Insurance

Please note that this is a Summary Document, and does not contain the full terms and conditions of the Insurance Contract arranged for Red Letter Days, which can be found in the Policy document. Full terms, conditions and exclusions are contained in the Master Certificate of Insurance number R02397AZZ, which is available for inspection upon request.

Master Certificate Holder

Red Letter Days as agent for each Insured Person each for his own rights and interests.

Insured Person

Any voucher recipient with respect to vouchers redeemed under the Red Letter Days scheme.

Country Of Domicile

For the purpose of this insurance, this will be the United Kingdom or the Insured Person’s normal country of domicile.

Operative Time

Whilst an Insured Person is carrying out an activity sold by and under the direction of Red Letter Days Ltd.

Your Insurer

Canopius Underwriting Limited on behalf of Syndicate 4444 at Lloyd's.

Significant Features, Benefits and Exclusions

The Section Schedules describe when the contract operates together with the benefits and limits that apply to each person insured.

Personal Accident

What is Covered:

If an Insured Person sustains an Injury during the Operative Time which within 24 months results in:

Death, disablement or sustaining of medical expenses;
Death or disablement solely as a result of unavoidable exposure to severe weather conditions;
Disappearance of an Insured Person, and if after a reasonable period of time has elapsed and all available evidence examined , there is reason to presume that the death of an Insured Person has occurred, the disappearance shall be considered to have been caused by an injury;

The Underwriters will pay the Insured an amount equal to the sum stated in the Schedule.

Lump sum payments following accidental death or injury resulting in loss of limb, sight, speech, hearing or permanent total disablement;
Weekly disability income benefits if you are prevented from working following an accident or illness;
Medical expenses are paid in addition to the above benefits. The Schedule of Benefits states the amount of cover and maximum limits applicable to each person insured.

Schedule Of Benefits

To pay in accordance with the following schedule of benefits in the event of the Insured Person sustaining Accidental Bodily Injury as herein defined causing:

Sum Insured
per Insured Person Benefit

£50,0001. Accidental Death

Disablement:

£50,0002. Loss of two or more Limbs or Sight in both Eyes or one of each
- £50,0003. a) Loss of one Limb or Sight in one Eye
- £50,000b) Loss of Speech
- c) Loss of Hearing in:
£50,000 4. Permanent Total Disablement definition
PTD any and every occupation Permanent Total Disablement definition
Not Insured 5. Permanent Disability (Continental Scale)

Disability Income (Items 6 and 7):

£150 6. Temporary Total Disablement (per week)
- 104 weeksBenefit Period
- 14 daysDeferment Period
Not Insured 7. Temporary Partial Disablement (per week)
- Benefit Period
- Deferment Period
50% of Benefit 4 8. Quadriplegia
37.5% of Benefit 4 9. Triplegia
25% of Benefit 4 10. Hemiplegia
25% of Benefit 4 11. Paraglegia
Insured Rehabilitation Expenses
Insured Home Modification
Insured Coma
Not Insured Hospital and Convalescence
Insured Loss of Enjoyment of Life
Not Insured Fracture
Not Insured Optical Injury

Medical Expenses

In addition to the Benefits shown for each category of Insured Persons, the Underwriters will pay any Medical Expenses necessarily incurred by the Insured or an Insured Person up to but not exceeding 10% of the total amount paid under Benefits Accident Death, Disablement or Permanent Total Disablement or 25% of the amount paid under Disability Income Benefit, whichever is the greater, but subject to a maximum of £5,000 for each Insured Person.

Rehabilitation Expenses

For a Permanent Total Disablement loss, an additional £500 per month is payable for tuition, advice, or treatment from a licensed vocational school, payable for a maximum of 6 months, provided such tuition advice or treatment is undertaken with the Underwriters prior agreement and the agreement of the Insured Person’s Medical Practitioner.

Home Modification

If a claim is paid for Loss of Hearing, Limbs, Speech and Sight or Permanent Total Disablement which requires modification to the home necessary for the Insured Person to perform daily activities of washing, cooking, bathing, and dressing and to remain in and move around their home, the Underwriters will pay the cost incurred for such modifications to a maximum of £5,000, limited to modification for external or internal wheel chair access, internal guide rails and emergency alert system. This benefit is only payable where such renovations are undertaken with the prior written agreement of the Underwriters and the agreement of the Insured Person’s attending Medical Practitioner.

Coma

If an Insured Person sustains an Injury during the Operative Time which results in Coma, the Underwriters will pay the Insured £350 per week for each full week of continuous unconsciousness up to a maximum period of 52 weeks.

