personal accident be insurance policy …...under part b payment under part a payment under part b...

“We’ll BE there WHEN you NEED US.”

And we live and breathe what we say. At AMA Insurance, you’re practically family. So much so that we’ll go above and beyond to provide you with the very best products that are tried and true — from auto, home, business and health insurance to travel medical, RV and life insurance. Because what’s important to us, is being there to help protect things when you need it most.

It’s just what family does.

For service call 1.800.615.5897Monday - Friday 8 am to 8 pm

Saturday 9 am to 5 pm

24-Hour Claims Service 1.888.426.2444

AMAInsurance.ca

PC

PERSONAL ACCIDENT INSURANCE POLICY

PERSONAL ACCIDENT INSURANCE


Page

INSURINGAGREEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

DEFINITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

COVERAGE

ONTHEMOVECOVERAGEDescriptionofCoverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3PaymentTables

Level1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Level2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

ALLTHETIMECOVERAGEDescriptionofCoverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6PaymentTables

Level1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Level2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

EXCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

EXCEPTIONSAgeofApplicant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10PaymentReduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10LimitperClaimant . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10LimitforMultipleClaimants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

PROVISIONSBeneficiary(ies) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10PaymentintheEventofLossofLifeoftheInsured . . . . . . . . . . . . . . . . . . . 10PaymentintheEventofLossofLifeoftheSpouseorDependent . . . . . . . . 10TermofCoverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Currency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

STATUTORYCONDITIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

November1,2014

1

PERSONAL ACCIDENT INSURANCE (The“Policy”)

INSURING AGREEMENT

Inconsiderationofthepremiumcharged,AlbertaMotorAssociationInsuranceCompanyagreesthatthe“Insured”namedonthePersonalAccidentInsuranceCertificateisinsuredunderthisPolicy .

Wewillpaytheamountspecifiedforaccidentallossoflifeoraccidental“injury”resultingdirectlyandindependentlyofallothercauses,whichariseoutofeventsoractivitiesdescribedundertheDescriptionofCoveragesubjecttothedefinitions,exclusions,exceptions,provisionsandstatutoryconditionsofthisPolicy .The“injuries”whicharecoveredandtheamountspayableareoutlinedinthePaymentTableinaccordancewiththeselectedcoverageoptionandcoveragelevelinthisPolicy .

ThisPolicyprovidesaccidentbenefitsthatarepayableinonesum .Forgreatercertainty,thisPolicydoesnotprovidehospitalizationordisabilityinsurance .

DEFINITIONS

InthisPolicy,thefollowingwordshavetheirmeaningssetoutbelow .

“You”or“your”meanstheperson(s)namedas“Insured”ontheInsuranceCertificateand,whilelivinginthesamehousehold,hisorher“spouse”oradultinterdependentpartnerandeligible“dependents” .

“Insured”meansthepersonnamedontheInsuranceCertificate .

“Spouse”meansthepersontowhomthe“Insured”ismarriedortheadultinterdependentpartnerofthe“Insured” .Adultinterdependentpartnermeanseitheroftwopersonswhohas:

(a) livedwiththeotherpersoninarelationshipofinterdependence

(i) foracontinuousperiodofnotlessthanthreeyears,or

(ii) ofsomepermanence,ifthereisachildoftherelationshipbybirthoradoption,or

(b) enteredintoanadultinterdependentpartneragreementwiththeotherpersoninaccordancewiththeAdultInterdependentRelationshipsAct .

“Dependent”means:

(a) yourunmarriedchildrenincludinglegallyadoptedchildrenandstepchildren,whoareovertheageof13daysandundertheageof

2

19yearsofageandwhoaredependentonyouforthemainpartoftheirsupportandmaintenance;

(b) unmarriedchildrenwhohavepassedtheir19thbirthdayandareafull-timestudentatanaccreditedcollegeoruniversity .Suchchildrenwillcontinuetobeaneligibledependentuptotheir25thbirthdayorthedatetheyceasetobeafull-timestudent,whicheveroccursfirst;

(c) childrenwhohavepassedtheir19thbirthdayandbecauseofmentalorphysicalinfirmityaredependentonyouforfinancialsupport .

“We”or“us”meanstheAlbertaMotorAssociationInsuranceCompany .

“Accident”meansthesuddenandunexpectedeventoractivitythatresultedinthe“injury” .

