Personal Accident Scheme
Aegis: Terms & Conditions
IMPORTANT NOTE: Data Protection Act
Any information you provide to SFS Group Ltd will only be used for the operation of your membership as it relates to you, your child or your child's school, and for internal SFS Group Ltd marketing purposes. It will not be released to any third parties. SFS Group Ltd follows a confidentiality policy, which means that your personal data will be processed fairly and securely in accordance with the Data Protection Act 1998.
Your personal data will be available only to those who need to see it for the purposes stated above. This may include our Insurers.
SECTION A. GENERAL DEFINITIONS
Accident means a sudden, unexpected, unusual, specific event which occurs at an identifiable time and place during the year.
Agreement means an application for membership under AEGIS, duly signed by both the Trustee and the Parent.
Assured means any child whose parent is a member of an AEGIS scheme.
Bodily Injury means identifiable physical injury which (a) is caused by an Accident and (b) solely and independently of any other cause, except sickness and disease directly resulting from, or medical or surgical treatment rendered necessary by, such injury, occasions the death or Permanent Total Disablement of the Assured within twelve months from the date of the Accident.
Commencement Date means the first day of the first term for which membership has been chosed or after receipt by SFS Group Ltd of a completed Agreement and the relevant contribution, whichever is the later.
Contribution means any amount payable for membership to be effective.
Holiday Period means a period during which the Assured was suffering continuously from a single Sickness or Injury and which falls between two terms in which the Assured was absent from lessons for a period equivalent to the chosen Qualification Period during the first term and during the first 14 days of the second term by reason of the same Sickness or Injury.
Insurer means Unum Limited (trading as Unum); Certain Underwriters at Lloyd's; Equity Red Star at Lloyd's; or any other insurance underwriter chosen by SFS Group Ltd
Loss of Limb means permanent loss by physical separation of a hand at or above the wrist or of a foot at or above the ankle and includes permanent total and irrecoverable loss of use of a hand, arm or leg.
Member means a parent(s) who has completed an Agreement; who meets the requirements for joining; and who has remitted the appropriate contribution to SFTS Trustees Limited.
Permanent Total Disablement shall be deemed to have occurred when the Assured has been totally disabled from attending full time education for a period of 12 consecutive months and at the end of that period is beyond hope of improvement and without prospect of being able to undertake any gainful occupation or being able to support him/herself financially.
Pre-existing Conditions means that no benefit shall be payable for the Assured's inability to attend school due to any medical condition that was diagnosed before membership started or due to any Sickness or Injury for which the child has received treatment, medication, medical advice or hospital care before membership started.
Sickness or Injury means a medical or physical condition that is certified by a medical practitioner acceptable to the Insurer and which, when it exists during term, results in an Assured being unable to attend lessons for the duration of that condition.
SECTION B. GENERAL CONDITIONS
1. Limit of Indemnity
The liability of Underwriters for any loss, theft or damage shall not exceed the sum(s) covered stated on the membership certificate.
2. Claims Procedure
It is a condition precedent to the liability of the Insurer that, following any happening likely to give rise to a claim, the Member shall:
a) as soon as reasonably possible notify and confirm in writing to the Insurer through SFS Group Ltd and, if required, give full details within 30 (thirty) days of the incident together with such information and assistance as the Insurer may reasonably require;
b) in the case of the Personal Possessions Insurance, notify the Assured's School following any loss, or damage by theft, attempted theft or malicious damage; and the police, if such a loss or damage has occurred outside the premises of the school.
3. Payment of Contributions Contributions are paid to SFTS Trustees Limited on or around the 7th of January, May and September each year. Such contributions shall be payable each term during the period of this Agreement until and including the final term of the academic year in which the Assured attains the age of 18.4. Evidence for claims
Payment of any Benefit under this Agreement is subject to satisfactory proof to the Insurer of such evidence as they may require in relation to:
a) the happening of an event by reference to which Benefit is payable and
b) the title of the person claiming payment.
5. Fraudulent Claims
If the Member shall make any claim knowing the same to be false or fraudulent as regards amount or otherwise, membership shall become void and all claims hereunder shall be forfeited.
6. Cooling Off Period Once your application has been accepted and your membership documentation issued, SFTS Trustees offer a 14 day cancellation period during which you are entitled to a refund of any contributions you have paid.7. Cancellation ClauseThe contract between a Member and the Trustee may be cancelled only at the end of any school term by 30 (thirty) days notice to the Member at their last known address. This contract may also be cancelled at any time by the Member by writing to SFS Group Ltd, and the cancellation will take effect from the end of the term in progress or the date of receipt of the notice by SFS Group Ltd if that date falls between the last day of one term and the first day of the following term at the relevant school.
