Insurance Assistance is the class of insurance destined to help and assist people in difficulties resulting from unforeseen and sudden events occurring during journeys out of their home country.
THE GUARDIAN® with the full support of THE GUARDIAN® Worldwide Assistance -London
The insured person is the person who has a right to THE GUARDIAN® benefits mentioned in the insurance contract.
A contractual document established and signed by The INSURER. It determines the Insurance Assistance coverage selected and proves the existence thereof.
A nucleus comprising doctors, technicians and operators which The INSURER places at the disposal of insured persons, 24 hours a day, every day of the year, in collaboration with an approved center for emergencies and for reanimation.
A medical team permanently on duty at the emergency center.
Admission to a hospital establishment for a period of 24 hours and over.
Any person who, without necessarily being a relative, is in close de facto relationship with the insured person.
A non-intentional, prejudicial event which determines the situation of difficulty in which the insured person finds himself.
Every alteration of the state of health which does not ensue from an accident and which is not the manifestation of a preexisting condition .
A sudden, violent and external occurrence, undergone involuntarily, causing physical lesions which can be objectively observed.
It is the place where the insured person is taken after an accident so as to make him apt to an evacuation or repatriation.
Theft with violence.
Suitcases or other containers ( travel bags, or backpacks act.) as well as enclosed items.
Articles intended for the personal use of the insured party during travel (such as items of clothing, shoes, toiletries, ect.).
Articles in the composition or making of which there are precious metals (platinum, gold, silver), precious stones, as also pearls, or other precious materials (ivory, amber, ect.).
Articles which, while not being precious articles, have nevertheless a market value such as furs, spectacles, binoculars, cameras, TV cameras, video cassettes, mobile phones, computers, sports equipment (ski, tennis racquets, golf clubs, sailboards, ect.).
Accidental injury resulting in death or permanent total disability.
The upper limit of the benefits provided for by the General Conditions.
2.- "The Guardian"® Coverage
This coverage covers, within legal and contractual limits, sudden illness and accidents occurring during a journey of the insured person out of his usual country of residence, according to the conditions defined in number 4 hereafter.
The insurer covers medical and hospital expenses caused by a sudden illness or accident occurring during a journey of the insured person out of his usual country of residence.
The INSURER will compensate the insured person for the loss or common theft of his luggage, while in the custody of an air carrier.
The insurer will compensate the insured person on the case of permanent total disability or in the event of accidental death of the insured person while traveling abroad. The insurer will compensate the beneficiary designated by the insured person.
The insurance contract is governed by Swiss Federal Law On insurance contracts, by the present General Conditions appearing in every individual policy taken out by the insured.
Only those persons or group of persons, aged from 0 to 70 years, are insured who are designated as beneficiaries in the policy of Assistance-Insurance or on a list of names annexed to the policy.
Those events are insured which occur during the duration of the contract and which are subject to the coverage contracted for.
Coverage is effective for the duration agreed upon in the policy.
Coverage of Assistance-Insurance comes into effect at midnight on the day of the collection of the premium by the insurer or his authorized agents .
Coverage remains in force until midnight of the last day of the contractual period .
In the case of an annual policy, only travel periods up to a maximum of 90 (ninety) consecutive days abroad from from the domicile or usual residence are covered.
The insured person is covered in the country of destination as well as all the countries he must normally pass through to arrive there.
The insured person or the insurer taker can ask for the extension of duration of the insurance contract. However, THE GUARDIAN ® will verify that there has not been a substantial increase in risk caused by the insured person, in which case THE GUARDIAN ® will have the right not to renew the contract. Furthermore the insured person must notify THE GUARDIAN ® of any change or alteration in his state of health. If the General Conditions of the Coverage selected have changed in the meantime, the new conditions are applicable. In the case of increased benefits , THE GUARDIAN ® can ask for a compliment to the premium.
