The text of this document is a translation made exclusively for learning purposes. In case of disagreements in interpretations and application of this document caused by any inaccuracies of translation, the Russian text prevails over translations.
THE TRAVELERS INSURANCE PLAN FOR THE DURATION OF FLIGHT/TRANSIT
Coverage of the Flight package | Package 1 | Package 2 |
---|---|---|
Amount insured (RUR) | Amount insured (RUR) | |
Damage, loss of luggage
(cl. 2.1. of Special terms)
|
40 000 | 40 000 |
Luggage delay
(cl. 2.2. of Special terms)
|
15 000 | 30 000 |
Death by misadventure
(cl. 4.2.1)
Invalidity by misadventure
(cl. 4.2.2)
Bodily harm by misadventure
(cl. 4.2.3)
|
500 000 | 500 000 |
Flight delay
(cl. 2.4. of Special terms)
|
6 000 | 10 000 |
First day hotel booking
|
10 000 | 20 000 |
Documents loss
|
3 000 | 5 000 |
Insurance plan against the impossibility of flight
Risks
(cl.3 of Special terms)
|
---|
Illness and/or injury diagnosed/received by the Policy holder 1 |
Death of the Policy holder or a close relative 2 |
Illness and/or injury diagnosed/received by a close relative of the Policy holder |
Refusal of visa for the Policy holder 3 |
Conscription of the Policy holder |
Participation of the Policy holder in an investigation as a victim or witness |
Official public emergency in the country of destination |
Failure to reach the airport because of a car accident blocking the way |
Termination of employment |
Physical damage done to personal or domestic belongings |
Failure to reach the airport because of a sewer system collapse blocking the way |
1 Not earlier than 20 days before the flight date indicated in the trip ticket, whereas the disease demands an urgent inpatient treatment , the failure of wich would create a real danger of death or a long-term loss of working capability and the disease is contraindicated for the trip.
2 Close relatives are spouses, parents, children (also adopted) and siblings.
3 The visa means the visa to the country of the planned trip in case of the visa documents package being sent timely (as the corresponding visa service requires it) and of the compliance of the Policy Holder with the requirements of the foreign state’s visa service for obtaining an entry visa.
TRAVEL INSURANCE POLICY TERMS AND CONDITIONS
The present Policy Terms of Travel Insurance (hereinafter referred to as the Terms of Travel Insurance) include Terms of insurance of individuals during business, private trips and tours; Terms of insurance against accidents and diseases; Terms of insurance of individuals’ civil liability during trips, and are the inherent part of the contract for insurance of citizens during business, private trips and tours (hereinafter referred to as the Insurance contract) developed on insurance conditions included in the Insurance General Terms of individuals during business, private trips and tours approved by Order No.28-1 of the Chief Executive Officer of the OOO Renaissance Insurance Group dated March 29, 2008, General Terms of Voluntary Insurance against Illnesses and Accidents of approved by Order No.23 of the Chief Executive Officer of the OOO Renaissance Insurance Group dated February 24, 2009, General Civil Liability Insurance Terms for individuals and legal entities approved by Order No. 40-1 of the Chief Executive Officer of the OOO Renaissance Insurance Group dated April 1, 2010.
The Insurant and persons specified in the Insurance Contract as the Insurant, Insured Person and Beneficiary shall be objects of insurance.
1. SUBJECT OF THE INSURANCE CONTRACT
1.1. The Insurer shall reimburse, for the specified fee (the insurance premium) paid by the Insurant, for expenses caused by occurrence of the insured accident during the Insured’s business, private trips or tours or by failure to make a business, private trips or tours.
2. GENERAL PROVISIONS
2.1. Scope of the insurance cover shall be specified by the Insurance Schemes available for individuals during their business. Private trips and tours (hereinafter referred to as the Insurance Scheme) specified in the Insurance Contract if the Parties do not agree otherwise. The Insurance Scheme is a list of insurance services specifying scope of insurance cover to be provided by the Insurer.
2.2. Insured accidents shall be events stipulated hereunder where the Insurer shall become obliged to pay the insurance indemnity when these events occur.
2.3. The insured amount (the insurance liability limit) shall be the maximum amount of the insurance indemnity stipulated under the Insurance contract paid by the Insurer under the Insurance contract when the insured accident occurs. The insured amount under the Insurance contract shall be set in rubles. Upon agreement of the parties the insured amount may be specified in foreign currency the equivalent of which shall be respective amounts in rubles at the rate of the Central Bank of the Russian Federation as of the payment date unless otherwise is stipulated under the Insurance contract. In cases when the laws of the Russian Federation allow settlements in foreign currency under an insurance contract, the insured amount may be set, and the insurance indemnity may be paid in foreign currency.
2.4. The insured amount (the insurance liability limit) may be set on all risks under the Insurance contract and on every certain risk. If treatment expenses and/or other expenses exceed the insured amount (the insurance liability limit) on a certain risk or on all risks under the Insurance contract, the expense portion exceeding the insured amount (the insurance liability limit) shall be on own retention of the Insurant/Insured Person.
2.5. The insurance premium shall be a payment for insurance which the Insurance shall pay to the Insurer in accordance with the Insurance contract. The Insurance premium under the Insurance contract shall be set in rubles. Upon agreement of the parties the insurance premium may be specified in foreign currency the equivalent of which shall be respective amounts in rubles at the rate of the Central Bank of the Russian Federation as of the payment date unless otherwise is stipulated under the Insurance contract..
2.6. The Insurance Contract shall be signed upon written request of the Insurant.
2.7. The Insurance contract shall come into force from the date the insurance premium is paid in full and within a period stipulated under the Insurance contract unless otherwise is agreed by the Insurance contract.
- If the Insurant is a legal entity, date of payment shall be the date when cash is credited to the bank account of the Insurer or his representative or paid through the cashier office if the Insurance Contract does not provide otherwise.
- If the Insurant is a legal entity:
- If insurance premium (insurance installment) is paid in cash, liability of the Insurant to pay insurance premium to the Insurer (insurance installment) shall be recognized as completed when cash is paid through the cash office of the Insurer/his representative or payment agent (subagent) involved in payment processing of individuals;
- If insurance premium (insurance installment) is paid by the Insurant avoiding bank account opening, liability of the Insurant to pay insurance premium (insurance installment) to the Insurer shall be recognized as delivered in the amount of cash paid by the Insurant to a credit organization or bank payment agency (subagent) involved in payment processing of individuals in accordance with law of the Russian Federation on national payment system;
- If insurance premium (insurance installment) is paid via bank transfer as within applicable forms of bank transfers, liability of the Insurant to pay insurance premium (insurance installment) shall be recognized as delivered in the amount specified in the payment order once credit organization providing services to the Insurant confirms completion of the payment.
2.8. On all risks excluding those stipulated by cl. 3.3.12 and 3.3.18 hereof, the insurance period starts and ends within terms stipulated under the Insurance contract but in any case it may not exceed a number of days specified in the Insurance contract and/or a total number of days spent in trip/s.
On risks stipulated by cl. 3.3.12 and cl. 3.3.18 hereof, the insurance period begins from the date following the date when the Contract is concluded, and expires on the date specified in the Insurance contract as the beginning of the insurance period on other risks than those listed in cl. 3.3.12 and cl.3.3.18 hereof.
2.9. The Insurance Contract shall not apply to the territory of a foreign state which resident the Insured Person is or officially registered according to procedure established by law and/or where the Insured Person is registered at a place of stay in accordance with local law unless otherwise is stipulated under the Insurance Contract
2.10. Insurance cover in the Russia Federation applies to accidents occurred during trips outside of area of 100 km from the place of permanent and/or temporary registration (residence) according to law of the RF, if the Insurance Contract does not provide otherwise.
2.11. If the Insurant cancels the Insurance contract after the beginning of the insurance term, insurance premium paid to the Insurer shall not be refunded if the Insurance contract does not provide otherwise;
2.12. If the Insurant cancels the Insurant contract before insurance term , insurance premium paid to the Insurer shall be refunded in full amount if the Insurance contract does not provide otherwise;
2.13. In case of early termination of the Insurance contract due to no risk of accident or insurance risk as a result of circumstances other than accident or claim, the Insurer has the right to retain part of the insurance premium proportionally to effective insurance period.
2.14. If the Insurance Contract or Travel Insurance Terms provide for a partial refund of insurance premium in case of Insurance contract early termination, the Insurer shall refund a portion of insurance premium within 14 (fourteen) bank days since a written notification is received from the Insurant and arrival of document supporting insurance premium payment as well as the original copy of the Insurance contract.
2.15. In case of accident on risks specified in cl..3.3.1 to cl.3.3.10, cl.3.3.11, cl.3.3.14, cl.3.3.16 and cl.3.3.17 hereof, the Insured Person (other persons in cases stipulated hereunder) shall contact an authorized representative of the Insurer, Assistance Company, on phone numbers specified in the Insurance Contract and act according to recommendation received.
2.16. In case the covered accident occurs on risks specified in cl.3.3.12., 3.3.13 and cl.3.3.18 hereof, the Insured Person shall immediately inform the Insurer, or within 24 hours in any event on the phone numbers specified in the Insurance Contract and act according to recommendations received.
2.17. The Insurer shall not cover expenses of the Insured on risks specified in cl. 3.3.1-3.3.9, 3.3.11, 3.3.14, 3.3.16 and 3.3.17 hereof, not agreed with the Assistance Company (except for medical reasons) and expenses resulted from the Insured’s refusal to follow orders of the Insurer, its representative and/or the Assistance Company.
2.18. On all risks, except for “After-Care”, commencing from the date the Insured returns in the Russian Federation (or any other territory where the Insured is permanently/temporarily registered), the Insurer shall not reimburse expenses of the Insured at a place of return: in the territory of the Russian Federation (or any other territory of permanent residence/ registration of the Insured), on medical aid and other expenses stipulated under the Insurance contract.
2.19. The Insurer shall effect the insurance payment within five working days upon preparing a certificate on the insured accident (if financial documentation is presented in the foreign currency, payment is effected in rubles at the rate of the Central Bank of the Russian Federation as of the date of accident). A certificate on the insured accident shall be executed within 15 (fifteen) working days commencing from the date when the full set of documents required for indemnity payment.
2.20. The Parties may specify an amount of expenses that shall not be reimbursed by the Insurer, i.e. excess, releasing the Insurer from payment of expenses that do not exceed a certain amount. Excess can be conditional or unconditional as shall be specified both as a percentage to sum insured or in absolute numbers:
- If conditional (non-deductible) excess is applied, the Insurer shall have no liability to indemnify expenses that do not exceed excess amount but shall indemnify those expenses in full amount that exceed the amount of excess.
- If unconditional excess is applied (deductible), expenses shall be indemnified in all cases net of excess amount.
2.21. The Concluding the Insurance contract in accordance with the Russian Federal Law “On personal data” No 152-FZ as of June 27, 2006 , the Insurant (Insured) shall give his consent that his personal data contained in documents transferred to the Insurer for performing the concluded Insurance contract will be processes, as well he give consent to the Insurer to provide information about performance of obligations under the Insurance contract by the Insurer and/or Insurant (Insured Person), including information about payment and an amount of the insurance premium (insurance installments), an amount of the insured amount, about occurrence and handling of claims, occurrence/probability of occurrence of insured accidents, payment of the insurance indemnity and other information related to the Insurance This consent of the Insurant (the Insured) shall be valid within the duration period of the Insurance contract and within 5 years after the Insurance contract expires. The present consent may be withdrawn by the Insurant (the Insured) through forwarding a respective written application to the Insurer.
2.22. The Insurant (Insured Person) signing the Insurance contract in accordance with Federal Law of the Russian Federation “On Fundamental Healthcare Principles in the Russian Federation” № 323-FZ as of 21.11.2011г., shall give the right to the Insurer to review his/her medical documentation for the purpose of Insurance Contract, other services and protection of rights of the Insured Person and also give right to medical institutions where the Insurant (insured Person) received, are receiving and will receive medical and other services to provide the Insurer with information presenting medical secret/ Information presenting medical secret shall be including as follows: information about referral of the Insured Person for medical assistance, his health condition, diagnosis of his illnesses and other information obtained in the course of medical examination and treatment after claim or illness is reported to the Insurer.
2.23. The Insurer shall guarantee confidentiality of medical and insurance secret in accordance with law of the Russian Federation.
