Sie sind auf Seite 1von 19

GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE

NNW (personal accident insurance ) PZU EDUKACJA INSURANCE introduced by resolution adopted by the Management Board

introduced by resolution adopted by the Management Board of Powszechny Zakład Ubezpieczeń Spółka Akcyjna no. UZ/423/2016 of 24 October 2016. With amendments introduced by resolution adopted by the Management Board of Powszechny Zakład Ubezpieczeń Spółka Akcyjna no. UZ/93/2017 of 7 April 2017.

TABLE OF CONTENTS Chapter I Introducing provisions

 

page

1

Sums insured and liability

page 11

Statutory information

.

.

.

.

.

.

.

.

.

.

.

.

page

1

Exclusions of liability

page 11

General provisions

.

.

.

.

.

.

.

.

.

.

.

.

page

2

Definitions

.

.

.

.

.

.

.

.

.

.

.

.

page 2

Chapter III Conclusion of an insurance contract and its term

. .

 

.

.

.

.

.

.

.

.

.

.

.

page 11

 

Chapter II insurance cover term. Insurance subject matter and scope

Insurance premium

 

page 12

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

page

 

4

Termination of an insurance contract and an end of liability

 

Insurance cover term

 

page

 

4

.

.

.

.

.

.

.

.

.

.

.

.

.

page 13

Insurance subject matter and scope

 

.

.

.

.

.

.

.

.

page

4

Refund of a premium

page 13

Benefits in a basic scope of insurance cover

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

page 5

 

Chapter IV Performance of an insurance contract

 

Options of insurance

 

page

 

5

.

.

.

.

.

.

.

.

.

.

.

.

.

.

page 13

Detailed provisions regarding basic benefits

 

Procedure in the event of an insurance

 

.

.

.

.

.

.

.

.

.

.

.

.

.

.

.

page 5

 

accident

.

.

.

.

.

.

.

.

.

.

.

page 13

Benefits in an extended insurance cover

 

Obligations of the Insured

 

page 13

.

.

.

.

.

.

.

.

.

.

.

.

.

.

page 8

 

Determination and payment of benefits

 

page 14

Additional benefits

 

.

.

.

.

.

.

.

.

.

.

.

page 8

 

Rules to rewarding additional benefits

 

Chapter V Final provisions

 

page

15

Referred to in

 

§ 13

 

.

.

.

.

.

.

.

.

.

.

.

.

page 9

 

CHAPTER I

 

INTRODUCTORY PROVISIONS

STATUTORY INFORMATION

Information mentioned in Art. 17 section 1 Act on insurance and reinsurance activity:

Type of information

Contract template editorial unit number

Premises

for

2 sec. 4, § 4, § 5, § 6, § 7, § 8, § 10 sec. 2 and 3,

§

payment

of

the

indemnity

and

§

12, § 13, § 14, § 17 sec. 2– 4, § 21, § 25,

other benefits

30, § 31, § 32, § 33, § 34, § 35, § 36, § 37, § 38, § 39, § 42.

§

Limitations and

§

4, § 8, § 9, § 10 sec. 2 i 3, § 12, § 13, § 14,

exclusions

of

17 sec. 5, § 21, § 31, § 32 sec. 3 i 4, § 33, § 34, § 35, § 36, § 37, § 38, § 39 sec. 4 –7, § 42, § 25.

§

liability of the insurance company entitling it to refuse

the payment of indemnity and other benefits or reduce them

 

Powszechny Zakład Ubezpieczeń Spółka Akcyjna, Distric court for the capital city of Warsaw, XII Commercial Division, National Court Register (KRS) 9831, Tax Identification Number (NIP) 526-025-10-49, share capital: 86 352 300.00 PLN paid UP in full, al. Jana Pawła II 24, 00-133 Warsaw, pzu.pl, hotline: 801 102 102 (fee according to operator’s tariff)

GENERAL PROVISIONS

§ 1

1. The general terms and conditions of NWW PZU EDUKACJA insurance, hereinafter referred to as the “GTCI”, shall apply to insurance contracts concluded by Powszechny Zakład Ubezpieczeń Spółka Akcyjna, hereinafter referred to as “PZU SA”, with natural persons, legal entities and organizational entities without legal personality for the benefit of pupils, students, children, personnel and representatives of insured persons.

2. The GTCI are also applicable o insurance contracts concluded by means of distance communication while observing the law provisions applicable within this scope. PZU SA uses Polish as a language used in relations with a consumer.

§ 2

1. Additional provisions, or provisions different from those set forth in these General Conditions may be introduced to the insurance contract, subject to contract with the Policyholder

2. In the case of introducing additional provisions or provisions different from those set forth in therein to insurance contract, these General Conditions are applicable within a scope not regulated by the above-mentioned provisions.

3. PZU SA is obliged to present to the Policyholder the differences between the contents of the insurance agreement and the General Conditions, in written form before concluding the insurance contract. If this obligation is not complied with, PZU SA may not quote the difference unfavourable for the Policyholder or for the Insured. This provision does not apply

to insurance contracts concluded by way of negotiations.

4. Relevant provisions of the Civil Code and other applicable provisions of Polish law shall apply to any matters not

regulated in the GTCI or in the insurance contract.

§ 3

1. The Policyholder may conclude insurance contract for account

of a third party (an account of the insurer). In this case the

Policyholder is obliged to inform the insurer about his/her rights and obligations resulting from the insurance contract

concluded for his/her account.

2. the case of concluding the insurance contract for account of

In

a

third party, the insurer may demand PZU SA to provide

information about provisions of the concluded insurance contract and the GTCI within a scope, within which it refers to the insured’s rights and obligations.

DEFINITIONS

GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE

DEFINITIONS GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE 2

2

§ 4

1. The terms used in the General Conditions shall have the meaning specified below:

and for whom outpatient treatment is not possible; under these General Conditions a day of hospital stay is a calendar day during which the Insured was staying at the hospital, regardless of the actual length of stay during that given day; the first day of hospitalization is the day of admission and the last one the day of discharge;; 13) consumer a natural person performing a legal activity not directly related to its business or professional activity; 14) intra-cranial haemorrhage extravasation of blood into the craniocerebral cavity; 15) treatment physicians’ visits and consultations, outpatient treatment, hospital treatment, outpatient procedures, surgical procedures, tests ordered by the physician, taking medication and applying dressings, transport from the location of accident to the hospital or outpatient clinic, rehabilitation; 16) outpatient treatment treatment other than hospitalization; 17) surgical treatment of a fracture internal or external stabilization of a fracture tied to a surgical procedure which interrupts tissue continuity;

18)

consequences of the insurer’s accident body

19)

injury, detriment to health or death; insurance accident a sudden event caused by an external reason, in consequence of which the Insured, regardless of his/her will, sustained bodily injury,

disturbance of health or died; 20) malicious tumour a disease manifesting itself by the presence of a malicious tumour (i.e. a tumour that is not encapsulated and is able to invade tissues and create remote metastases); within a meaning of these General Conditions the term “malicious tumour” includes leukaemia and malicious diseases of the lymphatic system, which is Hodgkin's lymphoma (Hodgkin's disease) or non-Hodgkin lymphoma; within a meaning of these General Conditions malicious tumours are not:

a) skin tumours, apart from malignant melanoma,

b) tumours, in the case when upon a histopathological examination is diagnosed a precancerous or preinvasive condition,

c) neoplasms with changes of carcinoma in situ type,

d) Hodgkin’s disease in its first stage,

e) neoplasms linked to AIDS or HIV virus infection;

21) frostbite damage of the skin and subcutaneous tissues due to low temperature; 22) insurance term the period of PZU SA liability defined in the insurance contract; 23) burn damage of the skin and subcutaneous tissues due to action of high temperature, chemicals, ionizing radiation or electric current; 24) surgeries a medical procedure performed at a medical facility by a physician authorized to perform it, under general or local anaesthesia, necessary to eliminate or alleviate the illness effects resulting from an insurance accident and conducted with a) the open or b) endoscope method; within a meaning of these General Conditions the surgery excludes: punctures, biopsies, injections, paracenteses, catharizing, tubing, cannulations, dialyses, blockades, venesections, tamponades, endoscopy;

25) country located in the region of the world at

26)

27)

risk of acts of terrorism, acts of war, martial law or state of emergency country which, as at the date of the insurance agreement, is entered in the list of countries to which travel is not advised due to threats of acts of terrorism, acts of war, martial law or state of emergency, published on the official website of the Ministry of Foreign Affairs of the Republic of Poland, with “Do not travel” or “Leave immediately” advisories; personnel teaching and administrative employees of the given school or other institution; establishmentnursery school, kindergarten, primary school, lower secondary school, general secondary school, occupational general secondary school, technical

primary school, lower secondary school, general secondary school, occupational general secondary school, technical