All contracts are concluded for a determined period and terminate definitively on their date of expiration, without their being able to be either extended or canceled before their expiration
THE GUARDIAN ® has the right to obtain, from the insured person, the communication of all information as well as all supporting documentation which it might deem to be of value for the provision of the services supplied by it to the insured person.
If the insured person provokes a substantial increase in risk during the period covered, THE GUARDIAN ® ceases to be bound by the contract.
The increase is substantial if it is based on a fact important for the appreciation of the risk and which would have been susceptible to influence the determination of THE GUARDIAN ® to conclude it to the agreed conditions.
If the insured person uses only a part of the benefits supplied by THE GUARDIAN ® , this latter is not obliged to supply compensation in cash or an alternative benefit of any kind or whatsoever.
If the cost resulting from an accident are less than the maximum limit fixed in the general conditions, the insured person cannot make any claim on the difference.
Premiums are paid by the insurance taker prior to the insurance of the policy.
In the case of default of payment of the premium by the taker, the policy is not issued and no obligation of assistance arises for the account of THE GUARDIAN ®.
If the same interest is insured against the same risk, and for the same period, by more than one insurer, in such a manner that the combined insured sums exceed the insurance value (double insurance), the taker of insurance is obliged to inform the insurer thereof without delay and in writing.
The rights of the insured person against third parties responsible for the accident are surrogated to THE GUARDIAN ® up to the amount of the compensation paid by THE GUARDIAN ®.
The insured person releases from professional secrecy all doctors or paramedical staff who have examined him both before and after the accident.
3.15.1
On signing the Contract
Any reluctance or omission to declare a factor circumstance
limiting the validity of the contract provides THE GUARDIAN
® with the right to cancel the contract as soon as
THE GUARDIAN ® acquires knowledge of it.
3.15.2
In Case of Damage
In order to benefit from THE GUARDIAN ® services,
the insured person must immediately and in priority contact
THE GUARDIAN ® Alarm Center at the following numbers.
Tel
+44 207 538 4239
If the insured person is not in a position to contact
THE GUARDIAN ®, the alarm given by a close person,
the police, the hospital, the fire brigade, or anyone
having intervened in the damage will be considered of
same worth as a call from the insured person himself.
Furthermore, the insured person must provide THE GUARDIAN
® with the following original documents :
- Official statement of accident issued by the police authorities.
- Medical prescriptions
- Medical and hospital bills, within two months after the occurrence of the disaster.
THE GUARDIAN ® has the right the verify the veracity of the disaster declared.
THE GUARDIAN ® is released from any obligation to supply benefits in the following cases :
- Failure by the insured person to notify THE GUARDIAN ® immediately of an accident.
- Failure by the insured person to communicate the documents necessary to THE GUARDIAN ® for settling the case of the accident.
- The committing by the insured person of a crime or an offense which was the cause of the damage.
- The lack of the necessary and compulsory prior approval by THE GUARDIAN ® for the organization and financing of the assistance.
- The lack of prior approval by THE GUARDIAN ® for treatment hospitalization, or for the acquiring of medicaments by the insured person.
- Failure by the insured person to notify THE GUARDIAN ® of the existence of another insurance for the same risks.
- Absorption by the insured person of narcotics and/or alcohol or other hallucinogenic products which led to the occurrence of the accident.
- Failure by to insured person to take measures which ought reasonably to have been taken to avoid the accident.
Any refusal from the insured person or the person who decides for him, of the contractual benefits provided by THE GUARDIAN ® in case of damage, decided in common agreement between THE GUARDIAN 's doctor and the doctors on the site of the damage, will have as a consequence the cancellation of the contract, except if the insured person changes his mind before the end of the insurance.
Any dispute arising from the contract of Assistance-Insurance is governed by Lebanese Law.
For any litigation arising from contract, THE GUARDIAN ® recognizes the court of its headquarters in Lebanon.
The following benefits are covered by THE GUARDIAN.
THE GUARDIAN ® will share in the costs of search and or rescue, undertaken by the competent authorities, up to USD $ 20,000.