3. TRAVEL INSURANCE TERMS AND CONDITIONS FOR BUSINESS, PRIVATE TRIPS AND TOURS
These Terms and Conditions of individuals’ insurance during business, private trips and tours (hereinafter referred to as Travel Insurance Terms and Conditions) are drafted based on Insurance Travel Terms and Condition for business, private trips and tours approved by Order No.
28-1 of the Chief Executive Officer of the OOO Renaissance Insurance Group dated March 3, 2008 (hereinafter referred to as the Rules of insurance during trips) in accordance with cl.1.9 hereof, and are the inherent part of the Insurance Contract for individuals’ insurance during business, private trips and tours (hereinafter referred to as the Insurance Contract).
3.1. Insurance Object. The insurance object shall be property interests not contradicting the laws of the Russian Federation and related to unforeseen expenses caused by occurrence of the insured accident when the Insured was in business, private or touristic trip and/or to the fact that the Insured could not make a business, private trip or tour due to occurrence of the insured accident during the validity of the Insurance Contract.
3.2. Insurance Indemnity can be paid according to the following procedure:
- reimbursement of services rendered as a result of accident directly to the Insured Person once he returns to his permanent place of residence providing that these services have been agreed in advance by the Insurer/representative of the Insurer or Assistance Company.
- reimbursement of services rendered by a company (Assistance Company) acting as claim assistant that arranged and paid for services provided to the Insured Person as a result of accident.
3.3. In accordance with the Insurance Scheme under the Insurance contract, the following risks (insured accidents) shall be covered:
3.3.1. EMERGENCY MEDICAL AID
The Insurer shall pay, on its own or though the Assistance Company for emergency medical help including surgery and inpatient medical services (except for additional expenses related to the provision of enhanced comfort wards, any type of prosthesis) rendered to the Insured Person due to medical conditions during the term of the Insurance Contract as a result of an accident or acute illness (excluding aggravation of chronic diseases in cases stipulated under the Insurance contract).
3.3.2. DENTISTRY
The Insurer shall pay for and arrange through the Assistance Company, where required, dental services of first dental aid necessity of which is caused by acute tooth pain, and emergency dental aid when treating traumas suffered in case of an accident occurred during the validity of the Insurance contract, in the amount not exceeding the insured amount (the liability limit) specified in the Insurance contract.
3.3.3 MEDICINES
The Insurer shall pay, on its own or through the Assistance Company, for the cost of certified medicines acquired as prescribed for treatment of consequences of an accident or an acute disease in accordance with the Insurance Contract (including aggravation of chronic diseases unless otherwise is stipulated under the Insurance Contract).
3.3.4 MEDICAL EQUIPMENT
The Insurer shall pay, on its own or through the Assistance Company, for temporary provision to the Insured Person of crutches, wheelchairs, other medical equipment and auxiliary medical equipment if these services are rendered as prescribed by the attending physician for treatment of acute disease or accident occurred during the term of Insurance Contract. Expenses related to repair of medical aid equipment shall be exceptions.
3.3.5 MEDICAL TRANSPORTATION
The Insurer shall pay for and the Service company shall arrange the following expenses providing the medical necessity (unless otherwise is agreed by the Parties under the Insurance contract):
a) transportation of the Insured from place of accident to one of the nearest hospitals;
b) transportation of the Insured from a hospital to an airport/ railway station for further returning to a permanent place of residence;
c) direct evacuation of the Insured (when required, with medical escort) to an airport/ railway station nearest to a permanent place of residence with which there is air/ railway communication if after treatment the Insured cannot return to a permanent place of residence as a regular passenger and/or his return ticket cannot be fully or partially used. In case it is impossible to use an original ticket partially, the Insurer pays the difference between the return amount and the cost of a new ticket.
The Insurer shall pay only for economy class transportation.
In case for medical reasons in accordance with subclauses “a”- “c” evacuation of the Insured envisages that the Insured shall be escorted by a legal person without medical education or qualification, the Insurer shall be entitled to pay for an economy-class air-ticket and/or hotel accommodation for a person escorting. The Service company or the attending physician determine whether the condition of the Insured allows to repatriate him as a regular passenger or respective preparing measures (devices, means) are required. In case a return ticket is invalid, repatriation is performed by regular flight or using other respective ways of transportation.
3.3.6 TRANSPORTATION OF REMAINS
In case of death of the Insured person during his stay outside of his permanent place of residence, the Insurer shall pay for and the Assistance Company shall arrange repatriation of the body, a coffin required for transportation, and transportation of remains to an airport with direct air/ railway communication and which is the nearest to the expected burial place in the place of permanent residence if the insured accident occurs abroad, or to the permanent place of residence if the insured accident occurs in Russia. Burial expenses shall not be reimbursed.
3.3.7 EVACUATION OF CHILDREN
If the Insured Person is unable to take care of his/her children travelling with him/her due to an acute disease or an accident occurred, the Insurer shall pay for and the Assistance Company shall arrange the return of children to their permanent place of residence.
3.3.8 RETURN TRIP
In case of death of a relative (father, mother, husband, wife, son, daughter, brother, sister), the Insurer shall pay for the airplane or railway ticket of economy class so that the Insured could return to the permanent place of residence if his original ticket cannot be used for return trip.
3.3.9 LOSS OF DOCUMENTS
If travel documents for travelling abroad (passport, visa and air ticket) are lost or stolen, the Insurer shall pay for the consular fee, and the Assistance Company shall provide information to the Insured Person to go through formal procedures in respective local organizations to replace lost or stolen documents.
3.3.10 LEGAL ASSISTANCE OF CATEGORY I
The Insurer shall arrange legal assistance and pay for expenses of the Insured Person incurred as a result of involvement in legal cases or non-legal cases (administrative proceedings) during the trip caused by inflicting harm by third parties to health, property, property interests of the Insured Person; inflicting harm to life, health or property of third parties causing civil liability of the Insured Person.
3.3.11 EMERGENCY VISIT
If the Insured is hospitalized for a period over 14 (fourteen) calendar days (unless otherwise is stipulated under the Insurance Contract) as a result of an accident, an acute disease or a hazard to life, upon official request of the Insurant and/or the Insured, the Insurer shall pay for a round-trip ticket of the economy class and/or hotel accommodation for any person being his relative defined by the Insured. Visit terms shall be stipulated under the Insurance contract.
3.3.12 CANCELLATION OF TRIP OF CATEGORY I
The Insurer shall reimburse the Insured Person expenses in the amount not exceeding amounts stipulated by the Insurance Contract (insurance liability limits), caused by refusal of the Insured Person to deliver Travel Product Contract in relation to loss compensation (actual damage), incurred by the touristic organization or the Insured in cases when this refusal is caused by death or an accident and/or disease posing a hazard to life and resulting in hospitalization of the Insured and/or his relatives (father, mother son, daughter, brother, sister).
3.3.13 LOSS OF LUGGAGE
The Insurer shall compensate the Insured for damage caused by loss of luggage belonging to the Insured during the official conveyance when going abroad or returning to Russia. The Insured shall provide the document confirming that the luggage is lost. Compensation is made in the amount of ruble equivalent of 25 foreign currency linked units, at the rate of the Central Bank of the Russian Federation as of the payment date, unless otherwise is stipulated under the Insurance contract, per one kilogram of the luggage weight but not exceeding the amount specified in the Insurance contract (the insurance liability limit), unless otherwise is agreed by the parties. In addition, “foreign currency linked units” shall mean the contract currency set in the Insurance contract.
3.3.14 LOSS OF AND DAMAGE TO MOTOR VEHICLE
The Insurer through the Assistance Company shall pay for expenses related to evacuation, transportation to the boundary of the Russian Federation or disposal of a motor vehicle used by the Insured Person for trip abroad if is no longer suitable for use.
3.3.15 AFTER-CARE
a) If after hospitalization caused by the acute disease or the accident during the trip the direct evacuation to the residence place is impossible for medical reasons but his staying in the medical in-patient department us not required, the Insurer shall reimburse expenses on hotel accommodation of the Insured in the amount stipulated under the Insurance contract but not more than for 7 (seven) calendar days (unless otherwise is stipulated under the Insurance contract).
b) The Insurer shall pay for services on its own or through the Service company with respect to staying of the Insured in the hospital but not more than for 14 (fourteen) calendar days (unless otherwise is stipulated under the Insurance contract) after repatriation performed upon agreement between the Insurer and a medical institution where the Insured received the after-care abroad providing that due to the health condition he needs further treatment in an in-patient department unless otherwise is stipulated under the Insurance contract.
3.3.16 TRIP DELAY
The Insurer shall reimburse documented expenses of the Insured caused by trip delay resulted from bad weather conditions, mechanical failure of a transportation facility certified for international carriage of passengers. The Insured shall register in accordance with the registration rules shown in a ticket issued by a transport operator to him and provide a written confirmation from a transport operator that a flight or sailing off was delayed due to the above-mentioned circumstances. This confirmation shall specify the delay period versus time of departure stated in a ticket of the Insured. The amount of the insurance indemnity shall be determined by the Insurance contract. The exception shall be expenses incurred by the Insured within first 12 (twelve) hours of any delay unless otherwise is stipulated under the Insurance contract.
3.3.17 EMERGENCY ESCORTING
If the Insured makes a group trip (from 2 persons) and due to an acute disease or an accident causing hospitalization stays in a country (place) of trip for a period exceeding a period determined by the trip, on the official request of the Insured, the Insurer shall pay for a return air/ railway ticket to an airport/ railway station nearest to a permanent place of residence with which there is direct air/ railway communication (economy class/ couchette car) and/or hotel accommodation in the amount stipulated by the Insurance contract but not more than for 7 (seven) calendar days (unless otherwise is stipulated under the Insurance contract) for any person selected by the Insured with whom the Insured made a trip and who cannot use his old ticket for returning. If it is possible to use the original ticket partially, the Insurer shall pay the difference between the amount of return and the cost of a new ticket.
3.3.18 CANCELLATION OF TRIP OF CATEGORY II
The Insurer shall compensate the Insured for expenses caused by Insured’s refusal to perform the Contract for tourist product sale related to compensation for losses (actual damage) incurred by the touristic organization or the Insured in cases when this refusal is caused by reasons other than death or an accident and/or disease posing a hazard to life and resulting in hospitalization of the Insured and/or his relatives and not dependent on expression of will of the Insured, including:
a) the Insured shall become obliged to participate in investigation actions as a complainant or a witness;
b) the Insured shall become obliged to participate in court hearings as a complainant or a witness;
c) the Insured shall become obliged to fulfil military duties;
d) rejection in issuing an entrance visa to a country of an expected trip;
e) other circumstances specified in the Insurance contract.
3.3.19 LUGGAGE DELAY
In case luggage is shipped improperly and the Insured could not receive his luggage on time, the Insurer reimburses for reasonable and vital expenses occurred because of this delay (purchase of clothes, personal care products, etc.).
In this case the Insured shall provide documented confirmation of a transport operator about this delay and its duration to the Insurer. The insurance indemnity is paid only in case the delay exceeds 24 hours unless otherwise is stipulated under the Insurance contract.
