MAPFRE INSULAR INSURANCE CORPORATION
Description of Coverage
This policy covers against loss resulting directly and independently of all other causes and the Company undertakes to pay compensation on the scale provided below for bodily injuries caused by accident subject to the provisions, exclusions & coverages hereinafter defined.
TOTAL PERMANENT LOSS OF THE USE OF A MEMBER SHALL BE TREATED AS LOSS OF SUCH MEMBER.
The loss of the first joint of the thumb or any other finger or any toe shall be considered as equal to the loss of one half of the thumb or finger or toe and the benefit shall be one half o the benefit above specified for the loss of the thumb or finger or toe
The loss of more than one phalanage of the thumb or of any other finger or of toe shall be treated as loss of the entire thumb or finger or toe.
Where, however, there is a loss of two or more parts of the hand, the percentage payable shall not be more than the loss of the whole hand.
Where the injury is not specified the Company will adopt a percentage of disablement which in its opinion is not inconsistent with the provisions of this table.
THE AGGREGATE OF ALL PERCENTAGE PAYABLE WITH RESPECT TO ANY ONE ACCIDENT WILL NOT EXCEED 100%.
MURDER & ASSAULT INCLUSION CLAUSE
IT IS HEREBY DECLARED AND AGREED THAT this policy extends to cover loss caused by the risks of MURDER or ASSAULT or any attempt thereat provided that such risks:
1. shall not have been provoked by the insured;
2. shall not have been occasioned by war, invasion act of foreign enemy, hostilities or warlike operations (whether war be declared or not), terrorist's attack by rebel groups, mutiny, riot, civil commotion, civil war, rebellion, revolution, insurrection, conspiracy, military or usurped power or state of siege, seizure, quarantine;
3. shall not have happened while the Insured is a) engaging in political activities or b) performing investigative, security or political function or c) holding any elective government position;
4. shall not have occurred in any of the following geographical areas, including their cities, towns, barrios and barangays.
a. Lanao del Norte
d. South Cotabato
b. Lanao del Sur
e. Zamboanga del Norte
h. Sultan Kudarat
c. North Cotabato
f. Zamboanga del Sur
i. Sulu Archipelago
MEDICAL REIMBURSEMENT EXPENSE
Where by reason of injury, the insured shall require treatment by a legally qualified physician or surgeon, confinement in a hospital or the employment of a licensed or graduate nurse, the company will pay the actual expense incurred thin fifty two weeks from the date of accident for such treatment, hospital charges and nurse fees, which is in excess of the deductible amount (if any) stated in the schedule, but not exceed the aggregate amount payable stated in the schedule as the result of an one accident.
ACCIDENT BURIAL EXPENSE BENEFIT
When injury results in the death of an insured person within 180 days after the accident the company will pay the actual burial expenses incurred but not exceed the maximum amount payable as stated in the schedule.
This policy does not cover loss caused by or resulting from any one or more of the following:
1. Intentionally self-inflicted injuries, suicide or any attempt thereat;
2. Illness, disease, or any bacterial infection other than bacterial infection occurring in consequence of an accidental cut or wound;
3. Accident occurring while the named insured is serving on full time active duty in the Armed Forces of any country of international authority (any premium paid to be returned by the Company pro-rata for any such period of full time active duty upon application by the Insured);
4. War, invasion, act of foreign enemy, hostilities or warlike operations (whether war be declared or not), mutiny, riot, civil commotion, civil war, rebellion, revolution, insurrections, conspiracy, military or usurped power, or state of siege, seizure, quarantine, or customs regulations or nationalization by or under the order of any government or public or local authority, or any weapon or instrument employing atomic fission or radioactive force, whether in time of peace or war. This exclusion shall NOT be affected by any endorsement which does not specifically refer to it, in whole or in part.
5. Travel or flight in any vehicle or device for (1) aerial navigation or (2) navigation beyond the earth's atmosphere, except while the named insured is riding as a passenger in a commercial scheduled Air Carrier.
6. Murder or Assault, provoked or any attempt thereat.
WAR AND TERRORISM EXCLUSION ENDORSEMENT
Notwithstanding any provision to the contrary within this insurance or any endorsements thereto it is agreed that this insurance excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing concurrently or in any other sequence to the loss:
* war, invasion, acts of foreign enemies, hostilities or warlike operations ( whether war be declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or unsurped power; or
* any act of terrorism For the purpose of this endorsement an act of terrorism means an act, including but not limited to the use of force or violence and/or the threat, of any person or group(s), of persons, whether acting alone or on behalf of or in connection with any organization(s) or government(s), committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.
