Accident insurance clauses for students and children (2009 edition)
1 general rules
1. 1 Contract Composition
This insurance contract consists of insurance clauses, application forms, insurance policies or other insurance certificates and approval forms. Any agreement on this insurance contract shall be in written form.
1.2 insurance
Full-time college, middle school and primary school students under the age of 40 (see 6. 1) and children registered in legally established schools or kindergartens for more than 18 months (including 18 months), who are in good health and can study and live normally, can be the insured under this insurance contract.
1.3 insurance
The insured with full capacity for civil conduct and other persons who have insurable interest in the insured may be regarded as the insured.
The insured is a person with limited capacity for civil conduct, and his guardian is the applicant. If the insured is under the age of 10, his parents are the insured.
1.4 beneficiary
When concluding this insurance contract, the insured or the applicant may designate one or more persons as beneficiaries of death insurance benefits. When there are several beneficiaries of the death insurance, the order and share of the beneficiaries shall be determined; If the share of benefits is not determined, all beneficiaries of death insurance benefits shall enjoy the same share of welfare rights. The beneficiary of disability or burn insurance in this insurance contract is the insured himself.
The insured or the applicant can change the beneficiary of the insurance money, but it needs to notify the insurer in writing (see 6.2 for the definition), and the insurer will make comments on this insurance contract. The insurer shall not bear any responsibility for legal disputes caused by the change of the beneficiary of insurance money.
Where the applicant designates or changes the beneficiary of the insurance money, it shall obtain the written consent of the insured. If the insured is a person without or with limited capacity for civil conduct, his guardian shall designate or change the beneficiary of the insurance money.
If the beneficiary intentionally causes the death or disability of the insured, or intentionally kills the insured, the beneficiary loses the right to benefit.
2. Guarantee content
2. 1 insurance liability
During the insurance period, the insured suffers accidental injury (as defined in 6.3), resulting in death, disability or burn (as defined in 6.4). The insurer shall pay the insurance benefits according to the following agreement, and the sum of the various insurance benefits paid shall not exceed the insured amount.
2. 1. 1 death insurance liability
If the insured suffers accidental injury during the insurance period and dies within 180 days from the date of the accidental injury, the insurer shall pay the death insurance money according to the insured amount, and the insurance liability to the insured shall be terminated.
If the insured suffers an accidental injury and his whereabouts are unknown from the date of the accidental injury, and is later declared dead by the people's court, the insurer shall pay the death insurance money according to the insured amount. However, if the insured returns after being declared dead, the beneficiary of the insurance money shall return the death insurance money paid by the insurer within 30 days from the date when he knew or should have known that the insured was still alive.
Before the death of the insured, if the insurer has paid the disability and burn insurance benefits agreed in 2. 1.2 and 2. 1.3, the death insurance benefits shall be deducted from the paid insurance benefits.
2. 1.2 Disability insurance liability
If the insured suffers accidental injury during the insurance period, and within 180 days from the date of the accidental injury, one of the disability degrees listed in the Table of Disability Degree and Insurance Payment Proportion attached to this insurance contract (hereinafter referred to as "Payment Table 1") occurs, the insurer shall pay the disability insurance money by multiplying the payment ratio listed in this table by the insurance amount. 180 If the treatment is still not finished on the same day, disability appraisal will be conducted according to the physical condition of that day, and disability insurance money will be paid accordingly.
(1) When the insured is disabled for more than one time due to the same accidental injury, the insurer shall pay the sum of various disability insurance benefits, but the total payment shall not exceed the insured amount. When different disability items belong to the same limb (see 6.5 for definition), only the disability insurance with the highest proportion will be paid.
(2) If the insured has been disabled before the accident, the insurer shall pay the disability insurance premium according to the proportion of the combined disability degree in the payment table 1, but the disability insurance premium corresponding to the disability degree in the payment table 1 shall be deducted.