3.4. If the Insurance Contract does not state otherwise and a scale up coefficient has not been applied to insurance premium, the following accidents shall not be recognized as valid claims and the following expenses shall not be reimbursed:
3.4.1. resulted from participation of the Insured Person in sports activities and/or another physical activity at the professional level (including sports events, competitions, preparation for them, etc.),
3.4.2. resulted from participation of the Insured Person in extreme sports activities unless otherwise is stipulated by the Insurance Contract. Extreme sports and leisure shall mean independent tourism; sports tourism; amateur sports (in special places): water (excluding swimming), underwater (with an instructor at a depth not more than 10 m), winter sports (alpine skiing, sleighing, snowboarding, skating, snowmobiling), mountain climbing, air etc.; sports games; action-oriented games of sports character; visits of water rides, water parks, waterslides, high board diving; hunting (including underwater); sailplane, paraglide, hang gliding, as well as application of other devices to fly; boating (row-boats, motorboats), riding floats, small vessels; riding bicycles of all types; riding motor bicycles, motor scooters, scooters, quad bikes; rest in mountain camps and in touristic and sports camps, as well as in regions 1000 m above sea level; climbing on foot, exploring caves; riding cars- off roaders (cars with framed structure, permanent four-wheel drive), sports cars; riding horses and other animals; as well as other types of physical activity with the high traumatism risk excluding cases specified in cl. 3.4.1;
3.4.3. related to any type of work performed by the Insured Person that is described by employment or civil and legal documents (instructions);
3.5. The following accidents shall not be recognized as valid claims and are not subject to reimbursement:
3.5.1. Directly related to failure of the Insured Person to follow safety instructions, violation of user guide and (or) use of equipment for wrong purpose during training, non-compliance with guidance of coaches, instructors professionally fulfilling their responsibilities in relation to active sports activities of the Insured Person (even if the Insurance Contract provides for “active sports” cover);
3.5.2. Directly related to diseases of the nervous system, mental disorders, consequences of congenital anomalies and related conditions, regardless of the limitations of identifying and classifying diseases, cancer, AIDSs, sexually transmitted diseases, particularly dangerous infections (smallpox, plague, cholera, etc.), with diseases that could be prevented by early vaccination and/or resulting from violations of the insured to prophylactic quarantine measures;
3.5.3. connected with any complications of the Insured Person’s health caused by pregnancy; as well as labor, abortion (excluding therapeutic abortion caused by an accident), as well as laboratory methods of examination related to pregnancy and not obligatory for diagnosing and treating a sudden disease or a trauma;
3.5.4. connected with operative therapy of cardio-vascular system including angiography, angioplasty and bypass surgery;
3.5.5. resulted from aircraft (motor, non-motor, parachutes of all types), any other transport vehicle (excluding a car) piloted by the Insured Person that requires official license
3.5.6. related to compensation of lost profit, moral damage; expenses related to professional mistakes of doctors;
3.5.7. related to treatment course of the Insured Person that has started and continues during insurance term;
3.5.8. connected with any harm and/or damage resulted from Insured Person’s illegal actions and/or caused and effected due to consumption of alcohol, drugs or toxic substances except for substances that were taken as prescribed by a qualified doctor and their consumption was not connected with treatment of drug and alcohol addiction. In case of suspect in alcoholic and drug intoxication if the insured accident occurs, a representative of the Insurer, the Assistance Company shall be entitled to demand that the Insured Person is going through a medical examination to identify alcohol/ drug substances in accordance with laws of the country of stay. In case of alcohol/ drug intoxication, as well as in case the Insured Person refuses to go through medical examination, payment of the insurance indemnity shall not be effected;
3.5.9. medical examinations, care, services or laboratory methods of examination not related to a sudden disease and which are not obligatory for diagnosis and treatment;
3.5.10. for scientific but not generally accepted examination and treatment methods, acquisition of non-certified medicines, vitamins, biologically active additives or other medicines that are not connected with main illness that medical assistance has been provided for;
3.5.11. for scheduled medical assistance provided for preventive actions for illnesses and conditions presenting no threat for life of the patient that do not require emergency medical assistance and which delay for an uncertain period shall not worsen the patient’s condition causing life and health threat;
3.5.12. medical evacuation or the transportation of the insured person as a result of minor illnesses or injuries that are treatable at the place of stay of the insured person and shall not affect the continuation of his trip;
3.5.13. for self-treatment of the Insured Person including use of alternative medicine worsening health or pathological process;
3.5.14. for medical services that have to be rendered by a medical institutions under compulsory medical insurance and other compulsory medical and social schemes;
3.5.15. computer tomography and nucleic magnetic resonance;
3.5.16. any prosthesis (including dental and eye), as well as on osteosynthesis;
3.5.17. expenses related to claims listed in cl. 3.3.2-3.3.6, when a trip was made for treatment purposes;
3.5.18. expenses related to treatment in recreation and treatment centers; recovery (rehabilitation) treatment, physiotherapy and manual therapy, treatment gym courses, massage, acupuncture apart from cases directly provided for in the Insurance Contract;
3.5.19. for cosmetic and plastic surgery (except for instances when plastic surgery is required as a result of injury caused by an accident during the insurance term);
3.5.20. preventive vaccination, immunization, disinfection, medical examination;
3.5.21. treatment of alcoholism, drug addiction and toxicomania;
3.5.22. expenses exceeding sums insured and liability limits of the Insurer;
3.5.23. expenses related to services provided to the Insured Person by a medical organization that has no applicable license or a person that has no right to perform medical business;
3.5.24. for the purchase and/or repair of medical care equipment (including crutches, wheelchairs and other medical equipment and tools, artificial limbs, eyeglasses and frames for them, contact lenses);
3.5.25. Treatment and diagnostics done by relatives of the Insured Person.
3.6. Expenses shall not be reimbursed if they relate to emergency aid provided to the Insured Person as stipulated under the Travel Insurance General Terms, if such expenses are caused by diseases that existed as of the date of the Insurance Contract and required treatment or dental care before insurance term, including diseases, their complications and consequences of an accident if they were treated during last 6 months before the Insurance contract. The Insurer shall be entitled not to apply this restriction if medical aid is required to save life or compulsory medical intervention to avoid long-term or permanent disability and/or death of the Insured Person providing that the Insurance Contract does not state otherwise
3.7. The Insurer shall not reimburse expenses related to “Legal Assistance of Category I” to persons accused of terrorism; in matters relating to the protection of consumer rights of the insured person; legal fees and extra legal fees of an insured person, such as a notary's fees, payment of State duty and other compulsory fees, fines, compensation awards (imposed) by the authorized body of monetary penalties during the trip.
3.8. The Insurer shall be released from insurance indemnity payment if the following occurs:
3.8.1. Intended or illegal actions (omission) of the Insured Person, Insurant as well as the persons acting on their behalf causing accident and (or) insurance indemnity payment (including trip making with medical counter indications and recommendations to cancel the trip given by a doctor properly qualified for medical practice according to law of the Russian Federation or other state);
3.8.2. Suicide, attempted suicide, self-harm (self-injury);
3.8.3. Intended violation of recommendations of the Assistance Company or travel agent, their representatives, local authorities in relation to safety precautions in the country of destination, violation of prescriptions of local authorities in the country of destination). For the purpose of the General Terms a person shall be recognized as acting intended if he was aware of dangers (illegality) of his actions (omission), anticipated possibility or inevitability of an accident and wanted it to happen, or anticipated an accident or was indifferent about possible implications of his actions (omission);
3.8.4. Wars, interventions, foreign troops military activities, armed conflicts, other similar of equal events (despite the fact whether the war was declared or not), civil war, riot, turmoil or other civil disturbances that may develop into a civil or military riot or other armed or illegal seizure of power;
3.8.5. Involvement of the Insured person in military maneuvers, training, military equipment testing and other similar operations as military man or a civil officer (except for cases specifically provided for in the Insurance contract with a scale up coefficient applied to insurance premium);
3.8.6. nuclear explosion, radiation or direct or indirect radiation exposure;
3.8.7. actions to support severity of claim to be indemnified by the Insurer in relation to an accident or failure to take reasonable actions to reduce potential losses by the Insurant (Insured Person). The Insurer shall have the right to reject indemnity payment at the extent that these actions of the Insured affected the amount of loss;
3.8.8. seizure, confiscation, requisition, seizure or destruction of property by orders of governmental authorities;
3.8.9. damage caused as a result of illegal actions (omission) of government authorities, local authorities or officials of these authorities including documents issued by these authorities or officials that are not in line with effective law or other regulations;
3.8.10. Accident that may turn into potential claim before the Insurance contract comes into force or after the applicable insurance cover expired, or outside insurance territory.
3.9. Actions of the Parties in case of a potential claim:
3.9.1. In case of claim the Insured Person shall contact an authorized representative of the Insurer, i.e. Assistance Company on the phones specified in the Insurance Contract and act according to recommendations received.
The Insurer shall reimburse cost if one call or one fax message if a detailed invoice is presented and payment confirmed.
3.9.2. In case of an accident and no contraindications, the Insurer shall be entitled to repatriate the Insured Person for further treatment in a permanent place of residence.
3.9.3. If the Insured Person paid his expenses f, he shall submit a written expense report to the Insurer upon arrival to his permanent place of residence у.
3.9.4. The report shall be submitted to the Insurer in writing by the Insurant or the Insured Person within 30 (thirty) days after any accident or not later than in 5 (five) days after arrival to a permanent place of residence. All certificates, information and evidence requested by the Insurer shall be provided for free and has all the data requested by the Insurer. Within 15 (fifteen) days upon receiving the application and all required documents and acknowledging the event to be the insured accident, the Insurer shall execute an insured accident certificate.
3.10. For reimbursement of expenses incurred the Insured Person or Insurant shall attaché the following documents to the report:
Note: All documents provided for by Travel Insurance Terms and Conditions for business, private trips and tours and for indemnity purposes shall be presented to the Insurer as original copies. If documents to be presented to the Insurer are issued in a foreign state, they should be properly legalized with apostil and/or translated by an official translation agency and notarized.