“Beneficiary”meansapersondesignatedtoreceivethemoneypayablefromaninsurancepolicyintheeventofdeathofthe“Insured” .

“Injury”meanslossoflife,lossofuseofalimb(s),orcompleteandtotallossofsight,speechand/orhearinginthecombinationssetoutintheappropriatePaymentTable .

3

COVERAGE

Coverageisprovidedforlossoflife,sight,speechand/orhearingandlossofuseoflimbsasoutlinedinthePaymentTableappropriatetoyourselectedcoverage .

Lossofsight,speechand/orhearingmeanscomplete,totalandirrecoverableloss .Lossofuseofalimbmeanstotalandirrecoverablelossofuse .

ON THE MOVE COVERAGE

Description of Coverage

IfyourInsuranceCertificateindicatesOn the Movecoverage,weprovideinsuranceasdescribedbelow:

Part A – Personal transportation or as a pedestrian

Youareinsuredwhile:

(a) Driving,ridingasapassengerin,boardingoralightingfromanyprivatepassengerautomobile,snowmobile,farmvehicle,recreationalvehicle,bicyclewhileusedforpersonaltransportation,orotherself-propelledlandvehicle,watercraftoraircraft,butNOTasanoperatorormemberofthecrewofanaircraftusedforpleasurepurposes,providedthat:

(i) anysuchself-propelledlandvehicle,bicycleorwatercraftisoperatedinstrictcompliancewithanyapplicablelicensingandregistrationlawsandnotbeingusedinanyoff-roadextremesport;and

(ii) theoperatorofanysuchself-propelledlandvehicle,bicycleorwatercraftisbylaw,authorizedandqualifiedtodrive,andnotengagedinarace,speedtestorillicitprohibitedtrade;

(b) Beingstruckwhileapedestrianbyanyself-propelledlandvehicle .

Privatepassengerautomobilemeansanautomobilenotlicensedtocarrypassengersforhirewhichisbeingusedforpleasurepurposesonly .

AND

Part B –On a scheduled airline flight or common carrier

Youareinsuredwhiletravellingasapassengeron,orboardingoralightingfroma:

4

(a) Scheduledairlineflight:anyaircraftlicensedtocarrypassengersandflownbyadulylicensedpilot,butexcludinganyflightforanyotherpurposethantheprimarypurposeoftransportationoffare-payingpassengers;and

(b) Commoncarrier:anylicensedtransportationusedasacommoncarrierforpassengerservicesuchasataxi,bus,subway,train,ferry,orship;

butNOTwhileanoperatorormemberofthecrewridingin,boardingoralightingfromanysuchscheduledairlineflightorcommoncarrier .

Payment Tables

Ifaccidentaldeathoraccidental“injuries”aresufferedbyyou,your“spouse”or“dependent”,asaresultofaneventoractivitydescribedintheDescriptionofCoverage,wewillpaytheappropriateamountasindicatedinthetablesbelow .Thepaymentamountfora“dependent”isdoubledwhenthereisno“spouse”inthehousehold .

Coverage Level 1

ThefollowingtableoutlinesthepaymentamountforalossdescribedunderPartAandPartBforOntheMovecoverage,level1 .

Type of loss Insured Spouse DependentPayment

underPartA

Payment

underPartB

Payment

underPartA

Payment

underPartB

Payment

underPartA

Payment

underPartB

Lossoflife $50,000 $100,000 $25,000 $50,000 $5,000 $10,000

Lossofuseofbothhands,bothfeetorbotheyes

$50,000 $100,000 $25,000 $50,000 $5,000 $10,000

Lossofuseofonehandandonefoot

$50,000 $100,000 $25,000 $50,000 $5,000 $10,000

Lossofuseofonehandandoneeyeoronefootandoneeye

$50,000 $100,000 $25,000 $50,000 $5,000 $10,000

Lossofspeechandhearing $50,000 $100,000 $25,000 $50,000 $5,000 $10,000

Lossofuseofonearmoroneleg $37,500 $75,000 $18,750 $37,500 $3,750 $7,500

Lossofuseofonehandoronefootoroneeye

$33,300 $66,600 $16,650 $33,300 $3,330 $6,660

Lossofspeechorhearing $25,000 $50,000 $12,500 $25,000 $2,500 $5,000

5

Coverage Level 2

ThefollowingtableoutlinesthepaymentamountforalossdescribedunderPartAandPartBforOntheMovecoverage,level2 .


