Product Disclosure Statement - Pilots Loss of Licence Insurance

Pilots Loss of Licence
Insurance
Permanent and Temporary Depravation of a Pilot’s Licence
By the Licence Issuing Authority
11/03/2015
Product Disclosure Statement V1.1
Contents
PRODUCT DISCLOSURE STATEMENT (PDS) ............................................................................................. 2
THE INSURER ....................................................................................................................................... 2
THE AGENT(S)....................................................................................... Error! Bookmark not defined.
CLAIMS & GENERAL ENQUIRIES .............................................................................................................. 2
SOME EXCLUSIONS FROM COVER APPLY................................................................................................ 3
YOUR DUTY OF DISCLOSURE ................................................................................................................... 3
YOUR DUTY OF DISCLOSURE FOR RENEWALS .................................................................................... 3
WHO NEEDS TO TELL US? ................................................................................................................... 3
IF YOU DO NOT TELL US ...................................................................................................................... 3
BENEFITS OF THIS FINANCIAL PRODUCT................................................................................................. 4
WHAT ISN’T COVERED BY THIS FINANCIAL PRODUCT ............................................................................ 5
REMUNERATION ..................................................................................................................................... 8
IF YOU HAVE A COMPLAINT OR QUERY .................................................................................................. 8
PRIVACY POLICY ...................................................................................................................................... 9
YOUR POLICY ........................................................................................................................................... 9
IMPORTANT INFORMATION ................................................................................................................... 9
DEFINITIONS.......................................................................................................................................... 10
1
PRODUCT DISCLOSURE STATEMENT (PDS)
THE INSURER
The insurer of this Policy:
Certain Underwriters at Lloyd's of London
One Lime Street
London
EC3M 7HA
UK
LLYOD’S REPRESENTATIVE
Howard Global Insurance Services Ltd
Marlow House
1A Lloyd’s Avenue
London EC3N 3AA
No 3867929
Phone: + 44 (0) 20 7702 5700 Fax: + 44 (0) 20 7702 5701
CLAIMS & GENERAL ENQUIRIES
For all claims queries contact:
WSC Insurance Brokers
Caringbah and Bowral NSW
Phone 1300 733 476 Mob: 0414 266 216
Fax: 02 4861 5144 E: stewart@wscbrokers.com.au
AFS Licence: 238854
Mail: PO Box 1437 Bowral NSW 2576
Website: www.wscbrokers.com.au
This Product Disclosure Statement (PDS) contains important information about this Pilot
Loss of Licence Insurance Product. Other documents may form part of this PDS. Any such
documents will include a statement identifying them as part of this PDS and will be provided
to You at the same time as You are given this PDS.
The information in this PDS has been prepared without taking into account Your personal
objectives, financial situation or needs. You should therefore consider this PDS carefully
before making any decision whether to take out this Pilot Loss of Licence Insurance, if You
already hold such insurance, to keep or renew the insurance.
This PDS is prepared by the Insurers who are responsible for it. It includes the terms and
conditions applying to this insurance which will be issued to You if You apply for, or seek to
renew, the insurance and We accept Your application or if You seek to be covered by it as an
Insured Person.
We recommend You read the PDS in conjunction with the Policy Wording.
2
SOME EXCLUSIONS FROM COVER APPLY
A benefit is not payable if an exclusion applies. These exclusions are explained in the
relevant Cover Sections and the Exclusions Section and in some cases in the Policy Schedule
or an Endorsement issued by Us.
YOUR DUTY OF DISCLOSURE
Whether You are entering into a policy for the first time or are proposing to renew, vary,
extend or reinstate a policy you have a duty of disclosure. If you are unsure if something is
relevant you should inform us regardless.
Your duty of disclosure for new policies when answering our questions You must be honest
and You have a duty under law to tell Us anything known to You, and which a reasonable
person in the circumstances, would include in the answer to the question. We will use the
answers in deciding whether to insure You and anyone else to be insured under the policy,
and on what terms.
YOUR DUTY OF DISCLOSURE FOR RENEWALS
If You have already entered into a policy and You are proposing to renew, vary, extend or
reinstate the policy Your duty of disclosure changes. You have a duty to tell us of everything
that You know, or could reasonably be expected to know, that is relevant to our decision to
insure You and to the terms of that insurance.