3.10.1. Documents to be presented for claim purposes based on accident category:
№ | Document name |
---|---|
1. | Written standard request form with all sections completed |
2. | Original insurance contract (insurance policy), a copy of the policy if the contract of insurance is concluded for one year. The insurance contract (policy) should specify the risk |
3. | Insurant premium payment receipt (other payment document) |
4. | Copy of applicant’s ID (passport) |
5. | Copy of all pages of external passport of the Insured Person |
6. | Certificate of inheritance under the insurance contract (Policy), issued by a notary public to be provided by the heirs of the insured person |
7. | If the Insured Person is a minor or incapable, his representative shall submit a request and provide documents legally supporting his authority in relation to the Insured Person. |
3.10.2. Documents to be provided based on claim category:
Insurance risk/ claim |
Document name |
---|---|
“Emergency Medical Aid”, (cl.3.3.1. of Insurance Terms and Conditions) |
- medical certificate with a diagnosis and detailed description of accident, recommendations of the attending physician; - invoice for medical services provided, medical transportation with a list of services, date of services and their cost, payment confirmation; - prescription for medicines issued by the attending doctor; - document supporting lease of medical equipment with applicable payment; - the original copies of documents supporting payment for medical services, medicines, other costs (cheques; receipts; copies of payment orders stamped by the Bank; the original slip checks for credit card payments); - print out of phone calls certified by mobile service provider, - bill from the hotel for telecommunication services with outbound call numbers and payment confirmation; - medical records (copies of outpatient, inpatient hospital records, hospital release notes, epecrisis) from medical institutions at the place of permanent residence of the Insured; - copy of the driving license; - alcohol/toxic substances/drugs test results; - copy of treatment center records if the Insured was there for treatment/rehabilitation purposes during his trip; - proof of inoculation in accordance with the requirements of the visa application centers of destination country (subject to requirements of country's travel visa service); - the original air/train tickets/e-ticket printout, the original boarding pass the insured/insured person's family member/other person supported by with payment confirmation; - official document of the carrier supporting the fact of cash refund/non-refund for ticket return/change/non-use; - original hotel bill with payment confirmation; - Certificate of death of the Insured Person; - copy of death certificate/medical death certificate specifying cause of death; - copy of police records, documents of authorized organizations in case of injuries caused in road accidents, other emergency events; |
“Dentistry”, (cl. 3.3.2. of Insurance Terms and Conditions) | |
“Medicines”, (cl. 3.3.3. of Insurance Terms and Conditions) | |
“Medical Equipment”, (cl. 3.3.4. of Insurance Terms and Conditions) | |
“Medical Transportation”, (cl. 3.3.5. of Insurance Terms and Conditions) | |
“Remains Transportation”, (cl. 3.3.6. of Insurance Terms and Conditions) | |
“Evacuation of Children”, (cl. 3.3.7. of Insurance Terms and Conditions) | |
“Emergency Visit”, (cl. 3.3.11. of Insurance Terms and Conditions) | |
“After-Care”, (cl. 3.3.15. of Insurance Terms and Conditions) | |
“Emergency Escort”, (cl. 3.3.17. of Insurance Terms and Conditions) | |
“Return Trip”, (cl. 3.3.8. of Insurance Terms and Conditions) |
- notarized copy of death certificate; relative of the Insured Person specified in cl 3.3.8 of Insurance Terms and Conditions. - original document or copy of hospital discharge epicrisis for passed away, stamped by the medical institution (in case of death in hospital) - document supporting kinship of passed away with the Insured Person, - original plane/railway ticket/print out of an e-ticket, original copy of the boarding pass of the Insured Person/relative with tickets payment confirmation. |
“Trip Cancelation of Category I“, (п. 3.3.12. of Insurance Terms and Conditions) |
- original copy of tourist product sales contract; - original copies of (original copy of travel voucher of form TOUR 1 and/or cash receipt, copy of payment order stamped by the bank), supporting payment of travel services according to the travel product sales contract; - documents supporting refund made by the travel company to the Insured Person of a proportion of cash under the travel product sales contract (copy of debit order stamped by the bank, copy of bank statement stamped by the bank); - original copy of agreement (act, protocol) of travel product cancellation; - unused travel documents for the planned trip, which expenses were included in payment for the travel product sales contract and the amount of non-refundable expenses of the Insured Person due to trip cancellation supported by documents of the travel company (original copy of the airplane ticket or e-ticket for every Insured Person stamped by the travel agent); - voucher supporting hotel booking for the Insured Person for planned rip period; - original copy of travel agent information letter about non-refundable expenses of the Insured Person that travel agent is not refunding as a result of trip cancelation according to the travel product sales contract stamped by the travel agent - original copy of discharge epicrisis stamped by medical institution (extract from records of inpatient clinic patient) supporting hospitalization of the Insured Person or his relative; - a copy of the document (reference) on the level of ethyl alcohol, drugs and toxic substances in biological fluids and tissues, breath of the insured or his relative; - notarized copy of death certificate, copy of medical death certificate of the Insured Person or his relative stating the cause of death; - documents supporting kinship of the Insured Person and relative. |
“Trip Cancelation of Category II“, (cl. 3.3.18. of Insurance Terms and Conditions) |
- original copy of tourist product sales contract; - original copies of (original copy of travel voucher of form TOUR 1 and/or cash receipt, copy of payment order stamped by the bank), supporting payment of travel services according to the travel product sales contract; - documents supporting refund made by the travel company to the Insured Person of a proportion of cash under the travel product sales contract (copy of debit order stamped by the bank, copy of bank statement stamped by the bank); - original copy of agreement (act, protocol) of travel product cancellation; - unused travel documents for the planned trip, which expenses were included in payment for the travel product sales contract and the amount of non-refundable expenses of the Insured Person due to trip cancellation supported by documents of the travel company (original copy of the airplane ticket or e-ticket for every Insured Person stamped by the travel agent); - voucher supporting hotel booking for the Insured Person for planned rip period; - original copy of travel agent information letter about non-refundable expenses of the Insured Person that travel agent is not refunding as a result of trip cancelation according to the travel product sales contract stamped by the travel agent - subpoena certified by the court; - investigator’s/court’s/prosecutor’s including resolution on forced attendance. - military attendance request certified by military recruitment office supporting military duties of the Insured Person; - official visa service rejection (if applicable), or any other document supporting visa rejection - stamp in external passport supporting visa rejection in country of assumed destination; - an official letter of visa service, indicating the actual date of entry visa and the reasons for issuing a visa on the particular dates (if applicable), - copy of foreign passport page with visa of assumed destination country; - copy and original copy of consular fees |
“Trip Delay”, (cl. 3.3.16. of Insurance Terms and Conditions) |
- travel document (original copy or a print out of an e-ticket); - official letter from a carrier (airline) properly certified and confirming flight delay specifying the time and reason for the delay; - receipts supporting expenses incurred from delay hour stated in the Insurance Contract чand till actual flight boarding |
“Loss of Documents”, (cl. 3.3.9. of Insurance Terms) | - consular fee payment original copy |
“Legal Assistance of Category I“, (cl. 3.3.10. of Insurance Terms and Conditions) | - the Court's decision supporting third parties causing civil liability of the Insured Person |
“Loss of Luggage”, (cl. 3.3.13. of Insurance Terms and Conditions) |
- travel document (original or printed copy of the electronic ticket); - boarding pass or stamp in the travel document confirming landing (original); - the detachable baggage token/baggage receipt (original); - paid luggage receipt, if applicable; - form (act) supporting loss or damage of the luggage during official transportation properly completed by an authorized person of the carrier (original); - official letter of the carrier confirming loss of luggage issued after the end of its search period (21 days). - travel document (original copy or e-ticket print out); - boarding pass or boarding stamp in a travel document (original copy); - the detachable baggage token/baggage receipt (original); - paid luggage receipt, if applicable; - form (act) supporting loss or damage of the luggage during official transportation properly completed by an authorized person of the carrier (original); - official letter of the carrier confirming loss of luggage issued after the end of its search period (21 days) |
“Luggage Delay”, (cl. 3.3.19. of Insurance Terms and Conditions) |
- travel document (original or printed copy of the electronic ticket); - boarding pass or stamp in the travel document confirming landing (original); - the detachable baggage token/baggage receipt (original); - paid luggage receipt, if applicable; - form (act) supporting loss or damage of the luggage during official transportation properly completed by an authorized person of the carrier (original); - official letter of the carrier confirming luggage delay in hours |
“Motor Vehicle Loss or Damage”, (cl. 3.3.14. of Insurance Terms and Conditions) |
- documents supporting motor vehicle damage; - documents supporting motor vehicle ownership rights; - green card with border crossing stamp; - documents supporting towing or disposal of the vehicle before border of the RF |
The Insurer shall have the right to reduce information and documents referred to in cl. 3.10. required for decision making on validity of claim.
4. ACCIDENT INSURANCE TERMS AND CONDITIONS
These Accident Insurance Terms and Conditions (hereinafter referred to as Accident Insurance Terms and Conditions) are drafted based on Voluntary Accident and Illness Insurance General Terms ratified by Order of the Chief Executive Officer of the OOO Renaissance Insurance Group № 23 as of February 24, 2009 (hereinafter referred to as Accident Insurance General Terms) and shall be an integral part of insurance contract for individuals on business, private trips and tours (hereinafter referred to as Insurance Contract).
4.1. The insurance object shall be property interests of the Insured Person related to his life, health damage and ability to work..
4.2. In accordance with the Insurance Scheme under the Insurance Contract the following risks (claims) may be covered):
4.2.1. “Death of the Insured caused by an accident”;
4.2.2. “Disability of the Insured Person caused by an accident”
4.2.3. Body injuries of the Insured Person caused by an accident specified in the Table of Insurance Indemnity (Insurance Indemnity Payment Table, cl.4.6. of the Terms of Accident Insurance.).
4.3. Events stipulated by cl.4.2.1.- 4.2.3 of the Terms of Accident Insurance shall be recognized as valid claims if they occurred during the insurance period (in accordance with cl.2.8. hereof) and confirmed by documents issued by authorized bodies in accordance with the established procedure (medical institutions, courts, etc.).
4.4. In case of claim such as Death of the Insured Person caused by an accident the insurance indemnity shall be paid as a lump sum in the amount of 100 % of the insured amount for this type of cover under the Contract.
4.5. In case of claim such as Disability of the Insured Person caused by an accident the insurance indemnity shall be paid as a lump sum in the amount of 100% of the insured amount for this type of cover under the Contract when disability group I is assigned; 75%- when disability group II is assigned; 50%- when disability group III is assigned. If a person under 18 (eighteen) years of age is classified as “disabled child”, insurance indemnity of 100% of sum insured specified by the Contract for this type of cover shall be paid.
4.6. Insurance indemnity for Body Injuries to the Insured Person shall be paid in accordance with the following Table 1.
№ | Type of Injury | Indemnity amount (as % of sum insured) |
---|---|---|
CENTRAL AND PERIPHERAL NERVOUS SYSTEM | ||
а) fracture of the outer plates of the bones of the skull | 5 | |
б) cranial vault | 15 | |
в) skull base | 20 | |
г) body and skull base | 25 | |
With open fracture an additional 5% of the sum insured shall be paid | ||
2. Intracranial traumatic hemorrhage | 15 | |
3. Brain concussion, mild brain injury with in-patient treatment of 10 days or more | 2 | |
4. Brain injury secondary to severe | 15 | |
5. Brain crush injury | 50 | |
6. Spinal cord injury at any level and a horse tail: | ||
а) partial break | 60 | |
б) complete break | 100 | |
7. Peripheral damage to the cranial nerves | 10 | |
8. Damage to the cervical, shoulder, lumbar, sacral plexus and nerves | ||
а) partial rupture of Plexus | 15 | |
б) complete rupture of Plexus | 40 | |
в) Break of nerves at the level of: wrist, ankle joint | 70 | |
г) Break of nerves at the level of: brachium, shin | 10 | |
д) Break of nerves at the level of: shoulder, elbow joint, hip, knee joint | 40 | |
Nerve damage shall be indemnified if damage caused limb paralysis | ||
ORGANS OF VISION | ||
9. Accommodation paralysis of one eye | 15 | |
10. Hemianopsia of one eye | 15 | |
11. Pulsating exophthalmos of one eye | 10 | |
12. Penetrating wound of eyeball, scurry trichiasis | 10 | |
13. Eye injuries causing: | ||
а) 50% or more of baseline vision reduction | 10 | |
б) complete loss of vision of one eye | 35 | |
14. Eye injury causing complete vision of the only eye with any vision capability or both eyes with any vision capability | 100 | |
15. Removal caused by blind eye-ball injury | 10 | |
16. Orbital fracture | 10 | |
