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Accidents Allianz Insurance
Conditions of your
Insurance Policy Allianz Group Accident Policy Policy No. Broker: 045764350 FERRER & OJEDA ASOCIADOS COR.SEG. S.L.
BARCELONA 10 July 2019
Policyholder
UNIVERSITAT DE BARCELONA
These are the terms and conditions for your Insurance Policy. It is very important that you read this
document carefully and check that everything you were expecting in your insurance is fully covered. It
is our pleasure to provide this service for you to cover your anticipated requirements and insurance.
Kind regards
FERRER & OJEDA ASOCIADOS COR.SEG. S.L. Allianz Seguros y Reaseguros, S.A.
With you from A to Z
www.allianz.es/eCliente
0133.0133.2 P
CONTENTS
CHAPTER I Identification details . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
CHAPTER II Purpose and scope of the Insurance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 CHAPTER III Claims . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
CHAPTER IV Administration of the policy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 CHAPTER V Fundamental questions of a general nature . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
APPLICABLE LEGISLATION
This insurance policy is subject to Spain's Insurance Contracts Act 50/80, which was published in Spain's
Official Government Gazette no. 250 of 17 October 1980; the Revised Text of Spain's Private Insurance Regulation and Supervision Act, approved by Royal Legislative Decree 6/2004 of 29 October; the amendments
and adaptations thereof; and its regulatory provisions. Both parties expressly agree to submit to civil and commercial law, thus excluding employment jurisdiction, unless expressly stated in the policy. The same condition will apply if the policy is formalised with a view to covering a group of workers, even if voluntary improvements to the General Social Security System are covered. In this regard, this policy is outside of and independent of any other policy that the Policyholder may have been obliged to take out as a consequence of the Company's Collective Agreement. For the reasons above, 'Accident' covered by the policy shall be considered to be only events that meet the requirements set out under the policy's General and Particular Terms and Conditions, in accordance with the Insurance Agreement Act. Declarations of accidents made by any other organisation outside the civil or commercial sphere shall not apply. Adhering to the terms of the Law, the insurance policy's Conditions have been written to be clear and
precise, so that anyone who has an interest in the policy can familiarise themselves with its exact scope.
Policy 045764350 Page 2 of 24
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SPECIFIC AND GENERAL CONDITIONS
Allianz Group Accident Policy
CHAPTER I
Identifying details
Policyholder UNIVERSITAT DE BARCELONA Company Tax No: Q0818001J
CL GRAN VIA D LES CORTS CATALANES, 585, 0, 0, 0, 0
08007 BARCELONA
Policy & Policy number: 045764350
duration Duration: From 00.00 on 07/09/2019 until 24.00 on 06/09/2010.
Renewable from 07/09/2020.
Broker FERRER & OJEDA ASOCIADOS COR.SEG. S.L. 125 9510145
Insurance Broker. No. DGS J0812 TAMARIT 155 159 08015 BARCELONA Tel: 932805959 [email protected]
Insurer Allianz, Compañía de Seguros y Reaseguros, S.A. - Spanish company subject to the
control and supervision of the Directorate General of Insurances and Pension Funds with registered office at Cl. Ramírez de Arellano 35. 28043 Madrid.
IDENTIFICATION OF THE TARGET INSURANCE RISK
Description Total number of insured people within the group:. 9525
Global Risk Number of Groups: 1
Description Number of Insured Persons: 9525
Group Risk category:. Students/scholars of universities and academies
Number 1 Detail of the activity: Students of Universitat de Barcelona
Covers Insured Sum insured Excess Max. Age
Accidental death 18,000 Euros 75
Permanent Disability due to 36,000 euros 75
schedule for accidents
Absolute permanent disability 36,000 euros 75
per accident
Health care Free choice 2000 euros 75
per accident
Unlimited health care in Included 75
Medical Chart
Death from myocardial infarction 12,000 euros 70
Being made an orphan 12,000 euros 75
Death by assault 12,000 euros 75
Funeral expenses due to accident 1500 euros 75
Spain
Funeral expenses due to accident 3000 euros 75
abroad
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Covers Insured Sum insured Excess Maximum Age
Prosthesis material, glasses, 1200 euros 75
acoustic devices, orthopaedics
Rescue operations or 1200 euros 75
search and transp. of injured party
Basic travel assistance Included 75
Clauses 1. Various guarantees covers for permanent incapacity
If several types of Permanent Disability have been covered,
no cumulative compensation will be paid that may correspond to the
application of several of them.
Covers with an added sum in the event of traffic accident are excluded.
2. Pre-existing conditions PRE-EXISTING CONDITIONS:
FOR ANY INSURED PERSONS WHO HAD INJURIES, ILLNESSES OR ANY TYPE OF DISABILITY PRIOR TO SIGNING THE POLICY OR IT COMING INTO FORCE FOR THOSE INSURED PERSONS, THE COMPENSATION IN THE EVENT
OF A CLAIM COVERED BY THE POLICY, THE AMOUNT TO BE PAID SHALL BE THAT WHICH WOULD CORRESPOND TO A PERSON WHO DID NOT SUFFER FROM SUCH CIRCUMSTANCES
THEREFORE, THE CONSEQUENCES, AGGRAVATIONS OR SITUATIONS RELATED TO PRE-EXISTING ILLNESSES, INJURIES OR DISABILITIES, BOTH PHYSICAL AND MENTAL, ARE EXCLUDED.
3. Blank clause - Accidental death 18,000 eur + 1500 eur death in Spain or
3,000 eur death abroad
- Death of a parent due to accident or illness 7200 eur.
- Death of both parents due to accident or illness 10,800 eur.
- Death from heart attack 10,800 eur.
- Death due to assault 10,800 eur (to be added to the principal sum of principal).
- Partial disability as per schedule for accidents up to 36,000 eur.
- Absolute Permanent Disability due to accident 36,000 eur.
- Health Care due to accident - unlimited at Recommended Centres or
2000 eur at a Centre of Your Choice.
- Search and rescue operations 1800 eur.
- Expenses for plastic/repairing surgery, prosthesis, glasses, maximum of
3010 eur
- Missing lessons due to accident for 20 days or more due to
accident or illness 1400 eur.
- Missing lessons due to accident for 2 consecutive months or more if
the accident occurs a maximum of 15 days before final exams,
additional sum to that stated in the previous point, reimbursement of tuition fees up to 2100 eur.
- Theft whilst on the university campus or travelling to/from it up to 1080
eur (personal items excluding jewellery), and 72 euros for cash
-Theft or robbery of bicycle, moped or motorcycle on the university campus up to 240 euros.
TRAVEL ASSISTANCE trips not exceeding 90 days):
- Repatriation or medical transfer of the Insured Included
- Costs for the Insured's hotel stay being extended max. 72 euros per day
and 5 days.
- Travel and accommodation for travelling companion Travel and max 72 euros day and 5 days.
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- Repatriation of deceased Insured Included - Early return due to death of a family member Included - Early return due to serious damage at home Included - Care for minors or disabled persons Included - Medical expenses due to accident or illness 6000 euros - Conveying urgent messages Included. - Legal defence expenses abroad up to 900 euros - Advance of judicial bail abroad up to 3600 euros - Private civil liability up to 30,050 euros. - Advance of funds abroad up to 1500 euros - Baggage warranty Included, with different sublimits 4. 24-HOUR COVER IT IS HEREBY STATED THAT THE COVER UNDER THIS AGREEMENT IS PROVIDED 24 HOURS A DAY, WITH ARTICLE 2 "PURPOSE OF THE INSURANCE" BEING DULY AMENDED.
Identification of The list of insured persons is available at: Students enrolled at the University of the Insured Group of Barcelona
Services for For fast response to queries, clarification requests, declaration of claims,
the Insured requests for involvement, correction of errors or correcting delays, the Policyholder
should contact: For any reason
The Broker FERRER & OJEDA ASOCIADOS COR.SEG. S.L. telephone 93 280 5959
Or by email [email protected]
For administrative queries and issues
Allianz Customer Call Centre 902 300 186
And via its website www.allianz.es
Travel assistance The insured benefit must be requested by calling ....................................... 902 108 784. If abroad, call ....................................................................................... +34 91 325 52 76
Health care medical team For assistance in Catalonia, Valencia, Murcia, Galicia, Madrid, Cantabria and Andalusia: 902 102 687
or 91 325 55 68
For assistance in the rest of the Spanish territory: 902 108 509 or 91 334 32 93
Premiums Ref: 365905168 Net Premium 48,383.09
Period: from 07/09/2019 to 06/09/2020 IPT (6%)
2902.98
Frequency of payment: Annual Surcharges
72.57
Consortium 1028.70
Total Invoice 52,387.34
On each expiry date of the policy, the premium shall be calculated on the Tariff that the Company has in force on that date, drawn up in accordance with applicable legislation and which shall be made available to the Department of Economy and Treasury's Directorate General of Insurances and Pension Funds.
