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Loss or Damage directly caused to Household Contents by insured perils
In consideration of Your having paid the premium for the Policy Period stated in the Schedule We hereby agree, subject to the terms, conditions and exclusions stated in the Policy, to pay the Sum Insured on the occurrence of any of the insured events as mentioned under the item What We cover during the Policy Period.
This Policy is an evidence of the contract between You and Universal Sompo General Insurance Company Limited. The information furnished by You in the Proposal Form and the declaration signed by You forms the basis of this contract.
The Policy, the Schedule and any Endorsement shall be read together and any word or expression to which a specific meaning has been attached in any part of this Policy or of Schedule shall bear such meaning wherever it may appear.
SCOPE OF COVER
Section 1 - Fire and Allied perils -Household Structure and Contents
WHAT WE COVER
Loss or Damage directly caused to Household Contents by insured perils listed hereunder and subject to its not being otherwise excluded.
1. Fire
2. Lightning
3. Explosion / Implosion.
4. Damage caused by an aircraft, other aerial or space devices and articles dropped there from.
5. Riot, Strike and Malicious Damage: - Visible physical Damage by external violent means directly caused to the property insured.
6. Strom, Cyclone, Typhoon, Tempest, Hurricane, Tornado, Flood and Inundation.
7. Impact Damage by any rail/road vehicle or animal by direct contact.
8. Subsidence and Landslide including Rockslide: Damage caused by subsidence of the part of site on which the insured property stands or landslide /rockslide.
9. Bursting and overflowing of water tank, apparatus and pipes.
10. Missile testing operations.
11. Leakage from automatic sprinkler installations
12. Bush Fire.
13. Earthquake Damage to property insured including by fire occasioned by or in consequence of earthquake including flood or overflow of the sea, lakes, reservoirs and rivers and/or landslide/rockslide resulting there from.
14. Terrorism
WHAT WE EXCLUDE
1 Damage caused by pressure waves.
2 Destruction or damage caused to the property by its own fermentation, natural heating or spontaneous combustion or its undergoing heating or drying process
3 Burning of property insured by order of any Public Authority.
4 Explosion/implosion losses to boilers (other than domestic boilers), economizers or other vessels, machinery or apparatus (in which steam is generated) including their contents.
5 Destruction or damage to property caused by centrifugal forces.
6 Damages caused by
a. Permanent or temporary dispossession of any building resulting from the unlawful occupation by any person of such building or prevention of access to the same.
b. Burglary, housebreaking, theft, larceny or any other such attempt or any omission of any kind of any person (whether or not such act is committed in connection with the disturbance of public peace) in any malicious act.
c. Total or partial cessation of work or the retardation or interruption or cessation of any process or operations or omissions of any kind
7 Damage by vehicle/animals belonging to or owned by You or Your Family.
8 Damages caused by :-
a) Normal cracking, settlement or bedding of structures.
b) Settlement or movement of made up ground.
c) Coastal or river erosion.
d) Defective design or workmanship or use of defective material
e) Demolition, construction, structural alteration or repair of any property or ground work or excavation.
9 Damage caused by
a) Repairs or alteration to Your Home.
b) Repairs, removal or extension of the sprinkler installation.
c) Defects in construction known to You.
10 Damages caused to the insured property by pollution or contamination.
11 Expenses necessarily incurred on Architect, Surveyor and Consulting Engineer's fees and Debris Removal following Damage to property insured by an insured peril in excess of 3% and 1% of the claim amount respectively.
12. Loss of earnings, loss by delay, loss of market or other consequential or indirect loss or damage of any kind or description whatsoever.
13. Loss, destruction damage to any electrical machine, apparatus fixture or fittings arising from or occasioned by overrunning excessive pressure, short circuiting, arcing, self-heating or leakage of electricity from whatever cause (lightning included provided that this exclusion will apply only to the particular electrical machine, apparatus, fixture or fittings which may be destroyed or damaged by fire so set up.
14. Livestock or pets
15. Valuables as defined under the Policy, unless specifically covered.
16. Loss or damage to property insured if removed to any building or place other than in which it is herein stated, except machinery and equipment's temporarily removed for repairs, cleaning, renovation or other similar purposes for a period not exceeding 60 days.
17. Liability in excess of First Loss Limit as stated in the Schedule
Special Condition applicable to Section 1
If the property hereby insured shall at the breaking out of any fire or at the commencement of destruction of or damage by any of the insured perils be collectively of greater value than the 100% of total value at risk (as based on the first loss percentage chosen), then You shall be considered as Your own insurer for the difference and shall bear a rateable proportion of the loss in same proportion as insured value at risk bears to actual value at risk Provided, however, that if the sum insured hereby on the property insured shall at the event of such fire or at the commencement of such destruction damage be not less than 85% of the collective value of the property insured, this condition shall be of no purpose and effect if the Policy has been taken on Full Value Basis (100% First Loss Limit).