2. 1.3 Burn insurance liability
During the insurance period, if the insured suffers accidental injury, resulting in one of the burn degrees listed in the Table of Payment Proportion of Accidental Burn Insurance Money attached to this insurance contract (hereinafter referred to as "Table II of Payment Proportion"), the insurer shall pay the burn insurance money by multiplying the payment ratio listed in this table by the insurance amount.
(1) If the insured causes multiple burns due to the same accidental injury, regardless of whether it occurs in the same part of the body (see 6.6 for definition), the insurer will only pay the highest proportion of the burn insurance money; If the insured suffers from burns accompanied by disability due to the same accidental injury, the insurer will only pay the insurance money according to the higher proportion of burn payment and disability payment.
(2) When the insured is burned due to different accidental injuries and occurs in the same part of the body, the insurer only pays the highest burn insurance premium, that is, if the amount of the later burn insurance premium is higher, the previous payment is deducted; If the last burn insurance premium is high, the insurer will not pay the next burn insurance premium.
(3) When the insured burns due to different accidental injuries and occurs in different parts of the body, the insurer pays the sum of various burn insurance benefits, but the total payment does not exceed the insured amount.
2.2 Exemption from liability
2.2. 1 reason excepted.
If the insured dies, is disabled or burns due to the following reasons, the insurer shall not be liable for paying the insurance money:
(1) Intentional behavior of the insured;
(2) The insured intentionally injures himself or commits suicide, except that the insured commits suicide as a person without civil capacity;
(3) Fighting, being attacked or being murdered due to the provocation or intentional behavior of the insured;
(4) Pregnancy, abortion, childbirth and drug allergy of the insured;
(5) Accidents caused by the insured's acceptance of any medical treatment including plastic surgery;
(6) The insured fails to take, smear or inject drugs according to the doctor's advice;
(7) The insured is under the influence of alcohol, drugs and controlled drugs;
(8) Diseases, including but not limited to altitude sickness, heatstroke and sudden death (see 6.7 for definition);
(9) Bacterial or viral infection not caused by accidental injury;
(10) explosion, burn, pollution or radiation caused by any biological, chemical or atomic weapon, atomic energy or nuclear energy device;
(1 1) terrorist attacks.
2.2.2 except for the period.
If the insured suffers accidental injury during the following periods, resulting in death, disability or burns, the insurer shall not be liable for paying insurance benefits:
(1) During war, military action, armed rebellion or riot;
(2) The insured engages in illegal and criminal activities, or is detained, served or at large according to law;
(3) The insured has mental and behavioral disorders (subject to the International Statistical Classification of Diseases and Related Health Problems promulgated by the World Health Organization (ICD- 10));
(4) During drunk driving, the insured drives without a valid driver's license (as defined in 6.8) or drives a motor vehicle without a valid driver's license;
(5) The insured engages in diving (as defined in 6.9), skydiving, hot air balloon sports (as defined in 6. 10), rock climbing (as defined in 6.10/), adventure activities (as defined in 6. 12) and martial arts competitions (as defined in 6.12)
(6) During the period when the insured is driving or taking a non-commercial flight;
(7) The insured suffers from AIDS or is infected with HIV (as defined in 6. 15).
2.3 Insurance amount
The insured amount is the highest amount that the insurer promises to pay.
The amount of insurance shall be agreed by the applicant and the insurer and stated in the insurance policy.
Once the insured amount is determined, it shall not be changed during the insurance period.
2.4 insurance period
Unless otherwise agreed, the insurance period is 1 year, subject to the starting and ending time specified in the insurance policy.
3 Obligations of the applicant and the insured
3. 1 Payment obligation
When an insurance contract is concluded, the applicant shall pay the insurance premium. The insurer shall not be liable for the insurance accident that occurred before the insurance premium was paid.
3.2 Obligation to declare age
When applying for insurance, the applicant should fill in the form according to the age of the insured.