Policy 045764350 Page 5 of 24
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CHAPTER II
Purpose and Scope of the Insurance
Article 1. INSURABLE INTEREST Fulfilment of the Policyholder's commitments to the
insured parties, when they suffer an accident
covered by the policy. In addition to the events included under the definition of Accident specified in point 9 of the Definitions section, and for the purposes of clarifying certain situations, the following events shall also be considered to be accidents for the purposes of the
cover under the policy, provided that they occur unintentionally:
a) Infections, where the pathogen has penetrated the body through an injury caused by an
insured accident. Also included are animal bites and insect stings, but excluding any general infection they cause, such as malaria, typhus, yellow fever, sleeping sickness and the like. Events arising from infections caused by the use of syringes, needles and any type of medical material are excluded.
b) Heatstroke, frostbite or other influences
from temperature or atmospheric pressure.
c) The consequences of surgical interventions
and treatments, if they are caused by an accident covered by the policy.
d) Accidents due to stroke, dizziness, fainting,
syncopation, epileptic seizures, mental
derangement, unconsciousness or sleepwalking,
provided that such ailments had not become
apparent before the policy was taken out.
e) In general, any events that are not expressly excluded or limited under the policy's Special and General Conditions.
The insurance cover is worldwide, except where
expressly stated for any of the covers insured.
If the Insured establishes their residence abroad, the cover provided under the insurance will be suspended upon expiry of the current annual renewal period at that time. A change of habitual residence abroad is understood to be when the Insured spends more than 183 days a year in another country, or when they have established their fiscal residence in another country. DEFINITIONS: In this policy, the following definitions apply: 1 - Policyholder: the individual or legal entity who
formulates the Application for Insurance so that
the policy can be drawn up, and who signs the policy with the Insurer. 2 - Insured: each individual for whom the insurance is taken out. 3 - Insurer: ALLIANZ, Seguros y Reaseguros,
S.A., which guarantees to provide the benefits
established in the event of a claim. 4 - Co-Insurers: The Insurance Companies who,
together with the Insurer, jointly assume responsibility for
the policy, but not jointly and severally between them vis-à-
vis the Policyholder, Insured or third parties. They are listed
in the policy, along with their percentage shares of the risks
and premiums. 5 - Beneficiary: in the event of death, the individual or legal entity who, having been designated by the Policyholder and/or Insured, is entitled to the agreed cover. If there is no express designation in the will or in the
policy, the beneficiaries in the event of death shall be
the legal heirs of the Insured. The beneficiary cannot be the policy holder, where this is not the Insured, except with the express consent of the Insured. In the event of any other benefit, the beneficiary thereof shall be the Insured, unless expressly agreed otherwise. 6 - Premium: the price of the insurance. The receipt shall also list any legally applicable surcharges and taxes. 7 - Deductible excess: this is the amount or percentage, expressly agreed, which in the event of a claim is payable by the Insured. 8 - Grace period: the period of time during which the insurance cover and any of its guarantees has no effect. 9 - Accident: bodily injury or death resulting from a violent, sudden, external and unintentional cause to the Insured. 10 - Loss: any event arising from an accident the
consequences of which are wholly or partly covered
by the policy's guarantees. The set of damages
and/or losses arising from an occurrence originating
in the same place and time is considered to
constitute a single and unique claim. 11 - Sum Insured: the maximum limit of
compensation set out in each of the policy types of cover, to be paid by the Insurer in the event of a
claim. When the insurance is taken out with a limit and/or sublimits, the Insurer's liability shall not be
that indicated in the previous paragraph, but the amount set under the corresponding cover. 12 - "In itinere" risk: the Insured person's travel from
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their home to the location where the activity that is the object of the insurance is carried out, and return to their home.
13 - Start and End Time of cover: the policy comes into effect at 00.00 hours on the start date shown, and ends at 24.00 hours on the end date shown.
14 - Maximum accumulation per claim: Unless
expressly indicated to the contrary within the policy,
cover for all items covered under the policy is limited to
a maximum of 28,500,000 euros per claim.
Article 2. PURPOSE OF THE INSURANCE
Any accidents that occur to the students of the
Teaching Centre taking out the policy are covered.
Insured persons must be recorded in the teaching
centre's official enrolment books.
The insurance cover applies only and exclusively to the teaching period that has been legally defined as such. Within this period, the following circumstances are covered: - During lesson times, games, gymnastics, extra hours of study, exams and any other act related to the school activity. - Round-trip to and from the teaching establishment.
- Extracurricular activities, inside or outside the school premises, provided that these are carried out under the tutelage of the teaching staff or the personnel responsible for said activity. - Excursions within the national territory, lasting less than ten days.
Article 3. EXPLANATION OF COVERS INSURED
The covers insured under this policy for the different
Groups and Insured Persons are defined below,
according to the detail set out in chapter I.
(Only the types of cover listed above are guaranteed for each Group of Insured Persons).
3rd 1. ACCIDENTAL DEATH
If, as a result of an accident covered by the policy, the Insured dies, the Insurer shall pay the guaranteed benefit to the Beneficiaries.
Any payments the Insurer may have made for permanent disability cover as a consequence of the accident that causes the death of the Insured shall be deducted from the compensation due in the event of Death, if higher.
This cover ceases at the end of the year in which
the Insured reaches the age set out in Chapter I
of these terms and conditions.
Policy 045764350
3rd 2. PERMANENT DISABILITY DUE TO ACCIDENT, ACCORDING TO THE SCHEDULE Permanent Disability is understood to be the situation of irreversible functional loss or limitation as a consequence of the damages arising from an accident covered by the policy. Permanent Disability will be compensable from the moment it is considered stable and definitive by means of a medical opinion. The degree of disability is not directly related to the different qualifications established by the Social Security for the contingency of Disability or Permanent Disability. Each situation of permanent disability corresponds to a degree of incapacity that is determined in accordance with the Schedule below. The maximum degree of compensation will be 100% of the Schedule. This cover ceases at the end of the year in which
the Insured reaches the age set out in Chapter I
of these terms and conditions. Schedule to assess the degrees of Permanent Disability: A) HEAD NEUROLOGICAL DEFICITS OF CENTRAL ORIGIN Absolute impairment of higher brain functions 100% Persistent vegetative state 100% Complete aphasia (total impairment of language formation and comprehension) 40% Complete fixed amnesia 40% Post-traumatic epilepsy with need for continued treatment 20% SKELETAL SYSTEM Loss of bone substance requiring cranioplasty 15% Loss of bone substance not requiring cranioplasty 4% Loss of significant substance without the possibility of repair in the upper and lower jaw with functional repercussion 30% OLFACTORY SYSTEM Partial loss of the nose 10% Total loss of the nose 25% Loss of smell (anosmia) 5% MOUTH Loss of all upper and lower teeth 10% Total amputation of the tongue 30% Loss of taste (ageusia) 5% Lower maxillary ablation 25% HEARING Loss of an ear 10% Loss of both ears 25% Total deafness in one ear 15% Total deafness in both ears 50% EYE One-eye blindness 30% Blindness in both eyes 100% B) TRUNK 1) SKELETAL SYSTEM: VERTEBRAL COLUMN
a) Complete loss of spinal mobility 60% b) Cervical segment: Complete loss of flexo-extension,
rotation and inclination movements 25% c) Back-lumbar segment: Complete loss of flexo-extension,
rotation and inclination movements 30%
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RIBS Rib fracture with persistent thoracic deformities and functional alterations 10% 2) ORGANS: LARYNX AND TRACHEA Paralysis of a vocal cord (dysphonia) 10% Paralysis of two vocal cords (aphonia) 30% Tracheotomised with cannula 30% LUNGS Loss of one lung 25% KIDNEY Loss of one kidney 25% Loss of both kidneys 70% SPLEEN Loss of spleen (splenectomy) with haematological impact 20% Loss of
spleen (splenectomy) with no haematological impact 10% FEMALE GENITAL APPARATUS Loss of mammary glands 25% Loss of ovaries 35% Loss of uterus 35% External female genital deformity:
- with functional alteration 40% - with no functional alteration 25%
MALE GENITAL APPARATUS Destructuring of the penis:
- with functional alteration 40% - with no functional alteration 25%
Loss of the testicles 35%
C) UPPER EXTREMITIES
Loss or disablement of Dominant Non Dominant both arms or hands 100% 100%
Loss of arm or hand and a lower limb 100% 100%
Amputation at humerus level 60% 50%
