General Terms and Conditions of The Pzu NNW (Personal Accident Insurance Pzu Edukacja Insurance

GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance)
PZU EDUKACJA INSURANCE
introduced by resolution adopted by the Management Board of Powszechny Zakład Ubezpieczeń Spółka Akcyjna no. UZ/423/2016 of 24
October 2016.
With amendments introduced by resolution adopted by the Management Board of Powszechny Zakład Ubezpieczeń Spółka Akcyjna no.
UZ/93/2017 of 7 April 2017.
TABLE OF CONTENTS
Chapter I – Introducing provisions . . . page 1 Sums insured and liability limits. . . . page 11
Statutory information . . . . . . . . . . . . page 1 Exclusions of liability . . . . . . . . . . page 11
General provisions . . . . . . . . . . . . page 2
Definitions . . . . . . . . . . . . . . . . . page 2 Chapter III – Conclusion of an insurance contract and its term
. . . . . . . . . . . . . page 11
Chapter II – insurance cover term. Insurance subject matter and scope Insurance premium . . . . . . . . . . . page 12
. . . . . . . . . . . . . . page 4 Termination of an insurance contract and an end of liability
Insurance cover term . . . . . . . . . . . . . . . page 4 . . . . . . . . . . . . . page 13
Insurance subject matter and scope . . . . . . . . page 4 Refund of a premium . . . . . . . . . . . . . . . page 13
Benefits in a basic scope of insurance cover
. . . . . . . . . . . . . . page 5 Chapter IV – Performance of an insurance contract
Options of insurance . . . . . . . . . . . . page 5 . . . . . . . . . . . . . . page 13
Detailed provisions regarding basic benefits Procedure in the event of an insurance
. . . . . . . . . . . . . . . page 5 accident . . . . . . . . . . . . . page 13
Benefits in an extended insurance cover Obligations of the Insured . . . . . . . . . . . page 13
. . . . . . . . . . . . . . page 8 Determination and payment of benefits . . . . . . . . . . page 14
Additional benefits . . . . . . . . . . . page 8
Rules to rewarding additional benefits Chapter V – Final provisions . . . . . . . page 15
Referred to in § 13 . . . . . . . . . . . . . . page 9
CHAPTER I
INTRODUCTORY PROVISIONS
STATUTORY INFORMATION
Information mentioned in Art. 17 section 1 Act on insurance and
reinsurance activity:
Type of information Contract template editorial unit number
Premises for § 2 sec. 4, § 4, § 5, § 6, § 7, § 8, § 10 sec. 2
payment of the and 3,
indemnity and § 12, § 13, § 14, § 17 sec. 2– 4, § 21, § 25,
other benefits § 30, § 31, § 32, § 33, § 34, § 35, § 36, §
37, § 38, § 39, § 42.
Limitations and § 4, § 8, § 9, § 10 sec. 2 i 3, § 12, § 13, § 14,
exclusions of § 17 sec. 5, § 21, § 31, § 32 sec. 3 i 4, §
liability of the 33, § 34, § 35, § 36, § 37, § 38, § 39 sec.
insurance company 4 –7, § 42, § 25.
entitling it to refuse
the payment of
indemnity and other
benefits or reduce
them
Powszechny Zakład Ubezpieczeń Spółka Akcyjna, Distric court for the capital city of Warsaw, XII Commercial Division, National Court Register (KRS)
9831, Tax Identification Number (NIP) 526-025-10-49, share capital: 86 352 300.00 PLN paid UP in full, al. Jana Pawła II 24, 00-133 Warsaw, pzu.pl,
hotline: 801 102 102 (fee according to operator’s tariff)
GENERAL PROVISIONS 3. PZU SA is obliged to present to the Policyholder the
differences between the contents of the insurance agreement
§1 and the General Conditions, in written form before concluding
1. The general terms and conditions of NWW PZU EDUKACJA the insurance contract. If this obligation is not complied with,
insurance, hereinafter referred to as the “GTCI”, shall apply to PZU SA may not quote the difference unfavourable for the
insurance contracts concluded by Powszechny Zakład Policyholder or for the Insured. This provision does not apply
Ubezpieczeń Spółka Akcyjna, hereinafter referred to as “PZU to insurance contracts concluded by way of negotiations.
SA”, with natural persons, legal entities and organizational 4. Relevant provisions of the Civil Code and other applicable
entities without legal personality for the benefit of pupils, provisions of Polish law shall apply to any matters not
students, children, personnel and representatives of insured regulated in the GTCI or in the insurance contract.
persons.
§3
2. The GTCI are also applicable o insurance contracts concluded
1. The Policyholder may conclude insurance contract for account
by means of distance communication while observing the law
of a third party (an account of the insurer). In this case the
provisions applicable within this scope. PZU SA uses Polish as Policyholder is obliged to inform the insurer about his/her
a language used in relations with a consumer. rights and obligations resulting from the insurance contract
§2 concluded for his/her account.
2. In the case of concluding the insurance contract for account of
1. Additional provisions, or provisions different from those set
a third party, the insurer may demand PZU SA to provide
forth in these General Conditions may be introduced to the
information about provisions of the concluded insurance
insurance contract, subject to contract with the Policyholder
contract and the GTCI within a scope, within which it refers to
2. In the case of introducing additional provisions or provisions
the insured’s rights and obligations.
different from those set forth in therein to insurance contract,
DEFINITIONS
these General Conditions are applicable within a scope not
regulated by the above-mentioned provisions.
GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE
2
§4 and for whom outpatient treatment is not possible; under
1. The terms used in the General Conditions shall have the these General Conditions a day of hospital stay is a
meaning specified below: calendar day during which the Insured was staying at the
1) acts of terrorism – individual or group actions directed hospital, regardless of the actual length of stay during that
against population or property to cause chaos, intimidate given day; the first day of hospitalization is the day of
the general public, disorganize public life, public admission and the last one – the day of discharge;;
transportation, service or manufacturing facilities – all in 13) consumer – a natural person performing a legal
order to achieve economic, political or social aims; activity not directly related to its business or professional
2) fight – a conflict of three or more persons dealing blows to activity;
each other, with each of them having a double role – as the 14) intra-cranial haemorrhage – extravasation of
assailed and assailant blood into the craniocerebral cavity;
3) Emergency Centre – the Emergency Centre working for 15) treatment – physicians’ visits and consultations,
PZU SA, providing services defined in the General outpatient treatment, hospital treatment, outpatient
Conditions; the Emergency Centre operates 24 hours a day procedures, surgical procedures, tests ordered by the
7 days a week and it is the location where the Insurer or a physician, taking medication and applying dressings,
person acting on his/her behalf is obliged to report the transport from the location of accident to the hospital or
insurance accident; the phone number of the PZU outpatient clinic, rehabilitation;
Emergency Centre is provided in the insurance contract; 16) outpatient treatment – treatment other than
the phone number of the PZU Emergency Centre is hospitalization;
provided in the insurance document. In the case of the 17) surgical treatment of a fracture – internal or
insurance contracts concluded by means of distance external stabilization of a fracture tied to a surgical
communication, pone number of Emergency Centre is also procedure which interrupts tissue continuity;
provided by electronic means. 18) consequences of the insurer’s accident – body
4) illness – an organism reaction to a disease-causing agent injury, detriment to health or death;
manifesting by function disorders and organism structure 19) insurance accident – a sudden event caused by
damage that causes adverse effects; an external reason, in consequence of which the Insured,