If the age of the insured declared by the applicant is not true, and its true age does not reach the age limit stipulated in this insurance contract, the insurer has the right to terminate the insurance contract and return the cash value to the applicant (see 6. 16 for the definition).
3.3 The obligation to tell the truth
The applicant shall truthfully fill in the application form for insurance, answer the inquiries raised by the insurer, and fulfill the obligation of truthfully informing.
If the applicant fails to fulfill the obligation of truthful disclosure stipulated in the preceding paragraph intentionally or due to gross negligence, which is enough to affect the insurer's decision to agree to underwrite or increase the premium rate, the insurer has the right to terminate the contract.
If the applicant intentionally fails to fulfill the obligation of telling the truth, the insurer shall not be liable for paying the insurance premium or returning the insurance premium for the insurance accident that occurred before the termination of the contract.
If the insured fails to fulfill the obligation of telling the truth due to gross negligence, which has a serious impact on the occurrence of the insured accident, the insurer shall not be liable for paying the insurance premium for the insured accident that occurred before the termination of the contract, but shall refund the insurance premium.
3.4 Notification obligation for change of address or mailing address
When the domicile or mailing address of the applicant changes, it shall promptly notify the insurer in writing. If the applicant fails to notify, the relevant notice issued by the insurer according to the last residence or mailing address specified in this insurance contract shall be deemed to have been served on the applicant.
3.5 Other content change notification obligations
During the insurance period, if the applicant needs to change other contents of the contract, he shall apply to the insurer in writing. After the insurer agrees, it shall issue the Approval Form and annotate it in this insurance contract.
If the insured has died, the insurer will not accept the application of the insured to change any content of this insurance contract.
3.6 Insurance accident notification obligation
After the occurrence of an accident within the scope of insurance liability, the applicant, the insured or the beneficiary shall promptly notify the insurer and explain in writing the cause, process and loss of the accident; If it is difficult to determine the nature, cause and loss degree of the insured accident due to intentional or gross negligence, the insurer shall not be liable for paying the insurance premium for the uncertain part, except that the insurer has known or should have known the occurrence of the insured accident in time through other means.
The above agreement does not include the delay caused by force majeure (see 6. 17 for the definition).
4 Insurance application and payment
4. 1 insurance application
When the applicant (defined as 6. 18) applies for insurance money from the insurer, he/she shall fill in the Insurance Payment Application Form and submit the following materials. If the applicant cannot provide the following materials due to special reasons, he shall provide other legal and effective materials. If the applicant entrusts others to apply, it shall also provide the original power of attorney, the identity certificates of the principal and the trustee and other relevant documents. In accordance with the provisions of this insurance contract, if the insurer thinks that the relevant documents and materials are incomplete, it shall promptly notify the applicant to supplement them. If the applicant fails to provide relevant materials, which makes it impossible for the insurer to verify the authenticity of his application, the insurer shall not be liable for paying the insurance money for the part that cannot be verified.
4. 1. 1 death insurance claim
(1) Insurance claim;
(2) The original insurance policy;
(3) the identity certificate of the applicant;
(4) The death certificate or autopsy report of the insured issued by the police or the judicial department, the second-level and above hospitals or medical institutions recognized by the insurer. If the insured is declared dead, the applicant shall provide the death certificate issued by the court;
(5) Certificate of cancellation of the insured's household registration;
(6) Other certificates and materials that the insured can provide to confirm the nature, cause and loss degree of the insured accident.
4. 1.2 application for disability or burn insurance
(1) Insurance claim;
(2) The original insurance policy;
(3) the identity certificate of the insured;
(4) A diagnosis certificate of disability or burn issued by the judicial department, a hospital above Grade II, a medical institution recognized by the insurer or other appraisal institution recognized by the insurer;
(5) Other certificates and materials that the insured can provide to confirm the nature, cause and loss degree of the insured accident.
4.2 Limitation of action
The limitation of action for the applicant to ask the insurer to pay the insurance money is two years, counting from the day when he knows or should know the occurrence of the insurance accident.