4.1.2 Removal and Medical Partition
When the state of the victim of an accident so requires, THE GUARDIAN ® organizes and undertake his removal to a medical center or his repatriation to his domicile or usual place of residence, with the agreement of the doctors in charge of his case in the conditions required by his state, up to a maximum amount of USD $ 100,000.
The benefits of medical removal and/or repatriation will only be supplied with the agreement of the medical service of THE GUARDIAN ® , in close cooperation with the doctor in charge of the place of stabilization.
Transport will be effected according too the decision of the THE GUARDIAN ® doctors, by air, by land or by sea.
4.1.3 Repatriation of the Mortal Remains
In the event of the death of the insured person during the journey out of home, or usual residence country, THE GUARDIAN ® will organize the repatriation of the mortal remains, in the state of which they are at the moment of the lifting of the body, to the domicile or place of usual residence in conformity with local laws and on condition that this transfer be materially feasible.
THE GUARDIAN ® will undertake the cost of transport of the mortal remains - up to a maximum amount of USD $ 15,000 and will organize the formalities pertaining thereto.
Costs relative to the funeral ceremony are not borne by THE GUARDIAN ® .
4.1.4 Medical Accompaniment
The insured person will be accompanied and assisted during his removal of his repatriation by medical or paramedical staff with specialization required by his condition and designated by THE GUARDIAN ® doctors.
4.1.5 Medical Advice at a distance
The emergency center and the THE GUARDIAN ® reply service, operating 24 hours per day, every day of the year, ensures a medical advisory telephone reply service to answer the needs of insured persons victims of accidents.
4.1.6 Indication of Local Medical Specialists
If the preliminary examination discloses a critical condition of the insured person and that this requires the intervention of a specialist, THE GUARDIAN ® will communicate to him at his request or at that of the doctor in charge at the location of the accident, the name of a doctor of that specialization in so far as there exits one in the region where the insured person is located and without THE GUARDIAN ® incurring in this respect any responsibility whatsoever for the medical treatment performed by the above mentioned doctor and the possible consequences thereof.
4.1.7 Urgent Dispatch of Medication
THE GUARDIAN ® organizes and undertakes the dispatch of medicaments which the treatment of the insured person requires and which are not available in the country where the accident has occurred, provided however that these medicaments are commercially available in the country of the head office of THE GUARDIAN ® or in one of the countries in which THE GUARDIAN ® has representation and that the utilization of these medicaments are authorized in the place where they are to be used. The cost of dispatch of the medicaments is for the account of THE GUARDIAN ® .
4.1.8 Dispatch of Urgent Messages
THE GUARDIAN ® will undertake, at its expense, to dispatch urgent messages in the name of the insured person to any person designated by him and being in the country of his domicile or hides usual residence, if he is not himself in a position to communicate with the desired person.
4.1.9 repatriation of other Insured Persons Involved in the same Accident
THE GUARDIAN ® organizes and undertakes, in as much as they are also insured with it for the same coverage, the cost of repatriation of all insured parties involved in the same accident who are unable to return home by the means of transport originally planned.
4.1.10 Sending of Someone Close
When hospitalization of a minimum of seven days, before removal or repatriation is deemed necessarily, THE GUARDIAN organizes and undertakes the return journey of someone close to the hospitalized insured person. The cost of the stay of this person in the place of the hospitalization will be indemnified up to USD $ 80 per day for a period not to exceed 10 days.
4.1.11 Assistance to Minor Children
If, following upon an illness or an accident, the insured person is not in a position to after children under fifteen years old traveling with him, and on condition that these latter are also insured with THE GUARDIAN ®, the latter will send a companion to fetch the children and accompany them back to their domicile or place of usual residence and undertakes the costs of the trip of this companion.
