Sarv Suraksha Policy Wording PDF
Sarv Suraksha Policy Wording PDF
Mentioned below are the standard coverages offered under Sarv Suraksha policy. Your entitlement for coverage/benefits shall be restricted to the coverage/benefits as
mentioned in your policy schedule.
§ Accidental Death: Pays the full sum insured in case of an accidental death.
§ Permanent Total or Partial Disablement: Pays the full sum insured in case of an accident results in permanent total or partial disablement.
§ Accident Hospitalization: Reimburses reasonable and customary medical expenses incurred up to maximum sum insured.
§ Householders Cover: Covers the household contents against a) Fire, Allied Perils, Earthquake & Terrorism and b) Burglary and/or Theft.
§ Critical Illness: Pays the full sum insured on first diagnosis of any one of the 10 critical illnesses covered under the policy after the first 90 days of commencement
of the policy and provided that the insured person survives a period of 30 days from the date of the first diagnosis.
§ Loss of Job: Pays upto 3 equated monthly installments EMI's in case of a loss of job of the insured person in view of mergers and acquisitions (M&A).
§ Credit Shield: Pays the balance outstanding loan amount upto the maximum sum insured in the event of Accidental Death or Permanent Total Disability.
§ Garage Cash: Reimburses a daily benefit towards the cost of alternate means of transport for up to a maximum of 7 days provided that the repairs are caused due
to accidental loss or damage and the claim amount under the Motor Insurance policy exceeds Rs. 5000.
Step 2 - Fill out the relevant claim form (We will share a soft copy of claim form on your email id. Alternatively, download the claim form from our website under Claims
tab.) Our Claims representative will contact you for assistance in filling the form and documentation
Step 3 - Send the duly signed claim form along with requisite documentation to our customer service office for claim processing.
Be sure to update your contact details if missing in the policy. We will update you of the claim at every stage through SMS and emails.
Track your claims real time. It's simple... Download our mobile app from https://m.hdfcergo.com/download or relevant app store. Just link your policy in 2 easy steps by
providing your policy no and Date of Birth / Policy start date.
§ For other changes like correction in Date of Birth, we may request for a government age proof (PAN Card, Aadhar Card, Passport etc) for effecting the changes. You can fax
or email a copy for effecting the changes
Our agreement to insure You is based on Your Proposal to Us, which is the basis of 7.2. This Policy may be cancelled by the Insured at anytime by giving at least
this agreement, and Your payment of the premium and the realization thereof by us. 14 days written notice to the Company. The Company will refund
This Policy records the entire agreement between Us and sets out what We insure, premium on a pro-rata basis by reference to the time cover is provided,
how We insure it, and what We expect of You and what You can expect of Us. subject to a minimum retention of premium of 25%. No refund of premium
shall be due on cancellation if the Insured has made a claim under this
GENERAL CONDITIONS APPLICABLE TO ALL COVERS Policy.
The due observance of and compliance with the terms, provisions, warranties 8.1. If any dispute or difference shall arise as to the quantum to be paid under
and conditions of this Policy insofar as they relate to anything to be done or this policy (liability being otherwise admitted) such difference shall
complied with by the Insured and/or the Insured's Family shall be a condition independently of all other questions be referred to the decision of a sole
precedent to any liability of the Company under this Policy. arbitrator to be appointed in writing by the parties hereto or if they cannot
agree upon a single arbitrator within 30 days of any party invoking
2. Reasonable Care arbitration, the same shall be referred to a panel of three arbitrators,
comprising of two arbitrators, one to be appointed by each of the parties
The Insured shall take all reasonable steps to prevent a claim from arising under to the dispute/difference and the third arbitrator to be appointed by such
this Policy; two arbitrators and arbitration shall be conducted under and in
accordance with the provisions of the Arbitration and Conciliation Act,
3. Duties and Obligations after Occurrence of an Insured Event 1996. It is clearly agreed and understood that no difference or dispute
shall be referable to arbitration as hereinbefore provided, if the Company
It is a condition precedent to the Company's liability under this Policy that, upon has disputed or not accepted liability under or in respect of this policy. It is
the happening of any event giving rise to or likely to give rise to a claim under this hereby expressly stipulated and declared that it shall be a condition
Policy: precedent to any right of action or suit upon this policy that the award by
such arbitrator/ arbitrators of the amount of the loss or damage shall be
3.1. The Insured shall immediately and in any event within 14 days give first obtained.
written notice of the same to the address shown in the Schedule for this
purpose, and in case of notification of an event likely to give rise to a 8.2. The applicable law in and of the arbitration shall be Indian law.
claim to specify the grounds for such belief, and
8.3. The expenses of the arbitrator shall be shared between the parties
3.2. The Insured shall within 28 days deliver to the Company its completed equally and such expenses along with all reasonable costs in the
claim form detailing the loss or damage that has occurred and an conduct of the arbitration shall be awarded by the arbitrator to the
estimate of the quantum of any claim along with all documentation successful party, or where no party can be said to have been wholly
required to support and substantiate the amount sought from the successful, to such party; as substantially succeeded.
Company, and
8.4. It is agreed condition precedent to any right of action or suit upon this
3.3. The Insured shall expeditiously provide the Company and its Policy that an award by such arbitrator or arbitrators shall be first
representatives and appointees with all the information, assistance, obtained.
records and documentation that they might reasonably require, and
8.5. In the event that these arbitration provisions shall be held to be invalid
3.4. The Insured shall not admit liability or settle or make or promise any then all such disputes shall be referred to the exclusive jurisdiction of the
payment in respect of any claim which may be the subject of indemnity Indian Courts.
hereunder, or incur any costs or expenses in connection therewith,
without the written consent of the Company which shall be entitled to 9. Notices
take over and conduct in the name of the Insured the defense and/or
settlement of any such claim, for which purpose the Insured shall give all Any notice, direction or instruction given under this policy of insurance shall be in
the information and assistance that the Company may reasonably writing and delivered by hand, post, or facsimile to:
require.
In case of the Insured, at the address specified in the Schedule or last known
4. Contribution - Not Applicable to Section 1 (Critical Illness) & Section 2 address.
(Personal Accident)
In case of the Company at:
If, at the time of any Claim, there is, or but for the existence of this Policy, would HDFC ERGO General Insurance Company Limited
be any other policy of indemnity or insurance in favour of or effected by or on 6th Floor, Leela Business Park, Andheri Kurla Road,
behalf of the Insured applicable to such claim, then the Company shall not be Andheri (East), Mumbai – 400 059, India
liable to pay or contribute more than its rateable proportion of any loss or Tel.: 91 22 66383600. Fax: 91 22 66383699
damage.
Notice and instructions will be deemed served 7 days after posting or
5. Subrogation - Not Applicable to Section 1 (Critical Illness) & Section 2 immediately upon receipt in the case of hand delivery, facsimile or e-mail.
(Personal Accident)
10. Governing Law
The Insured and any claimant under this Policy shall at the expense of the
Company do or concur in doing or permit to be done all such acts and things that The construction, interpretation and meaning of the provisions of this Policy shall
may be necessary or reasonably required by the Company for the purpose of be determined in accordance with Indian law. The section headings of this Policy
enforcing any civil or criminal rights and remedies or obtaining relief or indemnity are included for descriptive purposes only and do not form part of this Policy for
from other parties to which the Company shall be or would become entitled or the purpose of its construction or interpretation.
subrogated upon the Company paying for or making good any loss or damage
under this Policy whether such acts and things shall be or become necessary or 11. Entire Contract
required before or after the Insured's indemnification by the Company.
The Policy constitutes the complete contract of insurance. No change or
6. Fraud alteration in this Policy shall be valid or effective unless approved in writing by
the Company, which approval shall be evidenced by an endorsement on the
If the Insured or any claimant under this Policy shall make or advance any claim Policy.
knowing the same to be false or fraudulent as regards amount or otherwise, this
Policy shall be void and all claims or payments hereunder shall be forfeited and if 12. Territorial Limits
paid shall be recoverable from the Insured.
This Policy covers insured events arising during the Policy Period as specified in
7. Cancellation the Policy Schedule. The Company's liability to make any payment shall be to
make payment within India and in Indian Rupees only.