4.3 Payment of insurance benefits
After receiving the materials listed in Article 4. 1 of this insurance clause submitted by the applicant, the insurer shall promptly verify whether it belongs to the insurance liability. If the situation is complicated and the insurer fails to verify the insurance liability within 30 days after receiving the above request from the applicant, the insurer and the applicant shall negotiate a reasonable period according to the actual situation, and the insurer shall make the verification result within the agreed period and notify the applicant.
The insurer shall notify the insured or beneficiary of the verification result. For the insured, the insurer shall fulfill the obligation to pay insurance benefits within 10 days after reaching an agreement with the insured on the amount of insurance benefits; For those who do not belong to the insurance liability, a notice of refusal to pay insurance benefits shall be issued to the applicant within 3 days from the date of approval, and the reasons shall be explained.
If the insurer cannot determine the amount of insurance money within 60 days from the date of receiving the insurance claim and relevant certificates and materials, it shall pay the amount that can be determined according to the existing certificates and materials in advance; After the insurer finally determines the amount of insurance money to be paid, it shall pay the corresponding difference.
5. Contract Termination and Dispute Resolution
5. 1 termination of the contract
After the establishment of this insurance contract, the applicant may notify the insurer in writing to terminate the contract, except that the insurer has paid the insurance benefits in accordance with this insurance contract.
When the applicant terminates this insurance contract, he shall fill in the Application for Termination of Insurance Contract and provide the following supporting documents and materials:
(1) application for termination of insurance contract;
(2) The original insurance policy;
(3) Insurance premium delivery certificate;
(4) the identity certificate of the insured.
The applicant requests to terminate this insurance contract, and the validity of this insurance contract shall be terminated when the insurer receives the application for termination of the insurance contract. The insurer shall refund the cash value of the insurance policy within 30 days from the date of receiving the above-mentioned supporting documents and materials.
The right to terminate the insurance contract obtained in accordance with 3.2 and 3.3 shall be extinguished if it is not exercised for more than 30 days from the date when the insurer knows that there are reasons for termination.
5.2 Settlement of Contract Disputes
Disputes arising from the performance of this insurance contract shall be settled by both parties through consultation. If negotiation fails, it shall be submitted to the arbitration institution specified in the insurance policy for arbitration; If the arbitration institution is not specified in the insurance policy or an arbitration agreement is not reached after a dispute arises, a lawsuit shall be brought to the people's court according to law.
All disputes related to this insurance contract and arising from the performance of this insurance contract shall be handled in accordance with the laws of People's Republic of China (PRC).
6 explanation
6. 1 year
Full age calculated according to the date of birth recorded in the legal identity document.
6.2 Insurance companies
Refers to the branch of China People's Property Insurance Co., Ltd. which signed this insurance contract with the insured.
6.3 Accidental injury
Refers to the physical injury caused by external, sudden, unintentional and non-disease objective events as direct and independent reasons.
6.4 burns
It refers to the burn of body and soft tissue caused by accidents during the insurance period, and the degree of burn reaches third degree. The standard of third-degree burn is the damage of the whole skin (epidermis and subcutaneous tissue), which involves the necrosis, scabbing and final shedding of muscles, bones and soft tissues. The new nine-point method is adopted for burn area, and the calculation of burn degree and burn area shall be based on the appraisal result of the appraisal institution recognized by the insurer.
6.5 limbs
Refers to the limbs of the human body, that is, left upper limb, right upper limb, left lower limb and right lower limb.
6.6 parts
Refers to the parts of the human body agreed in the Table of Payment Proportion of Accidental Injury Burn Insurance Payment attached to this insurance contract, that is, the human body is divided into head, trunk and limbs.
6.7 sudden death
A seemingly healthy person dies suddenly and unexpectedly due to a potential disease or dysfunction.