5) severe bodily injuries – the following injuries arising as a regardless of his/her will, sustained bodily injury,
result of insurance accident, confirmed in medical disturbance of health or died;
documentation: 20) malicious tumour – a disease manifesting itself by
a) complete and permanent loss of vision, hearing, the presence of a malicious tumour (i.e. a tumour that is
speech, reproductive capacity or not encapsulated and is able to invade tissues and create
b) permanent and serious impairment, or loss of function of remote metastases); within a meaning of these General
an important organ or organs, and specifically: one-eyed Conditions the term “malicious tumour” includes leukaemia
blindness, serious two-sided sight impairment, loss of lower and malicious diseases of the lymphatic system, which is
limb at least on the level of the shank, loss of an important Hodgkin's lymphoma (Hodgkin's disease) or non-Hodgkin
internal organ, stiffness of one of the major joints lymphoma; within a meaning of these General Conditions
(shoulder, elbow, hip, knee, ankle) especially in an malicious tumours are not:
unfavourable position, loss of prehensile ability of the hand a) skin tumours, apart from malignant melanoma,
(loss of at least three fingers, including the thumb), paresis b) tumours, in the case when upon a histopathological
or paralysis of at least one limb; examination is diagnosed a precancerous or
6) temporary inability to study – a temporary inability of preinvasive condition,
the Insured to participate in all school classes, arising in c) neoplasms with changes of carcinoma in situ type,
consequence of insurance accident; a physician’s leave d) Hodgkin’s disease in its first stage,
from physical education classes does not mean inability to e) neoplasms linked to AIDS or HIV virus infection;
study under these General Conditions; 21) frostbite – damage of the skin and subcutaneous
7) temporary inability to work – a temporary inability of tissues due to low temperature;
the Insured to gainful employment, arising as the 22) insurance term – the period of PZU SA liability
consequence of the insurance accident, documented with a defined in the insurance contract;
medical certificate on temporary inability to work, issued in 23) burn – damage of the skin and subcutaneous
line with current legal provisions; tissues due to action of high temperature, chemicals,
8) insurance document – the policy, certificate or another ionizing radiation or electric current;
document confirming the conclusion of insurance contract; 24) surgeries – a medical procedure performed at a
in the case of an individual insurance contract, one medical facility by a physician authorized to perform it,
document may confirm a conclusion of more than one under general or local anaesthesia, necessary to eliminate
insurance contract; or alleviate the illness effects resulting from an insurance
9) acts of war – actions of armed forces aiming at accident and conducted with a) the open or b) endoscope
destroying the enemy armed forces on land, in the air or method; within a meaning of these General Conditions the
on sea; surgery excludes: punctures, biopsies, injections,
10) children – persons up to 25. years old, studying or paracenteses, catharizing, tubing, cannulations, dialyses,
staying in establishment, whereas a child within a meaning blockades, venesections, tamponades, endoscopy;
of these General Conditions is also a child until going to a 25) country located in the region of the world at
nursery school, kindergarten or school and a child that risk of acts of terrorism, acts of war, martial law or
does not attend a school due to the health reasons or who state of emergency – country which, as at the date of
the insurance agreement, is entered in the list of countries
has individual educational programme;
to which travel is not advised due to threats of acts of
11) occupational exposure to contagious material
terrorism, acts of war, martial law or state of emergency,
– a subjection of the insured to virus infection while
published on the official website of the Ministry of Foreign
performing his/her professional work of medical nature as a
Affairs of the Republic of Poland, with “Do not travel” or
result of a direct contact with potentially infected blood or
“Leave immediately” advisories;
another potentially infectious material, as a consequence of
26) personnel – teaching and administrative employees
prick, splash, scratch, cut, score, bite by a patient;
of the given school or other institution;
12) hospitalization - insured’s stay at the hospital in
27) establishment– nursery school, kindergarten,
consequence of an insurance accident, uninterrupted and
primary school, lower secondary school, general secondary
lasting for more than one day, tied to treatment of
school, occupational general secondary school, technical
conditions which arose as a result of insurance accident
3
secondary school, basic vocational school, school complex, d) HIV infection during blood transplantation –
educational centre, orphanage, sport schools of all levels, complications of blood or blood-related preparations
post-secondary school, high school or the other not transplantation in person not suffering for
mentioned above establishments, in that employment haemophilia, or
establishments; e) meningioma – histopathologic confirmed diagnosis
28) medical establishment – a healthcare entity of brain meningioma; excluding: the other changes
within a meaning of the Act on healthcare activity; in central nervous system, cysts, coccus, vascular
29) educational entity – nursery school, kindergarten, malformations, pituitary and spinal cord tumour, or
primary school, lower secondary school, general secondary f) Parkinson’s disease – chronic disease of
school, occupational general secondary school, technical extrapyramidal system, caused by primary
secondary school, basic vocational school, school complex, degeneration of nervous cells of substantia nigra,
educational centre, orphanage, sport schools of all levels, leading to a decrease in a quantity of neurons that
post-secondary school, high school; produce dopamine, which results in an occurrence
30) serious bodily harm – a bodily harm occurring as of at least two of three classical axial symptoms of
a result of the insured’s accident, which resulted in one of this disease: passive tremor, slowness of movement,
the consequences listed below, confirmed by medical plastic quality hypertonia (muscular rigidity), that
documentation: decrease upon an administration of drugs
a) hospitalization commenced up to 3 stimulating a dopaminergic system, in particular L-
days after the trauma and lasting DOPA; excluding symptomatic parkinsonism, or
without interruption for at least 14 g) vision loss caused by disease – confirmed by
days, ophthalmic examination and static examination of
b) an urgent surgical procedure (up to 7 vision field, binocular vision acuity loss below 5/50,
days from admission to hospital), not a subject to correction or binocular narrowing of
c) qualification of the insured for a a field of vision below20;
planned surgical procedure, 32) gainful work – a form of performing work for
d) permanent neurological deficit after remuneration:
damage to the brain, spinal cord or 1)under:
nerve roots, a) a civil law contract or
e) permanent worsening of acuity of b) an employment relationship or
vision or permanent narrowing of the c) an official relationship of administrative
field of vision, and legal nature, or
f) permanent worsening of the auditory 2)within performance of business activity
acuity, under own name, including the running of
g) partial amputation of limbs, a farmstead;
h) partial loss of internal organs; 33) orthopaedic objects and auxiliary materials –
2) Serious bodily harm excludes invasive examinations medical devices necessary from the medical standpoint,
(even conducted as a part of a surgical procedure replacing lost systems (organs) or supporting the lost or
