General Conditions of Personal Accident Insurance
Section 1- This insurance policy shall warranty the insured person against the results of accidents in the insurance period.
Section 2- The term of ‘accident’ means the death of the insured person without his/her will or to get bodily harmed as a result of sudden an unexpected incident.
Section 3- The following circumstances shall be counted as an ‘accident’:
- Breathing of the sudden and unexpected gasses.
- The injury, sprain and breaking off of the muscles and nerves as a result of burning and sudden actions.
- The death or bodily harm from hydrophobia as a result of beaten up.
Section 4- The following circumstances shall not be counted as an ‘accident’:
- The results and pathological situation with all kinds of illnesses.
- The effect of hardness and thickness, frozen, sunstroke and conjunction which has not occurred to the insured person as a result of incident.
- Committing suicide or pretend to commit suicide in the situation of any mental and spirit condition.
- Manifest intoxication, using narcotic substances, taking drugs and dangerous substances that are not needed to be taken by the insured person in the circumstances.
- Surgical interference (operation) and the application of rays of light which has not resulted by an accident that caused death or bodily harm.
Section 5- The following circumstances are excluded from the insurance:
- War or military action for war, invasion, collusion, riot and interior war as a result of these.
- Strikes, worker’s movement that have been locked-out, to involve fights in the public movements.
- To commit crime and murder or pretend to commit murder.
- Where the insured person take himself/herself in heavy dangers on purpose, not including the prevention of character and goods.
- Nuclear risks, use of nuclear, biological or chemical weapons, the attacks and sabotage as a result of manifestation of nuclear, biological and chemical weapons.
- Terrorist attacks and sabotages in relation with these attacks.
The insured person is excluded from drown in the water if he/she has not been involved in the incident on himself/herself.
Section 6- The following circumstances are also excluded from the insurance unless agreed otherwise:
- The use of or ride on the motorcycles or motor installed bicycles.
- The drove and banishment fishing with the high seas fishing, hunting of wild animals with wild pork, hunting on high mountains.
- Mountaineering with climbing on mountains, all kinds of sports on the snow and ice (skiing, ice skating, hockey and boxing); the game of jeered, riding, polo, rugby, dumbbell, wrestling, boxing, basketball, football and heavy and dangerous gymnasium movements with sailing sports and professional sport movements.
- The speed and resistance races in all kinds of sport competition.
- Flying in the air other than being a passenger.
- The eruption of volcanoes, landslide.
The boundaries of insured person’s possession
Section 7- This insurance policy is valid outside the boundaries of T.R.N.C.
Kinds of Warranty
- Warranty of death
Any accident that has been warranted by this insurance policy that has been caused the death of the insured person at the time accident or within 1 year of the date of accident, the amount of insurance with the benefits or if not, the legal rights shall be paid back shown in the insurance policy.
- Warranty of permanent infirmity
Any accident that has been warranted by this insurance policy that has been caused the infirmity at the time accident or within 1 year of the date of accident, after the end of medical check and after the detection of permanent infirmity, the amount of the warranty of permanent infirmity shall be paid back according to the following circumstances.
|(%) of the amount of insurance|
|The total loss of two eyes||100|
|The total loss of two arms or two hands||100|
|The total loss of two legs or feet||100|
|The total loss of one arm or one hand with one leg or foot||100|
|The mental illness that could not be cured||100|
|(%) of right||(%) of left|
|The total loss of arm or leg||60||50|
|The total loss of movement of shoulder||25||20|
|The total loss of movement of elbow||20||15|
|The total loss of movement of wrist||20||15|
|The total loss of thumb and index finger||30||25|
|The total loss of thumb and any finger other than index finger||25||20|
|The total loss of index finger and any finger other than thumb||20||15|
|The total loss of any three fingers other than thumb and index finger||25||20|
|The total loss of thumb only||20||15|
|The total loss of index finger only||15||10|
|The total loss of middle finger only||10||8|
|The total loss of ring finger only||8||7|
|The total loss of little finger only||7||6|
|The total loss of legs above the knee||50|
|The total loss of legs below the knee||40|
|The total loss of one leg||40|
|The amputation of feet with all fingers||30|
|The total loss of movement of hip||30|
|The total loss of movement of knee||20|
|The total loss of movement of ankle||15|
|The total loss of feet thumb||8|
|Non-joining of broken leg||30|
|Non-joining of broken feet||20|
|Non-joining of broken knee cap||20|
|Shortening of leg 5 centimeters or more||15|
|The total loss of one eye or the half loss of visibility power of two eyes||25|
|The total deaf of two ears||40|
|The total deaf of one ear||10|
|Non-joining of below jaw||25|
|Non movement of wounded perpendicular curve||30|
|The breaking of ribs which caused shape failures in chest||10|
The infirmity causes that have been stated above, even if they have lower effects, shall be determined according to its importance degree and in relation with the written list above.