Amputation at level of the forearm or hand 50% 40%
Ankylosis or total loss of movement - of the shoulder 30% 30% - elbow 25% 25% - pronosupination 8% 8% - wrist 12% 12%
Complete paralysis of the circumflex, subscapular or musculocutaneous nerve 15% 10%
Complete paralysis of the circumflex, radial or ulnar nerve::
- At arm level 25% 20% - At forearm/wrist level 15% 10%
Unconsolidated humerus or ulna and radius fracture 25% 25% Amputation of the thumb 22% 18% Index finger amputation 15% 12% Amputation of another finger 8% 6% C) LOWER EXTREMITIES Loss or disablement of both legs or feet 100% Loss of leg or foot and an upper extremity 100% Amputation at hip level 70% Amputation above the knee 60% Amputation below the knee 45% Amputation of first finger 10% Amputation of another finger 3% Total loss of hip movement: In functional position 30% In unfavourable position 40% Total loss of knee movement: In functional position 20% In unfavourable position 30% Loss of ankle and foot movement: Tibia tarsal joint ankylosis:
Policy 045764350
In functional position 10% In unfavourable position 20% Subastragalar ankyloses 5% Unconsolidated fracture of the femur, or tibia and fibula at the same time 30% Removal of the kneecap (patellectomy): Total 15% Partial 10% Post-traumatic foot deformities 10% Shortening: - Up to 1.5cm 2% - from 1.5cm to 3cm 5% - from 3cm to 6cm 10% - more than 6cm 15% Complete paralysis of the sciatic nerve 60% Complete paralysis of the external popliteal sciatic nerve 25% Complete paralysis of the internal popliteal sciatic nerve 15% Rules for assessing the Degree of Disability:
a) Compensation shall be fixed regardless of the profession and age of the Insured, as well as any other factor outside the schedule. b) Any injuries not listed, as well as any set out in
the schedule but which are not exactly in
accordance with those listed above, shall be
assessed taking into account their extent compared
to the cases mentioned, without the Insured
Person's profession having any influence
whatsoever. c) The loss of function of an organ or limb is
considered to be the anatomical loss of that organ or
limb. In the case of the fingers, 50% of the value of
the amputation will be paid out, except for the thumb,
which is paid at 100%. Physical defects existing before the accident:
a) The assessment of injuries to limbs or organs caused by the accident cannot be increased by a previous physical defect of other limbs or organs that have not been affected by the accident. b) The loss of or injury to previously malformed limbs or organs is assessed by the difference between the state before and after the accident.
Existence of several injuries on the same limb or organ: If the injuries affect only one limb or organ, the accumulated amount may under no circumstances exceed the percentage of disability provided for in the schedule for the total loss of that limb or organ. Lesions on different limbs or organs: Where there are several injuries caused by the same
accident, the extent of disability of each of them may
be accumulated, without this extent exceeding 100%
of the Schedule.
3rd 3. ABSOLUTE PERMANENT
DISABILITY DUE TO ACCIDENT The agreed benefit is guaranteed as a consequence of the Absolute Permanent Disability suffered by the Insured as a result of an accident covered by the policy.
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Absolute Permanent Disability is understood as that which definitively incapacitates the Insured from
continuing to carry out any type of work, regardless of their profession. This degree of disability must be legally declared as such by the corresponding Employment Authority.
This cover ceases at the end of the year in which
the Insured reaches the age set out in Chapter I
of these terms and conditions.
3rd 4. FREE-CHOICE OF ACCIDENT
HEALTH CARE
Health Care is understood to be Insured being
reimbursed for expenses arising from the provision of
medical, clinical and pharmaceutical services.
If, as a result of an accident covered by the policy,
the Insured Person requires Health Care, the Insurer shall reimburse the medical expenses up to the limit
amount established in the policy. This reimbursement shall be made for expenses
arising from benefits received during a maximum
period of two years from the date of the accident.
If the Insured Person exhausts the sum assured chosen
under the Health Care cover, this cover may not be
made available until the following year.
The following are considered to be included in the expenses listed above:
1. Those that are a consequence of first aid or arising from necessary urgent care. 2. Those relating to moving and rehabilitating the Insured Person where motivated by care needs and authorised by the Insurer or by the doctors appointed by the Insurer. 3. Expenses relating to the artificial maintenance of
vital signs for a maximum period of
60 days. From that point on, compensation will be paid
with the highest sum of those covered under the
Permanent Disability cover, regardless of the extent to
which the situation can be reversed.
4. Reimbursement of expenses for plastic and reconstructive surgery as a consequence of an accident covered by the policy and up to a limit of 30% of the sum set under the policy, up to a maximum of 1800 euros.
Only by taking out the specific Cover for prosthetic
materials, glasses, hearing aids, orthopaedic
material, osteosynthetic and external fixers shall the
reimbursement of expenses arising from such
material be covered.
This cover ceases at the end of the year in which
the Insured reaches the age set out in Chapter I
of these terms and conditions.
This Compensation ceases upon Death or
determination of the Insured Party's Permanent
Disability and is paid independently of them.
If the amount of the invoices to be paid by the
Insured exceeds 2000 euros, and provided that
the Insurer has checked and accepted the claim,
the Insured may request that the Insurer pay the
amount of such invoices directly to the doctors
and clinics that have provided the medical care,
up to the maximum amount of the covered
benefit.
3rd 5. UNLIMITED HEALTH CARE BY A
MEDICAL TEAM DUE TO ACCIDENT Health Care is understood to be the provision of medical, clinical and pharmaceutical services arising from an accident covered by the policy, provided that the medical care has been provided exclusively within the national territory. The following are considered to be included in the provision of this Cover: 1. Services to move and rehabilitate the Insured Party, when necessary and authorised by the Insurer. 2. Artificial maintenance of vital signs during a maximum period of sixty days from the date of the accident. From that point on, compensation will be paid with the sum for Permanent Disability cover, regardless of the extent to which the situation can be reversed. 3. Plastic and reconstructive surgery as a consequence of an accident covered by the policy, up to a maximum of 1800 euros. If, as a result of an accident covered by the policy,
the Insured Person requires medical assistance,
this will be provided by the Insurer in accordance
with what is set out below. This cover ceases when the Insured reaches the age
stated in Chapter I of these Terms and Conditions, upon
the Insured's death or determination of their permanent
incapacity or the stabilisation of the
injuries/consequences, and under any circumstances 2
years after the date of the accident. Only by taking out the specific Cover for prosthetic
materials, glasses, hearing aids, orthopaedic material, osteosynthetic and external fixers shall the
reimbursement of expenses arising from such material be covered, in accordance with the stated
Cover. Any compensation received by the Insured Person outside the scope of this article shall be excluded from the policy's cover. Request for medical assistance from the Medical Pool Medical care will be provided at Allianz Medical Pool Centres. In the event of an accident covered by the policy, Allianz must be contacted via the telephone numbers indicated, except in cases of vital urgency, and the details and location of the
Medical Pool Centre most suitable for caring for the
injuries suffered will be provided.
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The telephone numbers are as follows:
For care in Catalonia,
the Autonomous Region of Valencia, Murcia,
Galicia, Madrid, Cantabria and 902 102 687 Andalusia: or 91 325 55 68 For assistance elsewhere in 902 108 509 the Spanish territory: or 91 334 32 93
For information purposes, the Allianz medical team can be seen on the company's website: www.allianz.es During the first telephone call, at least the following needs to be provided:
- Personal data of the victim and type of injuries.
- Details of the group to which the victim belongs and the policy number.
- Date, place and description of the form of incident.
Subsequently, and under all circumstances within a
period not exceeding 7 days, the victim must provide the
duly completed Accident Report, stamped by the group
to which he or she belongs. The accident report can be
provided by contacting the telephone number given or
through the policy broker. If the duly completed
accident report is not received, the cost of the
health benefit shall be borne by the Insured.
Health Care Authorisation Any healthcare provision must be authorised in advance by Allianz. Health care received without Allianz's specific authorisation is not covered, except as stated in the case of a vital emergency. Authorisation for medical assistance, whether it be first
assistance or successive medical assistance, is to be
requested via the telephone numbers indicated. Allianz
will give its authorisation directly to the victim and/or to
the Medical Centre as the case may be.
