Comprehensive Accident Insurance Rider-
General
Comprehensive Accident Insurance is given with basic life insurance policies.
The Policyholder/Life Assured named in the Schedule of the Policy has paid the first premium and agreed to pay any subsequent premiums to the ETHIOPIAN INSURANCE CORPORATION (hereinafter called the Corporation) in consideration for the Insurance granted by this Comprehensive Accident Insurance.
The Policyholder/Life Assured and the Corporation have agreed that the statements made by the policyholder/Life Assured in the Proposed and Declaration or in any other written documents be the bases of the Insurance applied for by the policyholder/Life Assured, and that this comprehensive Accident Insurance is attached to and forms an integral part of and read together as one Contract with the said Policy.
In consideration of the foregoing, if the Life Assured, before reaching the age of sixty(60) and whilst this Comprehensive Accident Insurance is in full force, shall sustain Death, Disability, or Loss of Time upon receipt of satisfactory proof and subject to the Terms and Conditions set out in the Policy and/or this Comprehensive Accident Insurance or in subsequent endorsements made on the policy or this Comprehensive Accident Insurance, the Corporation will pay benefit(s) according to the Schedule of Benefits below Such Loss must however be effected directly and independently of all other causes through external, violent, and accidental means of which there is evidence of visible contusion or wound on the exterior of the body.
1. Definitions
1.1 Disability as herein appears is Disability which is the result of an accident and must be Total and Permanent and such that there is neither then nor at any time thereafter any work, occupation, or profession that the Life Assured can ever sufficiently do or follow to earn or obtain any wages, compensation or profit. Accidental injuries which independently of all other causes and within 90 days from the happening of such accident, result in Loss of sight or in the amputation of a limb shall be deemed to constitute such Disability.
1.2 Loss of limb shall mean Loss by severance at or above the wrist joints of hand or ankle joints of foot; Loss of sight shall mean total and irrecoverable Loss of sight, and Loss of thumb or finger shall mean Loss by severance at or above the metacarpophalangeal joints (i.e. amputation of all phalanxes).
2. Utmost Good Faith
If anything stated in the Proposed and Declaration be untrue, or if this Comprehensive Accident Insurance or the Policy to which it is attached be obtained through the withholding or misrepresenting of any material fact, or if the Life Assured become of intemperate habits, or make any false statements in support of a claim, then the policy and this Comprehensive Accident Insurance shall be void and all premiums in respect thereof shall be forfeited to the Corporation.
3. The Entire Contract
This Comprehensive Accident Insurance with the application thereof, the Policy, Proposal and declaration and subsequent letters and endorsements related to this Comprehensive Accident Insurance and/or the Policy shall constitute the entire Contract between the Policyholder/Life Assured and the Corporation. Unless provided for otherwise, the Terms and Conditions and the Schedule of the said policy in so far as they relate will apply to this Comprehensive Accident Insurance as they were set out herein.
4. Change of Occupation to Greater Hazard
If the Life Assured shall engage in any occupation more hazardous than specified in the Proposal and Declaration or any other document, this Comprehensive Accident Insurance shall become null and void unless the policyholder/Life Assured has notified the same and the Corporation has agreed in writing to accept the increased hazard and any additional Premium required has been paid.
5.Notice and Proof of Loss
a) Written notice with full particulars sufficient to identify the Life Assured and covering the occurrence, character, and extent of the Loss for which claim is made must be given to the Corporation within thirty days after the date of the accident causing such loss. In the event of Accidental Death, immediate notice thereof must be given to the Corporation. Failure to give notice within this period shall not invalidate any claim if it shall be shown not to have been reasonably possible to give such notice and that notice was given as soon as was reasonably possible.
b) Proof of Loss must be furnished to the Corporation at its office within ninety days after the notification of a claim for which the Corporation is liable.
c) The Corporation shall have the right and opportunity to examine the Life Assured in respect of whom a claim has been lodged when and so often as it may reasonably require during which time a claim hereunder is kept pending. Also the Corporation shall have the right and opportunity to make an autopsy in case of death where it is not forbidden by Law.
