Professional Documents
Culture Documents
WHEREAS the Insured carrying on the Business described in the Schedule and no other for the purpose of this insurance
by a Proposal and Declaration which shall be the basis of this contract and is deemed to be incorporated herein as
applied to Pioneer Insurance & Surety Corporation (hereinafter referred to as the “Company”) for the insurance hereinafter
contained and having agreed to pay the premium as consideration for such insurance.
IN WITNESS WHEREOF, the Company has caused this policy to be signed by its duly authorized officer.
JENNIFER C. TOLENTINO
First Vice President
Authorized Signature
IMPORTANT NOTICE:
The Insurance Commissioner, with offices in Manila, Cebu, and
Davao, is the Government official in charge of the enforcement Documentary Stamps to the value of Php
of all laws relating to Insurance and has supervision over have been affixed to the premium register where
insurance companies. He is ready at all times to render this policy is recorded.
assistance in settling any controversy between an insurance
company and a policyholder relating to insurance matters.
Please read the entire policy to determine your rights, duties and what is and what is not covered. Words with special meanings are defined
in the Definitions section or in the part of the policy where they are used. Throughout the policy, defined terms will be bold when used.
INSURANCE AGREEMENT
Pioneer Insurance & Surety Corporation (“Company”) will provide the insurance described herein in return for the payment of premium and compliance
with all applicable provisions of this policy.
In any Policy year, the aggregate benefits payable under this Policy in respect of any one Accident resulting in loss (es) within one hundred eighty (180)
days from date of Accident shall be the principal sum.
In any Policy year, the aggregate benefits payable under the disablement benefit of this contract in respect of one or more Accident(s) resulting in any
loss(es) within one hundred eighty (180) days from date of Accident(s) shall not exceed the principal sum (i.e. for subsequent Accident resulting in any
losses which would make the aggregate benefits exceed the principal sum), the amount(s) payable under the disablement shall be the principal sum
less the amount(s) paid for previous loss(es). However, the payment of the principal sum for such loss (es) shall not terminate the contract in so far as
Accidental death benefit is concerned.
The amount of benefit payable for accidental death shall always be the principal sum.
Any partial benefit already paid for any loss(es) shall not be carried over in the subsequent Policy year. (i.e. The amount of benefits to be paid in the
succeeding Policy year shall not be reduced by any amount paid in the preceding Policy year. A Policy year is defined as twelve months starting with the
first month premium was paid.)
Accidental Death Burial Benefit
If bodily injury due to an Accident should result in loss of life of the Insured Person, the Company will, in addition to all other benefits
payable under this Policy, pay the burial benefit as shown in the Policy Schedule.
The maximum liability of the Company for loss caused by Murder and Assault is deemed limited to the amount stated in the Policy Schedule.
Part II - Definitions
“Insured” means:
1. the Named Insured between 19 to 65 years old. Coverage may be renewed until he/she is 72 years old, at the option of the Company; and/or,
2. if Spouse or Family coverage, includes;
(a) Spouse of the Named Insured between 19 to 65 years old. Coverage may be renewed until he/she is 72 years old, at the option of the Company;
and/or,
(b) the child or children of the Named Insured and/or of the Named Insured, between 1 to 19 years of age. If the dependent is a full-time student,
unmarried and primarily dependent on the Named Insured for support, coverage may be extended until before he/she reaches the age of twenty-
three (23).
“Named Insured” means the Insured person(s) whose name(s) appear on the application form which shall form part of this Policy.
“Permanent” means lasting twelve (12) calendar months from the date of Accident and at the expiry of that period being beyond hope of improvement.
“Total Disability” means total and permanent paralysis of all limbs, or permanent and total loss of all intellectual capacity.
“Loss” with regards to arms, legs, hands and feet means total functional disablement or loss by complete and permanent severance of a hand
at or above the wrist or of a foot at or above the ankle.
