What are the risks covered by this insurance?
The accidents covered under this contract are those that occur in one of the following circumstances:
The consequences of medical or surgical acts following a covered accident;
Accidents occurring during the use and driving of motor vehicles and pedal cycles;
Accidents occurring in self-defense or attempting to rescue people in danger;
Accident to the insured while being transported as a passenger by any means of public passenger transport;
Accident resulting from playing sports as an amateur [5];
Lightning accidents;
Insect bites and animal bites.
Other risks can be guaranteed. Examples: practicing all sports on a professional basis, driving a motorcycle with a cylinder capacity greater than 50 cm3, etc. [6].
Important:
The following are not considered to be accidents:
Surgical operations and their consequences of any kind;
Preventive or cosmetic surgery;
Thermal cures and heliotherapy;
Pregnancy, miscarriages, childbirth and their consequences;
Apoplexies, sunstroke, hernias, lumbago and muscle tears.
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IV. What are the limits of the guarantees offered?
You should know, first of all, that in the event of an insured accident, the service provided by the insurer is conditioned by two things:
The guarantees provided for in the contract;
The capital limits set in the special conditions.
In addition, there are certain risks or risk circumstances, for which the guarantee is excluded, in other words, which are not guaranteed.
Some exclusions are common to all warranties, while others are specific to a particular warranty.
This contract does not cover accidents occurring in the following circumstances [7]:
The voluntary act of the insured, such as suicide;
The fact of civil or foreign war, riots or popular movements;
Due to natural disasters, such as earthquakes, floods ...;
Due to the insured's poor state of health;
Due to the atomic risk;
Due to illness of whatever nature, unless it is the direct consequence of a covered event.
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V. How to take out this insurance? What information to provide?
If you wish to take out an individual accident insurance contract, you must communicate to the agency of your choice all the circumstances concerning you and which are likely to make the insurer assess the risks that it bears. . Examples: your age, your overall health, your favorite sports, a description of your job, your hobbies, etc.
Precautions to take :
Some companies stipulate that the contract is automatically terminated on the date on which the insured reaches the age of 65. We must therefore inquire about this point;
Carefully read the general conditions, in particular with regard to exclusions, forfeitures and warranty limits [8];
Choose the guarantees best suited to your case and clearly define the insured capital;
During the contract, you must declare to your insurer all new circumstances which have the effect of modifying or even aggravating the risks [9].
Important:
Any reluctance [10] or intentional false declaration on the part of the insured with the aim of distorting the assessment of the risk, entails the nullity of the contract;
In the event of an omission or misrepresentation (in good faith), the insurer may:
Before the loss: maintain the contract at a higher premium, otherwise, terminate the contract;
After a disaster: reduce the indemnity (according to a proportional rule) and readjust the contract for the future [11].
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VI. What should I do in the event of a claim?
In the event of a claim, the insured party is first required to immediately take all the measures in his power to limit the consequences and to discover the person (s) responsible.
The victim should seek immediate medical attention;
Report the claim to the insurer in writing or verbally against receipt [12];
Provide the insurer with the doctor's medical certificate as soon as possible;
Communicate any document necessary for estimating his state of health throughout the duration of treatment until recovery or full consolidation.
Important:
The insurer must have free access to the injured person to ascertain his state of health. In the event of an unjustified refusal, the victim forfeits his right to compensation for the current accident.
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VII. What precautions should be taken to avoid the occurrence of a loss or at the limit
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