HEARING ORGANS | ||
17. Injury of ear auricle causing its absence | 10 | |
18. Ear injury causing: | ||
а) Hearing loss in one ear | 15 | |
б) complete deafness (oral and whispering speech - 0) | 30 | |
RESPIRATORY SYSTEM | ||
19. Fracture of nasal bones | 3 | |
20. Injury of lung resulted in: emphysema, hem pleura, aero pleura exudative pleurisy | ||
а) from one side | 10 | |
б) from both sides | 20 | |
21. Injury of lung resulted in: | ||
а) removal of lung part | 30 | |
б) lung removal | 50 | |
22. Fracture of breastbone | 5 | |
23. Fractures of ribs: | ||
a) 1 – 2 ribs | 3 | |
b) 3 ribs or more | 5 | |
24. Penetrating wound of breastbone, thoracotomy as a result of trauma: | ||
а) penetrating wound without injury of organs of chest cavity | 5 | |
б) with injury to organs of chest cavity | 20 | |
Indemnity shall not be paid on cl. 24, if a lung or its part has been removed as a result of rib cage injury | ||
25. Fracture of the hyoid bone | 15 | |
26. Damage the larynx, the trachea, the hyoid bone, shield-like cartilage affecting tracheotomycal tube | 20 | |
If indemnity is paid under cl 26, no indemnity shall be paid under cl. 25 | ||
CARDIOVASCULAR SYSTEM | ||
27. Injuries to heart, large vessels and larger shells causing cardiovascular insufficiency | 35 | |
28. Injury to major peripheral vessels causing no disorders in circulation system | 5 | |
29. Injury of major peripheral vessels causing heart failure | 25 | |
If indemnity is paid under cl. 27, 29,no indemnity shall be paid under cl. 28 | ||
DIGESTIVE ORGANS | ||
30. Fracture of the upper or lower jaw | ||
а) sone side | 5 | |
b) double side | 10 | |
в) fracture of zygomatic bone | 7 | |
31. Jaw injury causing: | ||
а) jaw partial loss | 40 | |
б) jaw complete loss | 60 | |
32. Tongue injury causing: | ||
а) lack of tongue at distal third level | 15 | |
б) lack of tongue at middle third level | 30 | |
в) tongue complete absence | 50 | |
33. Esophagus injury causing: | ||
а) esophagus narrowing | 30 | |
б) Esophageal obstruction, but not earlier than 6 months from the date of injury. Prior to that insurance indemnity shall be paid under cl. 33 а | 80 | |
34. Injury of intestines causing imposition of colostomy | 50 | |
35. Liver damage as a result of the injury causing: | ||
а) liver rupture requiring surgery | 20 | |
б) removal of the gall bladder | 15 | |
36. Removing more than 1/2 of liver as a result of injury | 30 | |
If indemnity is paid under cl. 35 а, no indemnity shall be paid under cl. 36 | ||
37. Spleen injury causing: | ||
а) subcapsular spleen break requiring surgery | 10 | |
б) spleen removal | 20 | |
38. Stomach, pancreas, intestines, peritoneum injury causing: | ||
а) removal of 1/3 of stomak or 1/3 of intestine | 15 | |
б) removal of 1/2 1/3 of stomach or pancreas, or 1/2 of intestine | 25 | |
в) removal of 2/3 2/3 of stomach or pancreas or 3/2 of intestine | 40 | |
г) removal of stomach with 2/3 of the pancreas or intestine | 50 | |
д) removal of stomach with intestine and part of pancreas | 90 | |
URINO-GENITAL SYSTEM | ||
39. Kidney injury causing: | ||
а) rupture of kidney, which surgery required | 10 | |
б) kidney part removal | 20 | |
в) kidney removal | 50 | |
40. Injury of urinary system organs causing: | ||
а) rupture of ureter, bladder, urethra requiring surgery | 10 | |
б) chronic kidney failure with hemodialysis | 50 | |
в) obstruction of the ureter, urethra, urinary fistulas | 40 | |
If injury affected a few organs of urinary system, percentage of sum insured shall be measured according to one of sub clauses of clause 40 that takes into account the most severe injuriesя | ||
SOFT TISSUES | ||
41. soft tissues of face, scalp, torso, limbs injuries, burns of stage III: | ||
а) 3% - 5% of body surface | 5 | |
б) 6% - 9% of body surface | 10 | |
в) 10% -20% of body surface | 20 | |
г) 21%-30% of body surface | 30 | |
д) 31% and more | 60 | |
No indemnity shall be paid for scars for open bone fractures and surgeries | ||
42. Burn disease, burn shock | 15 | |
SPINE | ||
43. Fracture of vertebral body | ||
а) one vertebra | 5 | |
б) two vertebrae | 10 | |
в) three or more vertebrae | 20 | |
44. Fracture of the spinous and transverse processes of three or more vertebrae. If at the same time threr is an injury specified in cl.43,cl.44 shall not apply | 10 | |
45. Complete rupture of the intervertebral ligament | 10 | |
46. Fracture of sacrum, coccyx | 5 | |
47. Removal coccygeal bone | 15 | |
UPPER LIMB, SHOULDER, CLAVICLE | ||
48. Fracture of the scapula, clavicle: | ||
а) fracture of one bone | 3 | |
б) fracture of two bones | 5 | |
в) ununited fracture, false joint | 15 | |
If indemnity was paid under cl.48а, б, indemnity shall be paid under cl.48 в net of indemnity paid earlier under cll 48а, б | ||
SHOULDER JOINT | ||
49. Injury of shoulder joint (articular fracture of hollow shovel, head of the anatomical neck of the humerus, greater tubercle): | ||
а) fracture of one bone | 5 | |
б) fracture of two bones, fracture-dislocation | 10 | |
50. Shoulder joint injury causing: | ||
а) the lack of motion in the joint (ankylosis)-not earlier than 3 months after the injury | 20 | |
б) “hanging” shoulder joint caused by reserection of joint surfaces of its bones. | 30 | |
If insurance indemnity was paid in relation to shoulder joint injury under cl.49 causing complications listed in cl.50, insurance indemnity shall be paid according to one of the sub clauses of cl.50 net of indemnity paid earlier under cl.49 | ||
SHOULDER | ||
51. Fracture of humerus at any level (excluding joints): | ||
а) without dislocation | 10 | |
б) with dislocation | 15 | |
52. Traumatic amputation of upper limb or its severe injury causing amputation: | ||
а) upper limb from shoulder blade, clavicle or part of them | 60 | |
б) humerus | 50 | |
в) the only upper limb | 80 | |
ELBOW JOINT | ||
53. Elbow joint injury: | ||
а) fracture of one bone of a joint without dislocation of fragments | 5 | |
б) fracture of two bonea of a joint without dislocation of fragments | 10 | |
в) fracture of bone (bones) with dislocation of fragments | 15 | |
54. Elbow joint injury causing: | ||
а) absence of joint movement | 25 | |
б) "hanging" elbow (as a result of resection of joint surfaces of the bones) | 35 | |
If insurance indemnity was paid in relation to elbow joint injury under cl.53 causing complications listed in cl.54, insurance indemnity shall be paid according to one of the sub clauses of cl.54 net of indemnity paid earlier under cl.53 | ||
FOREARM | ||
55. Fracture of the bones of the forearm (except for distal metaphysis and intra-articular fractures): | ||
а) of one bone | 5 | |
б) of two bones | 10 | |
56. Traumatic amputation or severe injury causing amputation of forearm at any level | 40 | |
RADIOCARPAL JOINT, WRIST | ||
57. Fracture of the bones of the distal metaphysis, in a typical location, complete rupture of ligaments: | ||
а) bone fracture | 3 | |
б) complete rupture of ligaments | 2 | |
58. Wrist joint ankylosis due to injuries that occurred during the insurance period (indemnity is paid not earlier than 6 months after the injury) | 10 | |
If insurance indemnity was paid under cl.57 a or б, insurance indemnity under cl.58 shall be paid net of indemnity paid earlier under cl.57 | ||
59. Fracture of carpal, metacarpus: | ||
а) of one bone | 3 | |
б) of 2 and more bones | 5 | |
60. Traumatic amputation or severe injury of wrist causing amputation of hand or wrist bones | 40 | |
WRIST, FINGERS | ||
61. Fracture of thumb | 3 | |
62. Loss of the first phalanx of thumb | 10 | |
63. Loss of thumb | 15 | |
SECOND, THIRD, FOURTH, FIFTH FINGER | ||
64. Fracture of thumb | 2 | |
65. Loss of index finger | 8 | |
66. Loss of first joint of index finger | 5 | |
67. Loss of any other finger | 5 | |
68. Traumatic amputation or injury causing amputation of all the fingers on one hand | 30 | |
LOWER EXTREMITY. HIP JOINT. | ||
69. Pelvis fracture: | ||
а) fracture of wing of ilium | 10 | |
б) fracture of the pubic, the ischium bone, body of ilium, acetabular fractures | 15 | |
70. Fracture of pubic, sacroiliac joints: | ||
а) one joint | 10 | |
б) two and more joints | 15 | |
71. Fracture of of femoral neck, complete rupture of ligaments: | ||
а) Fracture of of femoral head, neck | 10 | |
б) complete rupture of ligaments | 5 | |
72. Damage to the hip joint causing: | ||
а) joint ankylosis | 25 | |
б) "hanging” joint (causing femoral head, acetabulum resection) | 40 | |
If insurance indemnity was paid in relation to hip joint injury under cl.69, 71 causing complications listed in cl.72, insurance indemnity shall be paid according to one of the sub clauses of cl.72 net of indemnity paid earlier under cl.69, 71. | ||
HIP | ||
73. A hip fracture at any level (except for the joints): | ||
а) without fragment dislocation | 15 | |
б) with fragment dislocation | 20 | |
74. Traumatic amputation or severe injury causing amputation of limbs: | ||
а) above mid hip | 70 | |
б) up to mid hip | 60 | |
в) loss of the only limb | 100 | |
KNEE JOINT | ||
75. Injury of knee joint causing fracture of bones forming knee joint (distal and proximal femoral epiphysis of tibia epiphysis) | 20 | |
76. Knee joint injury causing: | ||
а) joint ankylosis | 30 | |
б) "hanging" knee joint as a result of resection ofr surfaces of the bones. | 40 | |
If insurance indemnity was paid in relation to knee joint injury under cl. 75 causing complications listed in cl.76, insurance indemnity shall be paid according to one of the sub clauses of cl.76 net of indemnity paid earlier under cl.75. | ||
SHIN | ||
77. Shin fracture: | ||
а) one bone | 10 | |
б) two bones | 15 | |
78. Traumatic amputation of lower limb till the middle of lower leg | 40 | |
ANKLE JOINT | ||
79. Ankle joint bones fracture: | ||
а) fracture of one ankle | 5 | |
б) fracture of both anklesк, fracture of ankles with edge of tibia, fraction of distal tibiofibular articulation | 10 | |
80. Ankle injury causing: | ||
а) joint ankylosis | 20 | |
б) "hanging" joint (as a result of resection of bone articular surfaces) | 30 | |
If insurance indemnity was paid in relation to ankle joint injury under cl. 79 causing complications listed in cl.80, insurance indemnity shall be paid according to one of the sub clauses of cl.80 net of indemnity paid earlier under cl.79. | ||
FOOT, TOES | ||
81. Foot bone(s) fracture: | ||
а) fracture of one or two bones (except for heel bone) | 5 | |
б) fracture of three bones, heel bone | 10 | |
82. Fracture of phalanges of foot toes | 2 | |
83. Traumatic amputation or injury resulting in amputation: | ||
а) big toe | 5 | |
б) other toe | 3 | |
в) foot | 30 |
4.7 Total amount of indemnity to be paid under the Insurance Contract with liability for all claims of the Insured Person as provided for by the Insurance Contract shall not exceed the amount of sum insured specified by the Contract in relation to a particular Insured Person for all claims taken together.
4.8 If the Insured Person received an indemnity for one of the claims causing indemnity payment for other claim being a consequence of the same accident, the indemnity amount for the first claim shall be deducted from the indemnity payment for the second claim.
4.9 Events listed in cl. 4.2.1. to 4.2.3. of Accident Insurance Terms shall not be recognized as valid claims if they were caused by the following circumstances and/or the following events shall not be recognized as valid claims (unless the Insurance Contract provides for otherwise):
4.9.1 Events specified in cl.3.4.1.to 3.4.3., 3.5.1. - 3.5.2, 3.5.5., 3.5.8., 3.5.17 of Travel Insurance Terms and Conditions.
4.9.2 If the Insured Person was in a state of alcohol intoxication at the moment of potential claim or while referring for medical aid or during accident investigation conducted by competent authorities (ethanol in biological fluids; tissues; breath is over 0.5 (five tenths) ppm and there are more than two different indicators, then a greater value shall be taken as a basis, or if alcohol intoxication is recorded in medical records), toxic or drug intoxication and/or poisoning, or pharmacological effect of drugs caused by use of drugs, toxic, potent, psychotropic and other substances without medical prescription;
4.9.3 Sending of the Insured Person to the place of imprisonment, temporary detention facilities and other detention places for persons suspected or accused of committing a crime.
4.9.4 All diseases or conditions affected by pregnancy or maternity, their complications or consequences, including abortion, induced and preterm labour excluding life threatening cases for the Insured Person and pregnancy and labour complication specified in the Body Injuries Insurance Indemnity Table 1 of 83 clauses). ;
4.9.5 Diseases or their consequences, consequences of claims that took place before or after effective term stipulated by the Insurance Contract (insurance cover) that the Insurer has not been informed in advance.
4.9.6 Self- treatment of the Insured resulted in worsening health condition or aggravation of pathology process
4.9.7 If the Insured Person sought medical assistance 24 hours after the accident using any available means.
4.9.8 If the Insured Person refuses treatment offered causing disability of the Insured Person or slowing down the recovery process.
4.10 The Insurer shall be released from insurance indemnity payment in circumstances referred to in cl.3.8. of Travel Insurance Terms and Conditions.
4.11 In the event of accident the Insured person shall inform the Insurer about the accident no later than within 31 (thirty one) calendar day since accident date and subsequently provide all the information and supporting documents.
4.12 For claim purposes the Insured Person (his heir or legal representative) shall must provide the following documents and information to the insurer:
4.12.1 Standard claim report according to format established by the Insurer specifying circumstances of claim;
4.12.2 Insurance Contract (insurance policy) information,
4.12.3 Insurance installment payment receipt (other payment document);
4.12.4 Applicant’s ID and document confirming his authority;
4.12.5 documents supporting accident, reasons and circumstances of the event (originals or certified copies) issued by competent authorities;
4.12.6 permission of the Insured Person for the use (including obtaining) by the Insurer of information presenting medical secret and the use of personal data and information presenting medical secret of the Insured Person.
4.13 Based on the nature and circumstances of the claim, the Insurer shall have the right may request the Insurant (beneficiary, insured person, heirs) to provide documents, a full list of which is determined by the Insurer for each individual case.
4.14 The Insurer shall have the right to reduce the list of documents to be provided if circumstances of claim and amount of damage caused are obvious for the Insurer.