Section 2 - Burglary Theft
WHAT WE COVER
Loss or Damage directly caused to
1. Contents or any part thereof whilst kept in the insured premises
2. Damage to Insured premises (including reasonable costs for damaged locks at the entry and/or exit points) caused by actual or attempted burglary and/or theft during the Policy Period. In any case the cost of repair or replacement of locks shall not exceed 5% of the sum insured
WHAT WE EXCLUDE
1. Loss or damage from any yard, garden outbuilding (including sheds or garages not attached to the building) or any other property outside the confines of the premises unless specified in the Schedule
2. Valuables and cash in safe/Almirah, unless specifically covered in the Schedule
3. Loss or damage of motor vehicles, trailers unless mentioned as covered in the Schedule
4. Loss or damage in which You, Your family members or any other person lawfully on or about Your premises is or is alleged to be in any way concerned or implicated
5. Loss or damage resulting from an act of Riot, Strike, Malicious Damage and Terrorism
6. Damage to glass and sign boards
7. Live stock
8. Loss or damage to contents or stock when the premises are left unoccupied for more than 30 consecutive days unless the same has been reported to us in writing and our written approval obtained.
9. Any consequential loss or legal liability
10. First Rs 2500/- under each and every claim
Special Condition applicable to Section 2
Reinstatement of Sum Insured
Immediately upon happening of loss or damage under the Policy, the Sum Insured stated in the Schedule shall be reduced by the amount of loss or damage and such reduced sum insured shall be limit in respect of any further damage occurring during the current period of insurance unless We give our consent upon payment of additional premium to reinstate the said sum insured.
Basis of Settlement
Subject to Special Condition above and deductible stated in the Schedule, We may at our option reinstate, replace or repair the assets covered under this Policy which are lost or damaged or pay the amount of Loss/Damage or may join with any other insurer(s) in doing so.
We shall not be bound to reinstate exactly or completely but only as circumstances permit and in reasonably sufficient manner and in no case We shall be bound to spend more in reinstatement than it would cost to reinstate the assets as it was at the time of occurrence of such damage, nor more than the limit of liability mentioned under the Schedule.
All claims settlement under this Policy are subject to the following conditions
1) When the Sum Insured represents the full value of the assets covered:
If actual value of the assets insured under this Policy shall at the time of loss be collectively of greater value than the sum insured opted by You, then You will be considered as being Your own insurer for the difference and shall bear a rateable proportion of the loss accordingly. Every item, if more, than one in the Policy shall be separately subject to this condition.
2) When the Sum Insured represents a fixed proportion of the value of the assets covered referred to as First Loss Limit:
If the fixed proportion of value of the assets is insured under this Policy and at the time of loss the full value at risk is greater value than the 100% value at risk as implied by the First Loss Limit chosen, then You will be considered as being Your own insurer for the difference and shall bear a rate able proportion of the loss accordingly. Every item, if more, than one in the Policy shall be separately subject to this condition.
Section 3 - Personal Accident
WHAT WE COVER
Accidental bodily injury directly resulting in the Death or disablement to insured person as per the Table of Benefits.
The scope of coverage shall depend on the benefit selected by you and as described in the Schedule
a) Basic Cover- Death only
b) Wider Cover- Death + Permanent Total Disability.
We shall pay to the insured person or his/her legal personal representative / assignee, the compensation set forth in Table of Benefits (as percentage of Capital Sum Insured)
Geographical eligibility: Worldwide
WHAT WE EXCLUDE
1. Natural Death
2. Compensation under more than one of the benefits mentioned in Table of Benefits in respect of same period of disablement.
3. Any other payment after a claim under one of the benefits 1or 2 in Table of benefits has been admitted and becomes payable.
4. Any payment in case of more than one claim under this Section during any one period of Insurance by which our liability in that period would exceed CSI
5. Payment of compensation in respect of Death or injury as a consequence of/resulting from
a) Committing or attempting suicide, intentional self-injury.
b) Whilst under influence of intoxicating liquor or drugs.
c) The abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as drugs and alcohol.
d) Whilst engaged in any adventurous sports like hand gliding, mountaineering, rock climbing, sky diving, professional or amateur racing, parachuting, skiing, ice skating, ballooning, river rafting, polo playing, horse racing or sports of similar nature and/or hazardous activities like Persons working in underground mines, explosives, workers involved in electrical installations with High tension supply, jockeys, circus Personnel or activities of similar nature
e) Committing any breach of law with criminal intent.
f) War, Civil War, invasion, act of foreign enemies, revolution, insurrection, mutiny, military or usurped power, seizure, capture, arrest,
restraint, or detainment, confiscation, or nationalization or requisition by or under the order of any government or public authority.