1) acts of terrorism individual or group actions directed against population or property to cause chaos, intimidate the general public, disorganize public life, public transportation, service or manufacturing facilities all in order to achieve economic, political or social aims; 2) fight a conflict of three or more persons dealing blows to each other, with each of them having a double role as the assailed and assailant 3) Emergency Centre the Emergency Centre working for PZU SA, providing services defined in the General Conditions; the Emergency Centre operates 24 hours a day 7 days a week and it is the location where the Insurer or a person acting on his/her behalf is obliged to report the insurance accident; the phone number of the PZU Emergency Centre is provided in the insurance contract; the phone number of the PZU Emergency Centre is provided in the insurance document. In the case of the insurance contracts concluded by means of distance communication, pone number of Emergency Centre is also provided by electronic means. 4) illness an organism reaction to a disease-causing agent manifesting by function disorders and organism structure damage that causes adverse effects; 5) severe bodily injuries the following injuries arising as a result of insurance accident, confirmed in medical documentation:

a) complete and permanent loss of vision, hearing, speech, reproductive capacity or b) permanent and serious impairment, or loss of function of an important organ or organs, and specifically: one-eyed blindness, serious two-sided sight impairment, loss of lower limb at least on the level of the shank, loss of an important internal organ, stiffness of one of the major joints (shoulder, elbow, hip, knee, ankle) especially in an unfavourable position, loss of prehensile ability of the hand (loss of at least three fingers, including the thumb), paresis or paralysis of at least one limb; 6) temporary inability to study a temporary inability of the Insured to participate in all school classes, arising in consequence of insurance accident; a physician’s leave from physical education classes does not mean inability to study under these General Conditions; 7) temporary inability to work a temporary inability of the Insured to gainful employment, arising as the consequence of the insurance accident, documented with a medical certificate on temporary inability to work, issued in line with current legal provisions; 8) insurance document the policy, certificate or another document confirming the conclusion of insurance contract; in the case of an individual insurance contract, one document may confirm a conclusion of more than one insurance contract; 9) acts of war actions of armed forces aiming at destroying the enemy armed forces on land, in the air or on sea; 10) children persons up to 25. years old, studying or staying in establishment, whereas a child within a meaning of these General Conditions is also a child until going to a nursery school, kindergarten or school and a child that does not attend a school due to the health reasons or who has individual educational programme; 11) occupational exposure to contagious material a subjection of the insured to virus infection while performing his/her professional work of medical nature as a result of a direct contact with potentially infected blood or another potentially infectious material, as a consequence of prick, splash, scratch, cut, score, bite by a patient; 12) hospitalization - insured’s stay at the hospital in consequence of an insurance accident, uninterrupted and lasting for more than one day, tied to treatment of

conditions which arose as a result of insurance accident GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE

3

of insurance accident GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA

28)

secondary school, basic vocational school, school complex, educational centre, orphanage, sport schools of all levels, post-secondary school, high school or the other not mentioned above establishments, in that employment establishments; medical establishment a healthcare entity

29)

within a meaning of the Act on healthcare activity; educational entity nursery school, kindergarten,

primary school, lower secondary school, general secondary school, occupational general secondary school, technical secondary school, basic vocational school, school complex, educational centre, orphanage, sport schools of all levels, post-secondary school, high school; 30) serious bodily harm a bodily harm occurring as

a result of the insured’s accident, which resulted in one of the consequences listed below, confirmed by medical documentation:

a) hospitalization commenced up to 3 days after the trauma and lasting without interruption for at least 14 days,

b) an urgent surgical procedure (up to 7 days from admission to hospital),

c) qualification of the insured for a planned surgical procedure,

d) permanent neurological deficit after damage to the brain, spinal cord or nerve roots,

e) permanent worsening of acuity of vision or permanent narrowing of the field of vision,

f) permanent worsening of the auditory acuity,

g) partial amputation of limbs,

h) partial loss of internal organs;

31)

2) Serious bodily harm excludes invasive examinations (even conducted as a part of a surgical procedure within a meaning of these General Provisions) aimed at diagnosing an illness or a confirmation of an illness existence;

serious illness an existence in the Insured the following illness:

a) cerebral stroke a sudden n focused or general disorder of brain activity, leading to permanent neurological deficiencies, caused only by vascular reasons as brain vessel lumen or transmural rupture of a brain vessel, excluding vascular reasons caused by brain or injury factors, or

b) renal failure a final stage of renal failure in a form of irreversible impairment of activity of both kidneys, as a consequence of which are performed regular, permanent dialyses or surgery procedure consisting in kidney transplantation, or

c) -Creutzfeldt-Jakob diseasesdiseases that disable a performance by the insured minimum three of five below mentioned activities of everyday life:

-moving at home moving between rooms at house, without necessity to assist by another

person, -controlling physiological activities self-control within a scope of defecation and urination, and maintaining personal hygiene, -dressing up independent dressing up and undressing, without necessity to assist by another person, -washing and toilet an independent performance of activities related to washing and personal hygiene, without necessity to assist by another person, -eating activities connected with independent eating of ready meals or

d) HIV infection during blood transplantation complications of blood or blood-related preparations transplantation in person not suffering for

32)

haemophilia, or

e) meningioma histopathologic confirmed diagnosis of brain meningioma; excluding: the other changes in central nervous system, cysts, coccus, vascular malformations, pituitary and spinal cord tumour, or

f) Parkinson’s disease – chronic disease of extrapyramidal system, caused by primary degeneration of nervous cells of substantia nigra, leading to a decrease in a quantity of neurons that produce dopamine, which results in an occurrence of at least two of three classical axial symptoms of this disease: passive tremor, slowness of movement, plastic quality hypertonia (muscular rigidity), that decrease upon an administration of drugs stimulating a dopaminergic system, in particular L- DOPA; excluding symptomatic parkinsonism, or

g) vision loss caused by disease confirmed by ophthalmic examination and static examination of vision field, binocular vision acuity loss below 5/50, not a subject to correction or binocular narrowing of a field of vision below20; gainful work a form of performing work for

remuneration:

1)under:

a)

a

civil law contract or

b)

an employment relationship or

c)

an official relationship of administrative and legal nature, or 2)within performance of business activity under own name, including the running of

a farmstead;

33) orthopaedic objects and auxiliary materials medical devices necessary from the medical standpoint, replacing lost systems (organs) or supporting the lost or

worsened functions of organs; a list of orthopaedic objects

and auxiliary materials is included in Regulation of Minister

of Health of 6 December 2013 on a list of medical devices

issued on order;

statutory representative a person whose empowerment to act on behalf of a person without legal capacity or with limited legal capacity, results from law provisions;

35) Rules and Regulations relevant rules and regulations governing electronic service provision; 36) rehabilitation treatment necessary from the

34)

medical standpoint, restoring functions and capacity after

the

insurance accident, performed by persons who possess

the

necessary qualifications and licenses;

37)

RP the Republic of Poland;

38)

sepsis in other words septicaemia systemic

39)

inflammatory response syndrome (SIRS) caused by infection; state of emergency an emergency state of a

40)

state, which introduction results in a restriction of some rights and civil freedoms; hospital a medical facility providing round-the-

clock care for patients in terms of diagnostics and treatment, with qualified team of physicians and nurses;

under these General Conditions, this term does not include

a nursing home, hospice, a rehabilitation centre,

sanatorium or spa, preventorium or sanatorium hospital unless hospitalization is connected with a treatment of consequences of an insurance accident; 41) coma a condition resulting from the insurance accident, lasting continually for at least 30 days and requiring the use of a life support system, entailing the presence of deep, quantitative disturbances of consciousness, having the form of lack of reaction to external verbal and pain stimuli, tied to severe brain damage; under these General Conditions, this term does

not drug-induced coma for treatment purposes;

GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE

for treatment purposes; GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA

4

42) permanent bodily harm complete physical loss

of an organ, or complete loss of its function; permanent disturbance of health permanent bodily harm or detriment to health, without prospects for improvement;

44) the Policyholder an individual, a legal person or

organizational entity with no legal personality, who signed an insurance contract with PZU SA for his/her own account or for account of the Insured; the Insured persons referred to in items 1-4 for whose benefit the insurance contract was concluded

45)

43)

a) a pupil, a student;

b) a child;

c) personnel of an establishment;

d) a statutory representative.