WHO NEEDS TO TELL US?
It is important that You understand You are answering our questions in this way for yourself
and anyone else that You want to be covered by the policy.
Your duty does not require disclosure of matters that:
 reduce the risk
 common knowledge
 We know or, in the ordinary course of our business, should know, and
 We have indicated We do not want to know.
IF YOU DO NOT TELL US
If You do not answer our questions in this way or disclose everything You know, the Insurer
may reduce or refuse to pay a claim, or cancel the policy. If You answer Our questions
fraudulently, The Insurer may refuse to pay a claim and treat this policy as never having
been in force.
Failure to comply with Your duty of disclosure, especially concerning Your Medical History, ,
could severely affect the result of any subsequent claim made on the policy and could lead
to a claim being declined.
3
BENEFITS OF THIS FINANCIAL PRODUCT
Benefits
The Insured Person is insured for those Benefits stated in the Schedule as 'Insured'.
2.1.
If an Insured Person sustains Bodily Injury or Illness (other than Classified Illness)
during the Period of Insurance which results in the Insured Person Losing his/her
Licence the Underwriter will pay the sum insured shown in the Schedule.
2.2.
If an Insured Person becomes Disabled as a consequence of Bodily Injury or Illness
(but not as a result of Classified Illness) sustained during the Period of Insurance and
the Insured Person remains Disabled for more than the Waiting Period the
Underwriter will pay the sum insured shown in the Schedule for each subsequent
full month for which the Insured Person remains Disabled. If the Insured Person
does not remain Disabled for a full month, a proportional benefit based on the
number of days Disabled will be paid. The Underwriter will only pay for up to the
maximum number of months of benefit shown in the Schedule in respect of any one
cause. No payment will be made in respect of the Waiting Period. No benefit will be
paid after the death of the Insured Person other than for Accidental Death.
2.3
If an Insured Person suffers from a Bodily Injury or Illness during the Period of
Insurance for which a diagnosis of a Critical Illness is made, the Underwriter will pay
one third of the Sum Insured shown in the Schedule for the Capital Benefit provided
that the Insured is alive thirty days following the date of such diagnosis.
Paralysis
)
Loss of limbs) As a result of
Blindness ) sickness or accident
Deafness
)
Alzheimer’s Disease
Parkinson’s Disease
4
2.4.
If an Insured Person becomes Disabled as a consequence of Classified Illness during
the Period of Insurance and the Insured Person remains Disabled for more than the
Waiting Period the Underwriter will pay the sum insured shown in the Schedule for
each subsequent full month for which the Insured Person remains Disabled. If the
Insured person does not remain Disabled for a full month, a proportional benefit
based on the number of days disabled will be paid. The Underwriter will only pay for
up to the maximum number of months of benefit shown in the Schedule in respect
of any one cause. No payment will be made in respect of the Waiting Period. No
benefit will be paid after the death of the Insured Person.
2.5.
If an Insured Person dies by Accidental Death (as defined) during the Period of
Insurance, The Underwriter will pay up to the maximum benefit shown in the
Schedule of Benefits or the Benefit noted and selected by the Insured Person on the
Health Declaration. Accidental Death includes the consequence of exposure to the
elements and the indirect consequence of accidental injury.
WHAT ISN’T COVERED BY THIS FINANCIAL PRODUCT
Exclusions
4.1.
Unless liability has been admitted by the Underwriter, Benefits 2.1. Benefit 2.2. or
2.3 will not be paid if the Insured Person dies either before Benefits have been paid
by the Underwriter or until the waiting period stated in the schedule or 60 days has
passed since the Insured Person first became Disabled.
4.2.
No Benefits will be paid if the Bodily Injury, Illness, Classified Illness or Critical Illness
is the direct or indirect consequence of:
4.2.1.
War involving any one of the following countries, United Kingdom, United
States of America, France, Peoples Republic of China or The Russian
Federation.
Nuclear/Chemical/Biological Terrorism Exclusion
It is agreed that, regardless of any contributory cause(s), this insurance
does not cover any claim(s) in any way caused or contributed to by an act
of terrorism involving the use or release or the threat thereof of any
nuclear weapon or device or chemical or biological agent.