This endorsement also excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in any way relating to (1) and/or (2) above. If the Underwriters allege that by reason of this exclusion, any loss, damage, cost or expense is not covered by this insurance the burden of proving the contrary shall be upon the Assured.
MOTORCYCLE RISK ENDORSEMENT
THIS POLICY EXTENDS COVER AGAINST DEATH AND/OR DISABLEMENT WHILE THE NAMED INSURED IS RIDING OR OPERATING ANY MOTORIZED TWO-WHEELED VEHICLE EXCEPT WHILE SUCH VEHICLE IS BEING USED FOR ANY RACE, SPEED TEST, OR EXHIBITION OR WHEN THE INSURED IS UNDER THE INFLUENCE OF LIQUOR, NARCOTICS OR PROHIBITED DRUGS
RESIDENTIAL OCCUPANCY WARRANTY
Warranted that the premises to which this insurance applies shall be occupied solely as dwelling and that no manufacturing storage or trading of goods for commercial purposes shall be carried out within said premises
PERSONAL ACCIDENT EXCLUSION LIST CLAUSE
1. Notwithstanding any provision to the contrary in this policy or in any endorsement thereto the company shall not be liable for any loss, damage, cost, expense or consequential loss of whatsoever nature directly or indirectly caused by, contributed to by, resulting from, or arising out of or in connection with:
a. Active war risks.
b. Kidnap & ransom written as such.
c. Dangerous sport activities such as hang gliding or para-sailing, parachuting, rock climbing or mountaineering, scuba diving, wrestling, boxing, acrobatics or similar kind of body-contact sports, skiing or other forms of winter sports, hunting, horse riding or any kind of motor race driving.
d. Test pilots and test drivers.
e. Naval, Military, Air Force or Police Services or Operations.
f. Professional divers when participating in diving.
g. Professional sport teams.
h. Stevedores and miners.
. Ship's, crew except Marina Fleet.
j. Aircraft pilots and crews in respect of flying risks.
k. Automatic passenger liability covers granted to airline operators or ticket agencies in respect of flying risks.
l. Air travel except as fare-paying passenger on a recognized airline operating on regular scheduled air routes and air travel by any chartered aircraft duly licensed as a recognized air carrier and flown by professional crews between property established and maintained airports.
m. Personal accident benefits under motor policies.
n. Personal accident benefits under life policies.
o. Long term disability and/or salary continuance business.
p. Insurance sold through travel card, credit card or charge card organizations and/or automatic vending machines
2. In any action, suit or other proceedings where the company alleges that by reason of the provisions of this condition any loss or damage is not covered by this insurance the burden of proving that such loss or damage is covered shall be upon the insured.
Nothing herein contained shall be held to vary, alter, waive or change any of the terms, limits or conditions of this policy except as herein above setforth.
MAPFRE INSULAR INSURANCE CORPORATION
Non – Coverable Illnesses:
TIRSO C. ABAD
President & CEO, MAPFRE Insurance
a. Alzheimer's disease
b.Any form of Brain Tumor
c.Any form of Cancer
d.Any type of Stroke
e.Any type/stage of Heart Failure
g.Blood Dyscrasias (Leukemia and others)
h.Chronic Renal disease or Chronic Renal failure
i.Diabetes Mellitus (DM) with complications (such as stroke, MI, Chronic Renal Failure)
j. HIV / AIDS
k. Hyperthyroidism (complicated)
l. Liver Cirrhosis
m. Major Organ Transplant
n. Multiple Sclerosis
o. Muscular Dystrophy
p. Myasthenia Gravis
q. Myocardial Infarction (ages 45 years old and above)
r. Psychiatric Disorders except Anxiety disorders
s. Rheumatic Heart Disease with complications (such as Mitral Valve Stenosis, Aortic Insuficiency/Regurgitation)
t. Spinal Cord Injury with paralysis
u. Systemis Lupus Erythematosus: Early onset; with complications (such as Heart failure, pleural effusion)
a. Bronchiectasis for ages 60 years old and above
b. Diabetes Millitus for more than 10 years or with insulin as maintenance treatment
c. Emphysema for ages 60 years old and above
d. Hyperthyroidism (uncomplicated)
e. Rheumatic Heart Disease (uncomplicated)
f. Systemic Lupus Erythematous (uncomplicated)
g. Tuberculosis (treated or untreated) for ages 60 years old and above