46) direct contract an insurance contract concluded by means of electronic distance communication while observing law provisions applicable in this respect; 47) remote contract an insurance contract concluded using direct means of remote communication through PZU SA’s hotline in compliance with the regulations applicable in this respect;

individual insurance contractinsurance contract concluded for the

account of a natural person named in the insurance document; 49) collective insurance contract an insurance contract, other than family insurance contract, covering at least five persons, or a contract concluded in the form of an open policy; 50) beneficiary a person named by the Insured as entitled to receive the benefit due on account of the insured’s death; 51) bodily harm organ or system injury caused by an insurance accident; 52) war an organised armed conflict between countries, nations or ethnic and social groups; 53) congenital heart defect hear anatomical incorrectness existing at birth of the Insured; 54) concussion post-trauma disorder of the brain function, whose main symptom involves short-term loss of consciousness with associated retrograde or anterograde amnesia; 55) traffic accident an insurance accident caused by vehicle or vehicles movement on the road, in which the Insured took part as a road user; terms:” vehicle”, “road”, “road user” are understood according to their meaning assigned to them by the applicable law provisions on road traffic;

48)

insurance accident an accident, suffering bodily injuries as a result of epilepsy attack or fainting caused by unknown reason other than chronic disease, intra-cranial haemorrhage, myocardial infarction, sepsis, serious illness, occupational exposition to infectious material; an insurance accident in the case of a hospital diet due to an illness is a stay of the Inured in the hospital;

57) myocardial infarction necrosis of part of the myocardium caused by a sudden reduction in blood flow to this part of myocardium; 58) medical profession laboratory diagnostician, pharmacist, physical therapist, physician, dentist, nurse, midwife, medical rescuer, hospital ward, paramedic, dental technician, pharmacy technician, electro- cardiology technician; 59) fracture a trauma-related break of the bone, or a trauma-induced slipping of the epiphysis:

a) open with rupture of the skin near the broken bone, b) closed

56)

when the skin near the broken bone is intact;

60) dislocation a trauma-related move of one surface of the joint in relation to the other, for the purpose of this insurance the dislocation must be confirmed with an imaging examination.

CHAPTER II

INSURANCE COVER TERM. INSURANCE SUBJECT MATTER AND SCOPE

INSURANCE COVER TERM

§ 5

PZU SA is liable for insurance accidents which occurred during the period of insurance.

INSURANCE SUBJECT MATTER AND SCOPE

§ 6

1. A subject matter of an insurance contract are consequences of

an insurance accident or a fact of an occurrence of an insurance accident, subject to sec. 2.

2. In respect of a statutory representative, a subject matter of an

insurance contract is a death of a statutory representative as a consequence of an insurance accident.

§ 7

Upon a request of the policyholder, for additional insurance premium, an insurance contract can be extended by an accident insurance resulted from

acts of terrorism, acts of war, war or state of emergency, which occurred on a

territory of a country that is situated in a world region threatened by acts of terrorism, acts of war, war or state of emergency.

§

1. The insurance contract can be concluded under one of three

8

following options:

1)

under option I or

2)

under option II or

3)

under option II Bis.

2. The types of benefits and their amount are specified in § 12.

§ 9

1 The insurance contract can be concluded:

1) in the basic scope of insurance cover specified in §§ 11–12 or 2) in the extended scope of insurance cover specified in §§ 13–27.

BENEFITS IN A BASIC SCOPE OF AN INSURANCE COVER

OPTIONS OF INSURANCE

§ 10

The Insured is entitled to benefits according to types and amounts

specified in the concluded insurance contract, which can be concluded under option I, option II or option II Bis.

§ 11

The insurance contract:

1) concluded under option I covers the following basic benefits, specified in Table 1 below:

Table no. 1

Basic benefits under option I

Item

Types of basic benefits

1

death benefit

2

death benefit in the area of an educational establishment

3

death benefit as a consequence of sepsis

4

for permanent disturbance of health

 

one-time benefit in the case of lack of permanent disturbance of health and of

consequences other than those listed in Tables 4, 5, 7, 8 specified in Table

5

no. 6

 

for the refund of the costs of purchasing orthopaedic objects and auxiliary

6

materials, as well as the cost of dental reconstruction of permanent teeth

7

for refund of the costs of vocational training of disabled persons

8

post-accident assistance benefits rendered in the territory of Poland

1) concluded under option specified in Table 2 below:

Table no. 2

Basic benefits under option II

II

covers the following basic benefits,

GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE

basic benefits, GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE

5

Item

Types of basic benefits

1

death benefit

2

death benefit in the area of an educational establishment

3

death benefit as a consequence of sepsis

4

for permanent bodily harm (Table no. 4)

 

for permanent disturbance of health caused solely by myocardial infarction,

5

intracranial haemorrhage or serious bodily harm

6

for fractures of bones or dislocations of bones (Table no. 5)

7

for consequences other than those listed in Tables no. 4, 5, 7 and 8 specified in Table no. 6

8

for burns or frostbite (Table no. 7)

9

for concussion or suspected concussion of the brain (Table no. 8)

10

for bites and stings

 

for refund of the costs of purchasing orthopaedic objects and auxiliary

11

materials, as well as the cost of dental reconstruction of permanent teeth

12

for refund of the costs of vocational retraining of disabled persons

13

post-accident assistance benefits rendered in the territory of the Republic of Poland

2) concluded under option II Bis covers the following basic benefits, specified in Table 3 below:

Table no. 3

Basic benefits under option II Bis

Item

Types of basic benefits

1

death benefit

2

death benefit in the area of an educational establishment

3

death benefit as a consequence of sepsis

4

for permanent bodily harm (Table no. 4)

 

for permanent disturbance of health caused solely by myocardial

5

infarction, intracranial haemorrhage or serious bodily harm

6

for fractures of bones or dislocations of bones (Table no. 5)

 

for consequences other than those listed in Tables no. 4, 5, 7 and 8

7

specified in Table no. 6 item 1 and item 2

8

for burns or frostbite (Table no. 7)

9

for concussion or suspected concussion of the brain (Table no. 8)

10

for bites and stings

 

for refund of the costs of purchasing orthopaedic objects and auxiliary

11

materials, as well as the cost of dental reconstruction of permanent teeth

12

for refund of the costs of vocational retraining of disabled persons

13

post-accident assistance benefits rendered in the territory of the Republic of Poland

DETAILED PROVISIONS REGARDING BASIC BENEFITS

§ 12

1. Benefit for death of the Insured is due as 100% of the sum insured. This benefit is due if death occurred not later than within 24 months from the date of the insurance accident.

2. Benefit for death of the Insured in the area of educational establishment - is due as 100% of the sum insured.

3. Benefit for death of the Insured as a consequence of sepsis - is due as 100% of the sum insured. This benefit is due if death occurred not later than within 24 months from the date of the insurance accident.

4. Benefit for permanent disturbance of health - is due in an amount corresponding to such percent of the sum insured in which the Insured sustained a permanent disturbance of health, and that permanent disturbance of health is determined:

1) by a physician designated by PZU SA, on the basis of the current “Table of norms for the assessment of percentage values of permanent disturbance of health”, approved by the relevant resolution of the PZU SA Management Board and valid as at the date of conclusion of the insurance contract, enclosed as appendix to the insurance contract; 2) not later than during the 24th month from the date of the insurance accident any later change in the degree of permanent disturbance of health (improvement or worsening) does not constitute grounds to change the amount of the benefit.

5. This benefit is the permanent disturbance of health occurred not later than within 24 months from the date of the insurance accident.

6. Benefit for permanent bodily harm is due - is due in an amount corresponding to the relevant percent of the sum insured, according to Table no. 4 below;

GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE

to Table no. 4 below; GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance)

6

 

Item

Item Type of fracture

Item Type of fracture

Typ

e of

frac

ture

   

2.0

for each fractured

rib in the case of up to 9 ribs

fractured; maximum 10.0 for

4

Fracture of the rib, ribs

all broken ribs (if more than 9 ribs are broken)

 

Fracture of the humeral bone:

 
 

5

a) one or multiple (other than open)

 

b) one or multiple, open

 

5

7

 

6

Dislocation of the shoulder joint

 

3

 

Fractures of the forearm bones (one or both):

 

a) one or multiple (other than open)

 

7

b) one or multiple, open

   

2

4

 

8

Dislocation of the elbow joint

 

3

 

Fractures of the hand bones, excluding finger bones:

 
 

9

a) one or multiple (other than open)

b) one or multiple, open

   

1

3

   

c) Fractures of finger bones

 

d) from 2nd to 5th finger a) one or multiple

10

(other than open)

 

1 for each finger

2 for each finger

 

one or multiple, open

 

Joint dislocations of the finger

 
 

11

bones from 2nd to 5th finger

 

2 for each finger

 

Fractures of thumb

 

a) one or multiple (other than open)

12

b) one or multiple, open

 

1

3

13

Dislocation of the thumb

 

2

14

Unstable fracture of the pelvis

 

10

15

Stable fracture of the pelvis

 

4,5

16

Dislocation of the hip joint

 

10

17

Fracture of the femur bone

 

10

18

Fractures of the shank bones (one or both)

 

7

19

Fracture of the patella

 

4

 

Dislocation of the knee joint,

 

20

excluding dislocation of the patella

 

5

 

Fractures of the foot bones, excluding toes:

 
 

21

a) one or multiple (other than open)

b) one or multiple, open

   

2

4

 

22

Fractures of the large toe

 

2.5

23

Fractures of the toes from 2nd to 5th toe

 

2 for each toe

24

Dislocation of the ankle

 

4

 

Fractures of the spine of

 

the vertebral body and vertebral

 

25

arches (excluding coccyx)

 

11 for each vertebra

 

Fractures of the spine of

 

the transverse process and

26

acanthi

 

2.5 for each vertebra

27

Fractures of the coccyx

 

3.5

GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE

0.5

for each fractured

  permanent tooth – if up to 9 permanent teeth are fractured; maximum 5 for
 

permanent tooth if up to 9 permanent teeth are fractured; maximum 5 for

7

28

Fracture of a permanent

all fractured permanent

 
   

tooth

teeth (if more than 9 permanent teeth are

 

fractured)

 

Permanent bodily injury - Table no. 4

Item.