within a meaning of these General Provisions) aimed worsened functions of organs; a list of orthopaedic objects
at diagnosing an illness or a confirmation of an and auxiliary materials is included in Regulation of Minister
illness existence; of Health of 6 December 2013 on a list of medical devices
31) serious illness – an existence in the Insured the issued on order;
following illness: 34) statutory representative – a person whose
a) cerebral stroke – a sudden n focused or general empowerment to act on behalf of a person without legal
disorder of brain activity, leading to permanent capacity or with limited legal capacity, results from law
neurological deficiencies, caused only by vascular provisions;
reasons as brain vessel lumen or transmural rupture 35) Rules and Regulations – relevant rules and
of a brain vessel, excluding vascular reasons caused regulations governing electronic service provision;
by brain or injury factors, or 36) rehabilitation – treatment necessary from the
b) renal failure – a final stage of renal failure in a medical standpoint, restoring functions and capacity after
form of irreversible impairment of activity of both the insurance accident, performed by persons who possess
kidneys, as a consequence of which are performed the necessary qualifications and licenses;
regular, permanent dialyses or surgery procedure 37) RP – the Republic of Poland;
consisting in kidney transplantation, or 38) sepsis – in other words septicaemia – systemic
inflammatory response syndrome (SIRS) caused by
c) -Creutzfeldt-Jakob diseases– diseases that
infection;
disable a performance by the insured minimum
39) state of emergency – an emergency state of a
three of five below mentioned activities of everyday
state, which introduction results in a restriction of some
life: rights and civil freedoms;
-moving at home – moving between rooms at 40) hospital – a medical facility providing round-the-
house, without necessity to assist by another clock care for patients in terms of diagnostics and
person, treatment, with qualified team of physicians and nurses;
-controlling physiological activities – self-control under these General Conditions, this term does not include
within a scope of defecation and urination, and a nursing home, hospice, a rehabilitation centre,
maintaining personal hygiene, sanatorium or spa, preventorium or sanatorium hospital
-dressing up – independent dressing up and unless hospitalization is connected with a treatment of
undressing, without necessity to assist by another consequences of an insurance accident;
person, 41) coma – a condition resulting from the insurance
-washing and toilet – an independent performance accident, lasting continually for at least 30 days and
of activities related to washing and personal requiring the use of a life support system, entailing the
hygiene, without necessity to assist by another presence of deep, quantitative disturbances of
person, consciousness, having the form of lack of reaction to
-eating – activities connected with independent external verbal and pain stimuli, tied to severe brain
eating of ready meals or damage; under these General Conditions, this term does
not drug-induced coma for treatment purposes;
4
42) permanent bodily harm – complete physical loss §6
of an organ, or complete loss of its function; 1. A subject matter of an insurance contract are consequences of
43) permanent disturbance of health – permanent an insurance accident or a fact of an occurrence of an insurance accident,
bodily harm or detriment to health, without prospects for subject to sec. 2.
improvement;
2. In respect of a statutory representative, a subject matter of an
44) the Policyholder – an individual, a legal person or
insurance contract is a death of a statutory representative as a
organizational entity with no legal personality, who signed consequence of an insurance accident.
an insurance contract with PZU SA for his/her own account
§7
or for account of the Insured;
45) the Insured – persons referred to in items 1-4 for Upon a request of the policyholder, for additional insurance premium, an
whose benefit the insurance contract was concluded insurance contract can be extended by an accident insurance resulted from
a) a pupil, a student; acts of terrorism, acts of war, war or state of emergency, which occurred on a
b) a child; territory of a country that is situated in a world region threatened by acts of
c) personnel of an establishment; terrorism, acts of war, war or state of emergency.
d) a statutory representative. §8
46) direct contract – an insurance contract concluded by means
of electronic distance communication while observing law provisions
1. The insurance contract can be concluded under one of three
applicable in this respect; following options:
47) remote contract – an insurance contract concluded using direct 1) under option I or
means of remote communication through PZU SA’s hotline in
compliance with the regulations applicable in this respect; 2) under option II or
48) individual insurance contract– insurance contract concluded for the 3) under option II Bis.
account of a natural person named in the insurance document;
49) collective insurance contract – an insurance contract, other than 2. The types of benefits and their amount are specified in § 12.
family insurance contract, covering at least five persons, or a contract §9
concluded in the form of an open policy;
1 The insurance contract can be concluded:
50) beneficiary – a person named by the Insured as entitled to receive
the benefit due on account of the insured’s death; 1) in the basic scope of insurance cover specified in §§ 11–12 or
51) bodily harm – organ or system injury caused by an insurance 2) in the extended scope of insurance cover specified in §§ 13–27.
accident;
BENEFITS IN A BASIC SCOPE OF AN INSURANCE COVER
52) war – an organised armed conflict between countries, nations or
ethnic and social groups; OPTIONS OF INSURANCE
53) congenital heart defect – hear anatomical incorrectness existing at
birth of the Insured; § 10
54) concussion – post-trauma disorder of the brain function, whose main The Insured is entitled to benefits according to types and amounts
symptom involves short-term loss of consciousness with associated
retrograde or anterograde amnesia; specified in the concluded insurance contract, which can be concluded under
55) traffic accident – an insurance accident caused by vehicle or vehicles option I, option II or option II Bis.
movement on the road, in which the Insured took part as a road user; § 11
terms:” vehicle”, “road”, “road user” are understood according to their
meaning assigned to them by the applicable law provisions on road The insurance contract:
traffic;
1) concluded under option I covers the following basic benefits, specified in
56) insurance accident – an accident, suffering bodily injuries as a result
Table 1 below:
of epilepsy attack or fainting caused by unknown reason other than
chronic disease, intra-cranial haemorrhage, myocardial infarction, Table no. 1
sepsis, serious illness, occupational exposition to infectious material; an
insurance accident in the case of a hospital diet due to an illness is a Basic benefits under option I
stay of the Inured in the hospital;
57) myocardial infarction – necrosis of part of the myocardium caused Item Types of basic benefits
by a sudden reduction in blood flow to this part of myocardium;
58) medical profession – laboratory diagnostician, pharmacist, physical
1 death benefit
therapist, physician, dentist, nurse, midwife, medical rescuer, hospital
ward, paramedic, dental technician, pharmacy technician, electro-
cardiology technician; 2 death benefit in the area of an educational establishment
59) fracture – a trauma-related break of the bone, or a trauma-induced
slipping of the epiphysis: 3 death benefit as a consequence of sepsis
a) open – with rupture of the skin near the broken bone, b) closed –
when the skin near the broken bone is intact;
4 for permanent disturbance of health
one-time benefit in the case of lack of permanent disturbance of health and of

