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PERSONAL ACCIDENT TERMS AND CONDITIONS
OLD MUTUAL LIFE ASSURANCE COMPANY (GHANA) LTD. (Here in after called the Company) having received a Proposal and Declaration with date as stated in the Application Form which together with the answers given by the Policyholder to any questions put forward by the Medical Examiner shall form the basis of this contract and hereby agrees with the Policyholder subject to the payment of the premium specified in the Application Form to pay the Sum Assured in accordance with the terms upon receipt of proof satisfactory as to: 1. Death or
Resulting directly and Independently of any other cause except from violent, accidental, external and visible means.
FRAUD WARNING: Deliberately presenting false information is unlawful. Failure to disclose accurate information may result in non-payment of claim and all benefits under the policy being terminated.
PERMANENT TOTAL DISABILITY (PTD): disability shall be deemed to be total whenever the insured, as a result of an accidental bodily injury, Is incapable of engaging in his own or any other occupation for remuneration or profit.
PERMANENT PARTIAL DISABILITY (PPD): (Including loss of sight and limbs or loss of hearing) Permanent Partial Disability means the insured person has suffered a permanent loss of physical function or loss of use of a body part, substantiated by a diagnosis by a medical practitioner. Permanent also means lasting twelve calendar months and at the expiry of that period; being beyond reasonable hope of Improvement.
GENERAL CONDITIONS 1. BENEFITS OF THE PERSONAL ACCIDENT POLICY TEMPORARY TOTAL DISABILITY ( TTD ) OR WEEKLY INDEMNITY: Temporary Total Disability is defined as a situation where a policy holder is incapacitated through accidental means in such a way that the person cannot return to active work over a period of time (three months maximum) or in such situation where he is clinically declared to be temporary disabled.
ACCIDENT: Accident is defined as a sudden, unexpected unforeseen and unintended event. The benefits under the Personal Accident Benefits Policy are Fourfold: (i) We will pay the Sum Insured, as mentioned in the Policy Schedule, for any injury that is caused due to an accident that immed iately or eventually results in the loss of life, provided that such loss occurs under the circumstances described in the policy within 365 Days from the date of the Accident.
a) Medical Expense Incurred: In situations where the Injured, who is covered under this policy incurs a medical expense due to an accident that he has suffered, Old Mutual will pay up to 10% of the Claim Payable. b) We shall not in respect of the same accident, be liable to pay in respect of any one person/s insured more than one of the Benefits (i) - (iv), nor shall more than one Benefit be payable in respect of the same period of time, c) Benefit shall only be payable provided death or loss occurs or disablement commences within twelve months of the date of the injury . (il) PERMANENT TOTAL DISABLITY (PTD): (Including Loss of Sight, Limbs and the Hearing) In case the injured suffers permanent disability as a result of accident, 100% of the capital sum assured will be made payable. (iii) PERMANENT PARTIAL DISABLITY (PPD): (Including Loss of Sight and Hearing) In case the injured suffers permanent partial disabi lity as a result of accident, 50% of the of the capital sum assured will be made payable. (iv) TEMPORARY TOTAL DISABLITY (TTD) OR WEEKLY INDEMNITY: In case of temporary disability, Old Mutual will pay 10% of the capital sum assured per month for six months. Temporary Disability is defined as a situation where a policy holder is incapacitated through accidental means in such a way that the person cannot return to active work over a period of time (three months maximum) or in such situation where he is clinically declared to be temporary disabled.
2. OBLIGATIONS OF INSURED WHEN A LOSS OCCURS
(i) The insured shall, as soon as possible give a written notice of any accident with full particulars and medical certificate (If any) to Old Mutual.
(il) The insured further shall when required by the company submit himself to be examined by a Medical examiner or an officer of the company.
(iii)In case of a fatal accident, the insured's legal representative shall be required to furnish the company with a certificate from a medical attendant of the insured stating as fully as possible, the cause of death and all such other information and evidence as the company may require to satisfy itself of its liability.
3.CONDITIONS VOIDING INSURANCE
Unless otherwise provided by agreement in writing and added hereto, the insurance, under any of the following circumstances, shall cease to exist.
(i) If the insured is or at any time during the continuance of the policy shall be insured against accident (other than coupon or travel insurance) with another insurer without notice In writing to Old Mutual.
(ii) If the insured becomes of unsound mind either temporarily or permanently.
(iii) If the injured without previous permission by the company engages or becomes employed in a more hazardous business or profession than that stated in the proposal and the policy.
(iv) If the insured is or becomes a member of the military, naval or air force of any country at war,whether war is declared or undeclared.
(v) If the insured is or becomes a member of any auxiliary or civilian non- combatant unit serving with the military, naval or air force of any country at war declared or undeclared.
4. EXCEPTIONS Unless otherwise provided by agreement In writing, this policy does not insure against;
(i) Death or disablement caused by suicide or any attempt thereat.
(ii) Disablement which has been self-inflicted while sane.
(iii) Accident occurring whilst the insured Is under the influence of alcohol, drugs veneral disease or insanity.
(iv) Death or disablement caused by participation In big-game hunting, mountaineering, racing of any kind, motorcycling, polo or football.
(v) Death or disablement as a result of travel or flight in any type of aircraft except as a fare paying passenger in an aircraft opera ted by a commercial passenger airline on a scheduled sen/ice over an established passenger route.
(vi) Death or disablement directly or indirectly occasioned by, contributed to by or arising out of or In connection with invasion, the act of foreign enemies, hostilities or warlike operations (whether war be declared or not) civil commotion, mutiny, rebellion, revolution, insurrection, military or usurped power.
(vii) Death or disablement caused by disease.
The company shall not be bound to accept any renewal and may cancel this policy by sending seven days' notice by registered letter to insured's last known address and in such event shall return to the insured the premium less the prorate portion for the period the policy has been in force.
6. SETTLEMENT OF DISPUTES
Any dispute arising out of or in connection with this document shall be resolved amicably between the parties, failing shall be referred to arbitration in accordance with the Alternate Dispute Resolution Act 2010 (Act 798).
In witness to the above, The Old Mutual Life Assurance Company (Ghana) Limited has caused this policy to be executed as of the policy date.
For any compliments or complaints about the way Old Mutual has rendered its services to you, please feel free to visit any Old Mutual office or branch. Alternatively, you can visit the National Insurance Commission (NIC) at National Insurance Commission: No-67, Independence Ave, Insurance Place, PO. Box CT 3456, Cantonments, Accra.