Type of permanent bodily injury

% of sum insured defined in the insurance contract

 
 

Complete loss of upper limb

 

1

at the shoulder or arm level

 

80

 

Complete loss of upper

 

2 limb at the elbow or forearm level

 

60

 

3 Complete loss of hand

 

50

 

4 Complete loss of the 2nd, 3rd, 4th and 5th fingers

8

for each finger

 
 

5 Complete loss of thumb

 

22

 

Complete loss of lower limb

 

6

on the hip joint or thigh bone level

 

75

 

Complete loss of lower limb

 

7 on the knee joint, shank or ankle joint level

 

60

 

8 Complete loss of foot

 

40

 

9 Complete loss of the 2nd, 3rd, 4th and 5th toes

3

for each finger

 
 

10 Complete loss of the large toe

 

15

 

11 Complete loss of vision in one eye

 

50

 

12 Complete loss of vision in both eyes

 

100

 

13 Complete loss of hearing in one ear

 

30

 

14 Complete loss of hearing in both ears

 

50

 

15 Complete loss of the auricular concha

 

15

 

16 Complete loss of the nose

 

20

   

2

for each permanent

 

tooth lost in the case

of

loss

of

up to

9

permanents

 

17

Complete loss of permanent

teeth;

teeth

maximum

110

for

all

permanent teeth lost in the

 

case of loss of more than

9

permanent teeth

 
 

18 Complete loss of the spleen

20

 

19 Complete loss of one kidney

35

 

20 Complete loss of both kidneys

75

Item

21

Type

Item Type of fracture

Complete loss of the uterus

Item

40

Type

fracture

 

of

22

of

fract

Complete loss of an ovary

20

or testicle

 

ure

     

23

 

Complete Fracture loss of of bones speech of the

100

GENERAL

1

 

calvaria and base of skull Paralysis or paresis of at

5

24 2
24
2
 

least Fractures two limbs, of below the craniofacial 3rd degree bones on the Lovette scale

100

4

7. Benefit for bone fractures or joint dislocations is due:

Table no. 5

Bone

fractures

or

joint

dislocations

4. Benefit for fractures of bones or dislocations of joints is due:

1)

according to Table 5 below:

Table no. 5

TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE

8

3

25

Coma lasting for more than

Fractures of the shoulder

4.5 for each bone

100

30 days

blade, collarbone, breastbone

1) does not include recurrent dislocations of the joints; 2) in the case of surgical treatment of a fracture or dislocation listed in Table no. 5 the Insured is entitled to aside from the benefit resulting from Table no. 5 an additional benefit in the amount of 2% of the sum insured for each organ that was operated; the organ that was operated shall be understood as an organ listed in Table no. 5. 7. Benefit for consequences other than listed in Tables 4,5, 7 and 8:

1) is due in an amount corresponding to the relevant percent of the sum insured, according to Table no. 6 below,

a) subject to the provision that under option I the benefit is due only if there is no permanent disturbance of health,

b) subject to the provision that under option II within a scope specified in item 1 or item 2, or item 3, according to Table no. 6 below,

c) subject to the provision that under option II within a scope specified in item 1 or item 2, according to Table no. 6 below;

Table no. 6

Consequences other than listed in Tables no. 4, 5, 7 and 8

Item

Type

Item Type of consequen ce

 

% of sum insured

 

of

defined

in

the

consequ

insurance

 

ence

 

contract

Optio

Optio

Optio

n I

n II

n

II

Condition

Bis

 

Sudden

       

poisoning

with

gases,

hospitalisation

1

chemical

1

5

5

products

 

and

substances

2

Electric shock,

hospitalisation

1

5

5

shock

by

lighting

 

Consequence

       

of

bodily

injuries under

a

physician’s

a

single and

intervention at

all

insurance

a

medical

accidents

facility,

within insurance term that are

combined with

further

treatment and

not

included

requiring

at

3

in

the Tables

least

one

0.5

0.5

none

or

cannot be

follow-up

visit

classified

at

the

under

the

physician’s

definition

of

surgery

serious bodily

(confirmed in a medical documentation

harm

(does

not apply

to

dental

)

intervention).

)

2) in case where the bodily harm or disturbance of health can be classified under two or three items in Table no. 6, the Insured is entitled to benefit only under one of these items, the one item, which is more favourable for him/her. 8. Benefit for burns or frostbite is due in an amount corresponding to the relevant percent of the sum insured, according to Table 7 below:

Table no. 7

Burns or frostbite

 

Type and size of burn / frostbite

%

of

sum

insured

defined

 

in

the

insurance

Item

contract

1

2nd degree burn up to 1% of body surface area

1.5

2

2nd degree burn from 1% to 15% of body surface area

4

3

2nd degree burn from 15% to 30% of body surface area Type and size of burn / frostbite

 

7

%

of

sum

insured

defined

 

in

the

insurance

Item

contract

4

2nd degree burn of more than 30% of body surface area

20

5

3rd degree burn up to 5% of body surface area

4

6

3rd degree burn from 5% to 10% of body surface area

10

7

3rd degree burn above 10% of body surface area

20

8

Burn of the respiratory tract, treated at hospital

20

9

2nd degree or higher frostbite of one finger or toe

1.5

 

2nd degree or higher frostbite

 

of more than one

10

finger or toe, frostbite of the nose or ear

4

9. Benefit for concussion or suspected concussion is due is due in an amount corresponding to the relevant percent of the sum insured, according to Table 8 below, if the Insured was hospitalized with relation to the concussion or suspected

concussion:

Table no. 8

Concussion or suspected concussion of the brain

   

%

of

sum

insured

defined

 

in

the insurance

Item

Hospitalisation

contract

 

1

2 days

1

2

3 days

2

3

4 days or longer

3

-

 

10.

Benefit for bites and stings is due is due as 10%

of the sum insured, if the Insured was hospitalized with relation to

a bite or sting.

11. Refund of the costs of purchasing orthopaedic

objects and auxiliary materials, as well as the cost of dental reconstruction of permanent teeth is due is due in the amount of up to 25% of the sum insured, if the need to incur these costs arose within 24 months from the date of the insurance accident, and the refund of costs of dental reconstruction of permanent teeth cannot exceed PLN 200.00

per tooth.

12. Refund of the costs of vocational retraining of

disabled is due in the amount of up to 25% of the sum insured, if the need to incur these costs within the territory of Poland arose within 24 months from the date of the insurance

accident.

13. Post-accident assistance benefits rendered in

the territory of the Republic of Poland The assistance services referred to in items 16 are rendered by the PZU Emergency Centre within the territory of the Republic of Poland with relation to the occurrence of an insurance accident during the insurance period, with the reservation that with relation to services referred to in item 3, assistance services are provided with relation to an accident. Depending on the insurance accident, at the request of the Insured or a person acting on his/her behalf, PZU SA organizes and covers the costs of the following assistance services:

1) Medical assistance

PZU SA organizes and covers the costs of medical assistance, up to PLN 2 000.00 for all the services listed below, with relation to each insurance accident:

a) physician’s house callorganization of a single physician’s call at the Insured’s place of stay and cover the costs of physician’s fee and travel costs, PZU SA does not cover the costs of additional diagnostic tests ordered by the physician during such visit, or,

b) medical consultations of the Insured at a medical facilityorganizing a physician’s visit of the Insured at a medical facility designated by the PZU Emergency Centre and covering the physician’s fee; PZU SA does not cover the costs of additional diagnostic tests ordered by the physician during such visit; at the request of the Insured PZU SA organizes transport to the medical facility and covers its cost,

c) nurse’s house call– if the Insured’s condition requires a nurse’s visit at his/her place of stay, PZU SA organizes and covers the cost of the nurse’s commute to the Insured’s home and her fees; this service includes the performance of medical procedures ordered by the attending physician,

d) transport organizing and covering the costs of

transporting the Insured:

- to an appropriate medical facility from the location of the Insured’s stay or the location of the insurance accident,

- between medical facilities where medical assistance was provided or if the Insured is referred to specialist tests or surgical procedure at another medical facility,

to another hospital, if the medical facility where the Insured is being hospitalized does not guarantee appropriate care for the Insured’s condition,