“Loss of Speech” means the permanent disability in articulating any three of the four sounds which contribute to the speech such as the Labial sound,
the Alveololabial sounds, the Palatal sounds and the Velar sounds or total loss of vocal cord or damage of speech center in the brain resulting in Aphasia.
“Accident” means an unforeseen and involuntary event, un- intentional on the part of the Insured which causes an Injury.
“Injury” means bodily Injury sustained in an Accident and is effected directly and independently of all other causes.
“Loss of Hearing” wherever used in this Policy shall mean permanent irrecoverable loss of hearing where:
If a dB = Hearing loss at 500 Hertz If b dB = Hearing loss at 1000 Hertz If c dB = Hearing loss at 2000
Hertz If d dB = Hearing loss at 4000 Hertz
1/6 if (a+2b+2c+d) is above 80dB.
“AIDS” or Acquired Immune Deficiency Syndrome” wherever used in this Policy shall have the meanings assigned to it by the World Health Organization.
AIDS includes Opportunistic Infection, Malignant Neoplasm or any disease or sickness in the presence of a sero-positive test for HIV.
“Opportunistic Infection” shall include but not be limited to pneumocystic carinii pneumonia, organism or chronic enteritis, virus and/or disseminated
fungi infection.
“Malignant Neoplasm” shall include but not be limited to Kaposi’s sarcoma, central nervous system lymphoma and/or other malignancies now known or
which become known as immediate causes of death, an illness, or disability, in the presence of Acquired Immune Deficiency.
“Acquired Immune Deficiency Syndrome” shall include HIV (Human Immune Deficiency Virus) encephalopathy (dementia) and HIV (Human Immune
Deficiency Virus) Wasting Syndrome.
“Registered Medical Practitioner” means any person qualified by degree in western medicine legally authorized in the geographical area of his/her
practice to render medical or surgical services, but excluding a Registered Medical Practitioner who is the Insured him/herself, an agent of the Insured,
his/her legal spouse, or a relative of the Insured.
The premium due shall be charged annually or monthly to the Named Insured’s credit card or bank account acceptable under this program or paid
annually in cash or check. No claim shall be admissible while the premiums are in arrears.
Part IV – Exclusions
1. war, invasion, act of foreign enemy, hostilities or warlike operations (whether war be declared or not), mutiny, riot, civil commotion, strike, civil war,
rebellion, revolution, insurrections, conspiracy, military or usurped power, martial law or state of siege, seizure, quarantine, or customs regulations,
or nationalization by or under the order of any government or public or local authority, or any weapon or instrument employing atomic fission
or radioactive force, whether in time of peace or war;
2. an Insured committing or attempting to commit suicide, any intentionally self-inflicted Injury, while sane or insane, or attempting to commit a criminal
act, or from deliberate exposure to exceptional danger (except in the attempt to save human life);
3. an Insured while serving in the Armed Forces of any country or international authority, whether in peace or war;
4. an Insured having taken a drug unless the drug was taken under the direction of a Registered medical Practitioner and not for the treatment of drug
addiction;
5. is directly or indirectly consequent on the Insured engaging in air travel except as a passenger in any properly licensed private and/or commercial
aircraft authorized by the appropriate government authorities for the transport of passengers for hire;
6. pregnancy, childbirth, abortion, miscarriage, or any related complication therefrom;
7. any kind of sickness or disease not resulting from Accidental bodily Injury; or any existing or prior physical defect or physical infirmity;
8. any gradually deteriorating condition;
9. bacterial infection of any kind (except pyogenic infection resulting from an accidental cut or wound) or out of or consequent upon or contributed
to by Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC), be named.