6. Settlement of Claim
a) All indemnities provided in this comprehensive Accident Insurance for Loss, will be paid immediately after receipt of due proof. Indemnity for Loss of life of the Life Assured is payable to the Beneficiary under the policy to which this Comprehensive Accident Insurance is attached, if surviving the Life Assured, and otherwise to the estate of the Life Assured. All other indemnities under this Comprehensive Accident Insurance are payable to the Policyholder.
b) Upon request of the Life Assured and subject to due proof of Loss all accrued indemnity for Loss of time on account of Disability will be paid at the expiration of each four weeks during the continuance of the Period for which the Corporation is liable, and any balance remaining unpaid at the termination of such period will be paid immediately upon receipt of due proof.
c) Permanent disabilities not mentioned above shall be compensated in accordance with their seriousness as compared with that of those mentioned, the occupation of the Life Assured person not being taken into consideration.
d) The partial or total %u201Cfunctional%u201D disability of a limb or an organ not specifically dealt with in the Schedule of Benefits is treated like the Partial or total Loss of the said limb or organ.
e) The total compensation payable in respect of one or more Losses due to one or more accidents is arrived at by adding together the various sums, but shall not exceed the total Sum Assured under this Comprehensive Accident Insurance or endorsement thereon.
7. Legal Proceedings
No action at law or in equity shall be brought to recover on this Comprehensive Accident Insurance prior to the expiration of sixty days after proof of Loss has been filed in accordance with the requirements of this Comprehensive Accident Insurance, nor shall such action be brought at all unless brought within two years from the expiration of the time within which proof of loss is required by the Corporation.
8. Renewal
This Comprehensive Accident Insurance may be renewed with the consent of the Corporation from time to time by the payment of the premium in advance at the Corporation%u2019s premium rate in force at time of renewal. A grace period of thirty one days shall be granted for the payment of any premium except the first. During this period of grace the Insurance under this Comprehensive Accident Insurance shall continue in force. If, at the expiration of the grace period any premium due and payable under this Comprehensive Accident Insurance shall not have been paid then the Insurance under this Comprehensive Accident Insurance will end. No Waiting Period (as may be set out in the Policy) is applicable for this Comprehensive Accident Insurance.
9.Termination
a) The Insurance under the Comprehensive Accident Insurance shall automatically terminate
1. if any premium on this Comprehensive Accident Insurance or on the Policy to which it is attached is not paid when due or within the grace period,
2. if the said Policy is surrendered or converted to Paid-up Insurance or benefit has been paid out or
3. on the anniversary date of said Policy nearest to the sixtieth birthday of the Life Assured. Termination of this Comprehensive Accident Insurance by the Life Assured or by the Corporation shall be without prejudice to any claim arising prior to such termination.
b) Whenever this Comprehensive Accident Insurance shall be terminated the additional premium thereof shall no longer be payable and there shall be no value on account thereof except for the return of the unearned portion, if any, of such premium paid which covered the period during which termination became effective, together with any additional premiums paid which fall due after termination. The subsequent payment or acceptance of any premium hereunder shall not create any liability unless this comprehensive Accident Insurance is reinstated but the corporation shall refund any such premium.
10. Reinstatement
If default be made in the payment of the agreed premium for this Comprehensive Accident Insurance, the Insurance herein under may be reinstated with the consent of the Corporation but only if the Policy to which this Comprehensive Accident Insurance is attached is in full force with no premium in default thereon. Such reinstatement shall only cover Loss resulting from accidental injury thereafter sustained.
11. Risks Excluded
The Insurance under this Comprehensive Accident Insurance shall not cover any Loss or Disability caused directly, or indirectly, wholly or partly, by
a. self- destruction or any attempt threat while sane or insane,
b. declared or undeclared war, strikes, riots, civil war, revolution, or any warlike operations,
c. Military, Naval or air force service in time of declared or undeclared war or while under orders for warlike operations or restoration of public order,
d. Making an arrest by an officer of the law,
e. Assault or murder or any other violation or attempt of violation of the law or resistant to arrest,
f. Heartstroke or sunstroke,
g. Participation in any brawl,
h. Racing on any wheeled-vehicle,
i. Pregnancy or childbirth,
j. Accident Occurring while or because the Life Assured is affected by alcohol or any drug.
k. Hernia, ptomaines or bacterial infection (except pyogenic infection which shall occur with and through an accidental cut or wound),
l. Any disease or sickness,
m. Poison, gas or fumes (voluntarily or involuntarily taken)
n. Entering, operating, or servicing, ascending or descending from or with any aerial device or conveyance except as a fare paying passenger in a commercial airline flying on a scheduled passenger trip or route.