Vital emergencies A vital emergency is any clinical condition that involves a risk of death or serious functional
consequences, and requiring immediate and urgent medical attention. This benefit is compulsory care by
any health institution. The condition of risk of death or serious functional consequences must be certified by a doctor/surgeon of the public or private emergency unit at which the victim was treated. In vital emergency cases involving a serious risk to
the life or integrity of the victim as defined below, the
latter may be cared for by the nearest Health Centre. Allianz will pay the Health Centre for health expenses
arising from the emergency care of the victim during the
first 48 hours from the date of the accident. Once the
initial emergency assistance is over, the victim must be
transferred to a Medical Pool Centre to continue their
Policy 045764350
treatment. Allianz will not assume the cost of the benefits
beyond the 48-hour period indicated in Centres
that are not part of the Medical Pool, unless
expressly authorised.
3rd 6. DEATH DUE TO MYOCARDIAL INFARCTION If, as a result of a myocardial infarction that occurs
under the scope and activities covered by the policy,
the Insured Person dies, the Insurer shall pay the
guaranteed benefit to the Beneficiaries. Any payments the Insurer may have made for
permanent disability cover as a consequence of the
infarction that causes the death of the Insured Person
shall be deducted from the compensation due in the
event of Death, if this is higher. This cover ceases at the end of the year in which
the Insured reaches the age set out in Chapter I
of these terms and conditions.
3rd 7. ORPHANHOOD If as a result of the same accident the Insured Person
and their spouse or partner - officially registered as
such - die, and there are dependent minor children or
children affected by Absolute Disability for all work, the
Insurer shall pay these children - regardless of the
designation of beneficiaries under the policy - an
additional sum stated in the policy, for all their children
and in respect of BEING MADE AN ORPHAN. This same sum shall be paid in the event that the deceased, the Policyholder, was the only living parent. This cover ceases at the end of the year in which
the Insured reaches the age set out in Chapter I
of these terms and conditions.
3rd 8. DEATH BY ASSAULT If the death of the Insured Person occurs as a result of robbery, kidnapping or any other type of
aggression on the part of third parties, the compensation for the DEATH cover shall be increased by an additional amount fixed under the policy, unless the assault occurred in one of the situations indicated in article 4 (EXCLUDED
RISKS). This cover ceases at the end of the year in which
the Insured reaches the age set out in Chapter I
of these terms and conditions.
3rd 9. Funeral expenses due to accident in Spain If, as a result of an accident covered by the policy, the
Insured Person dies in Spain, the Insurer shall pay an
additional amount stated in the policy by way of Burial and
Processing Expenses.
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This amount will be paid to the policy's Beneficiaries, as soon as the policy cover and the Beneficiary's status have been confirmed.
3rd 10. Funeral expenses due to accident abroad
If, as a result of an accident covered by the policy, the
Insured Person dies outside of Spain, the Insurer shall
pay an additional amount stated in the policy by way of
Burial and Processing Expenses. This amount will be
paid to the policy's Beneficiaries, as soon as the policy
cover and the Beneficiary's status have been
confirmed.
3rd 11. PROSTHESIS MATERIALS,
GLASSES, HEARING AIDS, ORTHOPAEDIC
MATERIALS, OSTEOSYNTHESIS AND
EXTERNAL FIXERS.
Exclusively by taking out this Cover, as a consequence
of an accident covered by the policy, the Insured
Person is covered for reimbursement of the costs of
prosthetic materials, glasses, hearing aids, orthopaedic
materials, osteosynthesis and external fixers up to the
limit stated in the policy, provided that said
accident has also led to the provision of medical
assistance.This reimbursement shall be made for
expenses arising from benefits received during a
maximum period of two years from the date of the
accident.
This cover ceases at the end of the year in which the Insured reaches the age set out in Chapter I of these terms and conditions.
3rd 12. RESCUE AND SEARCH OPERATIONS AND TRANSPORTING OF THE VICTIM
As a consequence of an accident covered by the policy, and within a period of two years from the date that it occurs, reimbursement of the Insured Party's expenses resulting from operations to search and rescue the victim and necessary transport up to the maximum indicated in the policy, per Insured Person and claim.
This cover ceases at the end of the year in which the Insured reaches the age set out in Chapter I of these terms and conditions.
3rd 13. BASIC TRAVEL ASSISTANCE
Modifying the corresponding 4th article (Exclusions) provides the following Travel Assistance cover:
Scope of Cover and Application
This cover applies to journeys made globally.
Policy 045764350
Insured Person Individuals resident in Spain who form part of an
Allianz group accident insurance policy. Duration of trips This cover is valid for trips of no more than 90 days. TRAVEL ASSISTANCE COVER - REPATRIATION 1. Medical transfer or repatriation in the
event of the Insured who is travelling becoming ill or involved in an accident.
In the event of the Insured contracting an illness or
being the victim of an accident during the course of
their insured trip, the Insurer's medical team will
determine the best course of action to follow,
depending on the seriousness and urgency of the
case. The Insurer will arrange any necessary contact
between its medical team and the doctor treating the
Insured so that the appropriate health care is
provided.
In the event of an emergency or serious illness, and in accordance with the opinion of the Insurer's medical team in contact with the doctor treating the Insured and their family, and taking account of whatever is medically necessary, the Insurer will take a decision on the medical transport and organise it from where the Insured is located to the nearest or most suitable hospital in view of the Insured's state of health or transport them home. The Insurer shall be solely and exclusively responsible for the Insured's repatriation to their home if it is medically necessary.
With regard to conditions that do not require repatriation, transport shall be provided using the most appropriate means to wherever the necessary care can be provided.
In addition, the Insurer will organise the repatriation of
the Insured and an insured travelling companion or
family (spouse, unmarried partner, parents and
grandparents, children, siblings), in the event that as a
result of medical need, the seriousness of which will be
judged by the Insurer's medical team, the misses the
planned means of transport for returning to their
habitual residence. Under these circumstances, the
Insured will need to call the Insurer beforehand and
request assistance for their medical needs.
The Insurer shall bear the additional transport costs of
insured travel companions or insured family (spouse,
ascendant, descendant, sibling), to the extent that the
means initially provided for their return cannot be used
for repatriating the Insured.
Once the Insured is recovered, if they and their insured
relatives or insured travel companions wish to continue
their journey and their state of health so permits, the
Insurer shall arrange for them to be transferred to their
trip destination,
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provided that the cost of this journey does not exceed the cost of returning home. However, costs arising from the illness suffered by the Insured shall not be covered if he/she decides to continue to their trip destination.
2. Repatriation of the deceased Insured
Person.
In the event of death of the Insured, the Insurer will cover:
- The costs of transporting the body from the place of death to the place of burial. - The necessary costs of preparing the body for transportation, up to a maximum of €600. - The additional travel costs for the deceased's
insured family members (spouse or partner, parents
or grandparents, children, siblings) or insured travel
companions, to the extent that the means initially
provided for their return cannot be used as a result
of the Insured being repatriated. 3. Care for minors or disabled persons.
If the Insured is to be repatriated by the Insurer
and is accompanied only by under-age or disabled children, the Insurer shall pay the costs
of travel of someone to accompany those minors or disabled persons on their return journey.
In the event that the Insurer arranges for the repatriation of a minor and this person is alone, the Insurer shall pay the travel expenses for someone to travel with them and accompany them during the repatriation.
4. Medical expenses.
The Insurer will cover the payment or reimbursement of medical, surgical, pharmaceutical and hospitalisation expenses incurred - ie those caused and arising from urgent medical care during a trip outside the country of normal residence and/or nationality of the Insured, up to a maximum limit of 3000 euros.
For the purposes of this cover, urgent medical care
shall be taken to mean that which is aimed at
resolving serious clinical situations, as well as those
that are liable to cause deterioration or danger to the
health or life of the Insured, which require medical
attention in a short period of time, and in all cases
depending on the time elapsed between such
situation arising and effective treatment being
started.
In general terms, it excludes any benefits that have not been previously requested of the Insurer, or that have been organised directly by the Insured without the involvement of the Insurer, except in duly verified situations of force majeure or material impossibility.