The insured person’s job shall not be counted in the determination of permanent infirmity causes.
The expression of loss of organ or partial loss of organ shall mean the non-functioning of that organ for a long period or forever.
The non-functional organ or part of any organ that does not function properly before the accident shall not be warranted.
If the non-functioning of a partial organ is increased after an accident, the warranty shall be calculated on the difference between the relation before and after that accident.
For the infirmities of the various organs or the various partial organs that occurred from the same accidents, the total amount of the warranty that has calculated separately could not exceed the amount shown in the insurance policy.
If the insured person is left-handed, the causes that have been determined for the left and right hand shall inversely be applied.
- Daily Warranty
If the insured person falls into the situation that he could not work permanently, the daily warranty shall be paid to him/her written in the insurance policy.
If the insured person falls into the situation that he/she could not work temporarily or until he/she could work, the daily warrant shall be reduced to half from that date.
This warranty shall be paid from the start date of medical treatment until the insured person becomes wealthy and could work. This period could not exceed 200 days.
- Warranty of medical expenses
The insurer shall pay the medical expenses up to the agreed amount, all the doctor and drug costs, radiography, bath, massage, hospital and other medical expenses (excluding transport expenses) within one year of the date of accident, with the condition that the medical expenses are included in the insurance warranty and must be written down in the insurance policy.
The replica teeth expenses that have been damaged as a result of accident shall be secured up to the 10 per cent of the amount of warranty.
The insured person’s place of work or actual payments by the insurance that are obligatory in law shall be reduced from the warranty that the insurer will pay for medical expenses.
If the medical expenses have been determined by the authorized insurers, these expenses shall be divided equally in between then in relation with the warranty.
The amount which the insurer has been paid to the responsible third parties for the medical expenses shall be substituted for the behalf of insured person.
The assembly of the kinds of warranty
Section 9- In an accident, any rights could not be gained for in the situation of death or permanent infirmity warranty. However, if the insured person has gained the permanent infirmity warranty, “the difference between the permanent infirmity warranty that has been paid to the insured person and the warranty of death” shall be paid to the rightful owners within one year from the date of accident or from the death as a result of this accident.
The daily warranty and medical expenses shall not be reduced from the death or the permanent infirmity warranty.
The conditions that heavier the results of accident
Section 10- In the cases of all the illnesses, breaking down of bodily formations or the deficiency of insured person which has been acquired seriousness as a result of incapable, wrong and false medical treatment that have been occurred after an accident which have
ready been happened before the accident or have been existed after the accident or have not been related to this accident, then the amount of warranty that needs to be paid shall not be calculated on the occurred result; it shall be determined on the result that this accident happened to a wealthy person who has had a full and true medial treatment.
The insured person’s obligation to declare
Section 11- This insurance has been concluded on the declarations of insured person.
The insured person is under an obligation to give right answers to the questions that have been asked to him/her in his/her offer letter and is under an obligation to declare the conditions that are related to the occurrence of risks if he/she knows. In the situations where the insured person has given the wrong answers or has given missing declarations:
- The insurance policy will be invalid if the insured person’s purpose realized.
- If there is nothing done on the purpose of the insured person, the insurer could either continue to hold the insurance policy as valid or cancel it with the condition of getting the risks that relates to the premium difference with its heaviness. If the insurer chooses the cancellation option, he/she shall inform the insured person within 1 month of cancellation date. The insurance shall end at 12:00 noon within 15 days after it has been posted and the premium for the unprocessed insurance shall be returned back. The unused right of cancellation in its period will be lost. If the wrong answers or missing declarations have been informed after the incident of damage, the warranty shall not be paid in the situations where the insured person has purposes; in the situation where the insured person does not have anything on purpose, according to the relation circumstances between the premium that has been realized and the premium that needs to be realized shall be reduced from the warranty.