7.1. This Policy may be cancelled by or on behalf of the Company by giving
the Insured at least 14 days written notice and in such event the 13. Renewal
Company shall refund to the Insured a pro-rata premium for the
unexpired Policy Period. For the avoidance of doubt, the Company shall This Policy is renewable for life unless the Insured Person or anyone acting on
remain liable for any claim that was made prior to the date upon which behalf of an Insured Person has acted in an improper, dishonest or fraudulent
this insurance is cancelled. manner or there has been any misrepresentation under or in relation to this
HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016). CIN: U66030MH2007PLC177117. Registered & Corporate
Office: 1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai – 400 059. For more details
on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade Logo of HDFC ERGO General Insurance Company Ltd. displayed above belongs to HDFC LTD and ERGO International AG and used by
HDFC ERGO General Insurance Company under license. Toll-free: 1800 2 700 700 | Fax: 91 22 66383699 | [email protected] | www.hdfcergo.com. UIN: HDFPAIP10004V010910. IRDAI Reg No. 146. 1
HDFC ERGO General Insurance Company Limited
Policy Wording
Policy or the renewal of the Policy poses a moral hazard Company, in the event of misrepresentation, mis-description or non disclosure
of any material fact.
We are NOT under any obligation to:
20. Notification of claim
i. Send renewal notice or reminders.
is the process of notifying a claim to the insurer or TPA by specifying the timelines
ii. Renew it on same terms or premium as the expiring Policy. Any change in as well as the address / telephone number to which it should be notified.
benefits or premium (other than due to change in Age) will be done with the
approval of the Insurance Regulatory and Development Authority and will be 21. Condonation of delay
intimated to You atleast 3 months in advance. In the likelihood of this policy
being withdrawn in future, we will intimate you about the same 3 months prior The Company may condone delay in claim intimation/ document submission
to expiry of the policy. You will have the option to migrate to similar indemnity on merit, where it is proved that delay in reporting of claim or submission of
health insurance policy available with us at the time of renewal with all the claim documents, is due to reasons beyond the control of the insured.
accrued continuity benefits such as cumulative bonus, waiver of waiting
period etc. provided the policy has been maintained without a break as per Notwithstanding the above, delay in claim intimation or submission of claim
portability guidelines issued by IRDA. documents due to reasons beyond the control of the insured shall not be
condoned where such claims would have otherwise been rejected even if
iii. We will not apply any additional loading on your policy premium at renewal reported in time.”
based on claim experience.
SECTION 1. CRITICAL ILLNESS
We shall be entitled to call for any information or documentation before agreeing
to renew the Policy. Your Policy terms may be altered based on the information If the Insured Person named in the schedule is diagnosed as suffering from a Critical
received. Illness which first occurs or manifests itself during the Policy Period, and the Insured
survives for a minimum of 30 days from the date of diagnosis, the Company shall pay
All applications for renewal of the Policy must be received by Us before the end the Critical Illness Benefit as shown in the schedule.
of the Policy Period. A grace period of 30 days for renewing the Policy is available
under this Policy. Any disease/condition contracted during the Grace Period will CRITICAL ILLNESS COVERAGE
not be covered and will be treated as a Pre-existing Condition.
1. First Heart Attack -of Specified Severity:
14. Continuity
The first occurrence of myocardial infarction which means the death of a portion
In case a customer wishes to renew the policy with us after the loan is closed, we of the heart muscle as a result of inadequate blood supply to the relevant area.
shall provide the continuity benefit by offering a similar stand alone product The Diagnosis for this will be evidenced by all of the following criteria:
pertaining to the section which the customer wishes to renew, preserving the
benefits accrued. ¡ A history of of typical clinical symptoms consistent with the diagnosis of
Acute Myocardial Infarction (for e.g. typical chest pain)
15. Loadings ¡ new characteristic electrocardiogram changes
¡ elevation of infarction specific enzymes, Troponins or other biochemical
We may apply a risk loading on the premium payable (based upon the markers
declarations made in the proposal form and the health status of the persons
proposed for insurance). The maximum risk loading applicable for an individual The following are excluded:
shall not exceed above 100% per diagnosis/ medical condition and an overall
risk loading of over 150% per person. These loadings are applied from ¡ Non-ST-segment elevation myocardial infarction (NSTEMI) with only
Commencement Date of the Policy including subsequent renewal(s) with Us or elevation of Troponin I or T
on the receipt of the request of increase in Sum Insured (for the increased Sum ¡ Other acute Coronary Syndromes
Insured). ¡ Any type of angina pectoris
We will inform You about the applicable risk loading through a counter offer letter. 2. Open Chest CABG:
You need to revert to Us with consent and additional premium (if any), within 15
days of the issuance of such counter offer letter. In case, you neither accept the The actual undergoing of open chest surgery for the correction of one or more
counter offer nor revert to Us within 15 days, We shall cancel Your application coronary arteries, which is/are narrowed or blocked, by coronary artery bypass
and refund the premium paid within next 7 days. graft (CABG). The diagnosis must be supported by coronary angiography and
the realisation of the surgery has to be confirmed by a specialist Medical
Please note that We will issue Policy only after getting Your consent. Practitioner.
You have a period of 15 days from the date of receipt of the Policy document to ¡ Angioplasty and/or any other intra-arterial procedures
review the terms and conditions of this Policy. If You have any objections to any ¡ Any key-hole or laser surgery
of the terms and conditions, You have the option of cancelling the Policy stating
the reasons for cancellation and You will be refunded the premium paid by You 3. Stroke resulting in Permanent symptoms:
after adjusting the amounts spent on any medical check-up, stamp duty charges
and proportionate risk premium. You can cancel Your Policy only if You have not Any cerebrovascular incident producing permanent neurological sequelae. This
made any claims under the Policy. All Your rights under this Policy will includes infarction of brain tissue, thrombosis in an intra-cranial vessel,
immediately stand extinguished on the free look cancellation of the Policy. Free haemorrhage andembolisation from an extracranial source. The Diagnosis has
look provision is not applicable and available at the time of renewal of the Policy. to be confirmed by a specialist Medical and evidenced by typical clinical
symptoms as well as typical findings in CT Scan or MRI of the brain.
17. Condition Precedent
Evidence of permanent neurological deficit lasting for at least 3 months has to be
The fulfilment of the terms and conditions of this Policy (including the payment of produced.
premium by the due dates mentioned in the Schedule) in so far as they relate to
anything to be done or complied with by You or any Insured Person shall be The following are excluded:
conditions precedent to Our liability.
¡ Transient ischemic attacks (TIA)
18. Contribution ¡ Traumatic injury of the brain
¡ Vascular diseases affecting only the eye or optic nerve or vestibular
Is essentially the right of an insurer to call upon other insurers, liable to the same functions
insured, to share the cost of an indemnity claim on a ratable proportion of Sum
Insured. 4. Cancer of specified severity:
This clause shall not apply to any Benefit offered on fixed benefit basis. A malignant tumour characterised by the uncontrolled growth & spread of
malignant cells with invasion & destruction of normal tissues. This diagnosis
19. Disclosure to information norm must be supported by histological evidence of malignancy & confirmed by a
pathologist. The term cancer includes leukemia, lymphoma and sarcoma.
The Policy shall be void and all premium paid hereon shall be forfeited to the
HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016). CIN: U66030MH2007PLC177117. Registered & Corporate
Office: 1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai – 400 059. For more details
on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade Logo of HDFC ERGO General Insurance Company Ltd. displayed above belongs to HDFC LTD and ERGO International AG and used by
HDFC ERGO General Insurance Company under license. Toll-free: 1800 2 700 700 | Fax: 91 22 66383699 | [email protected] | www.hdfcergo.com. UIN: HDFPAIP10004V010910. IRDAI Reg No. 146. 2
HDFC ERGO General Insurance Company Limited
Policy Wording
The following are excluded: Insured for whom coverage has been renewed by the Named Insured, without a
break, for subsequent years.
¡ Tumours showing the malignant changes of carcinoma in situ & tumours
which are histologically described as pre-malignant or non invasive, 3. Any sexually transmitted diseases or any condition directly or indirectly caused
including but not limited to: Carcinoma in situ of breasts, Cervical dysplasia by or associated with Human T-Cell Lymphotropic Virus type III (III LB III) or
CIN-1, CIN -2 & CIN-3. Lymphadinopathy Associated Virus (LAV) or the Mutants Derivative or
¡ Any skin cancer other than invasive malignant melanoma Variations Deficiency Syndrome or any Syndrome or condition of a similar kind
¡ All tumours of the prostate unless histologically classified as having a commonly referred to as AIDS.