60) dislocation – a trauma-related move of one surface of the joint in consequences other than those listed in Tables 4, 5, 7, 8 – specified in Table
relation to the other, for the purpose of this insurance the dislocation 5
no. 6
must be confirmed with an imaging examination.
for the refund of the costs of purchasing orthopaedic objects and auxiliary
materials, as well as the cost of dental reconstruction of permanent teeth
CHAPTER II 6
INSURANCE COVER TERM. INSURANCE SUBJECT MATTER AND SCOPE

INSURANCE COVER TERM 7 for refund of the costs of vocational training of disabled persons
§5
PZU SA is liable for insurance accidents which occurred during the period of 8 post-accident assistance benefits rendered in the territory of Poland
insurance.
1) concluded under option II covers the following basic benefits,
specified in Table 2 below:
INSURANCE SUBJECT MATTER AND SCOPE
Table no. 2
Basic benefits under option II
5
Item Types of basic benefits for refund of the costs of vocational retraining of disabled persons
12
1 death benefit
13 post-accident assistance benefits rendered in the territory of the Republic of
Poland
2 death benefit in the area of an educational establishment
DETAILED PROVISIONS REGARDING BASIC BENEFITS

3 death benefit as a consequence of sepsis
§ 12
4 for permanent bodily harm (Table no. 4) 1. Benefit for death of the Insured – is due as 100% of the sum insured.
This benefit is due if death occurred not later than within 24 months from
the date of the insurance accident.
for permanent disturbance of health caused solely by myocardial infarction,
intracranial haemorrhage or serious bodily harm
2. Benefit for death of the Insured in the area of educational
5 establishment - is due as 100% of the sum insured.
3. Benefit for death of the Insured as a consequence of sepsis - is due
as 100% of the sum insured. This benefit is due if death occurred not later
6 for fractures of bones or dislocations of bones (Table no. 5) than within 24 months from the date of the insurance accident.
4. Benefit for permanent disturbance of health - is due in an amount
7 for consequences other than those listed in Tables no. 4, 5, 7 and 8 – corresponding to such percent of the sum insured in which the Insured
specified in Table no. 6 sustained a permanent disturbance of health, and that permanent
disturbance of health is determined:
8 for burns or frostbite (Table no. 7) 1) by a physician designated by PZU SA, on the basis of the current “Table
of norms for the assessment of percentage values of permanent
disturbance of health”, approved by the relevant resolution of the PZU SA
9 for concussion or suspected concussion of the brain (Table no. 8) Management Board and valid as at the date of conclusion of the insurance
contract, enclosed as appendix to the insurance contract;
2) not later than during the 24th month from the date of the insurance
10 for bites and stings accident – any later change in the degree of permanent disturbance of
health (improvement or worsening) does not constitute grounds to change
the amount of the benefit.
for refund of the costs of purchasing orthopaedic objects and auxiliary
5. This benefit is the permanent disturbance of health occurred not later than
11 within 24 months from the date of the insurance accident.
6. Benefit for permanent bodily harm – is due - is due in an amount
corresponding to the relevant percent of the sum insured, according to
12 for refund of the costs of vocational retraining of disabled persons Table no. 4 below;
13 post-accident assistance benefits rendered in the territory of the Republic of

Poland
2) concluded under option II Bis covers the following basic benefits,
specified in Table 3 below:
Table no. 3
Basic benefits under option II Bis
Item Types of basic benefits
1 death benefit
2 death benefit in the area of an educational establishment
3 death benefit as a consequence of sepsis
4 for permanent bodily harm (Table no. 4)
for permanent disturbance of health caused solely by myocardial

infarction, intracranial haemorrhage or serious bodily harm
5
6 for fractures of bones or dislocations of bones (Table no. 5)
for consequences other than those listed in Tables no. 4, 5, 7 and 8 –

7 specified in Table no. 6 – item 1 and item 2
8 for burns or frostbite (Table no. 7)
for concussion or suspected concussion of the brain (Table no. 8)

9
10 for bites and stings
for refund of the costs of purchasing orthopaedic objects and auxiliary

11
6
Item Item Type of fracture Item Type of fracture
Typ
e of
frac
ture
2.0 for each fractured

rib – in the case of up to 9 ribs
fractured; maximum 10.0 for
4 Fracture of the rib, ribs all broken ribs (if more than 9
ribs are broken)
Fracture of the humeral

bone:
5 a) one or multiple (other than open)
5
b) one or multiple, open
7
6 Dislocation of the shoulder 3
joint
Fractures of the forearm
bones (one or both):
a) one or multiple (other than open)
7
2
4
8 Dislocation of the elbow joint 3
Fractures of the hand bones,

excluding finger bones:
9
1
3
c) Fractures of finger bones –

d) from 2nd to 5th finger a) one or multiple
10 (other than open)
1 for each finger
one or multiple, open
2 for each finger
Joint dislocations of the finger
11 bones – from 2 to 5
nd th
2 for each finger
finger
Fractures of thumb
12 b) one or multiple, open
1
3
13 Dislocation of the thumb 2
14 Unstable fracture of the pelvis 10
15 Stable fracture of the pelvis 4,5
16 Dislocation of the hip joint 10
17 Fracture of the femur bone 10
18 Fractures of the shank 7

bones (one or both)
19 Fracture of the patella 4
Dislocation of the knee joint,

20 excluding dislocation of the 5
patella
Fractures of the foot bones,
excluding toes:
21
2
4
22 Fractures of the large toe 2.5
23 Fractures of the toes – from 2 for each toe

2nd to 5th toe
24 Dislocation of the ankle 4
Fractures of the spine – of

the vertebral body and vertebral
25 11 for each vertebra
arches (excluding
coccyx)
Fractures of the spine – of
the transverse process and
26 2.5 for each vertebra
acanthi
27 Fractures of the coccyx 3.5
0.5 for each fractured
permanent tooth – if up 7
to 9 permanent teeth are
fractured; maximum 5 for
Fracture of a permanent all fractured permanent
28
tooth teeth (if more than 9
permanent teeth are
Permanent bodily injury - Table no. 4
% of sum insured
Type of permanent defined in the
Item. bodily injury insurance contract 7. Benefit for bone fractures or joint dislocations – is
due:
Complete loss of upper limb
1 at the shoulder or arm level 80 Table no. 5
Bone fractures or joint dislocations
Complete loss of upper
2 limb at the elbow or forearm 60
level
3 Complete loss of hand 50
4 Complete loss of the 2nd, 3rd, 8 – for each finger

4th and 5th fingers
5 Complete loss of thumb 22
Complete loss of lower limb

6 on the hip joint or thigh 75
bone level
Complete loss of lower limb

7 on the knee joint, shank or 60
ankle joint level
8 Complete loss of foot 40
9 Complete loss of the 2nd, 3rd, 3 – for each finger