underPartA

Payment

underPartB

Payment

underPartA

Payment

underPartB

Payment

underPartA

Payment

underPartB

Lossoflife $100,000 $200,000 $50,000 $100,000 $10,000 $20,000


$100,000 $200,000 $50,000 $100,000 $10,000 $20,000


$100,000 $200,000 $50,000 $100,000 $10,000 $20,000


$100,000 $200,000 $50,000 $100,000 $10,000 $20,000




$66,600 $133,200 $33,300 $66,600 $6,660 $13,320


6

ALL THE TIME COVERAGE

Description of Coverage

IfyourInsuranceCertificateindicatesAll the Timecoverage,weprovideinsuranceasdescribedbelow:

Part A – Any accident not excluded

Youareinsuredfor“injuries”resultingfromanyeventoractivitynotspecificallyexcludedundertheExclusionsofthisPolicy .

AND

Part B – On a scheduled airline flight or common carrier

Youareinsuredwhiletravellingasapassengeron,orboardingoralightingfroma:

(a) Scheduledairlineflight:anyaircraftlicensedtocarrypassengersandflownbyadulylicensedpilot,butexcludinganyflightforanyotherpurposethantheprimarypurposeoftransportationoffare-payingpassengers;and

(b) Commoncarrier:anylicensedtransportationusedasacommoncarrierforpassengerservicesuchasataxi,bus,subway,train,ferry,orship;

butNOTwhileanoperatorormemberofthecrewridingin,boardingoralightingfromanysuchscheduledairlineflightorcommoncarrier .

Payment Tables

Ifaccidentaldeathoraccidental“injuries”aresufferedbyyou,your“spouse”or“dependent”,asaresultofaneventoractivitydescribedintheDescriptionofCoverage,wewillpaytheappropriateamountasindicatedinthetablesbelow .Thepaymentamountfora“dependent”isdoubledwhenthereisno“spouse”inthehousehold .

7


underPartA

Payment

underPartB

Payment

underPartA

Payment

underPartB

Payment

underPartA

Payment

underPartB

Lossoflife $50,000 $100,000 $25,000 $50,000 $5,000 $10,000


$50,000 $100,000 $25,000 $50,000 $5,000 $10,000


$50,000 $100,000 $25,000 $50,000 $5,000 $10,000


$50,000 $100,000 $25,000 $50,000 $5,000 $10,000




$33,300 $66,600 $16,650 $33,300 $3,330 $6,660


Coverage Level 1

ThefollowingtableoutlinesthepaymentamountforalossdescribedunderPartAandPartBforAlltheTimecoverage,level1 .

8

Coverage Level 2

ThefollowingtableoutlinesthepaymentamountforalossdescribedunderPartAandPartBforAlltheTimecoverage,level2 .


underPartA

Payment

underPartB

Payment

underPartA

Payment

underPartB

Payment

underPartA

Payment

underPartB

Lossoflife $100,000 $200,000 $50,000 $100,000 $10,000 $20,000


$100,000 $200,000 $50,000 $100,000 $10,000 $20,000


$100,000 $200,000 $50,000 $100,000 $10,000 $20,000


$100,000 $200,000 $50,000 $100,000 $10,000 $20,000




$66,600 $133,200 $33,300 $66,600 $6,660 $13,320


9

EXCLUSIONS

Youarenotinsuredforanylossoflifeor“injuries”partly,directlyorindirectlycausedby:

1 . suicideorattemptedsuicidewhilesaneorinsane;

2 . intentionalself-inflictedinjury;

3 . physicalormentalinfirmity;

4 . insurrectionorwar,whetherdeclaredornot,oranyrelatedact,orparticipationinanyriotorcivildisorder;

5 . terroristactivityofanykindoranyrelatedactorconsequence,includingtheexplosionofweaponsofmassdestruction,and/orthereleaseofweaponsofmassdestruction,whethertheyinvolveanexplosivesequenceornot;

Orwhile:

6 . attemptingorcommittingacriminaloffence;

7 . participatinginanymanoeuvresortrainingexercisesoftheArmedForces;

8 . theoperatorofaself-propelledlandvehicle,watercraftorbicycleorasapedestrianwhileimpairedby:

(a)anydrug,unlessadministeredinaccordancewiththeadviceofalicensedphysician;

(b)alcohol,whenthealcoholconcentrationinthebloodexceeds80milligramsofalcoholin100millilitresofblood;or

(c) anyotherillicitsubstance .

