the right to recover against any other valid Insurance Policy or Source which could be called into contribution.
JURISDICTION
This contract of insurance is subject to the Law in Europe.
WHAT TO DO IN THE EVENT OF A SPORTS DIVING ACCIDENT
In the event of a Medical Emergency as a result of a Sports Diving Accident go to or call immediately the nearest physician or hospital without delay, then contact the MEDEX Assistance Coordination Centre.
GIVE YOUR NAME, I.D NUMBER “116” AND A BRIEF DESCRIPTION OF THE PROBLEM.
Assistance Coordinators are multilingual and are available 24 hours daily. CEGA GROUP NETWORK EXTENDS WORLDWIDE.
CEGA will immediately take the appropriate action necessary and continue to monitor your case until the situation is resolved.
NOTICE TO PHYSICIANS AND HOSPITALS
CONTACT CEGA IMMEDIATELY FOR BENEFITS VERIFICATION & PROCEDURES
CEGA Group:
UK Chichester, West Sussex +44(0)1243 621 562
COMPLAINTS
Any complaint you may have regarding your policy or the way in which it was sold to you may be addressed to Dive Master Insurance Consultants Ltd, 17-23 Rectory Grove, Leigh-on-Sea, Essex, SS9 2HA, England.
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