4th and 5th toes
10 Complete loss of the large toe 15
11 Complete loss of vision in 50

one eye
12 Complete loss of vision in 100

both eyes
Complete loss of hearing in

13 30
one ear
14 Complete loss of hearing in 50

both ears
15 Complete loss of the auricular 15

concha
16 Complete loss of the nose 20
2 for each permanent

tooth lost – in the case
of loss of up to 9
permanents
Complete loss of permanent teeth; 4. Benefit for fractures of bones or dislocations of joints –
17
teeth maximum 110 for all is due:
permanent 1) according to Table 5 below:
teeth lost – in the Table no. 5
case of loss of more than 2) Fractures of bones or dislocations of joints
9 permanent teeth
18 Complete loss of the spleen 20
19 Complete loss of one kidney 35
20 Complete loss of both 75

kidneys
Item Itemloss
21 Complete Type of fracture
of the uterus Item
40 Type of
Type fracture
of
22 Complete loss of an ovary 20
fract
or testicle
ure
23 Complete loss of speech 100
Fracture of bones of the
1GENERAL TERMS AND CONDITIONS OF THE 5PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE
calvaria and base of skull
Paralysis or paresis of at 8
least two limbs, below 3rd
224 Fractures of the craniofacial 100
4
degree on the Lovette scale
bones
325 ComaFractures
lasting for
of the
moreshoulder
than 100
4.5 for each bone
30 days
blade, collarbone, breastbone
1) does not include recurrent dislocations of the joints; 2) in case where the bodily harm or disturbance of health can
2) in the case of surgical treatment of a fracture or dislocation be classified under two or three items in Table no. 6, the
listed in Table no. 5 the Insured is entitled to – aside from Insured is entitled to benefit only under one of these items,
the benefit resulting from Table no. 5 – an additional benefit the one item, which is more favourable for him/her.
in the amount of 2% of the sum insured for each organ that 8. Benefit for burns or frostbite – is due in an amount
was operated; the organ that was operated shall be corresponding to the relevant percent of the sum insured,
understood as an organ listed in Table no. 5. according to Table 7 below:
7. Benefit for consequences other than listed in Tables 4,5,
7 and 8: Table no. 7
1) is due in an amount corresponding to the relevant percent of Burns or frostbite
the sum insured, according to Table no. 6 below, Type and size of burn / % of sum insured
a) subject to the provision that under option I the benefit is due frostbite defined
only if there is no permanent disturbance of health, in the insurance
b) subject to the provision that under option II – within a scope Item contract
specified in item 1 or item 2, or item 3, according to Table no. 6 1 2nd degree burn up to 1% 1.5
below, of body surface area
c) subject to the provision that under option II – within a scope 2 2nd degree burn from 4
specified in item 1 or item 2, according to Table no. 6 below; 1% to 15% of body surface
Table no. 6 area
Consequences other than listed in Tables no. 4, 5, 7 and 8 3 2nd degree burn from
Item Type Item Type of % of sum insured 15% to 30% of body surface 7
of consequen defined in the area
consequ ce insurance Type and size of burn / % of sum insured
ence contract frostbite defined
in the insurance
Optio Optio Optio
Item contract
nI n II n II
Condition Bis 4 2nd degree burn of more 20
than 30% of body surface
Sudden area
poisoning 5 3rd degree burn up to 5% 4
with of body surface area
gases, 6 3rd degree burn from 10
1 hospitalisation 1 5 5
chemical 5% to 10% of body surface
products area
and 7 3rd degree burn above 10% 20
substances of body surface area
2 Electric shock, hospitalisation 1 5 5 8 Burn of the respiratory 20
shock by tract, treated at hospital
lighting
9 2nd degree or higher frostbite 1.5
Consequence
– of one finger or toe
of bodily
2nd degree or higher frostbite
injuries under a physician’s
– of more than one
a single and intervention at 10 4
finger or toe, frostbite of
all insurance a medical
the nose or ear
accidents facility,
within combined with 9. Benefit for concussion or suspected concussion is due is
insurance further due in an amount corresponding to the relevant percent of the
term that are treatment and
sum insured, according to Table 8 below, if the Insured was
hospitalized with relation to the concussion or suspected
not included requiring at
concussion:
3 in the Tables least one 0.5 0.5 none
or cannot be follow-up visit
classified at the Table no. 8
under the physician’s Concussion or suspected concussion of the brain
definition of surgery % of sum insured
serious bodily (confirmed in a defined
harm (does medical in the insurance
not apply to documentation Item Hospitalisation contract
dental )
1 2 days 1
intervention).
) 2 3 days 2
3 4 days or longer 3 - to another hospital, if the medical
10. Benefit for bites and stings is due is due as 10% facility where the Insured is being
of the sum insured, if the Insured was hospitalized with relation to hospitalized does not guarantee
a bite or sting. appropriate care for the Insured’s
11. Refund of the costs of purchasing orthopaedic condition,
objects and auxiliary materials, as well as the cost of - from the medical facility to the
dental reconstruction of permanent teeth is due is due Insured’s place of stay after providing
in the amount of up to 25% of the sum insured, if the need to medical assistance, if according to the
incur these costs arose within 24 months from the date of the orders of the attending physician the
insurance accident, and the refund of costs of dental Insured should not use own transport
reconstruction of permanent teeth cannot exceed PLN 200.00 means or local public transport;
per tooth. 2) Rehabilitation and nursing care
12. Refund of the costs of vocational retraining of PZU SA ensures:
disabled is due in the amount of up to 25% of the sum a) organization of the rehabilitation process – if the
insured, if the need to incur these costs within the territory of attending physician ordered rehabilitation procedures,
Poland arose within 24 months from the date of the insurance PZU SA organizes and covers the cost of a physical
accident. therapist’s visits (therapist’s fee and costs of commute) at
13. Post-accident assistance benefits rendered in
the Insured’s place of stay or organizes and covers the
the territory of the Republic of Poland
costs of transporting the Insured to a rehabilitation
The assistance services referred to in items 1–6 are rendered
outpatient clinic and the costs of rehabilitation procedures
by the PZU Emergency Centre within the territory of the
performed at that outpatient clinic; this benefit is
Republic of Poland with relation to the occurrence of an
insurance accident during the insurance period, with the provided up to the total amount of PLN 500.00 per each
reservation that with relation to services referred to in item 3, insurance accident and the location where the procedures
assistance services are provided with relation to an accident. are performed is determined by the attending physician of
Depending on the insurance accident, at the request of the the Insured;
Insured or a person acting on his/her behalf, PZU SA b) delivery of small rehabilitation or medical
organizes and covers the costs of the following assistance equipment – if the Insured, according to
services: recommendations of the attending physician, should use
1) Medical assistance certain rehabilitation or medical equipment at home, PZU
SA organizes and covers the costs of an information
PZU SA organizes and covers the costs of medical
service regarding the stores or rental stores offering
assistance, up to PLN 2 000.00 for all the services listed
rehabilitation equipment. PZU SA also organizes and
below, with relation to each insurance accident:
covers the cost of transporting small rehabilitation
a) physician’s house call– organization of a single
equipment to the Insured’s place of stay; this benefit is
physician’s call at the Insured’s place of stay and cover
provided up to the total amount of PLN 300.00 and the
the costs of physician’s fee and travel costs, PZU SA does
cost of renting or purchasing the equipment is covered by
not cover the costs of additional diagnostic tests ordered
the Insured;
by the physician during such visit, or,
c) delivery of drugs prescribed by a doctor to the
b) medical consultations of the Insured at a medical
d) Insured’s place of stay – if according to the physician’s
facility– organizing a physician’s visit of the Insured at a
order the Insured has to stay at home, PZU SA organizes
medical facility designated by the PZU Emergency Centre
and covers the costs of delivering the necessary drugs
and covering the physician’s fee; PZU SA does not cover
prescribed by the doctor if they are available in the
the costs of additional diagnostic tests ordered by the
Republic of Poland; if the Insured needs also OTC drugs
physician during such visit; at the request of the Insured
which are available at the same location as the
PZU SA organizes transport to the medical facility and
prescription drugs, PZU SA shall deliver the OTC drugs
covers its cost,
indicated by the Insured; this benefit is performed up to
c) nurse’s house call– if the Insured’s condition requires
the amount of PLN 300.00 and the costs of the drugs are
a nurse’s visit at his/her place of stay, PZU SA
covered by the Insured;
organizes and covers the cost of the nurse’s commute e) home nursing care after hospitalization – if the
to the Insured’s home and her fees; this service includes Insured is hospitalized for longer than 2 days in
the performance of medical procedures ordered consequence of the insurance accident, PZU SA organizes
by the attending physician, and covers the cost of nurse’s care (costs of nurse’s
d) transport – organizing and covering the costs of commute and her fees) following the completion of
transporting the Insured: hospitalization, at the Insured’s place of stay; The