6.8 No valid driver's license
The insured has one of the following circumstances:
(1) No driver's license or the validity period of the driver's license has expired;
(two) driving a motor vehicle does not meet the driving license;
(3) Driving a bus, operating a bus or a motor vehicle carrying explosives, inflammable and explosive chemicals, toxic or radioactive substances during the internship period, and towing a trailer by a motor vehicle driven during the internship period;
(four) holding a driver's license that has not been verified according to the regulations, and driving a motor vehicle during the period when the driver's license is temporarily detained, detained, revoked or cancelled;
(five) the personnel who use all kinds of special mechanical vehicles and special vehicles do not have valid operation certificates issued by relevant state departments, and the drivers who drive commercial buses do not have valid qualification certificates issued by relevant state departments;
(6) Other circumstances in which a motor vehicle may not be driven in accordance with laws and regulations or the relevant provisions of the traffic administrative department of the public security organ.
6.9 diving
Refers to the underwater movement of auxiliary breathing equipment in rivers, lakes, oceans, reservoirs, canals and other waters.
6. 10 hot air balloon sports
Refers to the sports activity of taking off by hot air balloon.
6. 1 1 rock climbing
Refers to climbing cliffs, building external walls, artificial cliffs, ice cliffs, icebergs and other sports.
6. 12 exploration activities
It refers to the act of deliberately putting yourself in a natural state when you know that there is a danger of losing your life or hurting your body. For example, drifting, hiking through deserts or inaccessible virgin forests.
6. 13 Wushu Competition
Refers to the antagonistic competition between two or more people in judo, karate, taekwondo, Sanda, boxing and other boxing methods and various instruments.
6. 14 special effects
Refers to engaging in equestrian, acrobatics, animal training and other special skills.
6. 15 AIDS or HIV
HIV refers to human immunodeficiency virus, abbreviated as HIV in English. AIDS refers to acquired immunodeficiency syndrome caused by human immunodeficiency virus, abbreviated as AIDS in English.
If HIV or its antibody in human blood or other samples is positive and there are no clinical symptoms or signs, it is HIV infection; If obvious clinical symptoms or signs appear at the same time, it is AIDS.
6. 16 cash value
Unless otherwise agreed, cash value = insurance premium ×[ 1- (days after policy/days during insurance period)] ×75%. If the number of days is less than one day, it shall be counted as one day.
6. 17 Force Majeure
Refers to the unforeseeable, inevitable and insurmountable objective situation.
6. 18 policyholder
The applicant for death insurance benefits refers to the beneficiary or heir of the insured or other natural persons who have the right to claim insurance benefits according to law; The insured of disability or burn insurance refers to the insured himself.
Life Insurance Disability and Insurance Payment Proportion Table Level I Project Disability Maximum Payment Proportion Level I
two
three
four
five
six
seven
8. People who are permanently and completely blind in both eyes (Note 1)
Loss of wrist joint above both upper limbs or ankle joint above both lower limbs.
Loss of wrist joint above one upper limb and ankle joint above one lower limb.
One eye is completely blind forever, and the wrist joint of one upper limb is lost.
One eye is completely blind forever, and the ankle joint of one lower limb is lost.
Permanent complete loss of joint function of limbs (Note 2)
Persons who have permanently lost chewing and swallowing functions (Note 3)
The function of the central nervous system or the function of the thoracic and abdominal organs is extremely damaged, so that you can't engage in any work for life, and you need help from others to maintain the necessary activities of daily life (Note 4)100% Grade II-VII.
Twelve upper limbs, or two lower limbs, or one upper limb and one lower limb, each have two or more three major joints permanently losing their functions (Note 5).
Ten fingers missing (Note 6) 75% Grade Ⅲ eleven fingers
twelve
thirteen
fourteen
15 1. The wrist joint above the upper limb is lost or the three main joints of the upper limb permanently lose all functions.
The ankle joint above one lower limb is missing or the three major joints of one lower limb permanently lose their functions completely.