Gleason score greater than 6 or having progressed to at least clinical TNM
classification T2N0M0. 4. Treatment arising from or traceable to pregnancy, childbirth postpartum
¡ Papillary micro - carcinoma of the thyroid less than 1 cm in diameter complications including but not limited to caesarian section, birth defects and
¡ Chronic lymphocyctic leukaemia less than RAI stage 3 congenital anomalies.
¡ Microcarcinoma of the bladder
¡ All tumours in the presence of HIV infection 5. Occupational diseases such as occupational lung diseases including
asbestosis, pneumoconiosis, occupational asthma and occupational skin
5. Kidney Failure Requiring Regular Dialysis: diseases.
End stage renal disease presenting as chronic irreversible failure of both 6. War, whether war be declared or not, invasion, act of foreign enemy, hostilities,
kidneys to function, as a result of which either regular renal dialysis civil war, insurrection, terrorism or terrorist acts or activities, rebellion, revolution,
(haemodialysis or peritoneal dialysis) is instituted or renal transplantation is mutiny, military or usurped power, riot, strike, lockout, military or popular
carried out. Diagnosis must be confirmed by a specialist Medical Practitioner. uprising, civil commotion, martial law or loot, sack or pillage in connection
therewith, confiscation or destruction by any government or public authority or
6. Major Organ/Bone Marrow Transplant: any act or condition incidental to any of the above.
The actual undergoing of transplant of: 7. Naval or military operations of the armed forces or air force and participation in
operations requiring the use of arms or which are ordered by military authorities
¡ One of the following human organs: heart, lung, liver, pancreas, kidney , that for combating terrorists, rebels and the like.
resulted from irreversible end stage failure of the relevant organ or;
¡ Human bone marrow using haematopoietic stem cells. The undergoing of a 8. Any natural peril (including but not limited to storm, tempest, avalanche,
transplant must be confirmed by a specialist Medical Practitioner earthquake, volcanic eruptions, hurricane, or any other kind of natural hazard).
¡ Other Stem cell transplants 10. Consequential losses of any kind, be they by way of loss of profit, loss of
¡ Where only islets of langerhans are transplanted opportunity, loss of gain, business interruption, market loss or otherwise, or any
claims arising out of loss of a pure financial nature such as loss of goodwill or any
legal liability of any kind whatsoever.
7. Multiple Sclerosis with persistent symptoms:
11. Intentional self-injury and/ or the use or misuse of intoxicating drugs and/or
The definite occurrence of Multiple Sclerosis.The diagnosis must be supported alcohol.
by all of the following:
GENERAL CONDITIONS APPLICABLE TO SECTION 1
¡ Investigation including typical MRI and CSF findings, which unequivocally
confirm the diagnosis to be multiple Sclerosis. Due Observance
¡ There must be current clinical impairment of motor or sensory function,
which must have persisted for a continuous period of atleast 6 months. The due observance of and compliance with the terms, provisions, warranties and
¡ Well documented clinical history of exacerbations and remissions of said conditions of this Policy in so far as they relate to anything to be done or complied
symptoms or neurological deficits with atleast two clinically documented with by the Insured person shall be a condition precedent to the Company's liability
episodes atleast 1 month apart. under this Policy.
¡ Other causes of neurological damage such as SLE and HIV are excluded
Duties and Obligations of the Insured person as shown under section 1 of the
8. Surgery of Aorta schedule, upon the Diagnosis of an Event of Critical Illness
The actual undergoing of surgery for a disease of the aorta (meaning the It is a condition precedent to the Company's liability to make any payment under this
thoracic and abdominal aorta but not its branches, and excluding traumatic Policy that, upon the diagnosis of an event of Critical Illness:
injury of the aorta and- congenital narrowing of the aorta) needing excision and
surgical replacement of the diseased aorta with a graft. 1. The Insured person as shown in the schedule shall immediately and in any event
within 4 weeks of such diagnosis provide the Company with written notification of
9. Primary Pulmonary Arterial Hypertension a claim, and
The diagnosis by a Physician of primary pulmonary hypertension with 2. The Insured person as shown in the schedule shall expeditiously provide the
substantial right ventricular enlargement established by investigations including Company with or arrange for the Company to be provided with any and all
cardiac catheterization, resulting in permanent irreversible physical impairment information and documentation in respect of the Critical Illness, the claim and/or
to the degree of at least class 3 of the New York Heart Association Classification the Company's liability hereunder that may be requested, and the Insured
of cardiac impairment and resulting in the Insured being unable to perform his person as shown under Section 1 of the schedule shall present himself for
usual occupation. examination by the Company's medical advisors as may be considered
reasonably necessary by the Company at the Company's cost.
10. Permanent Paralysis of Limbs:
The Company shall be under no obligation to make any payment under this
Total and irreversible loss of use of two or more limbs as a result of injury or Policy until such time as the Insured person as shown in schedule has taken all
disease of the brain or spinal cord. A specialist Medical Practitioner must be of necessary steps to satisfy the Company that here has been an event of Critical
the opinion that paralysis will be permanent with no hope of recovery and must Illness within the terms of this Policy and this diagnosis has been confirmed by
be present for more than 3 months. the Company's medical advisors.
HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016). CIN: U66030MH2007PLC177117. Registered & Corporate
Office: 1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai – 400 059. For more details
on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade Logo of HDFC ERGO General Insurance Company Ltd. displayed above belongs to HDFC LTD and ERGO International AG and used by
HDFC ERGO General Insurance Company under license. Toll-free: 1800 2 700 700 | Fax: 91 22 66383699 | [email protected] | www.hdfcergo.com. UIN: HDFPAIP10004V010910. IRDAI Reg No. 146. 3
HDFC ERGO General Insurance Company Limited
Policy Wording
2. “Critical Illness” means an illness, sickness or a disease or a corrective measure each and every form of impairment mentioned in the PPD Table:
as specified in Section 1 of this Policy.
2.3.2. if the Accidental Bodily Injury causes the Insured's Permanent Partial
3. “Critical Illness Benefit” means the amount specified in the Schedule, which is Disability within 12 months of the Accidental Bodily Injury being
the maximum amount for which the Company may be liable to make payment for sustained other than as specified in the PPD Table above, the
any Critical Illness. Company's liability to make payment shall be as follows:
4. “Insured person” means the persons named in the Schedule provided that an 2.3.2.1. In the case of the Insured suffering partial loss or functional
Insured person has attained the age of 18 years and is not older than 65 years of impairment of one of the body parts or sensory organs mentioned in
age at the commencement of the Policy Period”. the PPD Table, the Company will pay a corresponding proportion of
the percentages specified in the PPD Table, as advised by the
5. “Named Insured” means the person or organization named in the Schedule. Company's medical advisors.
6. “Physician” means a qualified medical practitioner holding a valid and subsisting 2.3.2.2. In the case of the Insured's Permanent Partial Disability of a nature
license, granted by the appropriate licensing authority, acting within the scope of not detailed in the PPD Table, the Company will pay a proportion of the
his license, and who is not related to the Insured or the Named Insured by blood Sum Insured by reference to the degree to which the Insured's normal
or marriage. functional physical capacity has been impaired, as advised by the
Company's medical advisors.
7. “Medical Practitioner” means a person who holds a valid registration from the
Medical Council of any State or Medical Council of India or Council for Indian 2.3.3. If the Insured was suffering from any Permanent Partial Disability
Medicine or for Homeopathy set up by the Government of India or a State prior to the date upon which Accidental Bodily Injury was sustained,
Government and is thereby entitled to practice medicine within its jurisdiction; then the Company's liability to make payment hereunder shall be
and is acting within the scope and jurisdiction of licence. Medical Practitioner reduced by the extent of the same as advised by the Company's
who is sharing the same residence with the Insured person`s and is a member of medical advisors.
Insured Person's family are not considered as Medical Practitioner under the
scope of this Policy. 2.3.4. If the Accidental Bodily Injury sustained by the Insured causes a
subsequent Claim by the Insured under Coverage Parts A or B, then
8. “Policy” means the proposal, the Schedule, the Policy document and any this Coverage Part shall not be operative and the amounts payable
endorsements attaching to or forming part thereof either on the effective date or under either Coverage Parts A or B shall be reduced by the amount of
during the Policy Period. any payment made under this Coverage Part.