- to an appropriate medical facility from justification for the home nursing is determined by the
the location of the Insured’s stay or the attending physician of the Insured; the service is
location of the insurance accident, performed up to the amount of PLN 1 000.00 per each
- between medical facilities where insurance accident;;
medical assistance was provided or if 3) Psychological assistance
the Insured is referred to specialist If as the result of the accident covered by PZU SA liability
tests or surgical procedure at another the Insured suffers severe bodily injuries, or as the result
medical facility, of the accident in which the Insured participated the
following occurs:
a) death of the Insured’s spouse, or 8) caused by a malicious tumour – in the amount specified
b) death of the Insured’s child, or in an insurance contract;
c) death of the parents of the Insured or of the Insured’s 9) one-time benefit in the case of a death of a child due
spouse,
to a congenital cardiac defect – in the amount specified
d) death of a pupil from the Insured’s class and the Insured
reports the need for psychological assistance, PZU SA in an insurance contract;
organizes and covers the costs of the Insured’s 10) one-time benefit in the case of amputation of a
consultations with a psychologist, in a number limb or a part of a limb caused by a malicious
recommended by the psychologist during the first such tumour in a child– in the amount specified in an
visit, up to the total amount of PLN 1 500.00. If as the insurance contract;
result of the insurance accident covered by PZU SA 11) one-time benefit in the case of death of a statutory
liability the Insured dies, the spouse, children and parents
representative due to an accident – in the amount
of the Insured are entitled to the psychological assistance
described above; PZU SA organizes and covers the costs specified in an insurance contract;
of that person’s consultations with a psychologist, in a 12) one-time benefit in the case of death as result of a
number recommended by the psychologist during the first traffic accident – in the amount specified in an insurance
such visit, up to the total amount of PLN 1 500.00 per contract;
each such person; 13) one-time benefit in the case of an occurrence of a
4) Private tuition for students of primary schools, lower
serious illness – in the amount specified in an insurance
secondary schools and upper secondary schools,
excluding students of post-secondary schools contract;
pursuant to the Act on the education system – if due to 14) one-time benefit in the case of an occurrence of a
an insurance accident the student is unable to attend school virus infection due to an occupational exposure to a
for more than 10 days from the date of the insurance contagious material – in the amount specified in an
accident, PZU SA organizes and covers the costs of individual insurance contract;
tuition on up to 2 selected subjects covered by the school
15) refund of treatment costs incurred due to an
syllabus, up to PLN 400.00 per each insurance accident;;
occupational exposition to a contagious material – in
5) Medical hotline and telephone consultations with
the amount specified in an insurance contract.
6) the physician of the PZU Emergency Centre
PZU SA ensures an access to medical hotline, which means a
conversation with the physician of the PZU Emergency RULES OF AWARDING ADDITIONAL BENEFITS REFERRED
Centre, who within his/her professional capacity provides TO IN § 13
verbal information to the Insured regarding proceedings tied REFUND OF TREATMENT COSTS
to medical care. This information does not cover issues of
diagnosis and treatment. § 14
1. The treatment costs, in that rehabilitation costs, are refunded if
there were fulfilled cumulatively the following conditions:
BENEFITS IN EXTENDED INSURANCE COVER SCOPE
1) They were incurred in connection with a treatment of the
ADDITIONAL BENEFITS consequences of:
a) an accident, bodily injuries caused as a result of an
§ 13 attack of epilepsy or syncope other than a chronic
At the request of the Policyholder the insurance contract concluded disease;
under option I or option Ii or option II Bis may include the following b) heart stroke, intra-cranial haemorrhage, an accident
additional benefits upon the payment of additional premium: resulting from acts of terrorism, acts of war, martial law
1) refund of treatment costs – including rehabilitation or state of emergency, which took place on the territory
costs, in the amount specified in the insurance contract; of a country situated in the world region threatened by
2) lump-sum benefit for the period of a temporary acts of terrorism, acts of war, martial law or state of
inability to study or work – for one day of inability in the emergency, unless an insurance contract covers
amount specified in the insurance contract; consequences of an insurance contract of this type;
3) hospital per diem as a result of an accident– per one 2) they were substantiated from a medical point of view;
day of a stay in hospital in the amount specified in the 3) a necessity to bear treatment costs arouse not later than
insurance contract; within a period of 24 months counted from a date of
4) hospital per diem as a result of an illness– per one events, referred to in par. 1;
day of a stay in hospital in the amount specified in the 4) in the case of rehabilitation – if a necessity of its
insurance contract; performance arouses not later than within a period of 6
5) refund of flat adoption costs to permanent disturbance months counted from a date of events, referred to in par.
of health resulting from an insurance accident in the 1.
amount specified in an insurance contract; 2. A refund of costs, mentioned in sec. 1 takes place on the basis
6) one-time benefit due to sepsis occurrence - in the of invoices and proofs of their payment, however maximally up
amount specified in an insurance contract; to an amount of a limit determined in the insurance contract per
one insurance accident.
7) one-time benefit in the case of a death of the
3. Within a frame of the limit, mentioned in sec. 2, are also
Insured
covered costs of:
1) the Insurer’s accommodation within a rehabilitation period 4. The hospital per diem is paid out on the basis of a Hospital
in a locality, in which rehabilitation is performed, if a Discharge Summary Report issued by a hospital that confirms
rehabilitation centre is located at least 100 km from the the Insured’s hospitalisation.
Insurer’s place of residence – up to an amount of 150 PLN
per 24 h and max. up to 10 days and nights;
2) an accommodation of the Insured’s close person, in the HOSPITAL PER DIEM AS A RESULT OF AN ILLNESS
case of the Insured’s hospitalization after an insurance OTHER THAN A CHRONIC ILLNESS
accident in a hospital located at least 100 km from the
Insurer’s place of residence – up to an amount of 150 PLN § 17
per 24h and max. up to 10 days and nights; 1. The hospital per diem is paid out – for each day of a
LUMP-SUM BENEFIT FOR THE PERIOD OF TEMPORARY hospitalisation, subject to sec. 2.
INABILITY TO STUDY OR WORK 2. The hospital per diem is paid out from the 1st day of the
§ 15 hospitalization of the Insured provided that, the hospitalization
lasts at least 6 days and is paid out maximally within a period of
1. This lump sum is due to the Insured with regard to a 60 days due to one and all reasons of the hospitalization.
consequence of: 3. The hospital per diem is paid out on the basis of a Hospital
1) an accident, bodily injuries caused as a result of an attack of Discharge Summary Report issued by a hospital that confirms
epilepsy or syncope other than a chronic disease; the Insured’s hospitalization.
2. heart stroke, intra-cranial haemorrhage, an accident resulting 4. The hospital per diem is due, when a necessity of the
from acts of terrorism, acts of war, martial law or state of hospitalization arouses during an insurance term.
emergency, which took place on the territory of a country 5. By a chronic illness should be understood an illness that
situated in the world region threatened by acts of terrorism, acts occurred (diagnosed or not diagnosed) prior to commencing the
of war, martial law or state of emergency, unless an insurance insurance contract, with a long-term course usually lasting
contract covers consequences of an insurance contract of this throughout months or years, for which the insured suffered on a
type; date of concluding the insurance contract, whether it required a
3. The lump sum is paid out for each day of inability, in this medical intervention or not on the date of concluding the
inability to work or study lasts continuously longer than 14 days. insurance contract.
4. The lump sum is paid out maximally for a period of 180 days
due to one or all accidents occurred within an insurance term.
5. The lump sum is due, if an inability to study or work arouse not REFUND OF FLAT ADOPTION COSTS
later than within a period of 24 month counted from a date of
an insurance accident. § 18
6. The lump sum may be paid out on the basis of: 1. The refund of these costs is due if as a consequence of an
1) a certificate issued an attending physician, issued according insurance accident the Insured is a subject to permanent
to the applicable law provisions or deterioration to health and with regard to this there is a
2) an opinion issued by a medical examiner indicated by PZU SA necessity to adopt its place of residence to the resulting
or permanent deterioration to health.
3) in the case of insured minors in the event of an inability to 2. The refund of the costs mentioned in sec. 1 is due, if a
study that lasts no longer than 30 days – a statement of the necessity to adopt a place of residence occurs not later than
statutory representative. within 24 months counted from a date of determining a
permanent deterioration to health.
HOSPITAL PER DIEM AS A RESULT OF AN ACCIDENT