- from the medical facility to the Insured’s place of stay after providing medical assistance, if according to the orders of the attending physician the Insured should not use own transport means or local public transport; 2) Rehabilitation and nursing care PZU SA ensures:

a) organization of the rehabilitation process if the

attending physician ordered rehabilitation procedures, PZU SA organizes and covers the cost of a physical therapist’s visits (therapist’s fee and costs of commute) at the Insured’s place of stay or organizes and covers the costs of transporting the Insured to a rehabilitation outpatient clinic and the costs of rehabilitation procedures performed at that outpatient clinic; this benefit is provided up to the total amount of PLN 500.00 per each insurance accident and the location where the procedures are performed is determined by the attending physician of the Insured;

b) delivery of small rehabilitation or medical equipment if the Insured, according to recommendations of the attending physician, should use certain rehabilitation or medical equipment at home, PZU SA organizes and covers the costs of an information service regarding the stores or rental stores offering rehabilitation equipment. PZU SA also organizes and covers the cost of transporting small rehabilitation equipment to the Insured’s place of stay; this benefit is provided up to the total amount of PLN 300.00 and the cost of renting or purchasing the equipment is covered by the Insured;

c) delivery of drugs prescribed by a doctor to the

d) Insured’s place of stay – if according to the physician’s order the Insured has to stay at home, PZU SA organizes and covers the costs of delivering the necessary drugs prescribed by the doctor if they are available in the Republic of Poland; if the Insured needs also OTC drugs which are available at the same location as the prescription drugs, PZU SA shall deliver the OTC drugs indicated by the Insured; this benefit is performed up to the amount of PLN 300.00 and the costs of the drugs are covered by the Insured;

e) home nursing care after hospitalization if the Insured is hospitalized for longer than 2 days in consequence of the insurance accident, PZU SA organizes and covers the cost of nurse’s care (costs of nurse’s commute and her fees) following the completion of hospitalization, at the Insured’s place of stay; The justification for the home nursing is determined by the attending physician of the Insured; the service is performed up to the amount of PLN 1 000.00 per each insurance accident;;

3) Psychological assistance If as the result of the accident covered by PZU SA liability the Insured suffers severe bodily injuries, or as the result of the accident in which the Insured participated the following occurs:

a) death of the Insured’s spouse, or

b) death of the Insured’s child, or

c) death of the parents of the Insured or of the Insured’s spouse,

d) death of a pupil from the Insured’s class and the Insured

reports the need for psychological assistance, PZU SA organizes and covers the costs of the Insured’s consultations with a psychologist, in a number recommended by the psychologist during the first such visit, up to the total amount of PLN 1 500.00. If as the result of the insurance accident covered by PZU SA liability the Insured dies, the spouse, children and parents of the Insured are entitled to the psychological assistance described above; PZU SA organizes and covers the costs of that person’s consultations with a psychologist, in a number recommended by the psychologist during the first such visit, up to the total amount of PLN 1 500.00 per each such person; 4) Private tuition for students of primary schools, lower secondary schools and upper secondary schools, excluding students of post-secondary schools pursuant to the Act on the education system if due to an insurance accident the student is unable to attend school for more than 10 days from the date of the insurance accident, PZU SA organizes and covers the costs of individual tuition on up to 2 selected subjects covered by the school syllabus, up to PLN 400.00 per each insurance accident;;

5) Medical hotline and telephone consultations with 6) the physician of the PZU Emergency Centre PZU SA ensures an access to medical hotline, which means a conversation with the physician of the PZU Emergency Centre, who within his/her professional capacity provides verbal information to the Insured regarding proceedings tied to medical care. This information does not cover issues of diagnosis and treatment.

BENEFITS IN EXTENDED INSURANCE COVER SCOPE ADDITIONAL BENEFITS

§ 13

At the request of the Policyholder the insurance contract concluded under option I or option Ii or option II Bis may include the following additional benefits upon the payment of additional premium:

1) refund of treatment costs including rehabilitation costs, in the amount specified in the insurance contract; 2) lump-sum benefit for the period of a temporary inability to study or work for one day of inability in the amount specified in the insurance contract;

3)

hospital per diem as a result of an accidentper one day of a stay in hospital in the amount specified in the

insurance contract; 4) hospital per diem as a result of an illnessper one day of a stay in hospital in the amount specified in the insurance contract;

refund of flat adoption costs to permanent disturbance of health resulting from an insurance accident in the amount specified in an insurance contract;

6) one-time benefit due to sepsis occurrence - in the amount specified in an insurance contract;

a death of the

5)

7) one-time benefit in the case of Insured

8)

caused by a malicious tumour in the amount specified

9)

in an insurance contract; one-time benefit in the case of a death of a child due

to a congenital cardiac defect in the amount specified in an insurance contract; 10) one-time benefit in the case of amputation of a limb or a part of a limb caused by a malicious tumour in a childin the amount specified in an insurance contract; 11) one-time benefit in the case of death of a statutory representative due to an accident in the amount specified in an insurance contract; 12) one-time benefit in the case of death as result of a traffic accident in the amount specified in an insurance contract; 13) one-time benefit in the case of an occurrence of a serious illness in the amount specified in an insurance contract; 14) one-time benefit in the case of an occurrence of a virus infection due to an occupational exposure to a contagious material in the amount specified in an insurance contract; 15) refund of treatment costs incurred due to an occupational exposition to a contagious material in the amount specified in an insurance contract.

RULES OF AWARDING ADDITIONAL BENEFITS REFERRED TO IN § 13 REFUND OF TREATMENT COSTS

§ 14

1. The treatment costs, in that rehabilitation costs, are refunded if there were fulfilled cumulatively the following conditions:

1) They were incurred in connection with a treatment of the consequences of:

a) an accident, bodily injuries caused as a result of an attack of epilepsy or syncope other than a chronic disease; b) heart stroke, intra-cranial haemorrhage, an accident resulting from acts of terrorism, acts of war, martial law or state of emergency, which took place on the territory of a country situated in the world region threatened by acts of terrorism, acts of war, martial law or state of emergency, unless an insurance contract covers consequences of an insurance contract of this type; 2) they were substantiated from a medical point of view; 3) a necessity to bear treatment costs arouse not later than within a period of 24 months counted from a date of events, referred to in par. 1; 4) in the case of rehabilitation if a necessity of its performance arouses not later than within a period of 6 months counted from a date of events, referred to in par.

1.

2. A refund of costs, mentioned in sec. 1 takes place on the basis of invoices and proofs of their payment, however maximally up to an amount of a limit determined in the insurance contract per

one insurance accident.

3. Within a frame of the limit, mentioned in sec. 2, are also covered costs of:

1) the Insurer’s accommodation within a rehabilitation period in a locality, in which rehabilitation is performed, if a rehabilitation centre is located at least 100 km from the Insurer’s place of residence – up to an amount of 150 PLN per 24 h and max. up to 10 days and nights; 2) an accommodation of the Insured’s close person, in the case of the Insured’s hospitalization after an insurance accident in a hospital located at least 100 km from the Insurer’s place of residence – up to an amount of 150 PLN per 24h and max. up to 10 days and nights; LUMP-SUM BENEFIT FOR THE PERIOD OF TEMPORARY INABILITY TO STUDY OR WORK

§ 15

1. This lump sum is due to the Insured with regard to a consequence of:

an accident, bodily injuries caused as a result of an attack of

1)

epilepsy or syncope other than a chronic disease;

2. heart stroke, intra-cranial haemorrhage, an accident resulting from acts of terrorism, acts of war, martial law or state of emergency, which took place on the territory of a country situated in the world region threatened by acts of terrorism, acts

of war, martial law or state of emergency, unless an insurance contract covers consequences of an insurance contract of this

type;

3. The lump sum is paid out for each day of inability, in this inability to work or study lasts continuously longer than 14 days.

4. The lump sum is paid out maximally for a period of 180 days due to one or all accidents occurred within an insurance term.

5. The lump sum is due, if an inability to study or work arouse not later than within a period of 24 month counted from a date of an insurance accident.

4. The hospital per diem is paid out on the basis of a Hospital Discharge Summary Report issued by a hospital that confirms the Insured’s hospitalisation.

HOSPITAL PER DIEM AS A RESULT OF AN ILLNESS OTHER THAN A CHRONIC ILLNESS

§ 17

1. The hospital per diem is paid out for each day of a hospitalisation, subject to sec. 2.

2. The hospital per diem is paid out from the 1st day of the hospitalization of the Insured provided that, the hospitalization lasts at least 6 days and is paid out maximally within a period of 60 days due to one and all reasons of the hospitalization.

3. The hospital per diem is paid out on the basis of a Hospital Discharge Summary Report issued by a hospital that confirms the Insured’s hospitalization.

4. The hospital per diem is due, when a necessity of the hospitalization arouses during an insurance term.

5. By a chronic illness should be understood an illness that occurred (diagnosed or not diagnosed) prior to commencing the insurance contract, with a long-term course usually lasting throughout months or years, for which the insured suffered on a date of concluding the insurance contract, whether it required a medical intervention or not on the date of concluding the insurance contract.