For the purpose of this exclusion an act of terrorism means an act,
including but not limited to the use of force or violence and/or the threat
thereof, of any person or group(s) of persons, whether acting alone or on
behalf of or in connection with any organisation(s) or government(s),
committed for political, religious, ideological or ethnic purposes or
reasons including the intention to influence any government and/or to
put the public, or any section of the public, in fear.
If the Underwriters allege that by reason of this exclusion any claim is not
covered by this insurance the burden of proving the contrary shall be
upon the Assured. 02/02 LSW 1175
5
4.2.2.
A criminal act for which the Insured Person was found guilty and which
could have carried a custodial sentence (whether imposed or not).
4.2.3.
Active duty with any Armed Force on any kind of combat assignment.
4.2.4.
Intentional self-injury or attempted suicide.
4.2.5.
Pregnancy, childbirth, abortion or complications thereof.
4.2.6.
Venereal Disease or its consequences.
4.2.7.
Acquired Immune Deficiency Syndrome, AIDS related complex or any
related conditions or any condition resulting from the presence of the
Human Immuno Deficiency Virus (unless such condition was contracted as
a direct consequence of medical treatment for an unrelated illness or
medical condition - such illness or medical condition not being drug or
alcohol abuse or a venereal disease).
4.2.8.
Any Illness, Classified Illness or Critical Illness which You first sort Medical
attention or advice on within 12 (twelve) months before the
Commencement Date and the Illness, Classified Illness or Critical Illness
and was noted on the Medical Application unless agreed and accepted by
the Underwriter in writing.
4.2.9
Any condition or injury that you sort Medical attention or advice on within
12 (twelve) months before the Commencement date and the condition or
injury and was noted on the Medical Application unless agreed and
accepted by the Underwriter in writing.
4.2.10
Any psychiatric illness or mental or nervous disorders”.
4.2.11
Alcohol, other than under the Classified Illness Benefit. An Insured Person
being under the influence of alcohol exceeding those levels defined by law
for the use of a motor vehicle in the country in which the Insured Person
resides.
4.2.12. Drugs, other than under the Classified Illness. An Insured Person being
under the influence of drugs or narcotics that are not lawfully available or
which have not been prescribed by or taken in accordance with the
instructions of an independent qualified medical practitioner;
4.2.13. Flying involving hazardous activities including but not limited to the
following:
(i) the intentional dropping, spraying or release of any substance or object,
(ii) slung cargo,
(iii) aerial photography,
(iv) fire-fighting,
(v) slash and burn,
(vi) animal capture or
(vii) the use of ultra-light aircraft.
4.2.14. Deliberate exposure of the Insured Person to exceptional danger (except in
an attempt to save human life or to prevent loss of or damage to aircraft or
aircraft equipment).
6
REMUNERATION
Intermediary Remuneration
Your insurance broker is paid a commission when a policy is issued, renewed or varied. The
type and amount of remuneration may vary.
Third Parties
Third parties such as Group Employers, Financial Advisors and other providers may be paid a
commission when a policy is issued, renewed or varied. The type and amount of
remuneration may vary.
IF YOU HAVE A COMPLAINT OR QUERY
This Insurance does not comply with the Insurance Council of Australia’s General Insurance
Code of Practice. Any enquiry or complaint relating to this insurance should be referred to:
Howard Global Insurance Services Ltd
Marlow House, 1A Lloyd's Avenue, London, EC3N 3AA
Telephone +44 (0)20 7702 5700 Facsimile +44 (0)20 7702 5701
Registered in England & Wales at Craven House, 16 Northumberland Avenue, London WC2N
5AP, No 3867929
Authorised and Regulated by the Financial Conduct Authority
If this does not resolve the matter or you are not satisfied with the way a complaint has
been dealt with, you should write to:
Lloyd’s Underwriters’ General Representative in Australia
Suite 2, Level 21
Angel Place
123 Pitt Street
Sydney, NSW 2000
Telephone Number: (02) 9223 1433
Facsimile Number: (02) 9223 1466
If Your dispute remains unresolved You may be referred to the Financial Ombudsman
Service Limited under the terms of the General Insurance Code of Practice. For other
disputes You will be referred to other proceedings for resolution. Details are available from
Lloyd’s Underwriters’ General Representative in Australia at the address above.
