Accident & illness insurance policy exclusions & conditions

Personal accident or personal accident and illness insurance - policy overview

Summary of exclusions

This Insurance does not cover: -

  • The Insured Person whilst engaged or taking part in military, air force or naval service or operations (other than reserve or volunteer training)
  • The Insured Person whilst engaged or taking part in aeronautics or aviation, other than as a passenger
  • The Insured Person whilst engaged or taking part in mountaineering or rock climbing normally involving ropes and/or guides
  • The Insured Person whilst riding or driving in any kind of race
  • Any claims arising directly or indirectly caused or contributed to by the Insured Person’s intentional self-injury, suicide or attempted suicide, provoked assault, fighting (except in bona fide self-defence), or from the Insured Person’s own criminal act, or whilst engaged or taking part in civil commotions or riots of any kind.
  • War, whether war be declared or not, invasion or civil war; except whilst the Insured Person is travelling outside the United Kingdom, however this exception shall not apply where the Insured Person is taking an active part in such War, invasion or civil war
  • Any claims in any way caused or contributed to by Terrorism involving the actual or threatened malicious use of pathogenic or poisonous biological or chemical materials
  • Any claim arising out of any condition caused by, prolonged by, or aggravated by any psychiatric, mental or nervous disorder of the Insured Person, including anxiety, stress, depression and/or post-traumatic stress disorder
  • Any claims occasioned by or occurring while the Insured Person is in a state of insanity temporary or otherwise
  • Any claims in any way caused or contributed to by nuclear reaction, nuclear radiation or radioactive contamination
  • Any claims arising from physical or mental conditions or disabilities of a recurring or chronic nature from which an Insured Person suffered, and was known to suffer, prior to the inception of this Certificate
  • Any payment that would expose the Underwriters to any sanction, prohibition or restriction under UN resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom and United States of America
  • The Underwriters shall not be liable to pay any claim or benefit to the extent that the provision of such cover, payment of such claim or provision of such benefit would contravene local laws or regulations
  • Any claim for disablement arising from the interaction between Bodily Injury and another medical condition, whether diagnosed or not.
    Additional Exclusions applicable where this Insurance includes compensation for Illness
  • Any claims consequent upon the Insured Person’s pregnancy or childbirth
  • Any claims arising directly or indirectly arising out of, consequent upon or contributed to by a sexually transmitted disease or Acquired Immune Deficiency Syndrome (A.I.D.S.) or A.I.D.S. Related Complex (ARC), howsoever this syndrome has been acquired or may be named

Conditions - overview

To read the complete policy Terms & Conditions - see the downloads section at the bottom of this page

Other Occupations

If the Insured Person shall engage in any occupation in which greater risk may be incurred than in the occupation disclosed in this Certificate without first notifying the Underwriters and obtaining their written agreement to the amendment of this Certificate (subject to the payment of such reasonable additional premium as the Underwriters may require as the consideration for such agreement), then no claim shall be payable in respect of any Accident or Illness arising out of or in the course of such occupation.

Cancellation of this Insurance

If the Period of Insurance is less than 3 months and/or cover has been purchased to insure a specific event/activity: -

If the Period of Insurance is 3 months or longer and cover does not relate to a specific event/activity: -

Information given to the Underwriters

In deciding to accept this Insurance and in setting the terms and premium, the Underwriters have relied on information given by the Insured Person. The Insured Person must ensure that all information provided is accurate and complete.

If it is established that the Insured Person deliberately or recklessly provided false or misleading information, the Underwriters will treat this Insurance as if it never existed and decline all claims.

If it is established that the Insured Person were careless in providing the information relied upon in accepting this Insurance and setting its terms and premium, the Underwriters will: -

Claims notification

Notice must be sent to the Claims Administrators as soon as practicable of any Accident or Illness to the Insured Person. In no case will the Underwriters be liable to pay compensation to the Insured Person or to his representatives unless the medical adviser or advisers appointed by the Underwriters for the purpose shall be allowed so often as may be deemed necessary to make an examination of the person of the Insured Person.

Fraudulent claims

If the Insured Person, or anyone acting on his behalf, makes a claim knowing it to be false or fraudulent in amount or in any other respect, which is unknown to the Assured, the insurance will become invalid in respect of that Insured Person. This means the Underwriters will not pay the false or fraudulent claim, or any subsequent claim, in respect of that Insured Person.

If the Assured, or anyone acting on the Assured’s behalf, makes a claim knowing it to be false or fraudulent in amount or in any other respect, the whole insurance will become invalid. This means the Underwriters will not pay the false or fraudulent claim, or any subsequent claim, in respect of the Assured and all Insured Persons.

To read the complete policy terms and conditions - see the link below

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Accident & Illness Insurance Document Downloads

Key Facts Doc
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Wording / Certificate
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