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Accident insurance



1. Object
By this Assistance insurance contract, the Insured, within the territorial scope covered, will have the right to the different assistance benefits included in Decree 56/2003 of February 4, which regulates physical sports activities in the natural environment. issued by the Department of Culture of the Generalitat de Catalunya, which includes medical and health services, as well as various complementary benefits and which will be covered exclusively during the practice of the specific activity covered by the coverage.
It is expressly agreed that the Insurer’s obligations derived from the coverage of this policy begin at the beginning of the specific activity covered by the coverage and end at the moment the Insured has completed the aforementioned activity.

2. Insured
The physical persons listed in the Particular Conditions.

3. Time scope
The maximum period of coverage for each participant is limited to the time dedicated to the practice of the specific activity covered by the coverage, and may not exceed 15 days.

4. Territorial scope
The insurance is valid throughout the Spanish territory as well as the occurrence in areas bordering our borders (France, Andorra and Portugal) as long as the claims are made in Spanish Courts and under Spanish jurisdiction and laws and exclusively as a result of an accident that occurred. during the practice of the activity contracted with the Policyholder.

5. Guarantees covered
In the event of a claim covered by this policy, the Insurer, as soon as notified in accordance with the procedure indicated in Article 10, guarantees the provision of the following services:

Medical and health assistance in the event of an accident
The Insurer will be responsible for the expenses corresponding to the intervention of the professionals and health establishments required for the care of the Insured, injured.
The following services are expressly included, without the list being limiting:
a) Attention by emergency medical teams and specialists.
b) Complementary medical examinations.
c) Hospitalizations, treatments and surgical interventions.
d) Supply of medications in hospital, or reimbursement of their cost in injuries that do not require hospitalization.
e) Attention to acute dental problems, understood as those that require emergency treatment due to trauma.

Repatriation or medical transport of the injured
In the event of an accident occurring to the Insured, ARAG will be responsible for:
a) The expenses of transportation by ambulance to the nearest clinic or hospital.
b) The control by your Medical Team, in contact with the doctor who attends to the injured Insured, to determine the appropriate measures for the best treatment to follow and the most suitable means for their eventual transfer to another more appropriate hospital center or until their address.
c) The costs of transferring the injured person, by the most suitable means of transport, to the prescribed hospital or to his habitual residence.
The means of transport used in each case will be decided by the ARAG Medical Team based on the urgency and severity of the case. In the covered territorial delimitation, a specially conditioned medical plane may even be used.
If the Insured is admitted to a hospital not close to his home, ARAG will take charge, in due course, of the subsequent transfer to it.
In the event that the Insured does not have his habitual residence in Spain, he will be repatriated to the place where the trip begins in Spain.

Repatriation or transportation of the deceased Insured
In the event of the death of an Insured, the Insurer will organize the transfer of the body to the place of burial in Spain and will be responsible for its expenses. These expenses will be understood to include those for post-mortem conditioning in accordance with legal requirements.
Burial and ceremony expenses will not be included.
In the event that the Insured does not have his habitual residence in Spain, he will be repatriated to the place where the trip begins in Spain.

Rescue of people
If, as a result of the injuries suffered by the Insured, they must be rescued and transferred to a health center, ARAG will be responsible for the economic amounts that are claimed for this concept by public or private relief organizations.
For this guarantee to be applicable, the claim originating from it must have occurred in the place determined by the Policyholder for the practice of the insured activity.
The overall maximum economic limit for all the benefits described in the different services of this guarantee is 6,000 euros per claim and insured.
It is expressly established that, in the event of a circumstance covered by this insurance policy, the first 75 euros will always be paid by the Insured.

