Coversure lnsurance Term Definitions & Resources

An insurance policy can be full of jargon or unclear wordings, which can be difficult to wrap your head around. At Coversure we believe it is essential that you comprehend all the information about your policy to avoid any wanted surprises down the line. This list of commonly used insurance terms should help.

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“Accident” means an unforeseen and involuntary event which causes Injury.

“Acquired Immune Deficiency Syndrome” or “AIDS” shall have the meanings assigned to it by the World Health Organization including Opportunistic Infection, Malignant Neoplasm, Human Immunodeficiency Virus (HIV), Encephalopathy (Dementia), HIV Wasting Syndrome or any disease or illness in the presence of a seropositive test for HIV.

“Activities of Daily Living” means:

(a) Washing - the ability to wash in the bath or shower (including getting into and out of the bath or shower) or wash satisfactorily by other means;

(b) Dressing - the ability to put on, take off, secure and unfasten all garments and, as appropriate, any braces, artificial limbs or other surgical appliances;

(c) Transferring - the ability to move from a bed to an upright chair or wheelchair and vice versa;

(d) Mobility - the ability to move indoors from room to room on level surfaces;

(e) Toileting - the ability to use the lavatory or otherwise manage bowel and bladder functions so as to maintain a satisfactory level of personal hygiene;

(f) Feeding - the ability to feed oneself once food has been prepared and made available.

“Anniversary Date” means each anniversary of the Policy’s effective date stated in the Schedule.

“Civil War” means an internecine war, or a war carried on between or among opposing citizens of the same country or nations.

“Fractured Leg or Patella with Established Non-Union” means a complete break into two pieces of the patella or leg bone where:

(a) the patella or leg bone does not mend properly such that it cannot function normally; and

(b) this condition is diagnosed to last for the remainder of Your life.

"Hospital” means an establishment which meets all the following requirements:

(a) holds a license as a Hospital (if licensing is required in the state or governmental jurisdiction); and

(b) operates primarily for the reception, care and treatment of sick, ailing or injured persons as in-patients; and

(c) provides 24-hour a day nursing services by registered or graduated nurses; and

(d) has a staff of one or more Physician or Doctor(s) at all times; and

(e) provides organized facilities for diagnosis and major surgical facilities; and

(f) is not primarily a clinic, nursing, rest or convalescent home or similar establishment, or a place for alcoholics or drug addicts.

“Immediate Family Member” means any of Your spouse, parent, parent-in-law, grandparent, son, daughter, son-in-law, daughter-in-law, brother, sister, grandchild or legal guardian.

“Injury” means bodily injury which is solely caused by an Accident and independently of any other cause.

“Insured Person” means the person(s) insured and named in the Schedule or subsequently endorsed in the Policy.

“Loss of Thumb(s) / Finger(s) / Toe(s)” means complete severance through or above the metacarpophalangeal joints or metatarsophalangeal joints.

“Loss of Hearing” means total and irrecoverable loss of hearing.

“Loss of Limb” means loss by physical severance of a hand at or above the wrist or of a foot at or above the ankle.

“Loss of Sight” means the entire and irrecoverable loss of sight.

“Loss of Speech” means the disability in articulating any three of the four sounds which contribute to the speech such as the Labial sounds, the Alveololabial sounds, the Palatal sounds and the Velar sounds, or total loss of vocal cord or damage of speech centre in the brain resulting in Aphasia.

“Loss of Use of Limb(s) / Thumb(s) / Finger(s) / Toe(s)” means total functional disablement of any limb, thumb, finger or toe and is treated like the total loss of said limb, thumb, finger or toe.

“Malignant Neoplasm” shall include but not be limited to Kaposi's sarcoma, central nervous system lymphoma and/or other malignancies now known or which become known as immediate causes of death, an illness or disability, in the presence of Acquired Immune Deficiency Syndrome (AIDS).

“Opportunistic Infection” shall include but not be limited to pneumocystis carinii pneumonia, organism of chronic enteritis, virus and/or disseminated fungi infection caused in the presence of Acquired Immune Deficiency Syndrome (AIDS).

“Percentage of Sum Insured” means the Percentage of Sum Insured stated in Compensation Tables in the policy.

“Permanent” means lasting twelve consecutive months from the date of Accident and at the expiry of that period being beyond hope of improvement as certified by a Physician or Doctor.

“Permanent Total Disablement means when as the result of Injury and commencing within twelve consecutive months from the date of Accident, You are totally and permanently disabled and prevented from engaging in each and every occupation or employment for compensation or profit for which You are reasonably qualified by reason of Your education, training or experience; or if You have no business or occupation at the time of Injury, Permanent Total Disablement means the inability to perform the Activities of Daily Living of like age and sex. Such disability has to continue for a period of twelve consecutive months and be certified by a Physician or Doctor as total, continuous and Permanent for the remainder of Your life.

“Physician or Doctor” means any person qualified by degree in western medicine and legally authorized by the government with jurisdiction in the geographical area of his or her practice to render medical and surgical service, but excluding You, an Immediate Family Member or someone living in the same household as You.

“Policy” means the Policy in question and any other documents referred to in it.

“Policyholder” means a person who is an applicant of the Policy and is named in the Schedule as Policyholder.

“Pre-existing Condition” means a condition for which You received or were recommended by a Physician or Doctor for any medical treatment, diagnosis, consultation or prescribed drugs, or the existence of any symptoms (known or unknown to the Insured Person(s)) leading to a claim under this Policy, within three years preceding the Policy’s effective date, last reinstatement date or date of any increase of benefit coverage (to the extent of such increase only), whichever is later. Such conditions shall be covered provided You have been insured under this Policy for three consecutive years from the Policy’s effective date, last reinstatement date or date of any increase of benefit coverage (to the extent of such increase only), whichever is later.

“Proof of Loss” means written proof of the occurrence, character and extent of the loss for which a claim is made, to be submitted to Us in accordance with the Policy and of such nature as We may prescribe.

“Schedule” means the attachment to this Policy entitled “Schedule” as may be amended by Us from time to time.

“Second Degree Burn” means both the epidermis and the underlying dermis are damaged by heat, electricity, chemicals, light or radiation.

“Sum Insured” means the amount of sum insured stated in the Schedule.

“Terrorist” or “Member of a Terrorist Organization” means any person who commits, or attempts to commit, a Terrorist Act or who participates in or facilitates the commission of a Terrorist Act and/or is verified or recognized or designated by any government or authority or committee as a terrorist.

“Terrorist Act” means an act including but not limited to the use or threatened use of force or violence against person or property, or commission of an act dangerous to human life or property, or commission of an act that interferes with or disrupts an electronic or communication system, undertaken by any person or group, whether or not acting on behalf of or in connection with any organization, government, power, authority or military force, when the effect is to intimidate or coerce a government, the civilian population or any segment thereof, or to disrupt any segment of the economy.

“Third Degree Burn” means full thickness skin destruction caused by heat, electricity, chemicals, light or radiation.

“War” means war (declared or undeclared) or any warlike activities, including use of military force by any sovereign nation to achieve economic, geographic, nationalistic, political, racial, religious or other ends.

“We, Us, Our” means the insurer, which in this case is Starr International Insurance (Asia) Limited.

“You, Your, Yourself” means a person who is named as an Insured Person.

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