5. Conveying urgent messages. Policy 045764350
Messages arising from the cover provided under
this Policy, issued via the 24-hour Assistance
Centre, or which the Insured makes directly. If the
Insured him/herself conveys these directly, the
Insurer will only cover the costs arising from
sending these upon presentation by the Insured of
the invoice and proof of urgency of the message. EXCLUSIONS The following benefits and activities are
excluded. The exclusions listed below will apply to all cover listed above under the
Assistance/Repatriation cover. a) Illnesses, accidents and deaths resulting from the
consumption of alcohol, drugs and narcotics,
unless these have been prescribed by a doctor
and are taken as indicated by the doctor. b) Fraudulent acts and negligence on the part of
the Insured, as well as self-intentional injuries, suicide or attempted suicide.
c) Losses occurring in the event of war, whether declared or not, riots, popular or similar commotion, unless the Insured has been taken by surprise by the beginning of the conflict whilst abroad. In such a case, the cover provided under the policy shall cease 14 days after the dispute has commenced.
d) Effects from a radioactive, biological or chemical source.
e) Claims arising from earthquakes, tsunamis,
extraordinary floods, volcanic eruptions,
epidemics, quarantines, atypical cyclonic
storms and bodies falling from space and
meteorites, and acts of terrorism.
f) Aeronautical activities are excluded. Also
excluded is the practice of any sport on a
professional basis, paid or unpaid, in a
competition or preparatory training and activities
of gorge-walking, canyoning, bungy jumping,
mountaineering, climbing, diving, pot-holing, and
any other similar high-risk activity. Sports
expeditions by sea, mountain or desert are also
excluded. g) Accidents from skiing, that occur off-piste or
away from qualified areas.
h) Travel for therapeutic purposes. i) Search and rescue of people in sea,
mountain or desert areas. j) The costs of preparing the body exclude
the cost of burial, ceremony and funerals. k) Expenses caused by an illness or accident for
which the Insured was not re-established at the time of setting out on their journey or at the time that it continues, according to cover 1, or which in the opinion of the Insurer's doctor was contraindicated for said journey.
l) Repatriations or transfers occurring as a
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consequence of mental illness which, in the opinion of the Insurer's medical team, require a hospital stay of less than 24 hours.
For Medical Expenses cover, the following exclusions also apply:
m) Management of previously known diseases.
n) Expenses relating to thermal cures, heliotherapy or cosmetic treatments.
o) Costs of prostheses, implants and orthopaedic equipment, rehabilitation costs and physiotherapy.
p) Vaccination expenses, as well as dental expenses.
q) Costs of contraception and abortion. r) Preventive medicine expenses. s) Expenses that, in the opinion of the
Insurer's medical team, are contraindicated
for the pathology presented by the Insured.
t) Medical expenses incurred within 30 kilometres of the Insured home (15km in the case of Spain's islands).
u) Expenses related to chronic illnesses or any complication during pregnancy.
v) Expenses incurred for treatments started in the country of origin.
w) Medical expenses relating to any type of mental illness or psychological imbalance.
x) Expenses arising due to any pre-existing illness, whether or not the Insured is aware of it.
Article 4. EXCLUSIONS & LIMITATIONS
1- Non-insurable persons:
People affected by stroke, epilepsy, paralysis, mental illness, delirium tremens alcoholism, drug addiction, and other serious and/or permanent illnesses. The insurance shall cease when such illnesses manifest themselves and the Insurer shall return the part of the annual premium paid for the period of time not elapsed. Cover relating to people affected by diabetes mellitus shall be valid on the double condition that the blood glucose rate does not exceed 200 mg per decilitre and that the diabetes was not detected before the policy was taken out. For children under 14 years of age, and unless expressly indicated in the Special Conditions, death cover is excluded, and is replaced by an amount for Burial Expenses. This amount will be that shown under Death capital, with a maximum limit under all circumstances of 6000 euros.
2. Excluded Risks:
a) Unless a specific cover is taken out,
myocardial infarction is not considered an
accident for the purposes of this policy.
b) Events that do not qualify as an accident under the Definitions Section.
Policy 045764350
c) Those occurring prior to the insurance coming into effect.
d) Those caused as a consequence of a fraudulent
act on the part of the Insured, as well as those
arising from their active participation in crimes,
bets, duels, challenges or fights, except in
cases of legitimate defence or necessity.
e) Suicide or attempted suicide. f) Operations and interventions carried out
by the Insured on him or herself, or by anyone lacking the legally required professional qualification.
g) Use of helicopter, small plane and private
aircraft. Any other aircraft not used strictly
for public passenger transport. Air sports,
such as hang gliding, flying without an
engine, parachuting and similar are also
excluded.
h) All kinds of diseases, as well as any that are a
consequence of surgical interventions, not
caused by an accident.
i) Accidents that produce only psychological effects.
j) Those produced when the Insured is under the
influence of alcoholic beverages, toxic drugs or
narcotics, and where these are the cause of the
accident.
k) Participation in motor vehicle racing, including
training, as well as on circuits. Boxing,
mountaineering, bungee jumping, aeronautical
sports and others of similar risk. Accidents
occurring as a consequence of fishing on the
high seas or big game hunting, unless expressly
agreed in the Policy's Special Conditions.
l) Unless otherwise agreed, accidents arising from exercising the following professions:. Airline crew; State Security Corps, Armed Forces
and Sworn Guards; Divers or scuba divers;
Professional bullfighters; Trapeze artists,
acrobats, tightrope walkers and wild animal
tamers; Miners working in galleries and/or with
explosives. m) Accidents occurring in unexplored regions
and/or trips of an exploratory nature.
n) Activities that are illegal or contrary to the stipulations of UN or European Union embargoes.
o) Acts of war, terrorism, riots, revolutions and
earthquakes, unless they become
catastrophic, in which case they will be
covered by special legislation in force.
Accidents occurring outside Spanish territory
due to such causes shall not be excluded if
the Insured was in the country in which they
occurred prior to when they started, and does
not take an active part in them, and the
accident occurs within fourteen days of said
anomalous situation starting.
p) Those that are the direct or indirect
consequence of nuclear radiation or
radioactive contamination, as well as those
produced by laser, maser or ultraviolet rays,
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artificially caused. q) Claims caused by an extraordinary event
covered by the Insurance Compensation
Consortium.
Article 5. RISKS COVERED BY THE INSURANCE COMPENSATION CONSORTIUM Clause regarding compensation by the Insurance Compensation Consortium for losses arising from extraordinary events under personal insurance.
Pursuant to the revised text of the Insurance Compensation Consortium’s legal statutes, approved by Royal Decree 7/2004 of 29 October, a holder of a Policy of the type which has an obligation to incorporate a surcharge in favour of the aforementioned public business institution is entitled to arrange cover for extraordinary risks with any insurance company that meets the terms required under applicable legislation.
Compensation arising from claims caused by extraordinary events that occur in Spain or abroad, where the Insured's normal residence is in Spain, shall be paid by the Insurance Compensation Consortium so long as the Policyholder has paid the corresponding surcharges and under any of the following situations:
a) Where the extraordinary risk covered by the Insurance Compensation Consortium is not covered by the insurance policy taken out with the Insurer.
b) Where, although covered by that insurance policy, the Insurer's obligations cannot be met because they have been legally contended or because they are subject to a settlement procedure involving or taken up by the Insurance Compensation Consortium.
The Insurance Compensation Consortium shall adjust its actions according to the provisions of the aforementioned legal Statute, under Spain's Insurance Contracts Act 50/1980 of 8 October, under the Regulation governing insurance of extraordinary risks, approved by Royal Decree 300/2004 of 20 February, and related provisions. I. Summary of legal regulations 1. Extraordinary events covered
a) The following natural phenomena: earthquakes and seaquakes; extraordinary flooding, including sea storms; volcanic eruptions, atypical cyclonic storms (including extraordinary winds with gusts above 120 kilometres per hour and tornadoes); and bodies falling from space and meteorites.
b) Those caused violently as
Policy 045764350
a consequence of terrorism, rebellion, sedition, riots and popular commotion.
c) Events or acts by the Armed Forces or by the Security Forces and Corps during times of peace. Atmospheric and seismic phenomena, volcanic
eruptions and bodies falling from space shall at the
request of the Insurance Compensation Consortium
be verified via reports issued by AEMET (Agencia
Estatal de Meteorología, or National Meteorology
Agency), Instituto Geográfico Nacional (National
Geographical Institute) or other public organisations
competent in the matter. For events of a political or
social nature, or where damage has been caused
by Armed Forces or Security Forces actions during
peacetime, the Insurance Compensation
Consortium may request information about the
events from the competent jurisdictional and
government organisations.