9. “Policy Period” means the date between the commencement date specified in Permanent Total Disability & Permanent Partial Disability
the Schedule and, in respect of any Insured, the earlier of (a) the expiry date
specified in the Schedule and (b) the occurrence of an event of Critical Illness. Scale of Benefits Description Compensation as % of sum insured
10. “Schedule” means the Schedule, and any annexure to it, attached to and forming Death 100
part of this Policy. Loss of sight on both eyes 125
Loss of both hands 125
11. “Congenital Anomaly” refers to a condition(s) which is present since birth, and Loss of both feet 125
which is abnormal with reference to form, structure or position. Loss of one hand and one foot 125
Loss of one eye one hand 125
SECTION 2. PERSONAL ACCIDENT Loss of one eye one foot 125
Other total permanent disablement 100
1. Insured Event An arm at the shoulder joint 70
An arm above the elbow joint 65
1.1. In the event of any Accidental Bodily Injury sustained by the Insured
An arm beneath the elbow joint 60
during the Policy Period, the Company will make payment under such
A hand at the wrist 55
Coverage Parts as are specified in the Schedule as being operative.
A thumb 20
1.2. The Company's liability to make payment shall be limited to the Sum An index finger 10
Insured for each Coverage Part and 125% of Sum Insured under Part B. Any other finger 5
A leg above mid-thigh 70
Coverage Parts A leg upto mid-thigh 60
A leg upto beneath the knee 50
2.1. Coverage Part A: Death A leg upto mid-calf 45
A foot at the ankle 40
2.1.1. The Company will pay the Sum Insured in the event of Accidental A large toe 5
Bodily Injury causing the Insured's death within 12 months of the Any other toe 2
Accidental Bodily Injury being sustained, where after this Policy shall
Any eye 50
expire.
Hearing loss on one ear 30
2.1.2. The Company will also, in addition to the Sum Insured, pay up to 2% Hearing loss on both ears 75
of the Sum Insured or Rs.5,000/- (whichever is lower) towards the Sense of smell 10
cost of transporting the Insured's remains from the place of death to Sense of taste 5
the hospital/ residence and/or cremation and/or burial ground.
SPECIFIC DEFINITIONS APPLICABLE TO SECTION 2
2.2. Coverage Part B: Permanent Total Disability
The following words or terms shall have the meaning ascribed to them wherever
2.2.1. In the event of Accidental Bodily Injury causing the Insured's they appear in this Policy, and references to the singular or to the masculine shall
Permanent Total Disability within 12 months of the Accidental Bodily include references to the plural or to the female wherever the context so permits:
Injury being sustained, the Company will pay 125% of the Sum
Insured, where after this Policy shall expire. 1. “Policy” means the proposal, the Schedule, the Policy documents and any
endorsements attaching to or forming part thereof either on the effective date or
2.2.2. If the Insured was suffering from any permanent disability prior to the during the Policy Period.
date upon which Accidental Bodily Injury was sustained, then the
Company's liability to make payment hereunder shall be reduced by 2. “Claim” means a Claim under a Coverage Part in respect of an insured event
the extent of the same, as advised by the Company's medical that has taken place or is likely to take place.
advisors.
3. “Schedule” means the schedule, and any annexure to it, attached to and
2.3. Coverage Part C: Permanent Partial Disability forming part of this Policy.
2.3.1. In the event of Accidental Bodily Injury causing the Insured's 4. “Accident or Accidental” means a sudden, unforeseen and involuntary event
Permanent Partial Disability as mentioned in the PPD Table below caused by external, visible and violent means.
within 12 months of the Accidental Bodily Injury being sustained, the
Company will pay the percentage of the Sum Insured specified for 5. “Bodily Injury” means physical bodily harm or injury, but does not include any
HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016). CIN: U66030MH2007PLC177117. Registered & Corporate
Office: 1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai – 400 059. For more details
on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade Logo of HDFC ERGO General Insurance Company Ltd. displayed above belongs to HDFC LTD and ERGO International AG and used by
HDFC ERGO General Insurance Company under license. Toll-free: 1800 2 700 700 | Fax: 91 22 66383699 | [email protected] | www.hdfcergo.com. UIN: HDFPAIP10004V010910. IRDAI Reg No. 146. 4
HDFC ERGO General Insurance Company Limited
Policy Wording
mental sickness, disease or illness. AIDS.(Acquired Immune Deficiency Syndrome) and/or mutant derivatives or
variations thereof however caused.
6. “Physician” means a qualified medical practitioner holding a valid and
subsisting license, granted by the appropriate licensing authority, and acting 12. Pregnancy, resulting childbirth, miscarriage, abortion, or complication arising
within the scope of his license. out of any of the foregoing.
7. “Medical Practitioner” means a person who holds a valid registration from the 13. The Insured persons' participation in any naval, military or air force operations
Medical Council of any State or Medical Council of India or Council for Indian whether in the form of military exercises or war games or actual engagement
Medicine or for Homeopathy set up by the Government of India or a State with the enemy, whether foreign or domestic.
Government and is thereby entitled to practice medicine within its jurisdiction; If the Company asserts that by reason of these Exclusions any Claim is not covered
and is acting within the scope and jurisdiction of licence. Medical Practitioner by this Policy, the burden of proving that such Claim is covered shall be upon the
who is sharing the same residence with the Insured person`s and is a member of Insured person.
Insured Person's family are not considered as Medical Practitioner under the
scope of this Policy. SECTION 3. ACCIDENTAL HOSPITALIZATION BENEFIT
8. “Permanent Total Disability” means a Physician certified total, continuous If You are hospitalized on the advice of a Doctor because of accidental Bodily Injury
and permanent: sustained during the Policy Period, then We will reimburse You, Reasonable and
Customary Medical Expenses incurred up to a maximum sum insured shown in the
a. loss of sight of both eyes; schedule for this section aggregate in any one policy period. The medical expenses
reimbursable would include
b. Physical separation of or loss of ability to use both hands or both feet,
1. The reasonable charges that You/your family member named in the schedule
c. physical separation of or loss of ability to use one hand and one foot; necessarily incur on the advice of a Doctor As an in-patient in a Hospital for
accommodation; nursing care; the attention of medically qualified staff;
d. loss of sight on one eye and physical separation of or loss of ability to use undergoing medically necessary procedures and medical consumables.
either one hand or one foot.
2. Ambulance charges for carrying you from the site of accident to the nearest
9. “Insured” means the person or organization named in the Schedule. hospital subject to a limit of Rs. 1000 per claim.
No indemnity is available hereunder and no payment will be made by the Company 4. In-patient Care means treatment for which the Insured Person has to stay in a
for any Claim directly or indirectly caused by, based on, arising out of or howsoever Hospital for more than 24 hours for a covered event.
attributable to any of the following:
5. Medically Necessary means any treatment, test, medication, or stay in Hospital
1. Suicide, attempted suicide or self inflicted injury or illness; or part of stay in Hospital which
2. Whilst under the influence of intoxicating liquor or drugs; as per police charges or a. Is required for the medical management of the Illness or injury suffered by the
proved medically. Insured Person;
b. Must not exceed the level of care necessary to provide safe, adequate and
3. Any deliberate or intentional, unlawful or illegal activities with criminal intent, appropriate medical care in scope, duration or intensity.
error, or omission of the Insured person. c. Must have been prescribed by a Medical Practitioner.
d. Must conform to the professional standards widely accepted in international
4. From war (whether declared or not), civil war, invasion, act of foreign enemies, medical practice or by the medical community in India.
rebellion, revolution, insurrection, mutiny, military or usurped power, seizure,
capture, arrest, restraint or detainment, confiscation or nationalization or 6. Surgical Procedure means manual and/or operative procedure(s) required for
requisition of or damage y or under the order of any government or public local treatment of an Illness or injury, correction of deformities and defects, diagnosis
authority. and cure of diseases, relief of suffering or prolongation of life, performed in a
Hospital or day care centre by a Medical Practitioner.
5. Any consequential losses of any kind, and/or any actual or alleged legal liability
of the Insured person. 7. Outpatient Treatment means consultation, diagnosis or medical treatment taken
by any Insured Person at an outpatient department of a Hospital, clinic or
6. Whilst engaging in aviation or ballooning, whilst mounting into, dismounting from associated facility, provided that he is not Hospitalised.
or travelling in any balloon or aircraft other than as a passenger (fare paying or
otherwise) in any duly licensed standard type of aircraft anywhere in the world. 8. Illness means a sickness (a condition or an ailment affecting the general
soundness and health of the Insured Person's body) or a disease (affliction of the
7. Any loss suffered by the Insured person on account of his participation as the bodily organs having a defined and recognised pattern of symptoms) or
driver, co-driver or passenger of a motor vehicle during motor racing or trial runs. pathological condition leading to the impairment of normal physiological function
which manifests itself during the Policy Period and requires medical Treatment.