8. Termination of Agreement
SFTS Trustees Limited reserves the right to terminate this Agreement at any time on not less than three months' notice.
9. Notice
Notice shall be deemed to be received if sent by recorded delivery post and properly addressed; or if confirmed in writing by SFS Group Ltd after a telephone call from the Member.
10. Applicable Law
The parties are free to choose the law applicable to this insurance contract. Unless specifically agreed to the contrary this insurance shall be subject to English Law.
10. Complaints
Any enquiry or complaint should be addressed in the first instance to the Customer Service Department of SFS Group Ltd at Crossways House, 54-60 South Street , Dorking, Surrey , RH4 2HQ, Tel. 01306 746300 .
If you are still unhappy with any issue connected with the handling of your membership or claim, then you should direct your enquiry in writing to:
Equity Red Star
Personal Lines Division
Halford House
2 Coval Lane
Chelmsford
Essex CM1 1TZ
If you are still unhappy with any issue connected with the handling of your membership or claim, then you should direct your enquiry in writing to:
The Financial Ombudsman Service, South Quay Plaza, 183 Marsh Wall, London E14 9FR
Scheme specific Terms & Conditions
The Terms and Conditions below should be read in association with the AEGIS General Terms and Conditions indicated above.
The geographical limits of this Scheme: world-wide.
1. Policy Specific Definitions
Accident means a sudden, unexpected, unusual, specific event which occurs at an identifiable time and place during the period of membership. Accident shall also include:
a) exposure resulting from a mishap to a conveyance in which the Assured is travelling;
b) disappearance. If the Assured is not found within twelve months of disappearing, and sufficient evidence is produced satisfactory to the Underwriter that leads them inevitably to the conclusion that the Assured has sustained Bodily Injury and that such injury has caused the Assured's death, the Underwriter shall forthwith pay any death Benefit, where applicable, under this Scheme, provided that the person or persons to whom such sum is paid shall sign an undertaking to refund such sum to the Underwriter if the Assured is subsequently found to be living.
Bodily Injury means identifiable physical injury which:
a) is caused by an Accident, and
b) solely and independently of any other cause, except sickness or disease directly resulting from, or medical or surgical treatment rendered necessary by such injury, occasions the death or disablement of the Assured within twelve months from the date of the Accident.
Loss of a Limb means permanent loss by physical separation of a hand at or above the wrist or of a foot at or above the ankle and includes permanent total and irrecoverable loss of use of hand, arm or leg.
Permanent Total Disablement shall be deemed to have occurred when the Assured has been totally disabled from attending full time education for a period of 12 consecutive months and at the end of that period is beyond hope of improvement and without prospect of being able to undertake any gainful occupation or being able to support him/herself financially.
Pre-existing Conditions means no benefit shall be payable for the Assured's inability to attend school due to any medical condition that was diagnosed before the cover started or due to any Sickness or Injury for which the child has received treatment, medication, medical advice or hospital care before the cover started.
Sickness or Injury means a medical or physical condition that is certified by a medical practitioner acceptable to the Insurer and which, when it exists during term, results in an Assured being unable to attend lessons for the duration of the condition.
2. Schedule of Benefits
| Injury | Compensation |
|---|---|
| (i.) Permanent Total Disablement | £500,000 |
| (ii.) Quadriplegia | £500,000 |
| (iii.) Paraplegia | £250,000 |
| (iv.) Loss of two Limbs | £250,000 |
| (v.) Loss of two eyes | £250,000 |
| (vi.) Loss of one Limb | £125,000 |
| (vii.) Total loss of hearing (both ears) | £125,000 |
| (viii.) Total loss of speech | £125,000 |
| (ix.) Total loss of hearing (one ear) | £50,000 |
| (x.) Removal of lower jaw by surgical operation | £75,000 |
| (xi.) Shortening of at least 5 centimetres of lower limb | £37,500 |
| (xii.) Facial Disfigurement | Up to £5,000 |
| (xiii.) Death (to pay for a suitable memorial) | £7,500 |
| Loss by amputation or permanent total loss of use of right (if right handed) or left (if left handed). Amount in brackets for the reverse: |
|
| (xiv.) Shoulder or elbow | £62,500 (£50,000) |
| (xv.) One thumb | £50,000 (£43,750) |
| (xvi.) One index finger | £37,500 (£31,250) |
| (xvii.) Permanent total loss of wrist | £50,000 (£43,750) |
| (xviii.) Any other finger | £25,000 (£18,750) |
| Loss by amputation or permanent total loss of use of: | |
| (xix.) Hip, knee or ankle | £50,000 |
| (xx.) One big toe | £25,000 |
| (xxi.) Any other toe | £7,500 |
Conditions applicable to the above
a) Benefits (xiv) to (xviii) shall be reversed in the event of the Assured being left handed.