6. Consequential loss of any kind and/or any legal liability
7. Pregnancy including child birth, miscarriage, abortion or complication arising there from.
8. Participation in any naval, military or air force operations.
9. Curative treatments or interventions
10. Venereal or sexually transmitted diseases.
11. HIV and or related illness
12. Insured Person's participation or involvement in naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing.
Extra Benefits under the Policy in addition to capital sum Insured, in case the liability under the policy for Accidental Claim has been admitted.
Section 4 - Health Insurance
WHAT WE COVER
The Hospitalization expenses incurred by the insured when he/she sustains any injury or contracts any disease and is advised hospitalization by a Medical Practitioner
We will pay Reasonable and Customary charges of the following Hospitalization expenses:
1. Room, Boarding and Nursing Expense as provided in the Hospital/Nursing Home subject to following limits.
a) Sub limit per day for Normal Room
b) Expenses: 1.0% of Basic Sum Insured.
c) Sub limit per day for Intensive Care/Therapeutic Unit expenses: 2% of Basic Sum Insured
d) Registration Charges of Hospital/Nursing Home : Actual
2. Medical Practitioner/ Anesthetist, Consultant fees, Surgeons fees and similar expenses subject to a limit of 25% of Basic Sum Insured (excluding sum insured for Critical Illness).
3. Expenses on Anesthesia, Blood, Oxygen, Operation Theatre, Surgical Appliances, Medicines and Drugs, Diagnostic Materials and X-ray, Dialysis, Chemotherapy, Radiotherapy, Cost of Pacemaker, Artificial Limbs, Cost of Organs and similar expenses subject to a limit of 40% of Basic Sum Insured .
4. Expenses on Vitamins and Tonics only if forming part of treatment as certified by the attending Medical Practitioner.
5. Expenses incurred for Domiciliary Hospitalization will be paid up to a maximum aggregate sub-limit of 20% of the Basic Sum Insured.
6. Additional Benefits
a) An additional Daily Allowance amount equivalent to 0.1% of the Basic Sum Insured or Rs. 250/- per day whichever is less, for the duration of Hospitalization towards miscellaneous expenses. The maximum amount payable under this extension is limited to Rs 2500/- in a year
b) Ambulance charges in connection with any admissible claim limited to 1.0% of the Basic Sum Insured or Rupees 1000/- whichever is less for each claim.
1. Pre-Hospitalization medical expenses up to 30 days and Post Hospitalization medical expenses up to 60 days will also be reimbursed along with the aforesaid Hospitalization expenses subject to the overall Sum Insured limit of the Insured Person. Any Nursing expenses during Pre and Post Hospitalization will be considered only if Qualified Nurse is employed on the advice of the attending Medical Practitioner for the duration specified.
2. If medical expenses are incurred under two Policy Periods, Our total liability shall not exceed the Sum Insured of the Policy during which the Insured Person's medical treatment commenced and the entire claim will be considered under that Policy only.
WHAT WE EXCLUDE
1. Hospitalization/ Domiciliary Hospitalization expenses arising from all Diseases/ Injuries which are in Pre-existing Condition.
a) Any claim occurring as a result of any condition, ailment or injury or related condition(s) for which the insured had signs or symptoms, and/or was diagnosed, and/or received medical advice/ treatment, within 48 months prior to the insured's first policy with the Company would not be payable until 48 months of continuous coverage have elapsed, since inception/ reinstatement of the first policy with the Us.
2. Hospitalization/Domiciliary Hospitalization expenses for any Disease which incepts during first 30 days of commencement of this Insurance cover.
3. Hospitalization/Domiciliary Hospitalization expenses incurred in the first year of operation of the insurance cover on treatment of the following Diseases :
Cataract
Benign Prostatic Hypertrophy
Myomectomy, Hysterectomy
Hernia, Hydrocele
Fistula in anus, Piles
Arthritis, Gout, Rheumatism
Joint replacement unless warranted due to an accident
Sinusitis and related disorders
Medical Management of tonsillitis.
Stone in the urinary and biliary systems
Dilatation and Curettage
Skin and all internal tumors/cysts/nodules/polyps of any kind, including breast lumps unless malignant, adenoids and hemorrhoids
Dialysis required for renal failure
Surgery on tonsils and sinuses
Gastric and duodenal ulcers
4. Hospitalization for only Investigations and diagnosis.
5. Injury or Diseases directly or indirectly caused by or arising from or attributable to war, invasion, act of foreign enemy, war like operation (whether war be declared or not).
6. Circumcision unless necessary for the treatment of a Disease not otherwise excluded or required as a result of accidental bodily injury;
vaccination, except as may be requested for post animal bite treatment inoculation, cosmetic or aesthetic treatment of any description (including any complications arising thereof), plastic surgery except those relating to treatment of Injury or Disease.