Loss of Enjoyment of Life

The Underwriters will pay 5% of the Permanent Total Disablement sum insured to a maximum of £5,000, whichever is the lesser; for Loss of Enjoyment of Life to an Insured Person following a claim which is payable under Section 7, Benefits 2, 3.a), 3.b), 3.c)i), 4, 8, 9, 10 and 11. A claim will only be considered where the Insured Person’s Medical Practitioner has confirmed the necessity for assistance or a mechanical device.

Aggregate Limits of Liability

£1,000,000 Limit any One Event

If the Aggregate amount of all Benefits payable under this policy exceeds the Aggregate Limit of Liability the Benefit payable for each Insured Person shall be proportionately reduced until the total of all Benefits does not exceed the Aggregate Limit of Liability.

Definitions

Accidental Bodily Injury

A specific physical injury caused in and of itself by a single, unexpected, sudden and unintended event, which occurs at an identifiable time and placed to an Insured Person during the Operative Time and results solely and independently of all other causes and within 12 calendar months of the date of the event in the Death, Loss of Hearing or Speech, Loss of Limb, Loss of Sight, Total Disablement, Partial Disablement or Permanent Total Disablement of an Insured Person.

Loss of Hearing or Speech

Permanent, total and irrecoverable loss of hearing in an ear or permanent, total and irrecoverable loss of speech.

Loss of Sight

Permanent and total Loss of Sight shall be considered as having occurred:

a) in both eyes, if an Insured Person’s name is added to the Register of Blind Persons on the authority of a registered qualified ophthalmic specialist and is without hope of improvement; or

b) in one eye, if the degree of sight remaining after correction is 3/60 or less on the Snellen Scale and is without hope of improvement.

Loss of Limb or Limbs

The permanent and complete loss of or loss of use of a limb or limbs at or above the ankle or wrist.

Permanent Total Disablement

Definition 1:
Total Disablement caused other than by Loss of Limb or Sight or Speech or Hearing, which prevents the Insured Person from engaging totally in their usual occupation with the Insured for a period of twelve (12) consecutive months, and at the end of that period being without prospect of improvement.

Definition 2:
Total Disablement caused other than by Loss of Limb or Sight or Speech or Hearing, which prevents the Insured Person from engaging totally in any and every occupation for a period of twelve (12) consecutive months, and at the end of that period being without prospect of improvement.

Definition 3:
Total Disablement which has lasted for twelve (12) consecutive calendar months and entirely prevents the Insured Person from engaging in any occupation fro which the Insured Person is suited by education, training or experience for the remainder of their life.

Total Disablement or Total Disability

An Insured Person’s complete and physical inability to attend to their usual business or occupation which results solely and independently of any other cause from Accidental Bodily Injury.

Temporary Partial Disablement

Temporary disablement, which prevents the Insured Person from engaging in a substantial part of their usual business or occupation.

Temporary Total Disablement

Temporary disablement, which entirely prevents the Insured Person from engaging in their usual business or occupation.

Hemiplegia

The permanent paralysis in one vertical half of a patient’s body.

Paraplegia

The permanent and total paralysis of the two lower limbs, bladder and rectum.

Quadriplegia

The permanent and entire paralysis of both legs and both arms.

Triplegia

The permanent paralysis of three limbs.

Coma

A continuous unconscious state.

Loss of Enjoyment of Life

An Injury to an Insured Person which is expected to necessitate the assistance of another person or a mechanical device to undertake 2 or more of the following activities for the remainder of the Insured Person’s life:

Dressing and undressing; or
Washing, bathing and toileting; or
Eating and drinking; or
General household duties, shopping and driving.

SIGNIFICANT AND UNUSUAL EXCLUSIONS

General Exclusions

War
Suicide or attempted suicide or intentional self-injury
Pregnancy within 2 months of the estimated date of delivery, or childbirth
Nuclear or radioactive contamination
Criminal or illegal acts
Professional sports
Deliberate exposure to exceptional danger (other than in an attempt to save human life)
Armed Forces operational duties
Illness not directly resulting from an Injury