Permanent total loss of fingers (Note 7)
Ten toes are missing (note 8)
Permanent complete loss of binaural hearing function (Note 9) 50% Grade IV 16 points
seventeen
eighteen
nineteen
twenty
Eryi
22 1 eye is completely blind forever.
People who have completely lost their language function permanently (note 10)
Of the three main joints of the upper limb, the function of two joints is completely lost forever.
Of the three major joints of the lower limbs, the function of two joints is completely lost forever.
One thumb and forefinger, missing more than four fingers.
The lower limbs are permanently shortened by more than 5 cm.
30% patients lost toe function permanently, grade 5, grade 2 and grade 3.
Si Er
Erwu
Erliu
Erqi
sixteen
One of the three major joints of the upper limb permanently loses its function completely.
One of the three major joints of the lower limb permanently loses its function completely.
Absence of thumb in both hands
One foot and five toes are missing.
Eyelid defect is obvious in both eyes (note 1 1)
Permanent total loss of hearing in one ear
20% of the patients with nasal defect and obviously impaired olfactory function (note 12) are grade 6 to grade 30.
the Trinity
One hand thumb and forefinger are missing, or thumb or forefinger is missing more than three fingers.
Three or more fingers of a thumb or forefinger are permanently and completely incapacitated.
15% of patients permanently lost one foot and five toes, grade 7, grade 3, grade 3 and grade 3.
One thumb or forefinger is missing, or two or more of the middle finger, ring finger and little finger are missing.
10% of patients permanently and completely lose thumb and forefinger function Note:
1. Blindness includes losing or removing the eyeball, or being unable to distinguish between light and dark, or only being able to distinguish the person in front of you. The best corrected visual acuity is lower than the international standard visual acuity chart 0.02, or the visual field radius is less than 5 degrees, and there is a medical diagnosis certificate issued by a qualified ophthalmologist.
2. Loss of joint function means that the joint is permanently and completely stiff, or paralyzed, or the joint cannot move with consciousness.
3. Loss of chewing and swallowing function refers to the state that it is impossible to chew and swallow due to organic disorder or dysfunction caused by reasons other than teeth, and it is impossible to ingest or swallow except liquid food.
4. In order to maintain the necessary activities of daily life, all activities that need help from others refer to eating, defecating, dressing, living, walking and bathing. These are things that you can't do by yourself and need help from others.
5. The three major joints of upper limbs refer to shoulder joint, elbow joint and wrist joint; The three major joints of lower limbs refer to hip joint, knee joint and ankle joint.
6. Finger loss refers to complete amputation above the proximal interphalangeal joint.
7. Loss of finger function refers to amputation of distal interphalangeal joint, or stiffness of proximal interphalangeal joint or inability of joint to move with consciousness.
8. Loss of toe refers to complete amputation above toe joint.
9. Hearing loss means that the average hearing loss of language frequency is greater than 90 decibels. The language frequencies are 500, 1000 and 2000 Hz.
10, loss of language function means that more than three of the four language functions that make up a language cannot be constructed, or the vocal cords are completely removed, or the brain language center is damaged, resulting in aphasia, which must be certified by a qualified otolaryngologist (otolaryngologist), but does not include aphasia caused by any psychological disorder.
1 1. Obvious eyelid defect in both eyes means that the eyelids cannot completely cover the cornea when the eyes are closed.
12, nasal defect and significant impairment of olfactory function refer to all or half of nasal cartilage defect, bilateral nostril occlusion, nasal breathing difficulty, uncorrectable or bilateral olfactory loss.
The so-called "permanent total loss" refers to the complete loss of function after 180 days of treatment from the date of accidental injury. However, this restriction does not apply to cases that are obviously irreversible, such as enucleation.
The proportion of accidental injury and accidental burn insurance compensation: the burn site accounts for 2% but less than 5% and 50% and 5% and less than 8% and 75% and not less than 8% and 65,438+000% and 65,438+00% and 65,438+05% respectively.