General Conditions of Personal Accident Insurance
1- Purpose of the Insurance The purpose of this insurance is to guarantee, within the limits established and under the General Conditions, the following, and Particular, expressly agreed upon, the payment of an indemnity to the Insured or to the beneficiaries, if that person suffers a covered accident.
2- Concepts Personal Accident - event with a date characterized, exclusive and directly external, sudden, involuntary and violent, causing physical injury that in itself, is independent of everything and everything, has as a direct consequence the death or total or partial disability of the Insured. Also included in the concept of personal accident are injuries resulting from: a) Action of the ambient temperature or atmospheric influence, when the insured is subject to them as a result of a covered accident; (b) accidental escape of gases and vapors; c) Kidnapping and attempted kidnappings; d) Anatomical or functional alterations of the vertebral column, of traumatic origin, caused exclusively by radiologically proven fractures or dislocations.
3- Insurance Guarantees Accidental Death - 5,000.00 Total / Partial Permanent Disability due to Accident - 5,000.00 In the event of death, the insurance company will pay the insurance beneficiaries the corresponding amount. In the case of Permanent disability, provided that the treatment is terminated and the character of disability is definitive, the Insurer will pay an indemnity according to the table: Ex .: Total Permanent Disability Total loss of sight of both eyes ...... 100% importance insured Ex .: Partial invalidity Total loss of use of one of the lower limbs ...... .. 70% insured amount In the event of partial loss, the functions of the injured limb or organ are reduced, but not completely abolished.
4 - Occurrence of the Claim The Stipulant, Insured or its beneficiaries must inform the Insurer of the occurrence of a covered event, immediately after the knowledge of the same, through the form "NOTICE OF SINISTER"; The notice of claim must be accompanied, depending on the nature of the event, of the following documents listed below;
1) Accidental Death: - Claim notice, filled in by the stipulator and the beneficiary, or its legal representative, in the field of information of the insured in case of an accident; - Death certificate; - Birth certificate and / or marriage of the deceased (updated); - CPF, RG and proof of residence of the Insured; - CPF, RG and proof of residence of the beneficiaries; - Birth certificate and / or marriage of the beneficiaries; - Police Occurrence Bulletin, if applicable; - Necropsy examination report prepared by the IML, when applicable; - National Driver's License Card for the deceased when dealing with an automobile accident, where the same is the driver of the vehicle.
2) Total Permanent or Partial Disability Per Accident: - Notice of claim filed by the insured, or his legal representative when he is unable, and the attending physician; - CPF, RG and proof of residence of the insured; - High Medical Certificate; - Results of all examinations carried out in the insured person; - Police Occurrence Bulletin, if applicable; - National license for the insured person in the case of an automobile accident, where he is the driver of the vehicle; - Medical statement confirming the permanent disability status containing the full name of the doctor in charge and CRM or Social Security Award. Note: Personal documents must be presented in certified copies, except for Notice of Claim; The maximum period, after delivery of the documentation required by the insurer, for settlement of the claim will be 30 (thirty) days; In the event of justified and substantiated doubts on the part of the Insurer, other documents may be requested, restarting, from the delivery of the last document required, the count of the deadline referred to in the previous item.