4.15 In case of risk “Death caused by an Accident” (cl.4.2.1 of the Accident Insurance Terms and Conditions) the Insurer shall be provided with the following compulsory documents:
а) Notarized copy of death certificate of the Insured Person;
б) copy of medical death certificate with cause and (or) copy of death certificate with cause specified and (or) copy of counterfoil of medical death certificate;
4.15.1 Documents to be provided based on death cause.
а) documents from applicable authorities describing circumstances of the event and its classification;
б) copy of industrial accident properly certified by official of the employer (in case if he Insured Person dies while performing his employment duties);
4.15.2 Based on death cause and accident circumstances the Insurer shall have the right to request the following documents in addition to the above:
а) copy of the document (s) provided for by law or other regulations with information about cause of death of the insured:
- copy of post-mortem examination certificate;
- copy of forensic examination of the body or copy of the act of dead body forensic examination (documents shall contain alcohol and (or) drugs test in blood and/or toxic substances);
- copy of statement of relatives refusing autopsy and copy of pathologist certificate that is used for death certificate purposes (if no autopsy conducted);
б) data of alcohol and/or drugs and/or toxicologically relevant substances blood tests when applying for medical assistance (or admission to hospital in the form established by the legislation of the Russian Federation or international legislation);
- Postmortem summary;
- Medical records of patient issued by a medical institution where the Insured Person has been treated or medical institution keeping medical record of the Inured Person;
- Copy of records and (or) extract from inpatient or outpatient clinic patient for the entire treatment period with all diagnoses and dates of their identification from all medical institutions where the Insured Person received medical assistance;
- Ambulance call records (hereinafter referred to as Ambulance);
- The results of histological studies, MRI, ECG data, computer tomogram, x-rays and (or) description of radiographs (s), fluorography, ultrasound test results from a medical institution with number, date of performance specified and stamped by a medical facility if these tests were performed;
4.16 In the event of risk “Disability caused by accident” (cl.4.2.2 Accident Insurance Terms and Conditions) the following documents are compulsory for presentation to the Insurer:
4.16.1 Notarized copy of certificate issued by a social medical assessment body assigning disability group;
4.16.2 Copy of appointment card for social medical assessment certified by social medical assessment body or a medical institution that issued the appointment card;
4.16.3 Documents from applicable authorities with accident details;
4.16.4 Act about industrial accident (even if disability group is assigned as a result of industrial accident during performance of the Insured Person of his job duties).
4.16.5 Based on reasons for assigning of disability group and circumstances of accident in addition to the above documents, the insurer has the right to request the following documents:
4.16.5.1 Copy (copies) of certificate (certificates) on assignment of disability (issued earlier), certified by issuing institution and (or) copies of all social medical assessment appointment cards, and (or) copy of social medical assessment bureau on the examination results and assignment of disability group certified by social medical examination authority, copies of all acts issued by social medical assessment bureaus issued earlier certified by social medical assessment body related to examination results and assignment of disability group;
4.16.5.2 Information on alcohol and (or) drug test results or toxic substances in the blood sample while referring for medical aid (or hospitalization);
4.16.5.3 Illness historical records issued by a medical institution;
4.16.5.4 Copies of records and (or) extracts from outpatient and (or) inpatient clinic patient for the entire treatment period with diagnosis and dates of their identification from all medical institutions where the Insured Person obtained medical care with records of all referrals;
4.16.5.5 Copy of ambulance calls (hereinafter – Ambulance);
4.16.5.6 the results of histological examinations of the medical institution with a number, date, stamp, if applicable;
4.16.5.7 a copy of the expert opinion, Act of forensics to determine the severity of the harm caused to human health (document must contain information about the tests for alcohol content and (or) or drugs in the blood (if available);
4.16.5.8 x-rays or radiographs description (s) of magnetic-resonance tomography (hereinafter MRT), computer tomogram, ultrasound examination of the medical institution with number, date, stamp and outpatient facilities (hereinafter referred to as CLINIC);
4.16.5.9 copies of sick leaves certified by HR function of the employer.
4.17 Upon risk “Body Injuries Caused by Accident» (cl.4.2.3 of Accident Insurance Terms and Conditions) the following documents are compulsory for presentation to the Insurer
а) medical institution certificate supporting diagnosis and treatment period. The document shall have stamp of the clinic;
б) copy of sick leave (sick leaves) certified by the employer HR function;
в) x-rays or radiographs description (s) of magnetic-resonance tomography (hereinafter MRT), computer tomogram, ultrasound examination of the medical institution with number, date, stamp and outpatient facilities (hereinafter referred to as CLINIC;
г) documents from applicable authorities about circumstance of the event.
4.17.1 Based on the reason and circumstance caused injuries claimed and severe body injuries in addition to the above documents the Insurer shall have the right to request the following documents:
4.17.1.1 data of alcohol and/or drugs and/or toxicologically relevant substances blood tests when applying for medical assistance (or hospitalization);
4.17.1.2 copy of expert opinion, forensic analysis act to identify severity of health damage (supported by alcohol and (or) drugs blood test results, if they are identified);
4.17.1.3 illness historical records issued by a medical institution;
4.17.1.4 copy of records certified by the Clinic and (or) extract from inpatient or outpatient clinic patient for the entire period of treatment with diagnoses and dates of their identification from all medical institutions where the Insured Person received medical care with information about all referrals;
4.17.1.5 copy of Ambulance call records (Ambulance);
4.17.1.6 certificate from a medical institution specifying area of burn and severity (if patient has a few burns of various severity, they should be individually described);
4.17.1.7 certificate form a medical institution stating burn area and severity for the body and head separately ((if patient has a few burns of various severity, they should be individually described);
4.17.1.8 a certificate from a medical facility with a description of the objective status of the admission;
4.17.1.9 ophthalmologist opinion specifying vision area borders;
4.17.1.10 ophthalmologist opinion specifying visual acuity;
4.17.1.11 ophthalmologist opinion with speech audiometry data (perception of whisper and normal speech);
4.17.1.12 surgeon opinion with wound size;
4.17.1.13 surgeon opinion with sizes of scars after the injury;
4.17.1.14 surgeon opinion on tooth loss (lost part of tooth or crown should be specified);
4.18 In case of any claim reported in addition to the above documents, the Insurer shall have the right to request additional documents issued by applicable authorities:
4.18.1 In case of claim as a result of road accident (hereinafter referred to as Road Accident):
4.18.1.1 Road Accident certificate copy;
4.18.1.2 a copy of the Protocol and rule on a case of administrative violation (if recorded), decision of authorities about case dismiss or criminal case investigation);
4.18.1.3 copy of driving license (a document certifying the right to drive a vehicle) of the insured person or of the driver, who ruled the vehicle at the time of the Road Accident;
4.18.1.4 properly documented copy of inspection certificate on state of intoxication of the person driving the vehicle when accident occurred.
4.19 If a criminal investigation is launched in relation to death of the Insured Person and (or) litigation is in progress that will affect qualification of claim reported, the Insurer shall have the right to request sentence, court decision, copy of criminal investigation rejection and (or) criminal investigation request certified by policy authorities;
4.20 In case of any claim reported in addition to the above documents, the Insurer shall have the right to request additional documents issued by medical institutions:
4.20.1 Copy of gynecologist observation records (prenatal record);
4.20.2 Psychonurologic dispensary certificate (MON) and (or) certificate from narcological dispensaryc;
4.20.3 Certificate from the institution, indicating the date of the analysis and results of blood for HIV;
4.20.4 Certificate from the institution, indicating the date and the results of analyses on STDs (sexually transmitted diseases) and (or) a certificate from dermatoveneralogic dispensary
4.20.5 Certificate from the tuberculosis dispensary.
4.21 Heirs of the beneficiary shall in addition to the above documents provide certificate of inheritance under the insurance contract (Policy), issued by a notary public.
4.22 If the Insured Person is a minor or incapable, his representative shall file a claim supported by the documents confirming his authority of a representative.
4.23 All documents provided for the Accident Insurance Terms and Conditions related claim and to be provided to the Insurer shall be presented in the Russian language. If the documents issued in a foreign state, they should be properly legalized supported by an Apostille (if applicable) and (or) supported by a notarized translation.
4.24 Insurance indemnity shall be paid in cash or via bank transfer to the bank account of the Insurant, Insured Person or Beneficiary in accordance with current legislation of the Russian Federation.
5. TRAVEL CIVIL LIABILITY INSURANCE TERMS AND CONDITIONS FOR INDIVIDUALS
The Civil Liability Travel Insurance Terms and Conditions for individuals (hereinafter referred to as CL Insurance Terms and Conditions) are drafted according to General Terms of Civil Liability Insurance for Individuals and Legal Entities approved by Order No.40-1 of the Chief Executive of the OOO Renaissance Insurance Group dated April 1, 2010 (hereinafter referred to as the CL Insurance Terms) and shall present an integral part of the Travel Insurance Contract for Individuals during business, private trips and tours (hereinafter referred to as the Insurance Contract).
5.1. Valid claim shall mean damage caused by the Insurant/Insured Person to Third Parties as a result of activity subject to civil liability of damage compensation under legislation of the Russian Federation.
5.2. Insured activity shall mean a tour made by the Insurant/Insured Person (both in Russia and abroad according to the Insurance Contract) within the term of the Insurance Contract.
5.3. Damage caused to life, health and property of Third parties shall be supported by the effective court ruling according to legislation of the Russian Federation. However, Third Party claims related to compensation for the damage caused to their lives, health or property shall be presented to the Insurant/Insured Person within the term of the Insurance Contract.
5.4. Damaged caused to a few persons as a result of consecutive (or simultaneous) events (for example, fire, explosion etc), due to same cause shall be viewed as one claim. All claims for damage compensation reported as a result of these event shall be recognized as filed when first of these claims is reported against the Insurant/Insured Person.
5.5. Insurance Liability (cover) Scope.
5.5.1. Liabilities of the Insurer incurred as a result of claim include the following obligations to compensate for the damage based on the court ruling that came into legal force according to law of the Russian Federationа:
a) Caused to life and health of Third parties (“Personal Injury”);
b) Caused to property of Third Parties (“Property Damage”).
5.5.2. The Insurer shall compensate the Insured reasonable legal expenses related to assumed damage cases within the limit of insurance liability stipulated in cl 5.11.3.1. of CL Insurance Terms and Conditions.
5.5.3. The Insurer shall also indemnify within the limits of insurance liability specified in cl. 5.11.3.2. of CL Insurance Terms and Conditions necessary and reasonable expenses to minimize damage and rescue lives and property of persons affected by the accident.
5.5.4. Expenses incurred or related to satisfaction of the following claims shall not be reimbursed:
a) Loss of profit of Third Parties;
b) Damage caused to Third Parties above amounts specified by the effective court ruling;
c) Moral damage or damage to business reputation of a legal entity;
d) Damage caused in the course of sports competitions or during preparation for them, if the Insurant/Insured acted (or was going to act) as a direct participant if the Insurance Contract does not state otherwise providing that additional insurance premium is paid;
e) Damage caused by operation or other use of manned or unmanned aircraft;
f) Damage to persons having employment relationships with the Insurant/Insured Person caused by him while performing duties provided for in employment contracts. However, if damaged caused to the above persons off-hours and not in connection with employment duties, it shall be compensated in accordance with provisions of CL Insurance Terms;
g) Damage caused to damaged utility systems: cables, channels, water supply systems gas pipelines and other supply systems
h) Damage deliberately caused by the Insurant/Insured Person except for damage caused to live or health of third parties;
i) Claimed by the Insurant as a result of damage caused by the Insured Person or claimed by the Insured Person as a result of damage caused by the Insurant or other Insured Persons;
j) Claimed by a spouse, children (including adopted), parents (adoptive parents) of the Insurant /Insured Person, their brothers, sisters, grandchildren and grandparents, as well as their relatives and other persons, who live with the Insurant/Insured Person for a long while and share household activities with him/her;
k) Damage caused as a result of war or military actions, civil war, riots, civil disturbances, uprising, actions of armed formations or terrorists;
l) Damage caused by failure of the Insurant/Insured Person to remedy irregularities increasing insurance risk exposure within the term agreed upon with the Insurer;
m) Damage caused outside the insurance territory;
n) Damage caused as a result of driving or other use of auto and motor vehicle subject to compulsory registration with government authorities;
o) Damage caused as a result of use of fire arms, gas, pneumatic, cold or throwing weapons;
p) Damage caused from failure to perform or improper performance of contractual obligations;
q) Payment of forfeit (fine, penalty) for non-fulfillment or improper fulfillment of contractual obligations;
r) Damage caused as a result of force majeure;
s) Damage caused to life and health of Third Parties as a result of contamination with any infectious disease by the Insurant/Insured Person (his staff; animals in his ownership or given to him);
t) intoxication similar to the above; one-off, regular or long-term exposure to hazardous properties and environment (inhalation, application of any substances, food and etc.)