2. Risks that are excluded
a) Those that do not give rise to compensation according to the Insurance Contracts Act.
b) Those that are caused to persons covered under an insurance contract different to those under which it is obligatory to recharge in favour of the Consortium of Insurance Compensation.
c) Those arising through armed conflicts, even where
there this has not been preceded by an official
declaration of war.
d) Those caused by nuclear energy, without
prejudice to the provisions of Act 12/2011 of 27
May regarding civil liability arising from nuclear-
related or damage or damage caused by
radioactive materials. e) Those produced by natural phenomena other
than those under Section 1a above and in particular those caused by a rise in the water table, hillside movements, landslides or settling of land, rock fall and similar phenomena, except where these are manifestly caused by rainfall which, in turn, leads to extraordinary flooding in the area and occurring simultaneous to said flooding.
f) Those caused by uprising during the course of
meetings and demonstrations carried out in
accordance with the provisions of Fundamental
Law 9/1983 of 15 July regulating the right to
assembly, as well as during legal strikes, except
where the aforementioned actions can be classed
as events that are extraordinary to those stated in
Section 1b above.
g) Those caused by the bad intentions of the Insured.
h) Those corresponding to losses produced before payment of the first premium or when, pursuant to the Insurance Contract Act, the cover provided by the Insurance Compensation Consortium has been suspended or the insurance has expired due to non-payment of premiums.
i) Losses whose magnitude and severity are
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classified by the National Government as a "national catastrophe or calamity".
3. Extent of the cover
Cover for extraordinary risks will extend to the persons themselves and to any same sums insured set out in the insurance policy in relation to ordinary risks.
Under life insurance policies which, in accordance with
the provisions of the policy and regulations governing
private insurance, generate a mathematical provision,
the cover provided by the Insurance Compensation
Consortium shall refer to the capital at risk for each
Insured Party - that is, the difference between the sum
insured and the mathematical provision that the
Insurer that issued it must have constituted. The
amount corresponding to the mathematical provision
shall be paid by the aforementioned insurance
company.
II. Notifying the Insurance
Compensation Consortium of claims
The request for compensation for losses, the cover for
which falls on the Insurance Compensation Consortium,
shall be made by communicating this to the Policy holder,
the Insured or the beneficiary of the
policy, or by whomsoever acts on behalf of and in the name of the foregoing, or by the Insurer or insurance broker through whom the insurance is managed. To notify claims and obtain any information related to the
processing and status of claims, please
- telephone the Insurance Compensation Consortium’s Call Centre (900 222 665 or 952 367 042).
- Or visit the Insurance Compensation
Consortium website (www.consorseguros.es).
Assessment of claims: The task of assessing any
claims that are compensable under insurance
legislation and the contents of the insurance
policy shall be carried out by the Insurance
Compensation Consortium, without this being
linked to any assessment work being conducted
by any insurance company that covers ordinary
losses.
Payment of compensation: Payment of the compensation shall be made by the Insurance Compensation Consortium to the beneficiary of the insurance via bank transfer.
Policy 045764350 Page 15 of 24
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CHAPTER III
Claims
Article 6. CLAIMS AND COMPENSATION A) Documentation to be submitted in the event of a Claim: The Policyholder, Insured or Beneficiary must submit the documentation listed below to the Insurer, based on the relevant benefit: - In the event of Accidental Death:
a) Official death certificate, issued by the Civil Registry. b) Certificate from the doctor who attended the
Insured, confirming the accident that caused the
death or, if applicable, testimony of the full Legal
Proceedings and autopsy report, if carried out, or
other documents accrediting that the death was
due to an accidental cause.
c) Proof of Income from paying Inheritance Tax, or
declaration of exemption from it, duly completed by
the competent tax administration.
d) Where a Beneficiary has been expressly
designated: the document proving the Beneficiary's
identity, along with a certificate from the Register of
Wills and a copy of the last Will and Testament. If no
Beneficiary is expressly designated: certificate from
the Register of Wills and a copy of the last Will and
Testament and, if there is none, Declaration of Heirs
or Act of Notoriety. - In the event of Death from heart attack: The same documentation stated in the previous section, as well as proof that the death occurred as a result of a myocardial infarction. - Common to all cases of Death of the Insured: At
the request of the Beneficiaries, the Insurer will
make an advance payment for the amount
corresponding to the Inheritance Taxes that are
to be paid exclusively in relation to the insurance
policy. In order to make this advance payment, the Insurer must have accepted the claim and received the documentation necessary for it to do so, as well as evidence from the Tax Authorities stating the amount to be paid in regard to that Tax. The amount paid shall be reduced from subsequent compensation payments. - In the event of Permanent Disability according to the Schedule (including Progressive): a) Doctor's certificate, stating the reason for the injury, cause, onset, nature and consequences of it, and stating the resulting sequelae. Based on this documentation, the Insurer shall notify the amount of the compensation that it deems appropriate, in accordance with the aforementioned Schedule. Where there is disagreement, both parties shall submit to the decision of medical experts appointed by each party, with their written acceptance. If one
of the parties has not appointed an expert, they must
do so within eight days following the day on which it is
required by the other party. If this is not done, it will be
construed to mean that they expressly accept the
other party's report.
If the Experts reach an agreement, this shall be
recorded in a joint report which shall specify the
reasons behind the claim and the corresponding
degree of disability according to the Schedule. In
the event of disagreement, both parties will appoint
a third Expert and, if they do not agree on this
appointment, this will be done through the First
Instance Judge of the Insured's domicile, in
accordance with the procedure established in the
Civil Procedure Act, and they must issue their
opinion within no more than thirty days from their
appointment. The resulting final report shall be binding on both parties, unless the Insured contests it within one hundred and eighty days or the Insurer contests it within thirty days. Each party shall pay their own Medical Expert's fees. The fees of the third party and other expenses incurred shall be shared between the Insured and the Insurer. b) If applicable, a letter of payment or
exemption from the corresponding tax, duly
completed by the Tax Authorities. - In the event of Permanent, Total or Absolute Incapacity
or Major Disability: a) Doctor's certificate, stating the reason for the injury, cause, onset, nature and consequences of it. b) Definitive ruling by the competent Labour
Authority, expressing the recognised degree of
Permanent Disability caused to the Insured.
c) If applicable, a letter of payment or exemption from the corresponding tax, duly completed by the Tax Authorities.
- In the event of Health Care:
a) Proof and original invoices of the expenses incurred. b) Report regarding first medical care and/or hospital admission. c) Medical certificate specifying the reason, cause and consequences of the accident.
- In the event of Temporary Disability:
a) Medical certificate specifying the reason, cause and consequences of the accident. b) Sick Note and Discharge Note or, if the Insured is not registered in the Social Security System, a certificate from the attending doctor.
- In the event of Hospitalisation and Convalescence:
a) Medical certificate specifying the reason, cause and consequences of the accident. b) Sick Note and Discharge Note.
- In all situations: Declaration by the Insured or Beneficiary explaining
the accident: date, reason, cause, and consequences. Policy 045764350 Page 16 of 24
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B) PAYMENT OF COMPENSATION:
The compensation shall be paid by the Insurer at the
end of the investigations to establish the existence of a claim and, where appropriate, the degree of resulting incapacity. Once the aforementioned documents have been received, the Insurer will pay or consign the amount of the guaranteed benefit within five days in the event of Death or Permanent
Disability. In any event, within forty days of receipt of the declaration
of the claim, the Insurer shall pay the minimum amount
that it may owe
based on the circumstances known to it. If, within three months of the claim being made, the Insurer has not paid the compensation or paid any minimum amount it owes within the forty days stipulated above for a reason without justification or which may have been attributable to it, the compensation shall be increased by an annual interest equal to the interest on the money, in force at the time of accrual, increased by 50 per cent. After two years from the claim being made, this interest shall be no less than 20 per cent.
Policy 045764350 Page 17 of 24
Original copy for the Policyholder
CHAPTER IV
Administration of the Policy
Article 7. PAYMENT OF THE INSURANCE PREMIUM The Policyholder or Insured, as the case may be, is obliged to pay the first premium or the one-off
premium at the time the policy is agreed. Successive premiums must be made effective upon
corresponding due dates. If no place for payment of the premium is stated
under the Specific Conditions, it shall be taken to
mean that the payment must be made at the home of the Policyholder or of Insured, as the case may be. If the Specific Conditions specify that a direct debit is
agreed for payment of premiums, the payer is obliged
to pay the premium shall provide the Insurer with a
letter addressed to the bank or savings bank, giving
the appropriate direct debit order. If the Policyholder or Insured (as appropriate) fails to
pay the first premium or one-off premium when due,
the Insurer has the right to terminate the policy or
demand payment of the premium due under the policy.