REFUND OF FLAT ADOPTION COSTS

§ 18

6. The lump sum may be paid out on the basis of:

1. The refund of these costs is due if as a consequence of an

1)

a certificate issued an attending physician, issued according

insurance accident the Insured is a subject to permanent

to

the applicable law provisions or

deterioration to health and with regard to this there is a

2)

an

opinion issued by a medical examiner indicated by PZU SA

necessity to adopt its place of residence to the resulting

or

permanent deterioration to health.

3)

in

the case of insured minors in the event of an inability to

2. The refund

of the

costs mentioned

in

sec.

1

is due,

if

a

study that lasts no longer than 30 days a statement of the

statutory representative.

HOSPITAL PER DIEM AS A RESULT OF AN ACCIDENT

§

16

1.

The

hospital per diem

is

paid out

for

each day

of

a

hospitalisation, subject to sec. 3:

1) as a consequence of:

an accident, bodily injuries caused as a result of an attack of

epilepsy or syncope other than a chronic disease, heart stroke, intra-cranial haemorrhage, an accident resulting from acts of terrorism, acts of war, martial law or state of emergency, which took place on the territory of a country situated in the world region threatened by acts of terrorism, acts of war, martial law or state of emergency, unless an insurance contract covers consequences of an insurance contract of this type; 2) if a necessity to hospitalise occurred not later than within

a)

a period of 24 month counted

insurance accident.

from

a

date

of

an

2. The hospital per diem is due maximally within a period of 60 days due to one and all events, referred to in par 1.

3. The hospital per diem is paid out from the 1st day of the hospitalization of the Insured provided that, the hospitalization lasts at least 3 days.

necessity to adopt a place of residence occurs not later than

within 24 months counted from a date of determining a permanent deterioration to health.

BENEFIT DUE TO SEPSIS OCCURENCE

§ 19

1. This benefit is due to the Insured in case when sepsis occurs in him/her.

2. The benefit referred to in sec. 1, is paid out provided that a fact of a sepsis occurrence took place within an insurance term.

ONE-TIME BENEFIT IN THE CASE OF DEATH OF THE INSURED CAUSED BY A MALICIOUS TUMOUR

§ 20

1. The benefit is paid out to the beneficiary in the amount specified in the insurance contract.

2. The benefit referred to in sec. 1, is paid out provided that a death of the Insured took place within an insurance term.

3. The pay-out of the benefit mentioned sec. 1 is performed on the basis of a death report delivered to PZU SA that includes a statement about a death reason.

ONE-TIME BENEFIT IN THE CASE OF DEATH OF A CHILD DUE TO A CONGENITAL CARDIAC DEFECT

§ 21

1. The benefit is paid out to the beneficiary in the amount specified in the insurance contract.

2. The benefit referred to in sec. 1, is paid out provided that a death of the Insured took place within an insurance term.

3. The pay-out of the benefit mentioned sec. 1 is performed on the basis of a death report delivered to PZU SA that includes a statement about a death reason.

ONE-TIME BENEFIT IN THE CASE OF AMPUTATION OF A LIMB OR PART OF LIMB CAUSED BY A MALICIOUS TUMOUR IN A CHILD

§ 22

1. The benefit is paid out to the Insured in the amount specified in the insurance contract.

2. The benefit referred to in sec. 1, is paid out provided that an amputation of a limb or a part of a limb in the Insured took place within an insurance period.

3. The pay-out of the benefit mentioned sec. 1 is performed on the basis of a medical documentation delivered to PZU SA that is necessary to determine this health condition and an amputation reason.

ONE-TIME BENEFIT IN THE CASE OF DEATH OF STATUTORY REPRESENTATIVE DUE TO AN ACCIDENT

§

23

4.

The one-time benefit in the case of death of statutory representative due to an accident is paid out to the Insured in the amount specified in the insurance contract.

1.

The benefit referred to in sec. 1, is paid out provided that a death of the statutory representative took place as a result of an insurance accident, which took place within an insurance period, and the death took place within 24 months from a date of an occurrence of the insurance accident.

2.

The pay-out of the benefit mentioned sec. 1 is performed on the basis of a death report delivered to PZU SA that includes a statement about a death reason.

ONE-TIME BENEFIT IN THE CASE OF DEATH AS A RESULT OF TRAFFIC ACCIDENT

§ 24

1. The benefit is paid out to the beneficiary in the amount specified in the insurance contract.

2. The benefit referred to in sec. 1, is paid out provided that a death of the Insured took place within an insurance term.

3. The pay-out of the benefit mentioned sec. 1 is performed on the basis of a death report delivered to PZU SA that includes a statement about a death reason.

4. The benefit is not due when a death reason constituted a participation of the Insured in the sport contests: aviation, motor or motorboat ones.

ONE-TIME BENEFIT IN THE CASE OF AN OCCURRENCE OF A SERIOUS ILLNESS

§ 25

1. The benefit is paid out to the Insured in the amount specified in the insurance contract.

2. The benefit referred to in sec. 1, is paid out provided that a fact of an illness occurrence took place within an insurance period.

ONE-TIME BENEFIT IN THE CASE OF AN OCCURRENCE OF A VIRUS INFECTION DUE TO AN OCCUPATIONAL EXPOSURE TO A CONTAGIOUS MATERIAL

§ 26

1. The benefit is due to the Insured, who practices a medical profession or is a pupil/student of a medical school, in the amount specified in an insurance contract.

2. The benefit referred to in sec. 1, is paid out provided that a virus infection was diagnosed within an insurance term.

REFUND OF TREATMENT COSTS INCURRED DUE TO AN OCCUPATIONAL EXPOSITION TO A CONTAGIOUS MATERIAL

§ 27

These costs are a subject of refund, if there the following conditions are fulfilled cumulatively:

1) the costs were borne in connection with an exposition to a contagious material, which took place within an insurance period; 2) the costs were substantiated from a medical point of view; 3) the Insured practices a medical profession or is a pupil or a student of a medical school.;

SUM INSURED AND LIMITS OF LIABILITY

§ 28

1. The sums insured and liability limits for basic benefits and additional benefits included in the insurance contracts are specified in the insurance contract.

2. The insured sums and liability limits are specified in respect of each insurance case unless in these General Conditions is specified otherwise with regard to a concerned benefit.

3. The Policyholder within a term of the insurance contract, with a consent of PZU SA, may amend a sum insured or a scope of the insurance.

4. An amendment of the insurance conditions referred to in sec. 3, results in a necessity to recalculate a contribution for a period, in which the amended conditions are to be applicable.

5. In the case of an amendment of the sum insured or a scope of the insurance, PZU SA is liable under the limits of the amended sum insured or liability scope, beginning from the first day of making by PZU SA a statement about giving a consent for such amendment.

EXCLUSIONS OF LIABILITY

§ 29

1. PZU SA shall not be liable for consequences of the insurance accidents caused:

1) in a state of inebriation or under the influence of abusive substances, psychotropic substances, new psychoactive substances or replacement drugs within a meaning of the

provisions on counteracting drug addiction, unless that had no effect on the occurrence of the insurance accident; 2) as a result of an intoxication caused by nicotine, alcohol consumption or use of abusive substances, psychotropic substances, new psychoactive substances or replacement drugs within a meaning of the provisions on counteracting drug addiction, unless that had no effect on the occurrence

of the insurance accident;

3) as a result of participating in fights (excluding a defence in necessity) by the Insured and in connection with committing

a suicide or an attempted suicide by the Insured;

4) as a result of participating by the Insured in strikes, unrests, riots, protests, roadblocks or sabotage unless this participation of the insured in strikes, riots, civil commotion, protests, roadblocks or sabotage results from carrying out

official duties; 5) as a result of an accident resulting from acts of terrorism, acts of war, war or state of emergency, which took place in a territory of a country situated in the world region threatened by acts of terrorism, acts of war, war or state of emergency, unless this risk was included into the contract on the basis of

a separate insurance premium;

6) as a result of performing medical procedures, a performance of which has an impact on a human organism regardless of whom performed them, unless the performance of these medical procedures was related to direct consequences of

the Insured’s accident;

7) while driving a motor vehicle by the Insured, if the Insured did not have the license to drive the given vehicle, unless it that had no effect on the occurrence of the insurance

accident;

8) while driving the other vehicle than a motor vehicle by the

Insured, if the Insured did not have the license to drive the given vehicle, unless it that had no effect on the occurrence

of the insurance accident.