9 . operatinganyself-propelledlandvehicle,bicycle,orwatercraftunlessbylawauthorizedandqualifiedtodrive;

10 .participatinginanyraceorspeedtest .

THE FOLLOWING SECTIONS ARE APPLICABLE TO BOTH ON THE MOVE AND ALL THE TIME COVERAGE.

10

EXCEPTIONS

Age of Applicant

Coverageisavailabletonewapplicantsage16to74years .

Payment Reduction

TheamountpayabletoanypersoncoveredunderthisPolicyisreducedby50%uponthe“Insured”reachingtheageof80years .

Limit per Claimant

Ifthe“Insured”,“spouse”or“dependent”sustainsmorethanoneofthe“injuries”describedinthepaymenttableastheresultofanyone“accident”,wewillpaytheamountindicatedforeach“injury”butinnoeventwillthetotalamountpayabletoeachclaimantexceedtheamountpayableforlossoflife .

Limit for Multiple Claimants

ThemaximumamountpayablebyusunderallPersonalAccidentInsurancepoliciesarisingfromanyone“accident”,regardlessofthenumberofclaims,is$30,000,000 .

PROVISIONS

Beneficiary(ies)

The“Insured”maydesignateorchangea“beneficiary(ies)”uponwrittennoticetous,subjecttothelawsoftheProvinceofAlberta .

Payment in the Event of Loss of Life of the Insured

Intheeventofthedeathofthe“Insured”,theamountpayablewillbepaidtotheperson(s)designatedas“beneficiary”bythe“Insured”andshownonourrecords .

Ifno“beneficiary”hasbeendesignated,orifthereisnosurviving“beneficiary”,thepaymentwillbepaidtotheestateofthe“Insured” .

Payment in the Event of Loss of Life of the Spouse or Dependent

Intheeventofthedeathofthe“spouse”ora“dependent”,theamountpayablewillbepaidtothe“Insured” .

Ifthe“Insured”isdeceased,thepaymentwillbepaidtotheperson(s)designatedas“beneficiary”bythe“Insured”andshownonourrecords .

11

Ifno“beneficiary”hasbeendesignatedorifthereisnosurviving“beneficiary”,thepaymentwillbemadetotheestateofthe“Insured” .

Term of Coverage

ThetermofthisPolicycommencesontheeffectivedatestatedontheInsuranceCertificateandiscontinuousuntiltheexpirydatestatedontheInsuranceCertificateoruntilsuchtimethisPolicyisterminatedinaccordancewiththeStatutoryConditionssetoutbelow .WereservetherighttomodifythisPolicy .

Currency

Allpayments,premiumsorotheramountsexpressedinthisPolicyareinCanadiancurrency .

STATUTORY CONDITIONS

The Contract

Theapplication,thispolicy,anydocumentattachedtothispolicywhenissuedandanyamendmenttothecontractagreedoninwritingafterthispolicyisissuedconstitutetheentirecontract,andnoagenthasauthoritytochangethecontractorwaiveanyofitsprovisions .

Material Facts

Nostatementmadebytheinsuredorpersoninsuredatthetimeofapplicationforthecontractmaybeusedindefenceofaclaimunderortoavoidthecontractunlessitiscontainedintheapplicationoranyotherwrittenstatementsoranswersfurnishedasevidenceofinsurability .

Termination of Insurance

(1) Thecontractmaybeterminated

(a) bytheinsurergivingtotheinsured15days’noticeofterminationbyregisteredmailor5days’writtennoticeofterminationpersonallydelivered,or

(b) bytheinsuredatanytimeonrequest .

(2) Ifthecontractisterminatedbytheinsurer,

(a) theinsurermustrefundtheexcessofpremiumactuallypaidbytheinsuredovertheproratedpremiumfortheexpiredtime,butinnoeventmaytheproratedpremiumfortheexpiredtimebelessthananyminimumretainedpremiumspecifiedinthecontract,and

12

(b) therefundmustaccompanythenotice .

