Page 350 - M97TB9_2018-19_[low-res]_F2F_Neat2

12 12/20 M97/February 2018 Reinsurance
Chapter C3A Extent of cover and exclusions

Cover will provide a capital sum insured for each category of staff and in the event of an accident to an
insured person, a percentage of the sum insured will be paid depending on the type of injury. These are
shown in the schedule of compensation and are typically:
• death;
• total and irrecoverable loss of sight of one or both eyes;
• loss of one or two limbs;
• total and irrecoverable loss of sight of one eye and loss of one limb;
• permanent total disablement other than total loss of sight of one or both eyes or loss of limb;
• temporary total or partial disablement;

The last benefits shown are weekly benefits and a limitation on the number of weeks for which those
Limitation on the
number of weeks for benefits are payable will be included.
which some benefits
are payable In a large number of risks placed in the London Market, the percentage of the capital sum applicable to
each benefit is expressed according to a scale of benefits. In other cases, the schedule of benefits may
contain great detail, perhaps even extending to the percentage of the capital sum to be paid for the loss
of the tip of a finger.
In addition, medical expenses incurred in relation to the temporary disablement benefits are payable up
to a specified percentage of the claim payable under those benefits. Cover will contain various
provisions including:
• Compensation can only be payable under one item of the schedule of compensation in respect of the
consequences of one accident to an injured person, except temporary partial disablement preceding
or following temporary total disablement.
• No weekly benefits will be paid until the total amount shall be known and agreed.
• Compensation will only be paid if the death, injury or disablement occurs within twelve months of the
date of the accident. In the case of permanent total disablement this must last for twelve months.

The wording contains definitions of certain terms to clarify intent. Reference copy for CII Face to Face Training
Be aware
‘Accident’ means a sudden, unexpected, unusual, specific event which occurs at an identifiable time and place, but
shall also include exposure resulting from a mishap to a conveyance in which the member is travelling.

Exclusions include:
• War and civil war.
• Radioactive contamination.
• Engaging in certain occupations or leisure pursuits which would entail greater risk of injury. This does
not mean these activities are uninsurable, simply that detailed information may be needed and extra
conditions imposed.
• Air travel except as a passenger in a properly licensed multi-engine aircraft operated by a licensed
commercial air carrier. Depending on the details of individual cases this exclusion is frequently
deleted or modified.
• Attempted or actual suicide, intentional self-injury or injury arising through a state of insanity.
• AIDS or AIDS-related complex (ARC).
• Deliberate exposure to exceptional danger (except in the event of an attempt to save human life),
criminal acts or being under the influence of alcohol or drugs.