2. The liability of PZU SA is excluded for the consequences of illnesses or medical conditions, even those, which occur suddenly or were disclosed only as a consequence of the insurance accident or constitute a reason of the insurance accident, whereas an exclusion does not refer to the consequences of bodily injuries caused as a result of an attack of epilepsy or fainting due to the other reason than a chronic illness, heart stroke, intra-cranial haemorrhage, sepsis, occupational exposition to contagious material, unless the insurance contract includes the consequences of this insurance accident. The liability of PZU SA is also excluded for a fact of an occurrence of the consequences of illnesses or medical conditions, even those, which occur suddenly or was disclosed only as a consequence of the insurance accident or constitute a reason of the insurance accident, whereas an exclusion does not refer to the consequences of an occurrence of sepsis, virus infection upon an occupational exposition to contagious material or a serious illness, unless the insurance contract includes a fact of an occurrence of this insurance accident. If an illness of a medical condition not covered by a liability of PZU SA has an effect of an occurrence of an insurance accident, i.e. a reason of the insurance accident is both an illness, and an external reason, a liability of PZU SA includes bodily injuries, detriment to health or death, which are a consequence of the external reason, unless it is impossible to determine which bodily injuries or detriment to health are exclusively a consequence of the external reason; in this case it is assumed that the bodily injuries or detriment to health are a consequence of the external

reason.

3. The PZU SA’s liability shall not include assistance services if the event being the basis for organisation of such service arose:

1) with relation to or in consequence of circumstances referred to in sec. 1, with a reservation that in the cases referred to in sec. 1 par. 6 liability of PZU SA can be extended for the payment of additional insurance premium; 2) as a result of illnesses or medical conditions even those, which occur suddenly or were disclosed only as a consequence of the insurance accident or constitute a reason of the insurance accident, whereas an exclusion does not refer to the consequences of an occurrence of an attack of epilepsy or fainting due to the other reason than a chronic illness, heart stroke, intra-cranial haemorrhage, sepsis, occupational exposition to contagious material, unless the insurance contract includes in its insurance cover bodily injuries caused as a consequence of sepsis or an occupational exposition to contagious material.

4. The liability of PZU SA shall not include liability for costs of assistance services incurred by the Insured without any consent of the Emergency Centre, unless getting in touch with the Emergency Centre in a manner specified in § 43 sec. 1 was not possible for reasons not attributable to the Insured.

5. The liability of PZU SA shall not include liability for a compensation for an alleged pain, physical and moral suffering and suffered damages, which consist in a los, damage or destruction of property.

6.

A fact of being in the state of inebriation or the fact of being

under the influence of abusive substances, psychotropic substances, new psychoactive substances or replacement

drugs within a meaning of the provisions on counteracting drug addiction, as well as the driver’s authorisation to drive the vehicle shall be evaluated on the basis of the law of the state

in which the insurance accident occurred.

CHAPTER III

CONCLUSION OF INSURANCE CONTRACT AND ITS TERM

§ 30

1.

The insurance contract can be concluded with a mutual presence of both parties of this contract or by means of electronic distance communication (direct contract or remote contract).

2.

The insurance contract is concluded on the basis of an application of the Policyholder, which contains information necessary to perform an individual risk assessment and to determine the premium due.

3.

A

direct contract can be concluded provided that:

1) prior reading the Rules and Regulations and these General and accepting them by the Policyholder; 2) a prior confirmation provided by PZU SA related to an acceptance of the Policyholder’s application; 3) a payment of an insurance premium within a deadline specified in the insurance contract.

A

conclusion of the direct contract takes place upon a payment

of

an insurance premium or its first instalment.

4.

A

remote contract is concluded upon a confirmation of an

acceptance of the Policyholder’s application by PZU SA and upon

prior reading the Rules and Regulations and these General and accepting them by the Policyholder.

a

5.

The Insuring Party is obliged to inform PZU SA of all the circumstances known to him/her about which PZU SA asked in the offer form (application) or in other letters, before a

conclusion of the insurance contract. If the Policyholder concludes the insurance contract via a representative, this obligation applies also to the representative and covers circumstances known to him/her. If PZU SA concluded the insurance contract despite lack of answers to some of the questions, the omitted circumstances are treated as irrelevant.

6. Within a term of the insurance contract, the Policyholder is obliged to report any changes to the circumstances listed in section 5. The Policyholder is obliged to notify PZU SA of such

changes promptly upon receiving information about them.

7. In case of concluding the insurance contract for someone’s behalf, the obligations defined in sections 5 and 6 rests with both the Policyholder, and the Insured, unless the Insured was unaware of the contract concluded on his/her behalf.

8. PZU SA shall not be liable for consequences of the circumstances, which under a breach of sections 5-7 failed to be communicated to him/her. If the breach of provisions contained

in sections 5-7 was caused by intentional fault, in case of any

doubts it is assumed that the insurance accident provided for under the contract and its consequences result from the circumstances described in the preceding sentence.

§ 31

A conclusion of the insurance contract is confirmed by an insurance document by PZU SA.

§

1. If in response to a submitted offer PZU SA delivers to the Policyholder an insurance document, which provisions deviate to

an disadvantage of the Policyholder or the Insured in respect of

a content of an offer submitted to the policyholder, PZU SA is

obliged to pay attention to the above in the written form while

delivering this document, giving him/her at least 7-day deadline

to object. In the case of a failure to perform this obligation the

changes made to the disadvantage to the Policyholder or the Insured are not effective, and the insurance contract is concluded according to the conditions of the offer.

2. In the case of a failure to object, the insurance contract is effective according to a content of the insurance document on the next day upon an expiry of the deadline specified to object.

§ 33

1. The insurance contract is concluded for an indefinite period of

32

time.

2. The insurance contract is concluded as an individual contract or

a group contract in a named or unnamed form.

3. While concluding the insurance contract in a named form, the Policyholder is obliged to deliver to PZU SA a list of the given names and surnames of the Insured. In this case the insurance covers only, the persons specified in the list. In the case of a conclusion of a group insurance contract by means of distance communication, the above-mentioned list, the Policyholder is obliged to present it to PZU SA in a manner agreed by the parties.

4. The group insurance contract can be concluded in a unnamed form only in the case when it includes in its insurance cover all persons included in a group of persons specified in this contract.

5. In the case of a conclusion of the group insurance contract, the Policyholder is obliged to inform PZU SA about a given name, surname and a phone number of a person who maintains the list.

6. Unless stated otherwise in the insurance contract, in the case of concluding the insurance contract I an unnamed form, its

insurance cover includes all persons belonging to a group determined in the insurance contract without a need to file applications to include by the insurance cover the new persons and making a payment of an insurance premium ((in the case of

a change in a quantity of persons belonging to this group within

a term of the insurance contract).

§ 34

1. Subject to sec. 2-3, the liability of PZU SA commences on the day following the conclusion of the insurance contract, but no earlier than the day following the payment of an insurance premium or its first instalment, unless otherwise agreed.

2. In the case when in the insurance contract is specified a day of commencing an insurance term that is preceding to a date on which an insurance premium or its first instalment should be paid, the liability of PZU SA commences on a date specified in the insurance contract as a beginning of the insurance term.

3. In the case when in the insurance contract is specified a day of commencing an insurance term that is after a date on which an insurance premium or its first instalment should be paid, and the insurance premium or its first instalment was not paid to a date preceding the first day of the insurance term, the insurance contract is terminated on this date.

INSURANCE PREMIUM

§

1. An insurance premium is determined on the basis of the premium tariff as of a date of concluding the insurance contract. The premium is calculated for the period of liability of PZU SA.

2. An amount of the insurance premium is calculated depending

35

on:

1) a type of school or establishment;

2) a sum insured;

3) a liability limit;

4) an insurance period;

5) an insurance option;

6) a scope of insurance;

7) a postal code of the Insured or a place of residence of the Insured.

§ 36

1. Subject to sec. 2 and 3, the premium is paid at the time of concluding the insurance contract, unless other manner and dates were set forth in the insurance contract.

2. In the case of the direct contract, a payment deadline of an insurance premium is determined on a date at the latest preceding a date of commencing an insurance period determined in the insurance contract.

3. On request of the Policyholder, it is permitted to make a payment of the insurance premium in instalments, subject to sec. 4, The deadlines to pay the respective instalments of the insurance premium are determined from a date of concluding the insurance contract.

4. The insurance premium is paid in cash or, subject to agreement with PZU SA, in non-cash form.

5. If the payment of premium is made in the non-cash form, the date of payment is deemed to be the date when the full due amount of premium is posted in the account of PZU SA.

6. The insurance premium is not subject to indexation.

§ 37

In case of revealing circumstances which significantly change the probability of an insurance event, each of the parties may demand an appropriate change in the level of premium, starting from the day the said circumstance occurred, but not earlier than from the start of the current insurance period. If such request is submitted, the other party may terminate the insurance contract within 14 days, with immediate effect, by making a statement within this scope. TERMINATION OF INSURANCE CONTRACT AND END OF LIABILITY REFUND OF A PREMIUM

§ 38

1. The insurance cover expires:

1) upon the expiry of the insurance period, defined in the insurance document; 2) on the date, on which PZU SA is served a statement of the Policyholder about a withdrawal from the insurance contract in the case mentioned in § 39; 3) on the date, on which is served a statement about a withdrawal from the insurance contract in the case mentioned in § 39; 4) on the date of serving to the Policyholder a statement of PZU SA about a withdrawal from the insurance cover with immediate effect in the case when PZU SA is liable even prior to a payment of the insurance premium or its first instalment, and the insurance premium or its first instalment was not paid within a deadline; 5) upon an expiry of 7 days from serving to the Policyholder a notice to pay a subsequent instalment of the insurance premium, sent after its due date, with the information that a lack of payment within 7 days from notice delivery would cause termination of liability, 6) on the date, on which PZU SA is served a statement of the policyholder about a withdrawal from the insurance contract with immediate effect in the case mentioned in sec. 3; 7) on the date of a termination by mutual agreement; 8) with regard to the given Insured, on the date, on which the Insured passes away.