8. Any loss caused either directly or indirectly by nuclear energy, radiation. For the avoidance of doubt, Illness does not mean and this Policy does not cover
any mental illness or sickness or disease (including but not limited to a
9. Curative treatments or interventions that the Insured person performs or has had psychiatric condition, disorganisation of personality or mind, or emotions or
performed on his body against medical advice or without medical advice. behaviour) even if caused by or aggravated by or related to an Accident or
Illness.
10. Venereal or sexually transmitted disease.
9. Injury means accidental physical bodily harm excluding illness or disease solely
11. HIV (Human Immunodeficiency Virus) and/or any HIV related illness including and directly caused by external, violent and visible and evident means which is
HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016). CIN: U66030MH2007PLC177117. Registered & Corporate
Office: 1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai – 400 059. For more details
on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade Logo of HDFC ERGO General Insurance Company Ltd. displayed above belongs to HDFC LTD and ERGO International AG and used by
HDFC ERGO General Insurance Company under license. Toll-free: 1800 2 700 700 | Fax: 91 22 66383699 | [email protected] | www.hdfcergo.com. UIN: HDFPAIP10004V010910. IRDAI Reg No. 146. 5
HDFC ERGO General Insurance Company Limited
Policy Wording
verified and certified by a Medical Practitioner. 5. “Bodily Injury” means physical bodily harm or injury, but does not include any
mental sickness, disease or illness.
10. Medical Advise means any consultation or advise from a Medical Practitioner
including the issue of any prescription or repeat prescription. 6. “Insured” means the persons, or a person within a category, named in the
Schedule.
11. 8) Medical Expenses means those reasonable and customary medical
expenses that an Insured Person has necessarily and actually incurred for 7. “Named Insured” means the person or organization named in the Schedule.
medical treatment during the Policy Period on the advice of a Medical
Practitioner due to Illness or Accident occurring during the Policy Period, as long 8. “Policy Period” means the date between the commencement date specified in
as these are no more than would have been payable if the Insured Person had the Schedule and, in respect of any Insured person or any person within a
not been insured and no more than other hospitals or doctors in the same locality category of Insured persons, the earlier of (a) the expiry date specified in the
would have charged for the same medical treatment. Schedule and (b) the admission of a Claim under either Coverage Parts A or B.
9. “Sum Insured” means the amount stated in the Schedule, which (unless
12. Hospital means any institution in India established for In-patient Care and Day expressly stated otherwise) is the maximum amount per Insured person or
Care Treatment of illness and/or injuries and which has been registered as a person within a category of Insured persons for which the Company will make
Hospital with the local authorities under the clinical Establishments (Registration payment for any and all claims in the aggregate in relation to the Coverage Part
and Regulation) Act, 2010 or under the enactments specified under the to which the Sum Insured relates during the Policy Period.
Schedule of Section 56(1) of the said Act OR complies with all minimum criteria
as under: SPECIFIC EXCLUSIONS APPLICABLE TO SECTION 5:
a. has at least 10 in-patient beds, in those towns having a population of less No indemnity is available hereunder and no payment will be made by the Company
than 10,00,000 and 15 in-patient beds in all other places, for any Claim directly or indirectly caused by, based on, arising out of or howsoever
attributable to any of the following:
b. has qualified nursing staff under its employment round the clock,
1. Suicide, attempted suicide or self inflicted injury or illness;
c. has qualified Medical Practitioner(s) in charge round the clock, 2. Whilst under the influence of intoxicating liquor or drugs;
d. has a fully equipped operation theatre of its own where surgical procedures 3. Any deliberate or intentional, unlawful or illegal activities with criminal intent,
are carried out, error, or omission of the Insured.
e. maintains daily records of patients and will make these accessible to the 4. From war (whether declared or not), civil war, invasion, act of foreign enemies,
insurance company's authorized personnel. rebellion, revolution, insurrection, mutiny, military or usurped power, seizure,
capture, arrest, restraint or detainment, confiscation or nationalization or
SECTION 4. LOSS OF JOB (APPLICABLE FOR SALARIED PERSONS ONLY) requisition of or damage by or under the order of any government or public local
authority.
In the event of the insured person losing his job due to retrenchment from his
employer in view of mergers and acquisitions the policy will pay a maximum of 3 EMI Any consequential losses of any kind, and/or any actual or alleged legal liability
towards his loan account or lesser if he gets re-employed earlier. For a claim to be of the Insured.
admissible under this section the Insured person has to submit written proof towards
his retrenchment. 5. Whilst engaging in aviation or ballooning, whilst mounting into, dismounting from
or traveling in any balloon or aircraft other than as a passenger (fare paying or
SPECIFIC EXCLUSIONS APPLICABLE TO SECTION 4: otherwise) in any duly licensed standard type of aircraft anywhere in the world.
1. Loss of job due to reasons other than retrenchment as a result of mergers and 6. Any loss suffered by the Insured on account of his participation as the driver, co-
acquisition. driver or passenger of a motor vehicle during motor racing or trial runs.
2. Loss of job as a result of any disciplinary action. 7. Any loss caused either directly or indirectly by nuclear energy, radiation.
SECTION 5. CREDIT SHIELD INSURANCE POLICY 8. Curative treatments or interventions that the Insured performs or has had
performed on his body against medical advice or without medical advice.
Coverage
9. Venereal or sexually transmitted disease.
Credit Shield
10. HIV (Human immunodeficiency Virus) and/or any HIV related illness including
In the event of Accidental Death or Permanent Total Disability of the Insured Person AIDS (Acquired Immune Deficiency Syndrome) and/or mutant derivatives or
during the Policy Period, the Company will make payment under this policy as variations thereof however caused.
detailed below:
11. Pregnancy, resulting childbirth, miscarriage, abortion, or complication arising
The Company will pay the balance outstanding loan amount to the legal heirs of the out of any of the foregoing.
Insured or the Named Insured subject to the maximum Sum Insured specified in the
Schedule. 12. The Insured's participation in any naval, military or air force operations whether
in the form of military exercises or war games or actual engagement with the
The outstanding Loan amount would not include any arrears of the borrower due to enemy, whether foreign or domestic.
any reasons whatsoever. The claim to be settled only in respect of the death of the
first named borrower and not in respect of the others, which may happen in case If the Company asserts that. by reason of these Exclusions any Claim is not covered
loan is taken jointly. by this Policy, the burden of proving that such Claim is covered shall be upon the
Insured.
SPECIFIC DEFINITIONS APPLICABLE TO SECTION 5:
Duties and Obligations of the Insured after the Occurrence of an Insured Event.
The following words or terms shall have the meaning ascribed to them wherever
they appear in this Policy, and references to the singular or to the masculine shall It is a condition precedent to the Company's liability under this Policy that in the
include references to the plural or to the female wherever the context so permits: event of any Accidental Bodily Injury that may give rise to a Claim:
1. “Policy” means the proposal, the Schedule, the Policy documents and any 1. The Insured and/ or the Named Insured shall immediately and in any event
endorsements attaching to or forming part thereof either on the effective date or within 14 days provide the Company with written notification of a Claim, and the
during the Policy Period. Insured shall immediately and without any delay, consult a Physician and follow
such advice and treatment that the Physician might recommend, and
2. “Claim” means a Claim under a Coverage Part in respect of an insured event
that has taken place or is likely to take place. 2. The Insured shall take every other reasonable step and/or measure to minimize
3. “Schedule” means the schedule, and any annexure to it, attached to and the consequences of the Bodily Injury, and
forming part of this Policy.