SCHEDULE OF BENEFITS
Section I
Extent of Loss Percentage of Sum
Assured Payable
1.1 Loss of life 100
1.2 Loss of both hands 100
1.3 Loss of both feet 100
1.4 Loss of sight of both eyes 100
1.5 Loss of one hand and sight of one eye 100
1.6 Loss of one hand and one foot 100
1.7 Loss of one foot and sight of one eye 100
1.8 Total paralysis 100
1.9 Total insanity 100
1.10 Any other injury causing total and Permanent disablement 100
Section II
Extent of Loss Percentage of Sum
Assured Payable
2.1 Loss of sight of one eye 50
2.2 Loss of arm at shoulder 60
2.3 Loss of arm between elbow and shoulder 55
2.4 Loss of arm at elbow 50
2.5 Loss of arm between and wrist 50
2.6 Loss of hand at wrist 50
2.7 Loss of complete use of shoulder or elbow 30
2.8 Loss of complete use of wrist 25
2.9 Loss of four fingers and thumb of one hand 50
2.10 Loss of four fingers and one hand 40
2.11 Loss of thumb – both phalanxes 20
2.12 Loss of thumb – one phalanxes 10
2.13 Loss of Index finger %u2013 three phalanxes 15
2.14 Loss of Index finger %u2013 two phalanxes 10
2.15 Loss of Index finger %u2013 one phalanxes 5
2.16 Loss of Middle finger %u2013 three phalanxes 10
2.17 Loss of Middle finger %u2013 two phalanxes 5
2.18 Loss of Middle finger %u2013 one phalanxes 3
2.19 Loss of Ring finger %u2013 three phalanxes 6
2.20 Loss of Ring finger %u2013 two phalanxes 5
2.21 Loss of Ring finger %u2013 one phalanxes 3
2.22 Loss of Little finger %u2013 three phalanxes 5
2.23 Loss of Little finger %u2013 two phalanxes 4
2.24 Loss of Little finger %u2013 one phalanxes 3
2.25 Loss of metacarpals %u2013 first or second (additional) 3
2.26 Loss of metacarpals – third or fourth or fifth (additional) 3
2.27 Loss of leg at hip 70
2.28 Loss of leg between knee and hip 50
2.29 Loss of leg below knee or one foot 40
2.30 Loss of Toes %u2013 all five on one foot 16
2.31 Loss of Toes %u2013 great both phalanxes 7.5
2.32 Loss of Toes %u2013 great one phalanxes 3
2.33 Loss of Toes %u2013 other than great if more than one toe lost each 2
2.34 Loss of complete use of hip or knee or ankle 20
2.35 Shorting of at least 5 cm of lower limbs 15
2.36 Loss of sight of one eye 50
2.37 Loss of hearing %u2013 both ears 80
2.38 Loss of hearing %u2013 one ear 20
Section III
3.1 If the Life Assured sustains Temporary Total Disability which
a. commences within thirteen weeks from the date of accident;
b. continuously prevents the Life Assured from performing any and every duty pertaining to his occupation during such Disability; and
c. lasts for at least four weeks, then the Corporation will pay 3.75 per mille (or 5.00 per mille for Individual life) of the Sum Assured per week, subject however to the conditions that:
i. such payment will be made for a maximum of fifty-two weeks from the date of accident;
ii. no single payment will constitute a period shorter-than four weeks except for periods beyond which disability does not continue.
3.2 If the Life Assured sustains Temporary Partial Disability which
a. commences on the date of accident or immediately following Temporary Total Disability as stated under (3.1) above;
b. continuously prevents the Life Assured from performing one or more duties, but not all duties, pertaining to his occupation; and
c. lasts for at least four weeks (if such Disability starts from the date of the accident),
then the Corporation will pay one-third of 3.75 per mille (or one- fourth of 5.00 per mille for Individual Life) of the Sum Assured per week. Subject however to conditions (i) and (ii) stated under (3.1) of this section.
3.3 The total number of weeks under (3.1) and (3.2) of this section together will not exceed fifty two weeks.
Section IV
If the Life Assured incurs medical, pharmaceutical, hospital and other expenses as a result of an accident the Corporation shall make payment towards these expenses subject to an overall limit of Birr 3,000 per person for any one period of Insurance.