Changing of risks
Section 12- The insured person is under an obligation to give written notice to the insurer about the changes in the declarations on the offer letter and the entire changes to the included conditions that occurred in the insurance policy during the insurance period –like changing of job or occupation, the condition of being blind or deaf, epilepsy, partial or total paralyze, mental and nervous illnesses-.
If these changes are heavier the conditions of insurance and the insurer have been informed within 8 days, the insurer:
- either accepts the continuation of insurance on the condition of receiving reasonable premium,
- Or shall cancel the agreement within 8 days after he/she has been informed about circumstances.
In this situation the insurance shall end when the cancellation has been inform in the written form and the premium that will not be processed, shall be returned back on day basis. The validity of the insurance shall continue if the cancellation has not been used in its period.
If the insured person does not inform the changing of circumstances and the insurer does not cancel the agreement after he has been informed about the circumstances within 8 days or if he acts in a way that it shows he/she accepts the continuation of agreement as getting the insurance premium, the right of cancellation will be lost.
If there is no agreement for the payment of additional premium, the insured person could use the right of cancellation. In this situation the agreement will not be valid after the cancellation and the premium that will not be processed shall be returned back on the short-term insurance base.
The insurer will not be responsible for the realization of risks where the responsibility to give notice about this topic has not been done or the changes have heavier the risks. The relationship shall not be found between the heavier of risks and the realization of risks.
The obligations of the insured person in the situation of happening of risks
A) The notice of the happening of risks
The insured person or the rightful owners shall inform the insurer within 8 days after they have informed about the happening of risks.
The insured person or the rightful owners is under an obligation to inform the insurer by a report, about the place, date and the causes of the accident and also a report, that contains the situation that caused the accident with its possible results, to be obtained from the doctor who has made the medical treatment.
B) Starting the medical treatment and taking the necessary precautions
A doctor shall be called immediately after the accident to start the necessary medical treatment and to take all the necessary precautions in order to make the patient’s wealthy.
The insurer obtains the right to examine and control the hygienic situation of the person who has had an accident in all times and is under an obligation to give permission for these examinations and hygienic control.
The insurer shall respect for the recommendations and instructions of his/her doctor for the treatment of the person who has had an accident and becoming wealthy of him/her.
The obligation that have been considered in paragraphs (A) and (B):
- The rights that have been obtained from the insurance policy will be lost if they have not been done on purpose.
- The insurer shall not be responsible fro the part which has become heavier if they have not been done because of deficiency and the results of accident have become heavier for this reason.
C) Handling over the necessary documents
The insured person or the rightful owner is under an obligation to handle over all the necessary documents to the insurer about the results of the accident and the demonstration of the amount that needs to be paid.
The situation of agreement after the happening of risks
Section 14- The insured person or the rightful owner obtains the right of cancellation for the unprocessed days in the insurance agreement after the accident that the compensation payment needs to be done.
If the insurer cancels the agreement, the insurance shall be cancelled within 15 days after it has been posted at 12:00 noon and the premium for the unprocessed days shall be returned back to the insured person on the day basis.
If the insured person cancels the agreement, the validity of the insurance shall be lost after that cancellation and the premiums that are not processed could not be returned back.
The demonstration method of the warranty
- The amount of loss or damages that occurred to the insured goods shall be demonstrated by the parties according to this insurance policy.
- If the parties do not agree, the referee or expert witnesses shall demonstrate the amount of compensation for death, causes of permanent infirmity and capability of being employed or by taking these into account: the compensation amounts of degree of infirmity and daily warranty or expenses of medical treatment.
- Each party has the right to choose and cancel his/her own referee or expert witnesses and before starting the inspection period for these two referee or expert witnesses, for the adaptation of decisions in the topics that have not been agreed and shall be limited to this, the third referee or expert witnesses shall be demonstrated within 7 days after their referees or expert witnesses have been chosen.
