PERSONAL ACCIDENT AND MEDICAL EXPENSES INSURANCE

DIRK BLOEMERS JULIAN BERRY

‘No Certificado’/ ‘Certificado’/’No Limits’

(February 2007)

1. PREFACE

This is a personal accident and medical expenses group insurance covering members of the DiveAssure Association who have paid the Premium.

The Insurers will pay in accordance with the Schedule stated herein as a direct result of an Insured Event, all as defined herein, during the Period of Insurance according to the following terms, conditions and limitations.

2. DEFINITIONS

“Premium”

Complete, full and final payment of the premium as required for the programme chosen by the Person Insured on the application form, received by Global Diving Insurance Limited.

“The Insurers”

Certain Underwriters at Lloyd's.

"The Person Insured"

An individual who is at least 10 years of age but not more than 65 years of age and is qualified as a diver, and is the holder of a valid diver's certificate, or the holder of a valid diving instructor's certificate, (both certificates being recognised by international diving organisations), and who is Diving according to the generally accepted standards of the diving community,

or An individual who is at least 10 years of age and is in the process of obtaining his qualification as a diver, and is under the supervision of and Diving with a qualified diving instructor as described above on behalf of a diving centre which is authorised to qualify divers,

or  An individual who is at least 10 years of age and is diving with and under the supervision of a qualified diving instructor as described above on behalf of a diving club.

“Insured Event”

Means identifiable physical injury which

(a)            is caused by an accident to the Person Insured whilst engaged in Diving during the Period of Insurance and

(b)            solely and independently of any other cause, except sickness or disease directly resulting from, or medical or surgical treatment rendered necessary by such injury, occasions the death or total and permanent disability of the Person Insured and/or

(c)            incurs medical expenses

"Diving"

Diving within the depth limit specified in the Schedule, with the use of personal diving equipment and/or snorkelling, from the moment of entering the water until leaving the water.

"Personal Diving Equipment"

Personal diving equipment being the property of the Person Insured or in the care, custody or control of the Person Insured  which feeds compressed or enriched gas, plus each of the items detailed below which may be added to it:

Floating balance

Rapid release buckle on the diving appliance belt and on the weights.

Instrument to measure time and to measure depth (one per couple).

Warning instrument showing depletion of gas in the tank.

"Doctor"

Specialist qualified physician who treats the Person Insured after the Insured Event and/or during hospitalisation following the Insured Event.

"Hospital"

A medical institution recognised by the competent authorities as a hospital and which functions only as a hospital, and not an institution which is also a sanatorium and/or rehabilitation institution. For this purpose a hyperbaric chamber will be considered a Hospital.

"Escort"

A person who will accompany the Person Insured on the return to his country of origin on the instructions of the Doctor.

"Reasonable Expenses"

Fees and other costs charged for services necessarily rendered to the Person Insured as a direct result of an Insured Event.

“He, His” shall also mean “She, Her”

“Rescue, Evacuation and Transfer Expenses”

Reasonable Expenses incurred to rescue, evacuate and transfer the Person Insured from the place of the occurrence of the Insured Event to the nearest Hospital and/or between Hospitals when necessary, including by air ambulance

3. DETAILS OF THE COVER

The compensation paid by the Insurers will in no case exceed the amounts as stated in the Schedule but the limit for medical expenses shall also be the maximum limit for any one Insured Event.

A. Medical Expenses

Payment of Reasonable Expenses for services given to the Person Insured for Rescue, Evacuation and Transfer to Hospital, and expenses incurred in the diagnosis, treatment, including treatment in a hyperbaric chamber, laboratory tests, x-rays and any other treatment given to the Person Insured, which is essential to save the Person Insured’s life  or is reasonably required to cure and/or relieve the effects of the physical injury caused by the Insured Event.  Such expenses must be incurred within 365 days after the date of the Insured Event.

B. Death as a result of an Insured Event

The Insurers will pay to the beneficiary as stated in the application for the insurance the benefit for death as a direct result of an Insured Event, on condition that the death of the Person Insured occurred within 365 days after the date of the Insured Event. If there is no named beneficiary, the benefit will be paid to the Person Insured’s legal heirs.

C.Total and Permanent Disability

The Insurers will pay the Person Insured in a case of the Person Insured’s total and permanent disability beginning within 365 days from the date of the Insured Event and directly resulting from it providing that such disability:
(a) Entirely prevents the Person Insured from attending to any business or occupation for which they are reasonably suited by training, education or experience and
(b) Continues without interruption for at least 365 days and
(c) Is reasonably expected to
continue without hope of improvement.

In case of disability followed by the death of the Person Insured, one compensation only will be paid to the Person Insured and/or the Person Insured’s beneficiaries.

D. Travel Assistance

Travel Tickets

The Insurers will indemnify the Person Insured and an Escort for Reasonable Expenses incurred to purchase additional travel tickets to the country of domicile as stated in the application form if due to the Insured Event and on the written instructions of the Doctor, the Person Insured is prevented from using the originally purchased travel tickets.

Extra Accommodation Expenses

The Insurers will indemnify the Person Insured and his Escort for reasonable additional lodging accommodation expenses incurred in order to remain in the place where the Person Insured receives medical treatment following an Insured Event on the written instructions of the Doctor up to a maximum of USD 125 (or equivalent in other currencies) per day but in no case shall the maximum claim(s) under this Section E exceed the limit stated in the Schedule, any one Insured Event.