10. Murder and Assault, whether provoked or unprovoked.
2. Termination of Coverage.
The insurance of any Insured Person shall immediately terminate on the earliest of the following dates:
a) Insured ceased to be a qualified Named Insured;
b) The first day for which premium has not been paid except as provided for by the “Grace Period”;
c) Insured attains seventy-two (72) years of age;
d) Legal spouse attains seventy-two (72) years of age;
e) Legal spouse ceases to be spouse of the Insured person;
f) Dependent child (ren) attains nineteen (19) years of age (or twenty-three years of age if full-time student);
g) Dependent child becomes married or is no longer dependent on the Insured for support.
h) In the event of Accidental Death.
3. Cancellation
This Policy may be cancelled by the Company in accordance with Chapter I, Title 6, Sec. 64 of the Insurance Code.
If the Insured cancels this Policy, notice of which must be in writing, the Company shall retain the earned premium for the time this Policy
has been in force, computed in accordance with the Short Period Rate Scale indicated below:
PERCENT OF ANNUAL PREMIUM
2 months (Minimum) 100%
3 months 100%
4 months 50%
5 months 50%
6 months 50%
Over 6 months 25%
4. Premium
The premium due shall be charged annually or monthly to the named Insured’s credit card or bank account acceptable under this program
or paid annually in cash or check. No claim shall be admissible while the premiums are in arrears.
5. Grace Period.
A grace period of thirty-one (31) days will be granted for the payment of each premium, during which time the Policy shall be continued in force
unless the Policy has been canceled in accordance with the provisions of this Policy.
6. Free-Look Privilege
The Insured has five (5) days from the receipt of the Policy to examine the terms and conditions of the Policy and may cancel the Policy within
the foregoing 5-day period by written request to the Company in which case premiums paid will be refunded. If the Policy is sent by post,
it is deemed to have been delivered in the ordinary course of post. Where the policy is so cancelled, the Company shall have no liability whatsoever
under the cancelled Policy.
8. Notice of Claim.
Written notice of claim must be given to the Company within thirty (30) days after the occurrence or as commencement of any loss covered
by the Policy, or as soon thereafter as is reasonably possible.
9. Claims Form.
The Company, upon receipt of a notice of claim, will furnish to the claimant such forms as are usually required by the Company for filing proof of loss.
10. Time of Filing Claims Form.
Completed claims form and written proof of loss must be furnished to the Home Office of the Company within ninety (90) days after the date
of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible
to give proof within such time.
19. Assignment.
No assignment of interest under this Policy is binding unless and until the original or a duplicate thereof is filed with the Company. The Company
does not assume any responsibility for the validity of the assignment. No change of beneficiary under this Policy shall bind the Company,
unless consent thereto is formally endorsed hereon by an executive officer of the Company. No provision of the charter, constitution or by-laws
of the Company shall be used in defense of any claim arising under this Policy, unless such provision is incorporated in full in this Policy.
20. Waiver Clause
It is hereby declared and agreed that the provisions of Article 1250 of the Civil Code of the Philippines (R.A. 386) which reads:
“In case of extraordinary inflation of the currency stipulated should supervene, the value of the currency at the time of the establishment
of the obligation shall be the basis of payment ...” ...shall not apply in determining the extent of liability under the provision of this Policy.
Nothing herein contained shall be held to vary, alter, waive or change any terms, limits or conditions of the Policy, except herein above set forth.
For any loss of claim arising in, or where the insured or any beneficiary under the policy is a citizen or instrumentality of the government of,
any country (ies) against which any laws and/or regulations governing this policy and/or the Company, its parent company or its ultimate controlling
entity have established an embargo or other form of economic sanction which have the effect of prohibiting the Company to provide insurance
coverage, transacting business with or otherwise offering economic benefits to the Insured or any other beneficiary under this policy. It is further
understood and agreed that no benefits or payment will be made to any beneficiary (ies) who is/are declared unable to receive economic benefits
or payment under the laws controlling entity.
IN WITNESS WHEREOF, the PIONEER INSURANCE & SURETY CORPORATION has caused this policy to be executed on its behalf by the undersigned
Authorized Representative.