3. The Insured and/ or the Named Insured shall immediately and in any event
4. “Accident or Accidental” means a sudden, unforeseen and involuntary event within 14 days provide the Company with written notification of any other Claim
caused by external, visible and violent means. that may be made under any operative Coverage Part caused by the Accidental
Bodily Injury, and
HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016). CIN: U66030MH2007PLC177117. Registered & Corporate
Office: 1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai – 400 059. For more details
on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade Logo of HDFC ERGO General Insurance Company Ltd. displayed above belongs to HDFC LTD and ERGO International AG and used by
HDFC ERGO General Insurance Company under license. Toll-free: 1800 2 700 700 | Fax: 91 22 66383699 | [email protected] | www.hdfcergo.com. UIN: HDFPAIP10004V010910. IRDAI Reg No. 146. 6
HDFC ERGO General Insurance Company Limited
Policy Wording
4. In the event of the Insured's death, written notice accompanied by a copy of the ¡ Repairs or alterations to the buildings or premises
post-mortem report (if any) is given to the Company within 14 days (regardless ¡ Repairs, Removal or Extension of the Sprinkler Installation
of whether any other notice might already have been given to the Company), ¡ Defects in construction known to the Insured.
and
11. Bush Fire, excluding loss, destruction or damage caused by Forest Fire.
5. The Insured and/or the Named Insured shall expeditiously provide the Company
with or arrange for the Company to be provided with any and all information and 12. Earthquake - Fire and Shock
documentation in respect of the Claim and/or the Company's liability hereunder
that may be requested, and submit himself for examination by the Company's 13. The Company will also indemnify the Insured in respect of the accidental loss of
medical advisers as often as may be considered reasonably necessary by the or damage to Contents not insured elsewhere whilst temporarily removed from
Company at the Company's cost. the Insured Premises and in transit as accompanied baggage anywhere in India
to other premises to be used by the Insured or the Insured's Family as a
CLAIMS PAYMENT APPLICABLE: temporary residence, or to other premises where the Insured shall have placed
any Contents for the purposes of safe custody during the course of his temporary
The Company shall only make payment under this Policy to the legal heirs of the absence from the Insured Premises, provided that:
Insured or the Named Insured. Any payment made in good faith by the Company as
aforesaid shall operate as complete and final discharge of the Company's liability to ¡ Such absence does not exceed 120 days in the aggregate in any one Policy
make payment under this Policy for such Claim. Period, and
¡ The liability of the Company in respect of removed Contents shall not exceed
SECTION 6. HOUSEHOLDERS COVERAGE (FIRE AND BURGLARY) 10% of the Sum Insured hereunder.
¡ The Company shall not be liable for and no indemnity is available hereunder
Coverage Part A: Contents (excluding Valuables) For Std Fire And Sp Perils in respect of loss of or damage to:
¡ Contents of a consumable nature;
The Company will indemnify the Insured in respect of loss of or damage to the ¡ Motor vehicles, pedal cycles, or livestock.
Contents in the Insured Premises specified in the Schedule against: ¡ Valuables and/or Jewellery and/or Precious Items, unless specifically
stated to the contrary in the Schedule
1. Fire, excluding destruction or damage caused to the property insured by:
SPECIFIC EXCLUSIONS APPLICABLE TO THIS COVER OF SECTION 6:
¡ Its own fermentation, natural heating or spontaneous combustion.
¡ Its undergoing any heating or drying process. 1. The Company shall not be liable for 5% of the claim amount for each and every
¡ Burning of property insured by order of any Public Authority. claim arising out of Act of God perils (Lightning, Storm, Flood, Tempest,
Inundation and the like, Subsidence, Landslide and Rock slide, Earthquake).
2. Lightning.
2. Loss, destruction or damage to bullion or unset precious stones, any curios or
3. Explosion/implosion, excluding loss, destruction of or damage: works of art for an amount exceeding Rs. 10000/-, manuscripts, plans, drawings,
securities, obligations or documents of any kind, stamps, coins or paper money,
¡ To boilers (other than domestic boilers), economizers or other vessels, cheques, books of accounts or other business books, computer systems
Machinery or apparatus (in which steam is generated) or their contents records, explosives unless otherwise expressly stated in the policy.
resulting from their own explosion/implosion,
¡ Caused by centrifugal forces. 3. Loss, destruction or damage directly or indirectly caused to the property insured
by
4. Aircraft Damage: Loss, Destruction or damage caused by Aircraft, other aerial or ¡ Ionising radiations or contamination by radioactivity from any nuclear fuel or
space devices and articles dropped there from excluding those caused by from any nuclear waste from the combustion of nuclear fuel
pressure waves. ¡ The radio active toxic, explosives or other hazardous properties of any
explosive nuclear assembly or nuclear component thereof
5. Riot, Strike, and Malicious Damage: Loss of or visible physical damage or
destruction by external violent means directly caused to the property insured but 4. Loss, destruction or damage caused to the insured property by pollution or
excluding those caused by: contamination excluding:
¡ Total or partial cessation of work or the retardation or interruption or ¡ Pollution or contamination which itself results from a peril hereby insured
cessation of any process or operations or omissions of any kind. against.
¡ Permanent or temporary dispossession resulting from confiscation, ¡ Any peril hereby insured against which itself results from pollution or
commandeering, requisition or destruction by order of the Government or contamination
any lawfully constituted Authority.
¡ Permanent or temporary dispossession of any building or plant or unit or 5. Loss, destruction or damage to the stocks in Cold Storage premises caused by
machinery resulting from the unlawful occupation by any person of such change of temperature.
building or plant or unit or machinery or prevention of access to the same.
6. Loss, destruction or damage to any electrical machine, apparatus, fixture, or
6. Storm, Cyclone, Typhoon, Tempest, Hurricane, Tornado, Flood and Inundation: fitting arising from or occasioned by over-running, excessive pressure, short
Loss destruction or damage directly caused by storm, cyclone, typhoon, circuiting, arcing, self heating or leakage of electricity from whatever cause
tempest, hurricane, flood or inundation excluding those resulting from volcanic (lightning included) provided that this exclusion shall apply only to the particular
eruption or other convulsions of nature. electrical machine, apparatus, fixture or fitting so affected and not to other
machines, apparatus, fixtures or fittings which may be destroyed or damaged by
7. Impact Damage: Loss of or visible physical damage or destruction caused to the fire so set up.
property insured due to impact by any Rail/ Road vehicle or animal by direct
contact not belonging to or owned by the Insured or any occupier of the premises 7. Loss, or damage by spoilage resulting from the retardation or interruption or
or their employees while acting in the course of their employment. cessation of any process or operation caused by operation of any of the perils
covered.
8. Subsidence and Landslide including Rock slide: Loss, destruction or damage
directly caused by Subsidence of part of the site on which the property stands or Coverage Part B : Burglary and Theft
Land slide/Rock slide excluding:
1. The Company will indemnify the Insured in respect of loss of or damage to the
¡ The normal cracking, settlement or bedding down of new structures Insured Contents or any part thereof whilst contained in the Insured Premises
¡ The settlement or movement of made up ground caused by actual or attempted Burglary and or Theft.
¡ Coastal or river erosion 2. The Company will also indemnify the Insured in respect of the loss of or damage
¡ Defective design or workmanship or use of defective materials to Contents not Insured elsewhere caused by actual or attempted Burglary
¡ Demolition, construction, structural alterations or repair of any property or whilst temporarily removed from the Insured Premises and in transit as
ground works or excavations. accompanied baggage anywhere in India to other premises to be used by the
¡ Bursting and/or overflowing of Water Tanks, Apparatus and Pipes. Insured or the Insured's Family's a temporary residence, or to other premises
where the Insured shall have placed any Contents for the purposes of safe
9. Missile Testing operations. custody during the course of his temporary absence from the Insured Premises,
provided that:
10. Leakage from Automatic Sprinkler Installations, excluding loss, destruction or
damage caused by: ¡ Such absence does not exceed 120 days in the aggregate in any one Policy
HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016). CIN: U66030MH2007PLC177117. Registered & Corporate
Office: 1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai – 400 059. For more details
on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade Logo of HDFC ERGO General Insurance Company Ltd. displayed above belongs to HDFC LTD and ERGO International AG and used by
HDFC ERGO General Insurance Company under license. Toll-free: 1800 2 700 700 | Fax: 91 22 66383699 | [email protected] | www.hdfcergo.com. UIN: HDFPAIP10004V010910. IRDAI Reg No. 146. 7
HDFC ERGO General Insurance Company Limited
Policy Wording
Period, and 7. The powers conferred by this condition shall be exercisable by the Company at
¡ The liability of the Company in respect of removed Contents shall not exceed any time until notice in writing is given by the insured that he makes no claim
10 % of the Sum Insured hereunder. under the section, or if any claim is made, until such claim is finally determined or
withdrawn, and the Company shall not by any act done in the exercise or
SPECIFIC EXCLUSIONS APPLICABLE TO THIS COVER OF SECTION 6: purported exercise of its powers hereunder, incur any liability to the Insured or
diminish its rights to rely upon any of the conditions of this section in answer to
1. The Company shall not be liable for and no indemnity is available hereunder in any claim.
respect of: If the insured or any person on his behalf shall not comply with the requirements
of the Company or shall hinder or obstruct the Company, in the exercise of its
¡ Any consequential losses, or any loss or damage caused by actual or powers hereunder, all benefits under this section shall be forfeited.