BENEFIT DUE TO SEPSIS OCCURENCE
§ 16
§ 19
1. The hospital per diem is paid out – for each day of a
1. This benefit is due to the Insured in case when sepsis occurs in
hospitalisation, subject to sec. 3:
him/her.
1) as a consequence of:
2. The benefit referred to in sec. 1, is paid out provided that a fact
a) an accident, bodily injuries caused as a result of an attack of
of a sepsis occurrence took place within an insurance term.
epilepsy or syncope other than a chronic disease,
heart stroke, intra-cranial haemorrhage, an accident resulting from
acts of terrorism, acts of war, martial law or state of emergency,
which took place on the territory of a country situated in the ONE-TIME BENEFIT IN THE CASE OF DEATH OF THE
world region threatened by acts of terrorism, acts of war, INSURED CAUSED BY A MALICIOUS TUMOUR
martial law or state of emergency, unless an insurance contract § 20
covers consequences of an insurance contract of this type; 1. The benefit is paid out to the beneficiary in the amount
2) if a necessity to hospitalise occurred not later than within specified in the insurance contract.
a period of 24 month counted from a date of an 2. The benefit referred to in sec. 1, is paid out provided that a
insurance accident. death of the Insured took place within an insurance term.
2. The hospital per diem is due maximally within a period of 60 3. The pay-out of the benefit mentioned sec. 1 is performed on the
days due to one and all events, referred to in par 1. basis of a death report delivered to PZU SA that includes a
3. The hospital per diem is paid out from the 1st day of the statement about a death reason.
hospitalization of the Insured provided that, the hospitalization
lasts at least 3 days.
ONE-TIME BENEFIT IN THE CASE OF DEATH OF A CHILD § 25
DUE TO A CONGENITAL CARDIAC DEFECT 1. The benefit is paid out to the Insured in the amount specified
§ 21 in the insurance contract.
2. The benefit referred to in sec. 1, is paid out provided that a
1. The benefit is paid out to the beneficiary in the amount fact of an illness occurrence took place within an insurance
specified in the insurance contract. period.
death of the Insured took place within an insurance term.
3. The pay-out of the benefit mentioned sec. 1 is performed on the ONE-TIME BENEFIT IN THE CASE OF AN OCCURRENCE OF A
basis of a death report delivered to PZU SA that includes a
VIRUS INFECTION DUE TO AN OCCUPATIONAL EXPOSURE
statement about a death reason.
TO A CONTAGIOUS MATERIAL
§ 26
ONE-TIME BENEFIT IN THE CASE OF AMPUTATION OF A 1. The benefit is due to the Insured, who practices a medical
LIMB OR PART OF LIMB CAUSED BY A MALICIOUS TUMOUR profession or is a pupil/student of a medical school, in the
IN A CHILD amount specified in an insurance contract.
§ 22 2. The benefit referred to in sec. 1, is paid out provided that a
virus infection was diagnosed within an insurance term.
1. The benefit is paid out to the Insured in the amount specified in
the insurance contract.
2. The benefit referred to in sec. 1, is paid out provided that an REFUND OF TREATMENT COSTS INCURRED DUE TO AN
amputation of a limb or a part of a limb in the Insured took OCCUPATIONAL EXPOSITION TO A CONTAGIOUS
place within an insurance period. MATERIAL
3. The pay-out of the benefit mentioned sec. 1 is performed on the § 27
basis of a medical documentation delivered to PZU SA that is
necessary to determine this health condition and an amputation These costs are a subject of refund, if there the following conditions
reason. are fulfilled cumulatively:
1) the costs were borne in connection with an exposition to a
contagious material, which took place within an insurance
ONE-TIME BENEFIT IN THE CASE OF DEATH OF STATUTORY period;
2) the costs were substantiated from a medical point of view;
REPRESENTATIVE DUE TO AN ACCIDENT
3) the Insured practices a medical profession or is a pupil or a
§ 23 student of a medical school.;
4. The one-time benefit in the case of death of statutory
representative due to an accident – is paid out to the Insured in SUM INSURED AND LIMITS OF LIABILITY
the amount specified in the insurance contract.
§ 28
death of the statutory representative took place as a result of an 1. The sums insured and liability limits for basic benefits and
insurance accident, which took place within an insurance period, additional benefits included in the insurance contracts are
and the death took place within 24 months from a date of an specified in the insurance contract.
occurrence of the insurance accident. 2. The insured sums and liability limits are specified in respect of
2. The pay-out of the benefit mentioned sec. 1 is performed on the each insurance case unless in these General Conditions is
basis of a death report delivered to PZU SA that includes a specified otherwise with regard to a concerned benefit.
statement about a death reason. 3. The Policyholder within a term of the insurance contract, with a
consent of PZU SA, may amend a sum insured or a scope of the
insurance.
ONE-TIME BENEFIT IN THE CASE OF DEATH AS A 4. An amendment of the insurance conditions referred to in sec. 3,
RESULT OF TRAFFIC ACCIDENT results in a necessity to recalculate a contribution for a period,
in which the amended conditions are to be applicable.
§ 24 5. In the case of an amendment of the sum insured or a scope of
1. The benefit is paid out to the beneficiary in the amount the insurance, PZU SA is liable under the limits of the amended
specified in the insurance contract. sum insured or liability scope, beginning from the first day of
2. The benefit referred to in sec. 1, is paid out provided that a making by PZU SA a statement about giving a consent for such
death of the Insured took place within an insurance term. amendment.
3. The pay-out of the benefit mentioned sec. 1 is performed on the
basis of a death report delivered to PZU SA that includes a
statement about a death reason. EXCLUSIONS OF LIABILITY
4. The benefit is not due when a death reason constituted a § 29
participation of the Insured in the sport contests: aviation,
motor or motorboat ones. 1. PZU SA shall not be liable for consequences of the insurance
accidents caused:
1) in a state of inebriation or under the influence of abusive
ONE-TIME BENEFIT IN THE CASE OF AN OCCURRENCE OF A substances, psychotropic substances, new psychoactive
substances or replacement drugs within a meaning of the
SERIOUS ILLNESS
provisions on counteracting drug addiction, unless that had 3. The PZU SA’s liability shall not include assistance services if the
no effect on the occurrence of the insurance accident; event being the basis for organisation of such service arose:
2) as a result of an intoxication caused by nicotine, alcohol 1) with relation to or in consequence of circumstances referred