(3) Ifthecontractisterminatedbytheinsured,theinsurermustrefundassoonaspracticabletheexcessofpremiumactuallypaidbytheinsuredovertheshortratepremiumcalculatedtothedateofreceiptofthenoticeaccordingtothetableinusebytheinsureratthetimeoftermination .

(4) The15-dayperiodreferredtoinsubparagraph(1)(a)ofthisconditionstartstorunonthedaytheregisteredletterornotificationofitisdeliveredtotheinsured’spostaladdress .

Notice and Proof of Claim

(1) Theinsuredorapersoninsured,orabeneficiaryentitledtomakeaclaim,ortheagentofanyofthem,must

(a)givewrittennoticeofclaimtotheinsurer

(i) bydeliveryofthenotice,orbysendingitbyregisteredmail,totheheadofficeorchiefagencyoftheinsurerintheprovince,or

(ii)bydeliveryofthenoticetoanauthorizedagentoftheinsurerintheprovince,

notlaterthan30daysfromthedateaclaimarisesunderthecontractonaccountofaccidentaldeathoraccidentalinjury,

(b)within90daysafterthedateaclaimarisesunderthecontractonaccountofaccidentaldeathoraccidentalinjury,furnishtotheinsurersuchproofasisreasonablypossibleinthecircumstancesof

(i) thehappeningoftheaccidentorthestartofthedisability,

(ii) thelosscausedbytheaccident,

(iii)therightoftheclaimanttoreceivepayment,

(iv)theclaimant’sage,and

(v)ifrelevant,thebeneficiary’sage,

and

(c) ifsorequiredbytheinsurer,furnishasatisfactorycertificateastothecauseornatureoftheaccidentaldeathoraccidentalinjuryforwhichclaimismadeunderthecontractand,inthecaseofdisability,itsduration .

13

(2) Failuretogivenoticeofclaimorfurnishproofofclaimwithinthetimerequiredbythisconditiondoesnotinvalidatetheclaimif

(a) thenoticeorproofisgivenorfurnishedassoonasreasonablypossible,andinnoeventlaterthanoneyearafterthedateoftheaccidentorthedateaclaimarisesunderthecontractonaccountofsicknessordisability,anditisshownthatitwasnotreasonablypossibletogivethenoticeorfurnishtheproofinthetimerequiredbythiscondition,or

(b) inthecaseofthedeathofthepersoninsured,ifadeclarationofpresumptionofdeathisnecessary,thenoticeorproofisgivenorfurnishednolaterthanoneyearafterthedateacourtmakesthedeclaration .

Insurer to Furnish Forms for Proof of Claim

Theinsurermustfurnishformsforproofofclaimwithin15daysafterreceivingnoticeofclaim,butiftheclaimanthasnotreceivedtheformswithinthattimetheclaimantmaysubmithisorherproofofclaimintheformofawrittenstatementofthecauseornatureoftheaccident,sicknessordisabilitygivingrisetotheclaimandoftheextentoftheloss .

Rights of Examination

Asaconditionprecedenttorecoveryofinsurancemoneyunderthecontract,

(1) theclaimantmustgivetheinsureranopportunitytoexaminethepersonofthepersoninsuredwhenandasoftenasitreasonablyrequireswhileaclaimispending,and

(2) inthecaseofdeathofthepersoninsured,theinsurermayrequireanautopsy,subjecttoanylawoftheapplicablejurisdictionrelatingtoautopsies .

When Money Payable Other Than for Loss of Time

Allmoneypayableunderthecontract,otherthanbenefitsforlossoftime,mustbepaidbytheinsurerwithin60daysafterithasreceivedproofofclaim .

UnderwrittenbyAlberta Motor Association Insurance Company

11220109Street,NWEdmonton,ABT5G2T6Mail:Box8180,StationSouthEdmonton,ABT6H5X9

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“We’ll BE there WHEN you NEED US.”

And we live and breathe what we say. At AMA Insurance, you’re practically family. So much so that we’ll go above and beyond to provide you with the very best products that are tried and true — from auto, home, business and health insurance to travel medical, RV and life insurance. Because what’s important to us, is being there to help protect things when you need it most.

It’s just what family does.

For service call 1.800.615.5897Monday - Friday 8 am to 8 pm

Saturday 9 am to 5 pm

24-Hour Claims Service 1.888.426.2444

AMAInsurance.ca

PC


personal accident be insurance policy …...under part b payment under part a payment under part b...

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