6. Exclusions
The agreed guarantees do not include:
a) Acts voluntarily caused by the Insured or those involving intent or gross negligence on the part of the Insured.
b) Pre-existing chronic ailments or diseases, as well as their consequences, suffered by the Insured prior to the start of the trip.
c) Death by suicide or injuries or illnesses derived from the attempt or intentionally produced by the Insured himself, and those derived from the Insured’s criminal enterprise.
d) Claims produced by the ingestion of alcohol, psychotropic drugs, hallucinogens or any drug or substance with similar characteristics.
e) Aesthetic treatments and the supply or replacement of hearing aids, contact lenses, glasses and orthotics and prostheses in general, as well as the expenses produced by childbirth or pregnancy and any type of mental illness.
f) Injuries or illnesses derived from the Insured’s participation in sports bets or competitions, professional practice in any type of sport, the practice of any other type of sport than those expressly covered in this policy, and the rescue of people in the desert.
g) Assumptions that arise, directly or indirectly, from events produced by nuclear energy, radioactive radiation, natural catastrophes, military actions, disturbances or terrorist acts.

7. Limits
The Insurer will assume the expenses outlined, within the established limits and up to the maximum amount contracted for each case. In the case of events that have the same cause and occurred at the same time, they will be considered as a single claim.
The Insurer will be obliged to pay the benefit, except in the event that the loss has been caused by bad faith of the Insured.
In the guarantees that involve the payment of a liquid amount in money, the Insurer is obliged to pay the compensation at the end of the investigations and expert reports necessary to establish the existence of the claim. In any case, the Insurer will pay, within 40 days from receipt of the claim statement, the minimum amount of what it may owe, according to the circumstances known to it. If, within three months from the occurrence of the claim, the Insurer has not made such compensation for reasons that are not justified or attributable to it, the compensation will be increased by 20% per year.

8. Claim declaration
Faced with the occurrence of a claim that may give rise to the covered benefits, the Insured must, indispensable, contact the emergency telephone service established by the Insurer, indicating the name of the Insured, policy number, place and telephone number where you are, and the type of assistance you need. This communication may be made collectively.

9. Prescription
The actions derived from the insurance contract prescribe within a period of two years, counting from the moment they could be exercised.

Accident: An accident is understood to be the bodily injury that derives from a violent, sudden, external cause beyond the Insured’s intentionality, which produces permanent, total or partial disability, or death.
Permanent disability: Permanent disability is understood to be the organic or functional loss of the members and powers of the Insured whose intensity is described in these General Conditions, and whose recovery is not considered foreseeable according to the opinion of the medical experts appointed in accordance with the Law.
Insured sum: The amounts set in the Particular and General Conditions, the maximum limit of compensation to be paid by the Insurer in the event of a claim.
Disagreement in the evaluation of the degree of disability: If the parties agree on the amount and form of compensation, the Insurer must pay the agreed amount. In case of disagreement, the provisions of the Insurance Contract Law will be followed.

Payment of compensation:
a) The Insurer is obliged to pay the compensation at the end of the investigations and expert opinions necessary to establish the existence of the claim and, where appropriate, the amount resulting therefrom. In any event, the Insurer must make, within forty days, from the receipt of the claim declaration, the payment of the minimum amount of what the Insurer may owe, according to the circumstances known to him.
b) If within three months from the occurrence of the claim the Insurer has not made the repair of the damage or compensated its amount in cash for reasons not justified or attributable to it, the compensation will be increased by a percentage equivalent to the legal interest of the current money at that time, increased in turn by 50%.
c) To obtain payment in the event of death or permanent disability, the Insured or the Beneficiaries must send the Insurer the supporting documents indicated below, as appropriate:
c.1. Death:
– Death certificate.
– Certificate of the General Registry of Last Wills.
– Will, if it exists.
– Certification of executor regarding whether the insurance beneficiaries are designated in the will.
– Document that proves the personality of the beneficiaries and the executor.
– If the beneficiaries were the legal heirs, it will be necessary, in addition, the Declaration of Heirs Decree issued by the competent Court.
– Letter of exemption on Inheritance Tax or settlement, if applicable, duly completed by the competent Administrative Body.

c.2. Total permanent disability:
– Medical certificate of disability stating the type of disability resulting from the accident.

The Insurer guarantees, up to the sum of 3,000 euros in the event of death, or up to 6,000 euros in the event of Permanent and Total Disability, and subject to the exclusions indicated in these General Conditions, the payment of any compensation that may correspond, as a result of accidents occurring as a result of the practice of the insured activity.
It is expressly agreed that the Insurer’s obligations derived from the coverage of this policy begin at the beginning of the specific activity covered by the coverage and end at the moment the Insured has completed the aforementioned activity.
People over 70 years of age are not covered, guaranteeing those under 14 years of age in the risk of death, only up to € 3,000 for burial expenses and for the risk of Total and Permanent disability up to the amount set in the Particular Conditions.