E. Third Party (Civil) Liability Rider

The Insurers will indemnify the Person Insured for all sums that he/she shall become legally liable to pay to Third Parties as a result of accidental Bodily Injury occurring whilst the Person Insured is engaged in recreational snorkel or sport diving up to the Limit of Indemnity shown in the table below in respect of the relevant program.

Legal defence costs incurred by the Person Insured shall be included within the Limit of Indemnity.

WARRANTIES (Third Party rider)

For the coverage to be available to the Person Insured, it is a fundamental requirement of this Insurance that: Recreational diving or snorkeling activities are carried out in accordance with the guidelines and recommendations for safe diving practices as laid down by the Person Insured’s certifying authority and that the Person Insured satisfy him/herself that the equipment that he/she uses during recreational diving activities is maintained in a serviceable condition to accepted diving standards.

The Insurers will not be liable for the first €250 of any incident (applicable only to Third Party rider). This applies to each person making a claim separately.

EXCLUSIONS (Third Party rider)

The Insurers will not pay any claim arising from:                  

·         The use of spear guns when used in conjunction with an aqualung;

·         Any Property or Goods of others in the care, custody or control of the Person Insured;

·         Any goods or products sold by the Person Insured;

·         The use or occupation of any premises by the Person Insured;

·         The use or operation of any motor vehicle, watercraft or aircraft by the Person Insured;

·         Any commercial or professional activity by the Person Insured;

·         Bodily injury to the Insured Person’s employees arising out of their employment;

·         Seepage, pollution or contamination;

·         Any occurrence which at the time of happening would, but for the existence of this insurance, be insured under any other policy

Subject otherwise to terms, conditions and exclusions of the Recreational Diving Policy Wording to which this Rider attaches.

5. GENERAL EXCLUSIONS

The insurance will not cover death, disablement, loss or expense directly or indirectly arising out of or resulting from or contributed to by:

1.      war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or usurped power,

2.      Ionising radiation from or contamination by radioactivity from any nuclear fuel or from any nuclear waste, from the combustion of nuclear fuel or from the radioactive, toxic, explosive or other hazardous properties of any nuclear assembly or nuclear component thereof.

3.      the Persons Insured’s suicide, attempted suicide and/or intentional self-injury, whether the Person Insured was sane or not,

4.      the use of alcohol and/or drugs not prescribed by a registered medical practitioner,

5.      a criminal act by the Person Insured,

6.      the Person Insured engaging in or taking part in military service,

7.      mental illness and/or mental disturbance or nervous breakdown of the Person Insured, whether pre-existing or caused by the Insured Event,

8.      the Person Insured being in an abnormal state of health of which the Person Insured was aware and/or due to which he was disqualified or not entitled to engage in diving,

9.      the Person Insured diving in an area where diving is forbidden,

10.  the Person Insured diving whilst pregnant,

11.  the Person Insured diving as a professional diver other than as a diving instructor,

Additional exclusions applicable only to the ‘Sub’ and ‘Deportivo’ programs:

12.  Diving under ice,

13.  Underwater cave diving

14.  Diving using breathing mixtures other than compressed air or enriched air (EANx) with a maximum of 40% oxygen,

15.  Diving using rebreather apparatus

6. CLAIMS

The Person Insured will inform the Claims Administrator immediately of the occurrence of an Insured Event and its circumstances, and, as soon as possible, will submit all the reasonable documents (original(s) only) required including where applicable a letter of waiver of medical confidentiality signed by the Person Insured. The submission of the above waiver is fundamental to the Insurer's admittance of liability.

The Person Insured will co-operate with the Claims Administrator before and after submitting the claim and will do everything required in order to enable the Insurer to clarify his liability for payment and determine the amount to be paid under this insurance.

If required to do so, the Person Insured will make himself available, at the request of the Claims Administrator, for a medical examination by its appointed registered medical practitioner.

The Person Insured must send the Claims Administrator a full report of the Insured Event plus a medical report from the Doctor and/or from the Hospital(s) and must submit every other document required by the Insurer in accordance with the circumstances of the Insured Event.

The Insurer will be entitled to manage on its account any investigation and visit the Person Insured and have the Person Insured checked by the Insurer’s medical representative and/or any other representative, as the Insurer deems necessary.

7. GENERAL CONDITIONS

Other Insurance

On the occurrence of the Insured Event the Person Insured must give the Insurer notice immediately of any other insurance taken out for risks covered by this insurance. If on the occurrence of the Insured Event other insurances exist covering the Insured Event, then the Insurers shall pay only the sum in excess of the payments due by the other insurances.

Law and Jurisdiction

The proper Law and Jurisdiction governing this insurance shall be the Law of England and Wales and the English Courts shall have sole jurisdiction in any dispute hereunder.

Program	No Certificado	Certificado	No Limits
Recommended for :	Non certified divers diving under professional supervision, Snorkels and diving students	Certified divers	Certified divers using rebreather or mixed gases; Cave divers, Ice divers.
Medical expences and policy limit	E100,000	E100,000	E100,000
Civil Liability	E150,000	E150,000	E150,000
Death/Total and permanent disability	E6,000	E6,000	E6,000
Additional costs (for travel arrangements)	E4,000	E2,000	E2,000
Mixed Gases,	N0	No	Yes
Rebreather	No	No	Yes
Cave diving,	No	No	Yes
Ice diving	No	No	Yes
Depth Limit	30m	70m	No Depth Limit