In all cases, and unless otherwise agreed under the
Specific Conditions, if the premium has not been paid
before the loss occurs, the Insurer shall be released
from its obligation. In the event of non-payment of one of the premiums
following the first, the Insurer's cover shall be suspended one month after its due date. If the Insurer does not claim payment within six months of the due date of the premium, the insurance shall be deemed to be terminated. In any event, when the contract is suspended, the Insurer may only demand
payment of the premium for the current period. If the Policy has not been resolved or terminated in
accordance with the foregoing, the cover will take effect
again at 24.00 on the day on which the Policyholder pays
their Premium.
Article 8. DETERMINATION OF THE PREMIUM The Specific Conditions shall expressly indicate the amount of the insurance premiums or the procedures used to calculate them. In the latter case, a provisional premium shall be set, which
shall be regarded as a minimum and shall be required at the beginning of each insurance period. Upon each policy due-date, the premiums will be
updated, and will include any necessary adjustments to ensure the premiums are sufficient. Likewise, any necessary adjustments to take account of applicable legislation regarding Private Insurance Regulation and Supervision Regulations shall also be applied.
Article 9. PREMIUMS SUBJECT TO ADJUSTMENT In the event that elements or numbers liable to change have been used for calculating the premium, the frequency with which the premium must be readjusted shall be stated in the policy. If it is not stated, it shall be taken to mean that it is to be readjusted at the end of each insurance period. 1. Within thirty days of the end of each adjustment
period, the Policyholder or Insured must provide the Insurer with the data and documents necessary for them to be able to adjust the premium.
2. The premium resulting from the adjustment may not be less than the minimum net premium set under the Policy's Specific Conditions.
3. The Insurer shall, at any time, have the right to
carry out inspections in order to check and
investigate the data relating to the aspects and
numbers on which the premium is calculated. The
Policyholder or the Insured must provide the
Insurer with all the information, clarification and
evidence necessary so that they can verify the
aforementioned data.
4. If a loss occurs and the requirement stated in Article 10.4 has not been met due to an omission or inaccuracy of the statement by the Policyholder or the Insured, then the following rules shall apply: a) Bad faith on the part of the Policyholder or
the Insured: the Insurer will be released
from its obligation.
b) Where the inaccuracy or omission is due to any other reason, the benefit shall be reduced in proportion to the difference between the amount of the premium calculated and the premium that would actually have applied, according to the figures on which it is based.
Policy 045764350 Page 18 of 24
Original copy for the Policyholder
CHAPTER V
General Essential Matters
Article 10. REFERENCES TO THE
INSURANCE CONTRACT ACT
At the end of each section, the following General
Conditions of the Policy include references to the
applicable legal requirements so that you can more
accurately and easily enquire on these matters if you
wish.
These General Conditions aim to guide and
facilitate your understanding of the essential
matters that affect the Insurance Policy. LEGAL
REFERENCE: Articles 1, 2 and 3
10. 1. Persons involved in the insurance policy
1. The Policyholder: provides answers to the
Questionnaire so that the policy can be drawn up,
signs the contract and pays the premiums. 2. The Insured: who has a financial interest in the
purpose of the insurance and holds the rights arising from the Policy.
3. The Insurer: Allianz Compañía de Seguros y
Reaseguros, SA: guarantees to provide the
benefits established in the event of a loss.
Hereinafter, also referred to as "the Company".
4. The Co-Insurers: Insurance Companies who,
together with the Company, jointly assume
responsibility for the policy, but not jointly and
severally between them vis-à-vis the Insured or third parties. They are listed in the policy, along
with their percentage shares of the covers and
premiums.
5. The Creditor: holder of a right of pledge or a
priority claim on property insured, due to
deferred payment, loan or leasing, without
whose consent one cannot pay
compensation.
6. The Overseeing Body: the Treasury's General
Directorate of Insurance which supervises the
activity by virtue of the competence corresponding to
the Kingdom of Spain, member state of the
European Economic Area.
LEGAL REFERENCE: Articles 1, 7, 40 to 42, 84 to 88 and 100.
10. 2. Documentation and formalisation of the contract of insurance
A) The Insurer draws up the policy in accordance with
the Questionnaire responses given by the Policyholder
and applies the conditions and premiums according to
the declarations made. Therefore the replies provided
by the Policyholder are of essential importance to the
satisfactory outcome of the contract.
B) The Policy brings together in one single document
the Special Conditions of the Contract of Insurance
that establish the appropriate and individual details
of the contract, determine its purpose and scope
and bring together the clauses that, by the will of
the parties, regulate the functioning of the cover in
accordance with the Law; as well as the General
Conditions of the Contract of Insurance which
concern the rights and duties of the parties relating
to the starting up, duration and termination of the
contract. In addition, there may be Supplements, which are
amendments or clarifications made in agreement
with the Policyholder, and which change the initial
Conditions as often as necessary. C) The Policyholder must read and carefully
check the terms and conditions of the policy and
if appropriate, request within one month the correction of any errors. If they do not do so, the
policy will come into effect. D) If the policy is approved, the Policyholder
must sign it and also have the Insured sign it,
if that person is different. E) The Policyholder must pay the first premium. F) Only if the Policy's signing requirements have been met and the premium payment has been made shall the contract be duly formalised and come into effect, with any claims that arise from that point being admissible. LEGAL REFERENCE: Articles 1, 2, 3, 4, 5, 6, 8, 14 and 15.
10. 3. Duration of the contract of insurance A) The contract shall be in force from 00.00 on the day
that cover starts until 24.00 on the day that it ends. B) Every year, except in special cases, the policy will expire and will automatically be renewed. C) For the insurance to remain in force, the Policyholder
must pay the premium that corresponds to the
following annual renewal period. For this, they have a
grace period of one month after which, if payment
has not been made, the cover provided by the
Insurer shall be suspended, and it shall not be
responsible for any losses that occur from that time. D) If either the Policyholder or Insurer does not wish
to renew the policy on its annual renewal date, they
must advise the other party giving a least two
months' notice. E) Situations which may cause one of the parties
to decide to terminate the contract before expiry:
when there is an aggravation of the risk,
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where there has been a reservation or inaccuracy in statements made by the Policyholder or where there is a change in the legal status of the Policyholder or the Insured (for example, bankruptcy protection).
Where it is the Insurer that is cancelling, it shall extend cover for 15 days so that the Policyholder has time to take out another policy, and the Insurer shall also return the proportional part of the premium that has not been used. The Insured shall be entitled to do this immediately without the return of the proportional part of the premium. F) This also occurs when the insured property is sold or passed on to other persons. Special note should be made that the new purchaser or owner is not subrogated under the rights of the former Insured Party in the case of policies that name the Insured and that cover non-obligatory risks - as is the case here. Only at the prior request of the purchaser and the Insurer's express acceptance shall the insurance policy continue to be in force for the purchaser, who would then become the new Insured Party. LEGAL REFERENCE: Articles 8, 10, 12, 14, 15, 22, 34, 35, 36 and 37.
10. 4. Amending the contract of insurance A) Any changes in relation to the content of the
responses to the Questionnaire made by the
Policyholder prior to taking out the policy, must be
communicated to the Insurer as soon as possible,
in case it is necessary to make changes to the
Policy. B) Thus, a worsening or lessening of the risk, a
change in ownership of the insured property or any
change in their legal situation (for example, taking out
a mortgage) must be communicated by the
Policyholder, normally within 15 days, except in
situations that worsen the risk, which are to be
communicated immediately. C) The Insurer's response must generally be provided within 15 days except for situations where the risk is worsened, in which case the Insurer has two months to propose the change to the contract assuming of course that the Insurer has not made prior use of its rights to terminate the contract as described in the previous Section. D) Where the risk is reduced, the Policyholder has the right to the corresponding reduction in the premium, with effect from the next annual renewal date. LEGAL REFERENCE: Articles 11, 12, 13, 32, 34, 37 and 40.
10. 5. What to do in the event of a loss A) Above all, in the event of a loss, the Policyholder and the Insured must use all means available to minimise the consequences of the loss and cooperate in rescuing people and property.