SIGNIFICANT AND UNUSUAL LIMITATIONS

All Sections

Age limit

79 years

Conditions and provisions

Where an Insured Person is under the age of 16 years the Accidental Death benefit will be limited to £10,000.
Where an Insured Person is not in full time gainful employment or is a Partner or Child of an Insured Person: a) Permanent Total Disablement shall read, "Total Disablement, caused other than by Loss of Limb or Sight or Speech or Hearing, which prevents the Insured Person from engaging totally in any and every occupation for a period of 12 consecutive months and at the end of that period being without prospect of improvement. b) Disability Income benefit will not be payable.
If any claim submitted shall in any respect be false or fraudulent, the Underwriters shall be under no liability to make payment in respect of such claim and any benefit that the Underwriters have already paid must be paid back.
If after Underwriters have made a payment to the Insured in respect of the disappearance of an Insured Person and the Insured Person is found to be living, the Insured shall reimburse the Underwriters in full for all monies paid to them in respect of such disappearance.
Any claim for Disability Income benefit shall be deducted from any subsequent death, disablement or Permanent Total Disablement claim as a result of the same insured claim.
If an Insured Person is covered under Benefit 1 Accidental Death, but the benefit payable is less than for Benefits 2-4 and 8-11, the Underwriters will not pay more than the amount of the Accidental Death benefit (if an injury) does not immediately result in death) until at least 13 weeks after the date of the Injury.
If an Insured Person is not covered under Benefit 1 Accidental Death the Underwriters will not pay for Benefits 2-4 and 8-11, until at least 13 weeks after the date of the Injury, and the Underwriters will only pay if the Insured Person has not in the meantime died as a result of the Injury.
The Underwriters will not pay for more than one of the Benefits 1-4 in respect of the same Injury.
All material facts should be disclosed (these are facts which are likely to influence our acceptance or assessment of your insurance). If you are in doubt about facts considered material you should disclose them.
Underwriters, or their designated representatives, shall be furnished with all information, documentations and medical information they may reasonably require at all reasonable times during the term of this Policy, or until resolution of all claims, whichever is later.
Following notice of a claim, an Insured Person shall provide, when requested by Underwriters, all authorisations necessary to obtain an Insured Person’s medical records. Underwriters have the right to have an Insured Person examined by a physician or vocational expert of their choice, and at their expense, when and as often as they may reasonably request.
The Policy shall be governed by and construed in accordance with the law of England and Wales and the Insured and Insured Persons and Underwriters irrevocably agree that the Courts of England and Wales shall have exclusive jurisdiction in respect of any dispute which may arise out of or in connection with this Policy or any claim.
Compensation shall not be payable under more than one of the Items of the Schedule of benefits in respect of the consequences of one Accident.
The total sum payable under this insurance in respect of one or more claims shall not exceed the largest amount of benefit payable under any one of the items contained in the Schedule of Benefits.
If the Aggregate amount of all Benefits payable exceed the Aggregate Limit of Liability the Benefit payable to each Insured Person shall be proportionately reduced until the total of all benefits does not exceed the aggregate Limit of Liability.

CLAIMS PROCEDURE

Claims should be notified to the Broker, Marsh Ltd. Please telephone 0131 311 4223 between 09.00 and 17.00 weekdays and ask for the ‘Red Letter Days’ claims handler.

On the happening of any occurrence likely to give rise to a claim, you must give notice as soon as reasonably possible after the date of the occurrence and in any event within 60 days. In no event will we be liable to pay any claim where you fail to notify us in writing within 90 days after the date of the occurrence.

You will need to provide us with all information that we reasonably require to evaluate the incident or claim.

All persons under this insurance shall at all times take reasonable precautions to prevent accidents. All expenditure for which benefit is claimed must be reasonable and customary.

DISPUTES AND COMPLAINTS

Any enquiry or complaint should be addressed in the first instance to Red Letter Days who are dedicated to providing you with a high quality service.

If you have any questions or concerns about your insurance or the handling of a claim you should, in the first instance, contact Marsh Ltd, Charter House, 426 Avebury Boulevard, Central Milton Keynes, MK9 2NS.

In the event you remain dissatisfied and wish to make a formal complaint, it may be possible in certain circumstances to refer the matter to the Policyholder & Market Assistance at Lloyd’s. Their address is:

Policyholder & Market Assistance, Lloyd’s Market Services, One Lime Street, London, EC3M 7HA
Tel: 0207 327 5693
Fax: 0207 327 5225
Email: complaints@lloyds.com

In the event that the Policyholder & Market Assistance team is unable to resolve your complaint, it may be possible to refer it to the Financial Ombudsman Service (FOS). Following the complaints procedure with the FOS does not affect your rights to take legal action. Further details will be provided at the appropriate stage of the complaints process.

Financial Services Compensation Scheme

Lloyd’s insurers are covered by the Financial Services Compensation Scheme. You may be entitled to compensation from the Scheme if a Lloyd’s insurer is unable to meet its obligations to you under this contract. If you were entitled to compensation under the Scheme, the level and extent of the compensation would depend on the nature of this contract. Further information about the Scheme is available from the Financial Services Compensation Scheme (7th Floor, Lloyds Chambers, Portsoken Street, London E1 8BN) and on their website (www.fscs.org.uk)

Underwriters Address: Head of Accident & Health, Canopius Underwriting Limited, Gallery 9, One Lime Street, London EC3M 7HA

Canopius Underwriting Ltd is an Appointed Representative of Canopius Managing Agents Ltd, which is authorised and regulated by the Financial Services Authority.

Canopius Underwriting Limited and Canopius Managing Agents Limited are members of the Canopius Group.

29 May 2009