4.1.12 Putting up of Bail
The insurer will in the name and for the account of the insured party, put up any bail demanded for his liberation. If he has been deprived of his liberty by virtue of judicial or local administrative authorities on account of an offense, not deliberate on his part, provided, however, that he shall have supplied the insurer with a bank guarantee or whatever other form of guarantee, deemed by it to be satisfactory, for a maximum of USD $ 10,000.
The insured party undertakes to make restitution to the insurer of the sum advanced within 15 days following the putting up of the bail.
The following events are not covered by the insurer:
- The practice of reckless undertakings by the insured person.
- The practice of sports at high risks ( parachuting, acrobatics, races on mechanical appliances, ski jumping, hang-gliding, ect.).
- War, declared or otherwise, revolution, acts of sabotage, terrorism or vandalism.
- Strikes, street barricades erected at the time of public demonstrations, and generally troubles of all kinds and measures taken for restoring order.
- Telluric movements, flood volcanic, eruptions and other kind of natural phenomenon having the nature of a natural calamity.
- All damage to health brought about by ionizing rays ( nuclear radiation).
- Pathological ailments existing prior to the date of departure of the insured person or at the conclusion of the Insurance- Assistance policy.
- The consumption of narcotics and/or other hallucinogenic products or alcohol.
- Suicide or attempted suicide.
- Ablation and transplantation of organs, tissues or cells.
- Pregnancy and its consequences from the seventh month.
- Absconding and abduction
The insurer undertakes for its account, up to the amount provided for in the policy, to a maximum of USD $ 50,000, the medical and hospitalization casts arising from an accident or a sudden illness which occurred during the journey of the insured person combined with the limit of Removal and Repatriation Benefits limit.
The insurer benefits are accompanied by a franchise of USD $ 200 per case, for those insured persons up to 70 years of age.
The following are not covered by THE GUARDIAN:
- Complete physical examination or other medical investigation as also any treatment undertaken by the insured person, his doctor or the hospital establishment to which he has been admitted, which shall not have been approved by the THE GUARDIAN ® doctors.
- Treatments for preexistent illnesses as well as the possible complications due to these illnesses.
- Spontaneous consultations of doctors and specialists.
- The acquisition by the insured person of medicaments not prescribed by an authorized THE GUARDIAN ® Doctor.
- The
insured person is not covered when displacement is undertaken:
- Against medical advice.
- After the receiving of a diagnosis establishing an illness in terminal phase.
- In the intention to receive medical treatment for a preexisting illness.
- During an illness or an incapacity to work.
- During a pregnancy over 7 months.
- If a doctor has ordered an operation which has not yet been performed
The insurer will compensate the insured person up to USD $ 800 and this coverage shall apply in the event of loss, theft, or destruction of registered baggage while in the custody of an air carrier only.
- Theft or destruction, subjects to a deductible amount of 10 % of the amount of the claim.
- Replacement of clothes and personal hygienic items, not to exceed USD $ 50 for any one item.
The insurer does not provide coverage on a "new for old basis."
Exclusion of coverage on the following items:
- Bank notes, checks, travelers checks, credit card.
- Tickets and any other travel voucher.
- Passports, any other identity documents.
- Works of art or collectors items, souvenir acquired during the trip.
- Confiscation or withholding of luggage by customs or police authorities.
- Wear and tear following normal use
To receive the benefits " Baggage" in case of claim. The insured person is obliged to give notice in writing of the claim accompanied by the following documents:
- Formal claim file from the transportation provider " air carrier " and provide the plan administrator has paid the insured party its normal reimbursement for the lost checked luggage.
- Original invoice of any purchase of any article showing date and price
7.1 In the event of the insured person's accidental death (except while traveling on a common carrier) or total permanent disability following an accident, the insurer will provide the following benefits:
- Accidental death up to USD $ 20,000 combined with the repatriation of the mortal remains, to the beneficiary designated on your application.
- Accidental Total Permanent Disability Principal Sum of USD $ 20,000 for 100% Disability Principal Sum shall be reduced by 50 % if you are less than 17 years old.