Policy 045764350
B) The Policyholder, Insured or Beneficiary must immediately notify the Insurer, including by telephone or e-mail, the fact that a loss has occurred, the circumstances of it and its consequences, and do so within no more than seven days. C) The Insurer must immediately try to come to an agreement with the Insured or Beneficiary in order to establish the amount of compensation or provide the benefit or service. D) If the characteristics of the claim so require,
the Insurer will appoint a Loss Adjuster. The
Insured may, if they wish, appoint their own Loss
Adjuster. If either party does not appoint a Loss
Adjuster, they shall accept the expert opinion of the
Loss Adjuster appointed by the other party. E) Any disagreements between Loss Adjusters shall be resolved by appointing a third Loss Adjuster who shall settle the matter. F) The Lost Adjuster's opinion will be binding upon the parties except where one of them contests it legally. G) Where the Lost Adjuster's expert opinion is not
contested legally, the Insurer shall pay the
compensation within five days. H) In order not to prejudice the interests of the
Insured or Beneficiary, if the expert's report and
formalities are prolonged, the Insurer shall make a
provisional payment 40 days after the claim is
reported, subject to the definitive compensation. The provisional payment will be equivalent to the compensation that, at least, could reasonably be due, based on the circumstances known at that point. I) Once the compensation has been paid, on many
occasions the Insurer shall be entitled to make claims
against third parties who are responsible for the
damage. The Insured must safeguard this right of the
Insurer. LEGAL REFERENCE: Articles 16, 17, 18, 19, 32, 38, 39, 43, 82 and 104.
10. 6. Other matters of interest A) Principle of good faith. The Law provides for various situations which, when they occur, go against the interest of the Insured him or herself, as such situations are penalised with the contract being rendered invalid or non-effective, or have consequences such as it being contested, exemption from the obligation to compensate and the Insurer claiming for damages.
In general, such situations occur when the
Policyholder, Insured or Beneficiary act fraudulently or in bad faith or at serious fault; when the Policyholder makes incorrect declarations; when they conceal details; when they do not co-operate in rescue tasks and when they do not respect the principle of good faith that underlies the contract of insurance.
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B) Communications between the parties. All communications must be made in writing, by
telephone or by e-mail. Where the Policyholder, Insured,
Beneficiary or Creditor is writing to the Insurer, they may
write to its registered head office or one of its
branches. Such communication may be made directly to
the Insurer or through any Insurance Broker acting
as broker in the contract. The Insurer shall write to
the last known address of the Policyholder,
Insured, Beneficiary or Creditor.
C) Limitation of actions. Actions relating to claiming rights arising
under the contract are limited to five years.
D) Enquiries and clarification regarding incidents:
Any enquiries and clarifications made during the life of the policy regarding it being issued, its administration, processing of claims or termination of the contract shall be made orally or in writing at the choice of the Policyholder or Insured via:
1. Insurance Broker FERRER & OJEDA ASOCIADOS
COR.SEG. S.L. telephone 93 280 5959, e-mail
[email protected], or postal address
TAMARIT 155 159, 08015 BARCELONA.
2. The Company's Call Centre 902 300 186, Monday to Friday, from 8.15am to 7pm, except July and August until 6pm, or via the company's website www.allianz.es. Claims Line: 900 225 468
E) Customer Complaints Department:
For any complaint or claim regarding your legally recognised rights and interests, you may contact the company, in accordance with Order ECO 734/2004 of 11 March, regarding customer service departments and services and the ombudsman service for financial institutions, via the following
channels: Calle Tarragona, 109, 08014 Barcelona - Apartado de Correos no. (PO Box) 38, 08080 de Barcelona - e-mail: [email protected] - www.allianz.es - Fax 93 228 85 53 as well as at any office of the Company that is open to the public. In accordance with the rules of operation set out under the Regulation - available both on our website and at the company's offices that are open to the public - the complaint or claim will be resolved within no more than two months from the date on which it is submitted to the Customer Complaints Department.
The final decision shall be duly notified to you within ten calendar days from when it is taken. If acceptance of the complaint or claim is rejected, or it has
been totally or partially rejected, or within two months from
the date on which it is presented to the Customer
Complaints Department, without it having been resolved,
you are entitled to lodge your complaint or claim with the
Claims Department of the Directorate General of
Insurances and Pension Funds at Paseo de la Castellana
number 44, 28046 Madrid. F) Litigation regarding the contract: The judge with jurisdiction for lawsuits arising from the contract of insurance shall be that relating to the Insured's regular address in accordance with Article 24 of the Insurance Contracts Act. G) Restriction due to international economic sanctions: This policy does not provide cover or benefits for any business or activity to the extent that such
cover, benefit, business or activity, including those that are underlying, would violate any law or regulation of the United Nations or the European Union in relation to economic sanctions, as well as any other regulation relating to economic or commercial sanctions that may be applicable.
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BASIC INFORMATION ABOUT DATA PROTECTION
Data Controller: Allianz, Compañía de Seguros y Reaseguros, S.A.
Purpose: Taking out, maintaining, developing and managing insurance.
Legal grounds: Performance of a contract.
Recipients: Assignment to the company's third-party collaborators and shared insurance sector files. Intra-group international transfers.
Rights: Access, rectification, erasure and portability of data; limitation of or opposition to them being
processed, in accordance with the additional information.
Applicability: The Data Subject through the insurance broker.
Additional You can find additional and detailed information on Data Protection on our Information website: https://www.allianz.es/privacidad-seguridad
The party entering into the contract has expressly consented to the use of their personal health details necessary for taking out the insurance, and in addition consents to: Advertising and commercial prospecting purposes. YES
Transfer to other organisations within the Allianz GROUP in Spain (please see www.allianz.es for more details), to tell you, using any means, about the opportunities for taking out insurance and financial or related services that may be of interest to you. NO Automated decision making for creating a "business profile" based on the information provided. NO
FINAL CLAUSE
The Policyholder and/or Insured acknowledges
that they have received, read and checked this 22-
page policy for Allianz Group Accident Contract of
Insurance and accepts the conditions thereof, both
those which delimit and define the risk and those
which set the insured benefits and, likewise,
expressly declares that they are aware of and
accept the exclusions and limitations of the cover,
judging all of them to have been suitably
highlighted, and especially, the terms and
conditions covering the processing of their
personal data in computer files. The Policyholder
also declares that he/she has answered in good
faith the questions that allow the Company to carry
out the risk assessment and to present an quote
that meets his or her requirements and needs.
Therefore, after analysing the information prior to
enter into the contract, the Policyholder requests
that the policy be issued so that they can proceed
immediately to accept it and pay the premium.
The Policyholder also declares that the details
provided are accurate and that no circumstances
have been omitted or hidden that could affect the
risk being accepted and that they assume full
responsibility for the purposes of the provisions of
Article 10 of the Insurance Contracts Act 50/1980
of 8 October. The Policyholder similarly
undertakes to inform the Insurer, as soon as
possible, of any other circumstance that may affect
the insured risk.
This product is subject to the Foreign
Accounts Tax Compliance Act
(FATCA) signed between the USA and Spain,
and Royal Decree 1021/2015, which establishes
the obligation to identify the tax residence of
persons who own or control certain financial
accounts and to report on them under the
common reporting standard (CRS). Under this,
personal data will be provided to the Spanish Tax
Agency, from which it can be confirmed whether
the Policyholder, Insured and/or Beneficiary of the
policy are or are not a US person or entity or tax
resident living abroad. Lastly, the Policyholder declares that he or she
has received the information prior to taking out
the policy relating to the Insured being protected
as stipulated in Chapters VII and VI of Act
25/2015, of 14 July, regarding the organisation,
supervision and solvency of insurance and
reinsurance institutions, and Royal Decree
1060/2015, of 20 November, approving the
Regulations of that same Act, respectively, as
well as the information contained in Chapter VI of
the regulations regarding the distribution of
insurance and reinsurance. Both parties consider the text of this contract to be
an indivisible whole, and that it together with the
General Conditions, Special Conditions and any
Supplements and/or Appendices issued constitute
the Policy and that they have no validity or effect
separately, thus granting their full consent in
BARCELONA on 10 July 2019.
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I have received and accepted my copy We accept the contract and all We accept the contract and all its terms and conditions. its terms and conditions,
The Policyholder Allianz, Compañía de Seguros y Reaseguros, UNIVERSITAT DE BARCELONA S.A.
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Allianz Compañía de Seguros y Reaseguros,S.A. Customer Service Tel. 902 300 186 www.allianz.es/eCliente
Your insurance broker
FERRER & OJEDA ASOCIADOS COR.SEG. S.L. Insurance Broker No. DGS J0812
TAMARIT 155 159 08015 BARCELONA Tel: 932805959
With you from A to Z
Allianz, Compañía de Seguros y Reaseguros, S.A. Cl.Ramírez de Arellano 35 - 28043 Madrid - www.allianz.es NIF (Tax ID): A-28007748