2. The insurance contract can be terminated at any time by mutual agreement.

3. The Insurer may terminate the insurance contract with immediate effect at any time by making a statement within this scope.

§ 39

1. The Policyholder may withdraw from the insurance contract within 30 days, if the contract is signed for a period longer than

6 months, and when the Policyholder is an entrepreneur - within

7 days form a date of concluding the insurance contract by

making a proper statement. If at the latest upon concluding the insurance contract, PZU SA did not informed the Policyholder who is a consumer about his/her right to withdraw from the insurance contract, a deadline of 30 days shall run from a date, on which the Policyholder who is a consumer learned about this right. A withdrawal from the contract does not release the Policyholder from an obligation to pay an insurance premium for a period, within which PZU SA provided an insurance cover.

2. In the case of concluding the insurance contract by means of distance communication, in which the Policyholder is a consumer a deadline within which he/she is entitled to withdraw

from the insurance contract by making a written statement within this scope is of 30 days from a date of providing to him/her information, which should be conveyed to a consumer on the basis of the provisions on concluding the distance contracts, if this deadline is later. The deadline is deemed to be observed, if a statement about a withdrawal from the insurance contract was submitted prior to its expiry.

§ 40

If the insurance cover expires before an end of period for which the contract had been concluded, the Policyholder is entitled to a refund of the insurance premium for the unused cover period.

CHAPTER IV

PERFORMANCE OF INSURANCE CONTRACT

PROCEDURE IN THE EVENT OF AN INSURANCE ACCIDENT

OBLIGATIONS OF THE INSURED

§

41

1.

In the case of an insurance accident, the Insured is obliged

to:

 
 

1) attempt to alleviate the results of the accident by

 

immediately

seeking

medical care and following the

 

recommended treatment; 2) notify PZU SA of the occurrence of insurance accident and deliver:

 

a) a description of the reasons for and course of the accident,

b) medical documentation confirming the bodily harm or disturbance of health suffered by the Insured in consequence of the insurance accident,

c) documents necessary to establish a justification for and the amount of the claim;

d) invoices and proofs of payments of costs covered by the insurance scope;

e) if the Insured was driving a vehicle at the time of the

 

accident – the driver’s license of the Insured; 3) enable PZU SA to obtain information tied to circumstances described in documents listed in item 2, in particular from the doctors who took care of the Insured, both before and after the accident.

2.

In the case of death of the Insured, the beneficiary is obliged to present to PZU SA for inspection a copy of the Insured’s death certificate, copy of the death statistical document or copies of medical documentation confirming the reason for death, if he/she is entitled to obtain such documents, and document confirming his/her identity. If no beneficiary is named, the person requesting a payment of benefit, referred to in § 49 section 2 is obliged to submit in addition official documents confirming his/her marriage with or relationship to the Insured, or documents confirming that he/she was caring for the Insured

as at the date of his/her death.

 

§

42

PZU SA reserves the right to verify the provided documentation and

to seek opinion of specialist physicians.

§ 43

1. In order to use the assistance benefits referred to in § 12 sec. 13, the Insured (or the person acting on his/her behalf) should, immediately upon the occurrence of the insurance accident and before undertaking any actions on his/her own

account, notify the PZU Emergency Centre by telephone of the insurance accident and state the following information:

1) given name, surname and address of residence of the Insured and given name and surname or business name of the Policyholder; 2) telephone number at which the PZU Emergency Centre can contact the Insured or his/her representative; 3) a brief description of the event and type of required assistance; 4) follow the recommendations of the PZU Emergency Centre, providing information and the necessary powers of attorney.

2. If the Insured or the person acting on his/her behalf were not able to contact the PZU Emergency Centre by telephone in the manner referred to in section 1 for reasons beyond his/her control, and on his/her own organized and paid for the assistance services referred to in section 1, he/she shall be obliged to provide notification of the insurance accident within 7 days from the date on which contacting PZU Emergency Centre became possible. Furthermore, the Insured or the person acting on his/her behalf is obliged to state the reason for inability to contact PZU Emergency Centre.

3. If the Insured as a result of a failure to contact the Emergency Centre in the case referred to in section 2, organised on his/her own assistance services and bore their costs, PZU SA is obliged to refund to the Insured the costs he/she incurred up to their actual amount, but not more than up to the liability limit set under these General Conditions for the given assistance service, and if such limit had not been set up to the average price for performing such service in the location where such service had been performed maximally to the amount corresponding to an average price of a performance of the service of this type in the territory of a locality, in which the service has been rendered. The basis for consideration of the submitted claim is the delivery by the Insured of documentation necessary to establish justification for the claim and the amount of benefit: medical documentation confirming the occurrence of insurance accident covered by PZU SA liability, as well as invoices issued in the Insured’s name and proofs of their payment.

4. If the obligation to notify of the insurance accident within the deadline referred to in section 2 is breached intentionally or through gross negligence, PZU SA may reduce the benefit accordingly, if the breach made it impossible for PZU SA to establish the circumstances and consequences of the insurance accident. The consequences of a failure to notify PZU SA of the accident shall not occur if PZU SA, within the time defined in section 2, received information of circumstances that should have been communicated to it.

DETERMINATION AND A PAYMENT OF BENEFITS § 44

1. The types and amounts of vested benefits, when a subject of the insurance cover constitute the consequences of the insurance accident, are determined upon establishing that there exists a regular cause-and-effect relationship between the insurance accident and its covered consequences.

2. The establishment of the regular cause and effect relationship, referred to in section 1, and determination of the covered consequence of the insurance accident and a fact of an occurrence of the insurance accident, is done on the basis of delivered documents or information, listed in § 41 sec. 1, and on the basis of results of medical examinations.

3. The Insured is obliged to, upon a request of PZU SA and at its expense, to undergo additional medical examinations or examination necessary to determine a justification for the

4.

reported claims. Such examination is performed by the physicians designated by PZU SA.

A degree (percentage) of permanent disturbance of health is

determined on the basis of the “Table of percentage evaluation

of a disturbance of health of PZU SA” approved by a resolution

adopted by the Management Board of Powszechny Zakład Ubezpieczeń Spółka Akcyjna and applicable on a date of concluding the insurance contract, which is available in the organisational units of PZU Sa and on the web sites of PZU SA.

§ 45

1.

A degree (percentage) of permanent disturbance of health should be determined promptly upon a completion of treatment, considering a rehabilitation recommended by a physician, and in the case of a longer treatment at the latest in the 24th month from an occurrence of the insurance accident. The further change in a degree of permanent disturbance of health (improving or worsening) is not the basis for a change of the

benefit amount.

2.

When establishing the degree (percentage) of permanent disturbance of health, a type of work, an occupation or actions performed by the Insured are not taken into consideration.

3.

If

in consequence of the insurance accident the Insured sustains

more than one bodily harm, the amount of benefit for permanent disturbance of health, or for permanent bodily harm or for fractures and dislocations consist of the sum of benefits due for each bodily harm, but not more than up to the amount of the

sum insured set in the insurance contract.

4.

In connection with § 44 sec. 1 – in the case of the insurance accident contributes to a previously existing illness or medical condition not covered by the insurance contract is of a size of the accident consequences benefits due on the basis of the insurance contract are balanced by an impact of this illness or medical condition on a size of the consequences of the insurance accident.

5.

In the case of loss or damage to an organ or system whose functions had already been impaired before the insurance accident, the degree (percentage) of permanent disturbance of health is determined as a difference between the degree (percentage) of permanent detriment to the given organ or system after the accident, and the degree (percentage) of permanent disturbance of health which had existed before the accident.

6.

If the insured, before the determination of permanent

disturbance of health caused by a serious bodily injury received

a

benefit for injury to the same organ under other titles (Table

4, 5, 7, 8), then in the case where the determination of permanent disturbance of health by the physicians designated by PZU SA would result in a higher benefit being granted, the benefit granted under other titles (Table 4, 5, 7, 8) shall be credited against the benefit due for permanent disturbance, and PZU SA shall pay the difference between the benefit for permanent disturbance and the benefit due under other titles (Table 4, 5, 7, 8).

7.

Benefit for bites and stings referred to in § 12 section 10 is paid

irrespective of benefits paid for other reasons.

8.

The benefit is due, if permanent disturbance of health occurred not later than within 24 months from a date of the occurrence

of the insurance accident.