attempted Burglary and/or theft;
¡ Where the Insured or any member of the Insured's Family is or is alleged to 8. If the Company at its option, reinstate or replace the property damaged or
be concerned or implicated; destroyed, or any part thereof, instead of paying the amount of the loss or
¡ To livestock, motor vehicles and pedal cycles; damage, or join with any other Company or Insurer(s) in so doing, the Company
¡ To Valuables and/or Jewellery and/or Precious Items, unless specifically shall not be bound to reinstate exactly or completely but only as circumstances
stated in the Schedule. permit and in reasonably sufficient manner, and in no case shall the Company be
bound to expend more in reinstatement than it would have cost to reinstate such
Basis of Loss Settlement property as it was at the time of the occurrence of such loss or damage nor more
than the sum insured by the Company thereon. If the Company so elect to
1. Where the Insured Premises and/or Contents can reasonably be repaired or reinstate or replace any property the insured shall at his own expense furnish the
reinstated at a cost less than the replacement cost then the Company will Company with such plans, specifications, measurements, quantities and such
indemnify the Insured in respect of the expenses necessarily incurred to restore other particulars as the Company may require, and no acts done, or caused to be
the aforementioned to its state immediately prior to the happening of the actual done, by the Company with a view to reinstatement or replacement shall be
or attempted Burglary. deemed an election by the Company to reinstate or replace.
2. In the case of a total loss, the Company shall indemnify the Insured in respect of 9. If the property hereby insured shall at the breaking out of any fire or at the
the restoration or replacement costs. The Company shall not be bound to commencement of any destruction of or damage to the property by any other
reinstate or restore exactly or completely, but only as permitted by the peril hereby insured against be collectively of greater value than the sum insured
circumstances and in a reasonably sufficient manner and to the state that thereon, then the Insured shall be considered as being his own insurer for the
existed immediately prior to the happening of the Burglary. difference and shall bear a rateable proportion of the loss accordingly. Every
item, if more than one, of the section shall be separately subject to this condition.
3. The cover shall be issued on first loss basis.
SECTION 7. GARAGE CASH
GENERAL CONDITIONS APPLICABLE TO SECTION 6
The event of Accidental loss or damage first occurring or manifesting itself during the
1. This Section shall be voidable in the event of mis-representation, mis- Policy Period and causing the Insured vehicles Accidental loss or damage within the
description or non-disclosure of any material particular. 1st year of the Policy term, the Company will pay:
2. Under any of the following circumstances the insurance ceases to attach as 1. The Daily Allowance of Rs. 500 per day for each continuous and completed
regards the property affected unless the Insured, before the occurrence of any period of 24 hours of workshop repairs necessitated solely by reason of the said
loss or damage, obtains the sanction of the Company signified by endorsement Accidental loss or damage subject to maximum of 7 days once during the policy
upon the policy by or on behalf of the Company: period and the amount claimed under the motor policy should be greater than
Rs. 5000/-.
¡ If the building containing the insured property becomes unoccupied and so
remains for a period of more than 30 days. 2. Within 7 days of intimation of claim, the insured is to submit under this section of
¡ If the interest in the property passes from the insured otherwise than by will or the policy a detailed estimate of the cost of repairs; and estimated numbers days
operation of law. in repair of the vehicle.
3. This insurance does not cover any loss or damage to property which, at the time 3. The insured shall give the Company every assistance to see that such repair is
of the happening of such loss or damage, is insured by or would, but for the necessary and the charges are reasonable.
existence of this policy, be insured by any marine policy or policies except in
respect of any excess beyond the amount which would have been payable 4. The Insured shall take all reasonable steps to safeguard the vehicle from loss or
under the marine policy or policies had this insurance not been effected. damage and to maintain it in efficient condition and the Company shall have at all
times free and full access to examine the related documents of the Insured in this
4. The Insured shall also at all times at his own expense produce, procure and give behalf. In the event of any accident or breakdown, the vehicle shall not be left
to the Company all such further particulars, plans, specification books, unattended without proper precautions, being taken to prevent further damage
vouchers, invoices, duplicates or copies thereof, documents, investigation or loss and if the vehicle be driven before the necessary repairs are effected any
reports (internal/external), proofs and information with respect to the claim and extension of the estimated number of days damage or any further damage to the
the origin and cause of the loss and the circumstances under which the loss or vehicle shall be entirely at the Insured's own risk.
damage occurred, and any matter touching the liability or the amount of the
liability of the Company as may be reasonably required by or on behalf of the GENERAL DEFINITIONS APPLICABLE TO SECTION 7
Company together with a declaration on oath or in other legal form of the truth of
the claim and of any matters connected therewith. The following words or terms shall have the meaning ascribed to them wherever
they appear in this Policy:
5. In no case whatsoever shall the Company be liable for any loss or damage after
the expiry of 12 months from the happening of the loss or damage unless the 1. “Accident or Accidental” means a sudden, unforeseen and involuntary event
claim is the subject of pending action or arbitration; it being expressly agreed and caused by external, visible and violent means.
declared that if the Company shall disclaim liability for any claim hereunder and
such claim shall not within 12 calendar months from the date of the disclaimer 2. “Requires repair estimate” from preferably Automotive Manufacturer,
have been made the subject matter of a suit in a court of law then the claim shall authorized workshop or garages.
for all purposes be deemed to have been abandoned and shall not thereafter be
recoverable hereunder. 3. “Daily Allowance” means the amount and period specified in the Schedule.
6. On the happening of loss or damage to any of the property insured by this policy, EXCLUSIONS APPLICABLE TO ALL SECTIONS
the Company may:
No indemnity is available hereunder and no payment will be made by the company
¡ Enter and take and keep possession of the building or premises where the for any claim directly or indirectly caused by, based on, arising out of or howsoever
loss or damage has happened. attributable to any of the following:
¡ Take possession of or require to be delivered to it any property of the Insured 1. War, invasion, act of foreign enemy, hostilities (whether war be declared or not),
in the building or on the premises at the time of the loss or damage. civil war, rebellion, revolution, insurrection military or usurped power of civil
¡ Keep possession of any such property and examine, sort, arrange, remove commotion or loot or pillage in connection herewith.
or otherwise deal with the same.
¡ Sell any such property or dispose of the same for account of whom it may 2. Consequential loss of any kind or description.
Concern.
3. Loss or damage directly or indirectly caused by or arising from or in
HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016). CIN: U66030MH2007PLC177117. Registered & Corporate
Office: 1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai – 400 059. For more details
on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade Logo of HDFC ERGO General Insurance Company Ltd. displayed above belongs to HDFC LTD and ERGO International AG and used by
HDFC ERGO General Insurance Company under license. Toll-free: 1800 2 700 700 | Fax: 91 22 66383699 | [email protected] | www.hdfcergo.com. UIN: HDFPAIP10004V010910. IRDAI Reg No. 146. 8
HDFC ERGO General Insurance Company Limited
Policy Wording
consequence of or contributed to nuclear weapons material by or arising from or Call our 24X7 Toll free number 1800-2700-700 from any Landline & Mobile or 1800-
in consequence of or contributed to by ionising radiation or contamination by 226-226 from MTNL or BSNL Phone.
radioactivity from any nuclear fuel or from any nuclear waste from the For lodging a complaint online, email us to our customer service desk at
combustion of nuclear fuel (including any self-sustaining process of nuclear [email protected].
fission).
After investigating the matter internally, we will send our response within a period of
4. Loss or damage caused by depreciation or wear and tear. 10 days.
Proposer's Declaration: In case the resolution is likely to take longer time, we will inform you of the same
through an interim reply.
I/ We accept the Terms and Conditions of the insurance policy. I/We authorize the
insurance Company to obtain any records or references, be they medical or Escalation Level 1
otherwise, in consideration of this insurance or any potential claims in the future.