- If either one of the parties do not choose their referee or expert witnesses within 15 days of notification of other party or referee or expert witnesses chosen by the parties do not agree with the third referee or expert witnesses within 7 days, the third referee or expert witnesses shall be chosen by the authorized court.
- The duties of the selected referee or expert witness do not end if the insured person dies.
- If one of the referee or expert witnesses dies or resigns or rejected, the party whose referee or expert witness died resigned or rejected, is responsible to determine the new referee or expert witnesses. In the case of the death, resign or rejection of the third referee or expert witnesses, the referee or expert witnesses of each party is responsible to demonstrate the new referee or expert witnesses.
- If the parties agree, the demonstration formality could be made by only one referee or expert witness.
- The parties are responsible for the finance of their referee or expert witnesses. Finance of one referee or expert witnesses or third referee or expert witnesses is to be paid equally.
- In the execution, the investigations of the referee or expert witnesses’ committee or only one referee or expert witness shall be free from the sections of any Law Procedure Courts Acts.
- The disapproval of the decisions of the referees or expert witnesses could only be made through the Law Procedure Courts Act or if the decision is against to good faith, it could be disapproved after the delivery of the decision within 15 days to the authorized Court of First Instance.
- The decision of the referee or expert witnesses or third referee or expert witnesses that they have given on the amount of the loss or damage is final and binding by the parties.
- If the losses or damages have not demonstrated by any parties, then the compensation could not be obtained from the insurer an there could be no case.
Payment of insurance premium, beginning of the insurer’s responsibility and the default of the insured person
Section 16- If it is agreed that the whole of the insurance premium will be paid in installments, then first installment shall be paid as soon as the agreement has been made or latest on the date of handing over of the insurance policy. Unless agreed otherwise, in the situation of non payment of the first installment or premium, the responsibility of the insurer will not start and this condition shall be written down on the face of the insurance policy. The insured person falls into default if he/she fails to make the payment until the end of the handing-over date where it is agreed that the insurance premium or the premium will be paid in installments and the insurance agreement will be cancelled in 30 days from the date of falling into default without any notice if he/she still has not made any payment. The responsibility of the insurer will continue for first 15 days after the payment of premium in which it is agreed that the insurance policy will be handed-over with the start of the insurer’s responsibility.
In the situations in which it is agreed that the insurance premium will be paid in installments, the results of the non-payment on the defined payment date, the amount and in its fixed term shall be written on the insurance policy in order to inform insured person. If the insured person does not pay the fixed term premiums written on the insurance policy or the premium installments that he/she has been informed in writing, the insurance premium will be defaulted. The warranty of the insured person will stop within 15 days after the default of the premium loan. If the risks have not happened, the warrant shall continue from where it has stopped if the premium loan has been paid. If the premium loan has not been paid within 15 days from the date of stoppage of the insurance premium, the warranty will stop without a written notice.
In the situation of happening of risks, the fixed terms of the premium installments that has not yet come which does not exceed the amount of warranty where the insurer will have to pay becomes in promptly paid situation on the condition that it has to be written down on the face of the insurance policy.
According to this section, in the condition of cancellation of the insurance agreement, the premium that meets with the period in which the insurer’s responsibility continues shall be calculated on the day basis and the exceeding amount shall be given back to the insured person.
Tax, Picture, Fee and Management Expenses
Section 17- The insured person will be responsible for the current or possible tax expenses, picture or fees with the management expenses shown in the insurance agreement.
Section 18- In the insurance agreement, the insured person’s residence address that he/she declared is covered in the insurance policy. If the insured person changes his/her place of residence, he/she is under an obligation to inform the insurer with recorded delivery. Otherwise, the insured person will be responsible for all the results of the non-delivery of the delivery letter that has been made by the insurer.
The authorized court
Section 19- The authorized court to hear all the cases that have been taken to the court; by the insured person is the one which is within the place of residence of insurance agents or the agent who was the mediator to the insurance agreement and if the case has been brought by the insurer the authorized court will be the one within the place of residence of insured person which have stated in section 18.
Passage of time
Section 20- The entire requests which have been made through the insurance agreement will lapse in 2 years.