7. Cost of spectacles and contact lens or hearing aids.
8. Dental treatment or surgery of any kind unless requiring inpatient hospitalization due to Accident.
9. Convalescence, general debility, run down condition or rest cure, external congenital disease or defects or anomalies, sterility, venereal disease, intentional self-injury and use of intoxicating drugs/alcohols.
10. Any expense on treatment related to HIV, AIDS and all related medical conditions.
11. Expenses on Diagnostic, X-Ray, or Laboratory examinations unless related to the treatment of Disease or Injury falling within ambit of Hospitalization claim.
12. Expenses on treatment arising from any infertility, sub fertility or assisted conception treatment.
13. Expenses on Voluntary termination of pregnancy within first 12 Weeks.
14. Injury or Diseases directly or indirectly caused by or contributed to by nuclear weapons/material.
15. Any expense on treatment of Insured Person as an outpatient in a Hospital.
16. Any expense on Naturopathy, non-allopathic treatment and/or any treatments not approved by Indian Medical Council any expense related to Disease/Injury suffered whilst engaged in adventurous sports.
17. Expenses on treatment arising from or traceable to pregnancy, childbirth, miscarriage, an accidental abortion or complications of any of these, including caesarean section. This exclusion is not applicable to ectopic pregnancy.
18. Any Expense of any treatment related to Human T-Cell Lymphotropic Viruses types III (III-LB-III) or Lymphadenopathy Associated Viruses (LAV) or the Mutant derivatives or Variations Deficiency Syndrome.
19. External medical equipment of any kind used at home as post hospitalization care like wheelchairs, crutches, instruments used in treatment of Sleep Apnea Syndrome (C.P.A.P) or Continuous -Peritoneal Ambulatory Dialysis (C.P.A.D) and oxygen concentrate for bronchial asthmatic condition, etc.
20. War, riots, strike, terrorism acts, nuclear weapon induced treatment section.
GENERAL EXCLUSIONS APPLICABLE TO THE POLICY
1) Radioactive contamination
Any loss, damage or legal liability directly or indirectly caused by:
ionizing radiation or radioactive contamination from nuclear fuel or nuclear waste arising from burning nuclear fuel; or the radioactive, poisonous, explosive or other dangerous properties of any nuclear equipment or nuclear part of that equipment.
2) War Risks
Any consequence whatsoever resulting directly or indirectly from or in connection with any of the following regardless of any other contributing cause or event. War, invasion, act of foreign enemy hostilities or a warlike operation or operations (whether war be declared or not) civil war rebellion revolution insurrection civil commotion assuming the proportions of or amounting to an uprising military or usurped power.
3) Sonic bangs
Any loss, damage or legal liability directly or indirectly caused by pressure waves caused by aircraft and other flying objects traveling at or above the speed of sound.
4) Pollution and/or Contamination
Loss, destruction or damage caused to the insured property by pollution or contamination excluding
Pollution or contamination which itself results from a peril hereby insured against Any peril hereby insured against which itself results from pollution or contamination
5) Gradually occurring losses
Loss or damage by Wear and tear, depreciation, insects, vermin's, moth, fungus, corrosion, rust, atmospheric or climatic conditions ingress of water, gradually operating cause, process of cleaning, dyeing, repair, alteration or restoration.
6) Willful Act
Loss or damage caused by or arising out of willful act of the insured or any person acting on his/her behalf including circumstance, fact or matter You are or ought to be reasonably aware prior to the commencement of this contract.
7) Accidental External
Loss or damage caused by arising out of accidental external means other than due to the perils covered
8) Consequential Losses
Loss by delay, loss of market, loss of goodwill and / or any other consequential or indirect loss or damage not covered under the Policy.
9) Public Authority
Loss, destruction or damage caused to the property insured by burning by order of any Public Authority
Permanent or temporary dispossession resulting from confiscation, commandeering, requisition or destruction by order of the Government or any lawfully constituted Authority
10) Liability
(a) Liability more specifically insured elsewhere
(b) Liability arising out of Asbestosis or any matter related to or arising out of the sale, manufacture, production, distribution or the like of asbestos.
GENERAL CONDITIONS APPLICABLE TO THE POLICY
1. Reasonable care
You must take all reasonable steps to protect the property insured, prevent damage or accidents and maintain the property insured in a sound condition.
2. Mis-description
This Policy shall be void and premium paid shall be forfeited in the event of mis-representation, mis- description or non-disclosure of any materials facts as sought to be declared on the Proposal Form by You or Your representative.
3. Alteration of Risk
The cover afforded under this Policy shall be suspended and no payment shall be made hereunder if there is any material changes in the facts and matters stated in the proposal
The ownership of the building, stocks/contents/any other insured property passes from You to any other person or entity otherwise than by the operation of the law of succession as applicable.