The compensation limit will be set:
a) In case of death:
When it is proven that the death, immediate or supervening within a period of one year from the occurrence of the loss, is the consequence of an accident guaranteed by the policy, the Insurer will pay the amount established in the Particular Conditions.
If after the payment of compensation for permanent disability, the death of the Insured occurs, as a result of the same claim, the Insurer will pay the difference between the amount paid for disability and the sum insured in the event of death, when said amount is higher.
b) In the event of total permanent disability: The Insurer will pay the total amount insured.

The following are not covered by this warranty:
a) Partial disabilities.
b) Bodily injuries that occur in a state of mental derangement, paralysis, stroke, diabetes, alcoholism, drug addiction, spinal cord diseases, syphilis, AIDS, encephalitis, and, in general, any injury or disease that diminishes physical capacity or psychic of the Insured.
c) Bodily injuries as a result of criminal actions, provocations, fights, -except in cases of legitimate defense- and duels, recklessness, gambling or any risky or reckless undertaking, and accidents as a result of war events, even when there is no been declared, popular riots, earthquakes, floods and volcanic eruptions.
d) Diseases, hernias, lumbago, intestinal strangulation, complications of varicose veins, poisonings or infections that do not have as a direct and exclusive cause an injury included within the insurance guarantees. The consequences of surgical operations or unnecessary treatments for the healing of accidents suffered and those that belong to the care of the person himself.
e) The practice of sports that are not expressly covered in the Particular or General Conditions of the policy.
f) The use of a two-wheeled vehicle with a cylinder capacity greater than 75 c.c.
g) The exercise of a professional activity, provided that it is not of a commercial, artistic or intellectual nature.
h) Any person who intentionally causes the loss is excluded from the benefit of the guarantees covered by this policy.
i) Situations of aggravation of an accident that occurred prior to the formalization of the policy are not included.

The maximum compensation for this policy and for a single claim, will not exceed € 1,200,000.

Claims of an extraordinary nature will be compensated by the Insurance Compensation Consortium, in accordance with the provisions of the legal Statute that creates the Insurance Compensation Consortium (BOE of December 19), Law 50/1980, of October 8 , of the Insurance Contract (BOE of October 17), Royal Decree 2022/1986, of August 29, which approves the Regulation of Extraordinary Risks on the Person and Goods (BOE of October 1), and provisions complementary.

I. Summary of the rules
1. Covered Risks
a) Phenomena of nature of an extraordinary nature (flood, earthquakes, volcanic eruption, atypical cyclonic storm, fall of sidereal bodies and aeroliths).
b) Acts derived from terrorism, riot or popular tumult.
c) Facts or actions of the Armed Forces or the Security Forces or Bodies in times of peace.
2. Risks excluded
Armed conflicts, demonstrations and legal strikes; nuclear energy, vice or defect inherent to the goods; bad faith of the Insured; indirect damages; those corresponding to policies whose date or effect, if later, does not precede by 30 days the loss occurred, except for replacement, substitution or automatic revaluation; claims produced before the payment of the first premium; suspension of coverage or termination of insurance due to non-payment of premiums; and those classified by the Government of the Nation as “national catastrophe or calamity.”

II Procedure for action in the event of a claim
Notify the offices of the Consortium or the Insurance Entity of the ordinary policy of the occurrence of the loss within a maximum period of seven days after having known it. The communication will be formulated in the model established for this purpose, which will be provided to you at said offices, accompanied by the following documentation:
• Copy or photocopy of the premium receipt or certification from the Insurance Entity, certifying the payment of the premium corresponding to the current annuity, and expressly stating the amount, date and form of payment thereof.
• Copy or photocopy of the extraordinary risk coverage clause, of the General, Particular and Special Conditions of the ordinary policy, as well as the amendments, appendices or supplements to said policy, if any.