7
PRIVACY POLICY
Lloyd’s and its agents are bound by the obligations of the Privacy Act 1988 as amended by
the Privacy Amendment (Private Sector) Act 2000 (The Act). These set basic standards
relating to the collection, use, disclosure and handling of personal information.
“Personal information” is essentially information or an opinion about a living individual
whose identity is apparent or can reasonably be ascertained from the information or
opinion.
An individual who believes their privacy may have been prejudiced has a right to make a
complaint about the matter. In the first instance, Your complaint should be addressed to
Underwriters. If You or the Insured are dissatisfied with the response, You may refer the
matter to Lloyd’s Australia Ltd, who has the appropriate authority to investigate and
address matters of this nature. Lloyd’s Australia can be contacted at:
Lloyd’s Australia Ltd
Suite 2, Level 21, Angel Place
123 Pitt Street
Sydney, NSW 2000
Telephone: 02 9223 1433
Fax:
02 9223 1466
Lloyd’s Australia will respond in writing within fifteen (15) working days, and if You remain
dissatisfied with their response, You will be provided at that time with the details of any
other avenues for resolution that may be available to You
YOUR POLICY
The information You have given will be the basis of the contract of insurance with Us. For
the contract to be valid, all the information You have given Us must be true and complete.
Your policy, which is Our policy booklet, the most recent policy schedule and any
endorsement(s) is evidence of that contract.
This is an important document which You should read carefully and keep in a safe place.
In return for Your premium We will provide insurance as described in the following pages
and in Your policy schedule. The Geographical Limit of this cover is World Wide, This Policy
is governed by and is to be construed in accordance with the Law of the Commonwealth of
[Australia] and happen within the period of insurance as shown on Your policy schedule.
You must pay Your insurance premium with 30 days from the policy commencement date
stated on the payment notice otherwise Your policy will cease to operate.
IMPORTANT INFORMATION
Please read this policy booklet with Your policy schedule to make sure that You are satisfied
with Your insurance. If You have any questions please contact Us.
8
DEFINITIONS
Accident
Shall mean a single, sudden and unexpected event which occurs at an
identifiable time and place during the Period of Insurance.
Accidental Death
Accidental Death to an Insured Person happening during the Period of
Insurance which is not the consequence of sickness disease or any
degenerative condition or gradually operating cause. Accidental Death
includes the consequence of exposure to the elements and the indirect
consequence of accidental injury.
Anniversary Date
As stated in the Schedule
Benefits
The Benefits defined in Section 2 and which are shown as insured in the
Schedule.
Bodily Injury
Accidental injury to an Insured Person sustained during the Period of
Insurance which is not the consequence of sickness disease or any
degenerative condition or gradually operating cause and solely and,
independently of any other cause, it causes the disablement of the
Insured. Bodily Injury includes the consequence of exposure to the
elements and the indirect consequence of accidental injury.
Classified Illness
An illness which first manifests during the Period of Insurance which is
by its nature or origin:
a)
b)
Critical Illness Benefit
either directly or indirectly consequent upon or contributed to by
drugs or alcohol (unless prescribed by a Medical Practitioner in the
treatment of an Illness), or
is incapable of diagnosis with available objective evidence or has
not been diagnosed despite such evidence being available.
If the Insured sustains Bodily Injury or Illness during the Period of
Insurance for which a diagnosis of a Critical Illness is made by the
Underwriter, the Underwriter will pay one third of the Sum Insured
shown in the Schedule for the Capital Benefit provided that the Insured
is alive thirty days following the date of such diagnosis.
Paralysis )
Loss of limbs) As a result of
Blindness ) sickness or accident
Deafness
)
Alzheimer’s Disease
Parkinson’s Disease
9
Critical Illness Cont:
Any of the following diagnoses:
Paralysis
Total and permanent paralysis as a result of sickness or accident.
Evidence of total permanent failure of spinal cord conductivity due to
transection must be provided, and the temporal and causal connection
with the damaging occurrence must be obvious.
Loss of Limbs
Complete and permanent loss of function of both legs, or both arms, or
one arm and one leg through accident or disease.
Blindness
Total, clinically certified, irreversible loss of sight in both eyes as a result
of acute sickness or accident. The blindness must be certified by an
ophthalmologist’s report.
Deafness
Total, clinically certified, irreversible loss of hearing in both ears as a
result of acute sickness or accident. The deafness must be certified by a
Medical Practitioner.