b) If compensation is payable in respect to the Assured under more than one form of permanent disability as a result of one Accident the total payable shall not exceed 100% of the Sum Insured.
c) In the event of the Assured sustaining any permanent disability not noted above the compensation payable shall be calculated by assessing the degree of disability relative to this extension, but without reference to the Assured's occupation.
d) If compensation is payable for loss of or loss of use of a whole member of the body then compensation for parts of that member cannot also be claimed.
e) Facial Disfigurement is defined as permanent scarring affecting at least 20% of the facial area.
f) The maximum amount the Underwriter will pay in respect of an Accident involving more than one person under this certificate or any other Policy of Personal Accident Insurance insured by the Underwriter under the SFS Schools Scheme is GBP10,000,000. If a claim exceeds this limit, the Underwriter will pay an amount which is proportionately reduced until the total loss does not exceed this limit.
Important notice
THIS SCHEME DOES NOT PROVIDE SICKNESS OR DISEASE INSURANCE.
The Underwriter hereby agrees with the Member, to the extent and in the manner herein provided, that if the Assured sustains Bodily Injury caused by an Accident, they will pay to the Member, or to the Member's Executors or Administrators, according to the Schedule of Benefits after the total claim shall be substantiated under this scheme.
Provided always that:
If Injury (i) of the Schedule of Benefits is covered and an Accident causes the death of the Assured within twelve months following the date of the Accident and prior to the definite settlement of the Benefit for disablement provided for under Injuries (ii) to (xxi), but excluding (xiii), of the Schedule of Benefits, there shall be paid only the Benefit provided for in the case of death.
3. Exclusions
This scheme does not cover death or disablement in any way caused or contributed to by:
a) radioactive contamination;
b) the Assured engaging in active service in any of the armed forces of any nation other than members of the Territorial Army Volunteer Reserve, the Royal Air Force Volunteer Reserve or the Royal Navy Volunteer Reserve or the like whilst engaged in training;
c) the Assured engaging in flying of any kind other than as a passenger;
d) the Assured's suicide or attempted suicide or intentional self-injury or the Assured being in a state of insanity;
e) Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or Human Immunodeficiency Virus (HIV) howsoever these have been acquired or may be named;
f) the Assured's own criminal act;
g) the Assured being under the influence of alcohol or drugs.
Notwithstanding any provision to the contrary within this scheme or any endorsement thereto it is agreed that this scheme excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any of the following regardless of any other cause or event contributing concurrently or in any other sequence to the loss:
- war, invasion, acts of foreign enemies, hostilities or warlike operations (whether war be declared or not), civil war, rebellion, revolution, insurrection, civil commotion assuming the proportions of or amounting to an uprising, military or usurped power; or
- any act of terrorism.
For the purpose of this exclusion an act of terrorism means an act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organisation(s) or government(s), committed for political, religious, ideological or similar purposes including the intention to influence any government and/or to put the public, or any section of the public, in fear.
This scheme also excludes loss, damage, cost or expense of whatsoever nature directly or indirectly caused by, resulting from or in connection with any action taken in controlling, preventing, suppressing or in any way relating to a) and/or b) above.
If the Underwriter alleges that by reason of this exclusion, any loss, damage, cost or expense is not covered by this scheme the burden of proving the contrary shall be upon the Insured.
In the event any portion of this exclusion is found to be invalid or unenforceable, the remainder shall remain in full force and effect.
4. Conditions
a) Notice must be given to the Underwriter as soon as reasonably practicable, via SFS Group Ltd, of any Accident which causes or may cause a claim within the meaning of this scheme, and the Assured must as early as possible seek the attention of a duly qualified medical practitioner. Notice must be given to the Underwriter as soon as reasonably practicable in the event of the death of the Assured resulting or alleged to result from an Accident.
All medical records, notes and correspondence referring to the subject of a claim or a related Pre-existing Condition shall be made available on request to any medical adviser appointed by or on behalf of the Underwriters and such medical adviser shall, for the purpose of reviewing the claim, be allowed so often as may be deemed necessary to make an examination of the Assured.
b) Any fraud, concealment or deliberate mis-statement either in the proposal on which this insurance is based or in relation to any other matter affecting this insurance or in connection with the making of any claim hereunder shall render this insurance null and void and all claims hereunder shall be forfeited.