5.5.5. Total amount of insurance indemnity to be paid for all claims occurred within the insurance period shall not exceed specified sum insured.
5.6. The Insurer shall be released from indemnity payment in case of event referred to in cl. 3.8. of the Travel Insurance Terms and Conditions
5.7.Responsibilities of the Parties in case of an accident.
5.7.1. Take all necessary actions to identify the reasons, progress and implications of an accident;
5.7.2. Immediately but in any event no later than within 3 (three) business days inform the Insurer/his representative and competent authorities about the accident through any communication mean available to him that is able to support the fact of such communication;
5.7.3. Immediately inform the Insurer (his representative) about all claims filed against him as a result of event
5.7.4. Take all possible and reasonable action to prevent or minimize damage and for life resue of affected persons;
5.7.5. Make sure that the Insurer/his representative is involved in the inspection of damaged property and assessment of damage caused to the extent that is possible;
5.7.6. Provide all possible assistance to the Insurer/his representative for legal and out-of-court protection in case of damage compensation for claims related to;
5.7.7. Provide the Insurer/his representative with all available information and documents to judge on the reasons, progress and implications of the insured accident, nature and amount of damage caused;
5.7.8. Issue a Power of attorney or other documents required, if the Insurer appoints a lawyer or other authorized person to protect interests of both the Insurer and the Insured Person in relation to the insured accident. If the Insurer rejects from court representation of interests of the Insurant/Insured Person, the Insurer shall indemnify actual legal expenses that are pre-agreed with the Insurer (his representative) for protection of his interests in such legal proceedings);
5.7.9. Strictly follow recommendations of the Insurer/his representative;
5.7.10. Avoid paying indemnity, partially or fully recognize claims filed against him in relation to potential claim as well as avoid accepting any direct or indirect obligations for settlement of these claims without consent of the Insurer;
5.7.11. Accept no claims filed in relation to damage caused, accept no obligations for settlement of these claims and make no payments to Third Parties in relation to damage caused.
5.8. If the Insurant/Insured Person fails to fulfill obligations specified in cl.5.7, the Insurer shall have the right to reject indemnity payment.
5.9. Insurance indemnity payment procedure.
5.9.1. Insurance Indemnity shall be paid in accordance with effective court ruling.
5.9.2. For insurance indemnity payment purposes the Insurant/Insured Person shall submit claim report and original copies of the following documents to the Insurer:
5.9.2.1. Insurance Contract (policy);
5.9.2.2. Effective court decision according to legislation of the Russian Federation stating the amounts to be indemnified by the Insurer in relation to the accident as provided for by the Insurance Contract, if court decision on the damage caused is taken in the Russian Federation;
5.9.2.3. Ruling on recognition and enforcement of decision of the foreign court made by the Russian court if court decision on damage caused has been taken outside the Russian Federation properly supported by notarized translation of the foreign court decision into the Russian language;
5.9.2.4. Copy of the passport with original to be provided or a notarized copy;
5.9.2.5. Document supporting payment of the Insurance contract;
5.9.2.6. Beneficiary shall provide the following documents that are compulsory: legal documents (legal entities and private entrepreneur’s registration documents, tax registration certificate, documents supporting the authority for communication with the Insurer for claim purposes (Order of appointment as the CEO (similar document to act on behalf of a legal entity without the Power of Attorney) , original copy of Power of Attorney/ Power of Attorney supporting the right to receive insurance indemnity, ID and tax registration document for individuals and private entrepreneurs, as well as documents supporting Beneficiary’s interest in the insured property
5.10 Insurance indemnity shall be paid by the Insurer/his representative to Third Parties (parties affected according to CL Insurance Terms and Conditions), except for reimbursement of expenses related to services of the lawyer in relation to the claim and expenses specified in cl.5.5.3. of CL Insurance Terms and Conditions.
5.11. In the case of damage to health of an individual, or the death of an individual, as well as damage caused to an individual or legal entity, insurance indemnity shall be paid as follows:
5.11.1. for "Personal Injury" risk:
5.11.1.1. In the amount of salary (income) lost by an individual that he had or definitely could have as well as additional expenses related to health recovery (including treatment, additional nutrition, purchasing of medicines, external care, rehabilitation and treatment in recreation centers, purchasing of specialized vehicles, other career training, prosthetic care providing that these additional expenses are incurred as a result of damage caused to health of a Third Party and the person is not entitled to obtain them free of charge): for injuries or health damages;
5.11.1.2. In the amount of average monthly salary of the affected person as a survival benefit for minors and/or family members unable to work dependent on the aggrieved person but not more than the liability limit specified for this type of indemnity (burial expenses shall not be covered): for accidents damaging life and health causing death.
5.11.2. for "Property Damage" risk:
5.11.2.1. Direct actual damage caused by property damage or destruction that is identified with property total loss as the amount of its fair value at the date of accident net of depreciation; in case of a partial damage in the amount of expenses required for its repair to the condition it has been before the accident if this property is recoverable.
5.11.3. for risks provided for in cl.5.5.2. and cl. 5.5.3. CL Insurance Terms and Conditions:
5.11.3.1. expenses related to services of a lawyer for anticipated claims within the amount equivalent to 1.000 of the US dollars;
5.11.3.2. necessary and reasonable expenses to rescue life and property of affected persons or to minimize damage caused by the accident within the amount equal to 1.000 US dollars.
Special insurance terms for travelers during the period of travel/flight
These Special Terms are generated based on Policy Terms and Conditions for travelers ratified by the Order of the CEO of Renaissance Insurance Group LLC as of June 19, 2009 No. 90 (hereinafter referred to as Policy Terms) and incorporate insurance terms used by Renaissance Insurance Group LLC as a basis to write Contracts (policies) to insure risks such as “Loss of Luggage”, “Trip Cancellation of II Category”, “Trip Failure” .
These Special Terms are an integral part of Policy Terms. If any of the provisions of these Special Terms modifies and /adds Policy Terms, Special Terms shall prevail. All issues that are not governed by these Special Terms shall be governed by the provisions of Policy Terms.
These Special Conditions are an integral part of the Insurance Contract (policy) and shall be attached to it together with Policy Terms. This fact is supported by written evidence in the Insurance Contract (policy).
Travelers’ Insurance Contract (policy) signed based on Policy Terms and these Special Terms shall cover travel/flight described in special notes of the Insurance Contract (policy) according to the travel document.
For the purpose of insurance cover the Parties have agreed to calculate dates and time using local time of applicable departure and arrival countries (this condition applies if special notes of the Insurance Contract (policy) do not specify Moscow time as applicable dates and time).
1. TERMS AND DEFINITIONS
Insured Person – Person is an individual for whose benefit the Insurant enters into the Insurance Contract with the Insurer. For the insurance purpose individuals shall be insured if they travel/fly one way or if they have a return arrangement (to a temporary destination and /or from a temporary destination) based on a travel document described in the Insurance Policy.
Trip - is a temporary stay of the Insured Person outside administrative boundaries of the territory of residence.
Individual Travel Product - is a combination of flight/travel and accommodation during the trip, i.e. one way or return travel/flight document supporting payment and booking of the temporary accommodation and travel (a voucher or any other document supporting booking and payment of temporary accommodation).
Overbooking – is a situation when travel documents of a particular class sold exceed the number of sits of a particular class in a particular carrier.
Loss of Luggage – is a destroy, damage or loss of luggage of the Insured Person checked in with the carrier according to procedures stipulated by the transportation charters and codes of the carrier during the official transportation via travel/flight to a country (place) of temporary destination and/or from a country (place) of temporary destination.
2. INSURANCE SCHEME
In accordance with the Insurance Program under the Travelers Insurance Contract (policy) signed based on these Special Terms the following risks (insured events) can be covered:
2.1. Loss of Luggage
2.1.1. The Insurer shall reimburse damage caused to the Insured Person as a result of lost luggage of the Insured Person checked in by the carrier according to the transportation charters and codes of the carrier during the official transportation via travel/flight to a temporary or from a temporary destination.
2.1.2. The insurance reimbursement for lost luggage is 100% of sum insured. In case of destroy reimbursement shall be made according to the reimbursement table.
Loss of Luggage Reimbursement | ||
---|---|---|
№ | Type of Damage | Amount of Reimbursement as % of sum insured |
1. | Damage of luggage surface as a result of mechanical, chemical or thermal interaction or any other interaction causing the following damage: | |
1.1. | Over 25,0% of overall luggage surface damaged | 45 |
2. | Partial damages of: | |
2.1. | Luggage handle | 10 |
2.2. | Luggage lock | 11 |
2.3. | Luggage wheel | 11 |
2.4. | upper/lower part of luggage is damaged | 15 |
2.5. | Providing that a few luggage parts are damaged at the same time | 25 |
3. | Damage of the surface and/or parts of luggage leading to luggage non-recovery | 100 |
2.1.3. In case of Loss of Luggage claim the Insured Person shall obtain documents supporting loss or damage of luggage (e.g. a commercial act generated by a representative of the carrier) from authorized bodies (such as the carrier, local police etc) at the place of accident within the time period specified by effective legislation. Refusal of the above authorities to issue the appropriate papers shall be documented in writing.
2.1.4. The Insured Person shall submit the following documents to support claim and for subsequent reimbursement:
- Reimbursement application;
- ID
- Insurance Policy
- Original document supporting policy payment
- Travel document (original copy or a printed version of e-ticket);
- Boarding pass or a stamp in a travel document supporting boarding (original copy);
- Luggage token/luggage receipt (original copy);
- Paid luggage receipt if applicable;
- Luggage loss or damage form (act) duly completed and certified by an authorized carrier’s official in the course of official transportation (original copy);
- Official letter from a carrier supporting the fact of loss of luggage written after the search term (21 days).
2.1.5. This event is not a valid claim if not supported by documents from authorized officials describing the event including the refusal of authorized authorities to issue the documents as a result of the Insured Person/Insurant to apply for supporting documents on a timely manner
Loss of Luggage risk shall not cover:
- Luggage natural wear and tear (scratches, chips), rust, mold, discoloration and other natural changes of luggage properties;
- Loss of luggage as a result of confiscation, arrest, seizure or destroy of the insured luggage or luggage items by the order of the government authorities;
- Luggage damaged caused by overweight;
- Luggage damage caused by insects or gnawing animals;
- Damage caused by incorrect packing of fragile or piercing items, fluid containers;
- Damage of the luggage that follows the owner separately or by post.
2.2. Luggage Delivery Delay
2.2.1. The Insurer shall reimburse viable and essential expenses (clothes and personal hygiene items purchasing, sports items rental etc) incurred by the Insured Person as a result of incorrect transportation of the luggage of the Insured Person checked in and transported by the carrier according the procedure stipulated by transportation charters and codes during the official transportation/flight to or from temporary destination resulted in delay of luggage arrival for over 48 hours if the Insurance Contract (policy) does not specify other time period.
2.2.2. Insurance reimbursement shall be made in the amount of expenses actually incurred, but no more than 75% of sum insured (liability limit of the Insurer) provided for this risk in Traveler’s Insurance Contract (policy).
2.2.3. In case of “Luggage Delivery Delay” claim the Insure Person shall furnish the Insurer with a written evidence of the delay from the carrier specifying the delay period: documents supporting expenses incurred by the Insured Person and their relation with the luggage delay.
2.2.4. For reimbursement purposes the Insured person shall provide documents to support claim:
- Reimbursement application form;
- ID;
- Insurance policy;
- Original copy of policy payment document;
- Travel document (original copy or a printed version of e-ticket);
- Boarding pass or a stamp in a travel document to support boarding (original copy);
- Luggage token/luggage receipt (original copy);
- Paid luggage receipt if applicable;
- Form (act) of luggage delivery delay during official transportation duly completed and certified by an authorized official of the carrier stating the delay period in hours (original copy);
- Receipt supporting expenses incurred from hour exceeding period of luggage delay specified in the Insurance Contract and until actual luggage location but no more than 21 days.