I/We certify that all the information provided in this proposal and any attachments For lack of a response or if the response provided does not meet your expectation,
are true and correct. I/We understand that all information provided in this proposal you can write to: [email protected]
and any attachments are material to the insurer's decision to provide this insurance,
and that insurance will be provided, at the insurer's sole discretion, in reliance upon After examining the matter, final response would be conveyed within a period of 15
the truth of such information. I/We hereby authorize HDFC ERGO General days from the date of receipt of your complaint on this e-mail id.
Insurance Company Limited to use relevant data for marketing purposes either
directly or through third party agents. Escalation Level 2
Note: In case, you are not satisfied with the decision/resolution of the above office, or have
not received any response within 15 days, you may write to: [email protected]
The Proposer agrees that the receipt of the Proposal Form by HDFC ERGO General
Insurance Company Limited along with the premium payment does not tantamount Escalation Level 3
to the acceptance of the Proposal for insurance by HDFC ERGO General Insurance
Company Limited and does not result in a concluded contract of insurance. The If after following Escalation Level 1 and 2 as stated above your issue remains
acceptance of the Proposal for insurance shall be at the Company's sole and unresolved, you may approach the Insurance Ombudsman for Redressal.
absolute discretion. In the event of acceptance of the Proposal for insurance by
HDFC ERGO General Insurance Company Limited, such acceptance shall be Contact Details of Insurance Ombudsman
specifically intimated to the Proposer by HDFC ERGO General Insurance Company
Limited along with the date from which the insurance Cover shall become effective.
HDFC ERGO General Insurance Company Limited shall not be liable for any claim
in respect of an event giving rise to a claim covered under the Policy of Insurance
that has occurred prior to policy issuance and any such claim is not covered under
this policy (Your proposal form will be considered after HDFC ERGO General
Insurance Company Limited receives premium payment and realizes the same.)
Fraud Warning:
The proposer understands that if a proposal has been completed for this insurance,
then the statements and all particulars provided in such proposal, and any
attachments thereto, are material to the insurance company's decision to provide
this insurance. The proposer further understands that the insurance company will, in
its sole discretion, issue this Policy in reliance upon the truth of such statements and
particulars. This policy shall be voidable at the option of the Company in the event of
mis-representation, mis-description or non-disclosure of any material particulars by
the Proposer.
Any person who, knowingly and with intent to defraud the insurance company or any
other person, files a proposal for insurance containing any false information, or
conceals for the purpose of misleading, Information concerning any fact material
thereto, commits a fraudulent insurance act, which will render the policy voidable at
the sole discretion of the insurance company and result in a denial of insurance
benefits. If a claim is in any respect fraudulent, or if any fraudulent or false plan,
specification, estimate, deed, book, account entry, voucher, invoice or other
document, proof or explanation is produced, or any fraudulent means or devices are
used by the insured person, insured organisation, policyholder, beneficiary,
claimant or by anyone acting on their behalf to obtain any benefit under this policy, or
if any false statutory declaration is made or used in support thereof, or if loss is
occasioned by or through the procurement or with the knowledge or connivance of
the insured person, insured organisation, policyholder, beneficiary, claimant or other
person, then all benefits under this policy are forfeited.
Anti-Rebating Warning:
As per Section 41 of the Insurance Act 1938, as amended, the practice of rebating is
prohibited, as follows: No person shall allow or offer to allow, either directly or
indirectly, as an inducement to any person to take out or renew or continue an
insurance policy in respect of any kind of risk relating to lives or property in India, any
rebate of the whole or part of the commission payable or any rebate of the premium
shown on the policy, nor shall any person taking out or renewing or continuing a
policy accept any rebate, except such rebate as may be allowed in accordance with
the published prospectus or tables of the insurer. Violations of Section 41 of the
Insurance Act 1938, as amended, shall be punishable with a fine which may extend
to `10 Lakhs.
However, should a customer feel that our services need improvement and wish to
lodge your feedback / complaint, you may:
HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016). CIN: U66030MH2007PLC177117. Registered & Corporate
Office: 1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai – 400 059. For more details
on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade Logo of HDFC ERGO General Insurance Company Ltd. displayed above belongs to HDFC LTD and ERGO International AG and used by
HDFC ERGO General Insurance Company under license. Toll-free: 1800 2 700 700 | Fax: 91 22 66383699 | [email protected] | www.hdfcergo.com. UIN: HDFPAIP10004V010910. IRDAI Reg No. 146. 9
HDFC ERGO General Insurance Company Limited
Policy Wording
Names of Ombudsman and Addresses of Ombudsmen Centres Office of the Insurance Ombudsman,
Hindustan Building. Annexe, 4th Floor, C. R. Avenue,
Office of the Insurance Ombudsman,
KOLKATA - 700 072.
2nd Floor, Ambica House, Nr. C. U. Shah College, Ashram Road,
Tel : 033 - 22124339 / 22124340
AHMEDABAD - 380 014.
Fax : 033 - 22124341
Tel.: 079 - 27545441 / 27546139
Email: [email protected]
Fax: 079 - 27546142
Email: [email protected] Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe, S.V. Road, Santacruz (W),
Office of the Insurance Ombudsman, MUMBAI - 400 054.
62, Forest Park, BHUBANESHWAR - 751 009. Tel : 022 - 26106928 / 26106552
Tel.: 0674 - 2596455 / 2596003 Fax : 022 - 26106052
Fax: 0674 - 2596429 Email: [email protected]
Email: [email protected]
Office of the Insurance Ombudsman,
Office of the Insurance Ombudsman, 2nd Floor, Jeevan Darshan, N. C. Kelkar Road, Narayanpet,
th
Fatima Akhtar Court, 4 Floor, 453 (old 312), Anna Salai, Teynampet, PUNE - 411 030.
CHENNAI - 600 018. Tel: 020 - 32341320
Tel.: 044 - 24333668 / 24335284 Email: [email protected]
Fax: 044 - 24333664
Email: [email protected] Office of the Insurance Ombudsman,
th
Bhagwan Sahai Palace, 4 Floor, Main Road, Naya Bans,
Office of the Insurance Ombudsman, Sector 15, Dist. Gautam Buddh Nagar,
th
‘Jeevan Nivesh’, 5 Floor, Near Panbazar Overbridge, S. S. Road, NOIDA (U.P) - 201 301.
GUWAHATI - 781 001 (ASSAM). Tel.: 0120 - 2514250 / 2514251 / 2514253
Email: [email protected]
Tel.: 0361 - 2132204 / 5
Fax: 0361 - 2732937 Office of the Insurance Ombudsman,
st
Email: [email protected] 1 Floor, Kalpana Arcade Building, Bazar Samiti Road, Bahadurpur,
PATNA - 800 006.
Office of the Insurance Ombudsman, Email: [email protected]
2nd Floor, Janak Vihar Complex, 6, Malviya Nagar, Opp. Airtel,
Near New Market, BHOPAL (M.P.) - 462 003. OFFICE OF THE GOVERNING BODY OF INSURANCE COUNCIL
Tel.:- 0755 - 2769201 / 9202 Smt. Ramma Bhasin, Secretary General,
Fax : 0755 - 2769203 Shri Y.R. Raigar, Secretary,
rd
Email: [email protected] 3 Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W),
MUMBAI - 400 054
Office of the Insurance Ombudsman, Tel : 022 - 26106889 / 6671
nd
S.C.O. No.101-103, 2 Floor, Batra Building, Sector 17 - D, Fax : 022 - 26106949
CHANDIGARH - 160 017. Email- [email protected]
Tel.: 0172 - 2706468 / 2705861
Fax: 0172 - 2708274
Email: [email protected]
HDFC ERGO General Insurance Company Limited. (Formerly HDFC General Insurance Limited from Sept 14, 2016 and L&T General Insurance Company Limited upto Sept 13, 2016). CIN: U66030MH2007PLC177117. Registered & Corporate
Office: 1st Floor, HDFC House, 165 - 166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai - 400 020. Customer Service Address: 6th Floor, Leela Business Park, Andheri Kurla Road, Andheri (E), Mumbai – 400 059. For more details
on the risk factors, terms and conditions, please read the sales brochure before concluding the sale. Trade Logo of HDFC ERGO General Insurance Company Ltd. displayed above belongs to HDFC LTD and ERGO International AG and used by
HDFC ERGO General Insurance Company under license. Toll-free: 1800 2 700 700 | Fax: 91 22 66383699 | [email protected] | www.hdfcergo.com. UIN: HDFPAIP10004V010910. IRDAI Reg No. 146. 9