Alzheimer’s Disease
Deterioration or loss of intellectual capacity or abnormal behaviour as
evidenced by the clinical state and accepted standardised
questionnaires or tests, arising from Alzheimer’s disease or irreversible
organic disorders, excluding neurosis and psychiatric illness, resulting in
significant reduction in mental and social functioning requiring the
continuous supervision of the Insured Person. The diagnosis must be
clinically confirmed by an appropriate consultant and be supported by
the Company’s Chief Medical Officer.
Parkinson’s Disease
Slowly progressive degenerative disease of the central nervous system
as a result of loss of pigment containing neurones of the brain
(substantia nigra).Unequivocal diagnosis of Parkinson’s Disease must be
provided by a consultant neurologist where the condition

cannot be controlled with medication; and

shows signs of progressive impairment; and

activities of daily living assessment confirms the inability of the
Insured Person to perform, without assistance, three or more of
the following:
bathing, dressing, using the lavatory, eating, ability to move in or out of
bed or a chair.
Only idiopathic Parkinson’s disease is covered. Drug-induced or toxic
causes of Parkinsonism are excluded.
10
Underwriter
Certain Underwriters at Lloyd’s in London as stated on the Schedule.
Commencement Date
The latter of either the date shown in the Schedule or the date an
Insured Person first becomes insured under this Policy.
Disabled
Such state of health that prevents and continues to prevent an Insured
Person from reaching the required Licence Standards for the Licence
held by the Insured Person.
Expiry Date
The first to occur of either the date shown in the Schedule or the date
that the Insured Person ceases to be insured under this Policy (either by
agreement or automatically in accordance with Condition 5.2.)
Illness
Any illness not included under Bodily Injury which first manifests during
the Period of Insurance. Illness includes premature senile degenerative
change but excludes Classified Illness.
Insured
The Insured stated in the Schedule.
Insured Person
The Insured Persons defined in the Schedule.
Licence or Certificate
All Licences and Certificates held by an Insured Person in accordance
with the Insured Person's usual Occupation.
Licensing Authority
Shall mean the civil aviation authority or aviation authorities by which
the Insured is required to be licensed in order to carry out the ordinary
duties of his occupation or employment.
Loss of Licence
Deprivation of a Licence by the Licence Issuing Authority as a
Permanent
consequence solely and directly of Bodily Injury, Illness, Classified Illness
or Critical Illness which is permanent or if the Licensing Issuing
Authority, as a matter of practice or in accordance with its regulations,
does not issue a permanent denial of the medical certificate, restoration
of the Licence is unlikely to occur on medical grounds for the
foreseeable future in the opinion of the Underwriter. For this purpose
the foreseeable future will be deemed to be a period of not less than 5
years from the date the Insured Person first became Disabled.
Loss of Licence
Temporary
11
Deprivation of a Licence by the Licence Issuing Authority as a
consequence solely and directly of Bodily Injury, Illness, Classified Illness
or Critical Illness which is Temporary or if the Licensing Issuing Authority,
as a matter of practice or in accordance with its regulations, does not
issue a permanent denial of the medical certificate, restoration of the
Licence is likely to occur on medical grounds for the foreseeable future
in the opinion of the Underwriter. For this purpose the foreseeable
future will be deemed to be a period of not less than 2 years from the
date the Insured Person first became Disabled.
Medical Practitioner
A registered member of the medical profession who is qualified to treat
the cause of Disability and who is not a relative or friend of the Insured
Person for the purposes of certifying such Disability.
Occupation
The Occupation of an Insured Person as declared to the Underwriter
Premium
Any Premium due to or payable by the Underwriter from time to time.
Period of Insurance
The Period commencing with the Commencement Date and ending with
the Expiry Date both days inclusive and any other Period which the
Underwriter agrees to accept.
This Policy
The Policy, the Schedule and any Endorsements or Memoranda attached
to the Policy from time to time.
You/Your
Means; the named Insured in the Schedule or the Insured Member.
Waiting Period
The Waiting Period stated in the Schedule. All periods of absence
resulting from the same medical condition will be aggregated for the
purposes of assessing whether the Waiting Period has been exceeded.
We/Our/Us
Means; the Underwriter subscribing to this Insurance.
12