2.3. Trip Cancellation of Category II
2.3.1. The Insurer shall reimburse expenses (real damage) incurred by the Insured Person in cases when the Insured Person had the travel document for the scheduled travel/flight and when the planned trip was cancelled as a result of the following:
а) departure delay;
б) overbooking;
в) flight cancellation due to bad weather conditions, mechanical breakage of carrier vehicle certified for international passenger transportations.
2.3.2 Insurance reimbursement shall be paid in the actual amount of expenses incurred by the Insured Person based on the insurance scheme:
- Payment of non-refundable cost of first day of hotel accommodation in the trip but not more than liability limit (sum insured) provided for this risk;
- Payment of non-refundable cost of all accommodation days booked in a hotel during the trip but no more that liability limit (sum insured) provided for this risk.
2.3.3. In case of claim on Trip Cancellation of Category II risk the Insured Person shall provide the Insurer with a written confirmation of the carrier of flight delay, overbooking, flight cancellation due to bad weather conditions, and mechanical breakage of carrier vehicle certified for international passenger transportation.
2.3.4. For reimbursement purposes for Trip Cancellation of Category II risk the Insured Person shall submit the following documents supporting claim:
- Reimbursement application form;
- ID;
- Insurance Policy;
- Original copy of insurance policy payment document;
- Travel document (original copy or a printed version of e-ticket);
- Original copy of official document from airline duly certified describing the event;
- Receipts and other documents (original copies or bank copies duly certified) supporting hotel accommodation expenses incurred;
- Confirmation from the hotel of the payment of one or all unused days with the amount of non-refundable cost of accommodation.
2.4. Trip Delay
2.4.1. The Insurer shall reimburse viable and essential expenses (food and personal hygiene items purchasing, sports items rental etc) incurred by the Insured Person as a result of rip delay for over 6 hours if the Insurance Contract (policy) does not provide for other time period, due to bad weather conditions, mechanical breakage of carrier vehicle certified for international passenger transportation
2.4.2. The amount of reimbursement shall be specified by the Insurance Contract (policy)
2.4.3. The Insured Person shall check-in according to check-in rules and procedures stated in the travel document issued by the carrier and submit written evidence from the carrier that the flight or departure has been delayed due to aforementioned circumstances. This confirmation shall state the delay time versus departure time specified in the travel document of the Insured Person.
2.4.4. For the purpose of reimbursement under Trip Delay risk the Insured Person shall submit the following documents supporting claim:
- Reimbursement application form;
- ID;
- Insurance Policy;
- Original copy of insurance policy payment document;
- Travel document (original copy or a printed version of e-ticket);
- Original copy of official document from airline/carrier supporting the delay with delay time in hours;
- Receipts supporting the expenses incurred from the hour exceeding trip delay time specified by the Insurance Contract and till the actual boardin
3. TRIP FAILURE
3.1. The Insurer shall reimburse cost of unused by the Insured Person and non-refunded travel documents by the carrier for the Insured Person to travel/fly to a planned destination and when the scheduled trip has been cancelled as a result of the following:
a) Death of the Insured Person;
b) Death of a relative of the Insured Person (father, mother, husband, wife, son, daughter, brother, sister);
c) Illness and (or) injury diagnosed (suffered) by the Insured Person but not earlier than 20 calendar days prior to the trip (start day of the assumed trip) specified in the travel document;
d) Illness and (or) injury diagnosed (suffered) by a relative (father, mother, husband, wife, son, daughter, brother, sister ) of the Insured Person but not earlier than 20 calendar days prior to the trip (start day of the assumed trip) specified in the travel document;
e) Military obligation of the Insured Person;
f) Obligation of the Insured Person to be involved in investigation as a witness or complainant;
g) Entry visa rejection providing that the document package delivered to the Consulate on a timely manner (in accordance with requirements of Visa Section of foreign states) to comply with entry visa requirements of visa offices of foreign states according to visa procedures;
h) Official launch of state of emergency in the destination territory;
i) Failure to use travel document for the planned trip as a result of a road accident or failure of public utilities on the way of the Insured Person to the airport/railway station leading to non-boarding;
j) Damage or loss (destroy) of property of the Insured Person 24-hours before take off as a result of fire, flood, illegal actions of third parties or failure of public utilities that requires personal presence of the Insured Person at the place of permanent residence causing failure to use the applicable travel document;
k) Forced loss of employment of the Insured Person as a source of income due to reasons that do not depend on him (termination of Employment Contract) not earlier than 30 days prior to planned trip:
- In case of company dissolution;
- Staff redundancy of the employer;
- Change of ownership of the company property (if the Insured Person was a CEO of the company, deputy CEO or Chief Accountant).
For the reimbursement purposes under Trip Failure risk the Insured Person shall submit a written reimbursement application within 3 (three) business days after the Insured Person (in case of death of the Insured Person to other legal reimbursement beneficiary) becomes aware of the covered event and the following documents supporting claim:
3.2.1. In case of claim as a result of death or illness and/or injury of the Insured Person or a relative of the Insured Person (father, mother, husband, wife, son, daughter, brother, sister ) the following documents shall be delivered):
- Original copy of the policy;
- Copy of the external passport and the original passport;
- Unused travel documents with payment confirmation;
- Hospital discharge letter supporting hospitalization of the Insured Person or his/her relative, notarized copy of entry of death, documents supporting kinship of the Insured Person and the relative;
3.2.2. In case of claim due to military obligation of the Insured Person the following documents shall be delivered:
- Original copy of the policy;
- External passport copy and the original passport;
- Unused travel documents with the payment confirmation;
- Draft notice certified by military enlistment office;
3.2.3. In case of claim as a result of obligation of the Insured Person to be involved in investigation as a witness of complainant:
- Original copy of the policy;
- Copy of external passport and original external passport;
- Unused travel documents with payment confirmation;
- Summons of the detective, prosecutor, court certified by the prosecutor’s office/court and notice on compulsory process;
3.2.4. In case of claim due to entry visa rejection for the country of planned visit:
- Original copy of the policy;
- Copy of external passport and original external passport;
- Unused travel documents with payment confirmation;
- Official rejection of visa section (if it has been issued or any other document confirming visa rejection)
3.2.5. In case of claim due to official launch of state of emergency in the territory of planned trip the following documents shall be submitted:
- Original copy of the policy;
- Copy of external passport and original external passport;
- Unused travel documents with payment confirmation;
- Official announcement /decision of government authorities or international organization to launch emergency state in the country of planned trip;
3.2.6. In case of claim as a result of inability to use the travel document for planned trip caused by a road accident or failure of public utilities on the way of the Insured Person to the airport/railway station causing failure to board the following documents shall be submitted:
- Original copy of the policy;
- Copy of external passport and original external passport;
- Unused travel documents with payment confirmation;
- Road accident police certificate (form 748 or form 154);
- Police regulation or definition issued by the road police;
- Document supporting failure of public utilities with the date and time stated and with the description of event and damages issued by emergency authorities and utility bodies, Ministry of Emergencies;
3.2.7. In case of claim due to damage or loss of real estate owned by the Insured Person as a result of fire, flood, illegal actions of third parties or public utilities failure (that happened not earlier than 24 hours before take off to the planned destination) requiring personal presence of the Insured Person at the place of permanent residence causing failure to use travel document:
- Original copy of the policy;
- Copy of external passport and original external passport;
- Unused travel documents with payment confirmation;
- Original copy of fire report certified and signed by the official (official title and rank to be specified);
- Original copy and copy of fire evidence certified and stamped by the original stamp of the body of the Ministry of Internal Affairs (Road Police);
- Original copy of certificate issued by the Ministry of Internal Affairs (Road Police stamped and signed by the ministry or police official (official title and rank to be specified;
- Document supporting failure of public utilities with the date, time and circumstances described issued by utility management authorities, emergency authorities, Ministry of Emergencies;
3.2.8. In case of claim due to forced unemployment of the Insured Person and loss of work as a source of income due to circumstances that do not depend on him (Employment Contract termination) no later than 30 days prior to the date of planned trip:
- Copy of external passport and original external passport;
- Unused travel documents with payment confirmation;
- Employment record (book) or documents replacing it;
- Copy of terminated employment contract from last employment (with all amendments);
3.3. The Insurer has the right to request other documents to define or measure expenses incurred by the Insured Person/Insurant.
4. VALIDITY OF THE INSURANCE CONTRACT (POLICY).
4.1. The Insurance Contract comes into force from the date of full insurance premium payment as a lump sum if otherwise is not agreed by the Parties in the Travelers' Insurance Contract (policy). Insurance premium payment is the date of total insurance premium to be credited on the bank account of the Insurer or paid through the Insurer's \representative of the Insurer cashier's office.
4.2. Insurance period incepts and ends in terms specified in the Insurance Contract (policy) and shall not be less than 24 hours. Insurance cover shall be valid based on the chosen insurance scheme as follows:
4.2.1. for Loss of Luggage, Luggage Delivery Delay risks it starts when the carrier announces luggage collection (not hand baggage) after the trip/flight to the temporary destination or from the temporary destination. In case of travel/flight to a temporary destination or from the temporary destination using two or more carrier vehicles the insurance cover is applicable for all flights to be made for the purpose of the trip/over flight.
4.2.2. for Trip Delay risk it starts from the moment when carrier announces flight delay and ends after actual departure or cancellation of flight specified in the travel document.
In case of travel/flight to the temporary destination or from the temporary destination using two or more carrier vehicles specified in travel documents the time of insurance cover shall cover all the passages to be made for the purpose of the trip/over flight.
4.2.3. for Trip Cancellation of Category II it starts when the Insurance Contract comes into force and ends no later than the date specified in the insurance contract as the date of insurance period inception.
4.2.4. For Trip Failure risk it starts from the date when Insurance Contract comes into force and ends after last passage departure of the trip specified in the travel document.
4.3 Insurance territory shall be defined based on the chosen insurance scheme as follows:
4.3.1 for Loss of Luggage , Luggage Delivery Delay is identified by the territory where luggage (not a hand baggage) is checked in for official transportation for the passage stated in the travel document and namely:
- Airport area: departure, arrival, transit, forced transit;
- Railway station area: departure, arrival, transit, forced stop.
4.3.2. for Trip Delay risk is specified by passage departure territory specified in the travel document and namely:
- Airport territory: departure, transit, forced transit;
- Railway station: railway station territory in the following areas: departure, transit, forced stop.
4.3.3. For Trip Cancellation of Category II, Trip Failure risks: all countries of the world are covered.
4.4. Term of the insurance contract covers one way or return trip/flight of the Insured Person based on the insurance scheme including trip/flight using two or more carrier vehicles specified in a travel document and its data is stated in special notes of the Insurance Contract (policy).
4.5. The Insurance Contract (policy) covering Luggage Delivery Delay, Trip Delay, Trip Cancellation of Category II shall not be signed once the official information about luggage release delay is disclosed in open sources (airport display, railway station display, web site of the carrier, mass media etc) and/or after the Carrier officially declares luggage release delay and /or flight/trip delay or its cancellation. The Insurance Contract (policy) signed after the aforementioned moment shall not be valid and shall carry no legal implications for its parties. The Insurer shall return the insurance premium in full amount to the Insurant that has been paid under this Insurance Contract (policy) within 5 (five) business days since the Insurer received a written notification from the Insurant with all payment details and form of payment.
4.6. In case of early termination of the Insurance Contract the insurance premium shall be returned according to the following procedure:
4.6.1. The Insurer has the right to terminate the Insurance Contract at any time. Termination of the Insurance Contract if initiated by the Insurant shall be executed by the Insurer based on written notification of the Insurant.
4.6.2. In case of the Insurance Contract termination by the Insurant before inception sum insured paid to the Insurer shall be returned to the Insurant in full amount.
4.6.3. In case of the Insurant Contract termination after inception sum insured paid to the Insurer shall not be returned.
4.6.4. Sum insured shall be returned within 30 (thirty) calendar days since the date of termination of the Insurance Contract if the Insurance Contract does not say otherwise.
4.6.5. In case of early termination of the Insurance contract by the Insurant if within the expired insurance period at least one claim is reported or potential claim is recorded, sum insured shall not be returned.
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