consumption or use of abusive substances, psychotropic to in sec. 1, with a reservation that in the cases referred to in
substances, new psychoactive substances or replacement sec. 1 par. 6 liability of PZU SA can be extended for the
drugs within a meaning of the provisions on counteracting payment of additional insurance premium;
drug addiction, unless that had no effect on the occurrence 2) as a result of illnesses or medical conditions even those,
of the insurance accident; which occur suddenly or were disclosed only as a
3) as a result of participating in fights (excluding a defence in consequence of the insurance accident or constitute a reason
necessity) by the Insured and in connection with committing of the insurance accident, whereas an exclusion does not
a suicide or an attempted suicide by the Insured; refer to the consequences of an occurrence of an attack of
4) as a result of participating by the Insured in strikes, unrests, epilepsy or fainting due to the other reason than a chronic
riots, protests, roadblocks or sabotage unless this illness, heart stroke, intra-cranial haemorrhage, sepsis,
participation of the insured in strikes, riots, civil commotion, occupational exposition to contagious material, unless the
protests, roadblocks or sabotage results from carrying out insurance contract includes in its insurance cover bodily
official duties; injuries caused as a consequence of sepsis or an
5) as a result of an accident resulting from acts of terrorism, occupational exposition to contagious material.
acts of war, war or state of emergency, which took place in a 4. The liability of PZU SA shall not include liability for costs of
territory of a country situated in the world region threatened assistance services incurred by the Insured without any
by acts of terrorism, acts of war, war or state of emergency, consent of the Emergency Centre, unless getting in touch with
unless this risk was included into the contract on the basis of the Emergency Centre in a manner specified in § 43 sec. 1 was
a separate insurance premium; not possible for reasons not attributable to the Insured.
6) as a result of performing medical procedures, a performance 5. The liability of PZU SA shall not include liability for a
of which has an impact on a human organism regardless of compensation for an alleged pain, physical and moral suffering
whom performed them, unless the performance of these and suffered damages, which consist in a los, damage or
medical procedures was related to direct consequences of destruction of property.
the Insured’s accident; 6. A fact of being in the state of inebriation or the fact of being
7) while driving a motor vehicle by the Insured, if the Insured under the influence of abusive substances, psychotropic
did not have the license to drive the given vehicle, unless it substances, new psychoactive substances or replacement
that had no effect on the occurrence of the insurance drugs within a meaning of the provisions on counteracting
accident; drug addiction, as well as the driver’s authorisation to drive the
8) while driving the other vehicle than a motor vehicle by the vehicle shall be evaluated on the basis of the law of the state
Insured, if the Insured did not have the license to drive the in which the insurance accident occurred.
given vehicle, unless it that had no effect on the occurrence
of the insurance accident.
2. The liability of PZU SA is excluded for the consequences of CHAPTER III
illnesses or medical conditions, even those, which occur CONCLUSION OF INSURANCE CONTRACT AND ITS TERM
suddenly or were disclosed only as a consequence of the
insurance accident or constitute a reason of the insurance § 30
accident, whereas an exclusion does not refer to the
consequences of bodily injuries caused as a result of an attack 1. The insurance contract can be concluded with a mutual
of epilepsy or fainting due to the other reason than a chronic presence of both parties of this contract or by means of
illness, heart stroke, intra-cranial haemorrhage, sepsis, electronic distance communication (direct contract or remote
occupational exposition to contagious material, unless the contract).
insurance contract includes the consequences of this insurance 2. The insurance contract is concluded on the basis of an
accident. The liability of PZU SA is also excluded for a fact of an application of the Policyholder, which contains information
occurrence of the consequences of illnesses or medical necessary to perform an individual risk assessment and to
conditions, even those, which occur suddenly or was disclosed determine the premium due.
only as a consequence of the insurance accident or constitute a 3. A direct contract can be concluded provided that:
reason of the insurance accident, whereas an exclusion does not 1) prior reading the Rules and Regulations and these General
refer to the consequences of an occurrence of sepsis, virus and accepting them by the Policyholder;
infection upon an occupational exposition to contagious material 2) a prior confirmation provided by PZU SA related to an
or a serious illness, unless the insurance contract includes a acceptance of the Policyholder’s application;
fact of an occurrence of this insurance accident. If an illness of a 3) a payment of an insurance premium within a deadline
medical condition not covered by a liability of PZU SA has an specified in the insurance contract.
effect of an occurrence of an insurance accident, i.e. a reason of A conclusion of the direct contract takes place upon a payment
the insurance accident is both an illness, and an external of an insurance premium or its first instalment.
reason, a liability of PZU SA includes bodily injuries, detriment to 4. A remote contract is concluded upon a confirmation of an
health or death, which are a consequence of the external acceptance of the Policyholder’s application by PZU SA and upon
reason, unless it is impossible to determine which bodily injuries a prior reading the Rules and Regulations and these General and
or detriment to health are exclusively a consequence of the accepting them by the Policyholder.
external reason; in this case it is assumed that the bodily 5. The Insuring Party is obliged to inform PZU SA of all the
injuries or detriment to health are a consequence of the external circumstances known to him/her about which PZU SA asked in
reason. the offer form (application) or in other letters, before a
conclusion of the insurance contract. If the Policyholder insurance cover includes all persons belonging to a group
concludes the insurance contract via a representative, this determined in the insurance contract without a need to file
obligation applies also to the representative and covers applications to include by the insurance cover the new persons
circumstances known to him/her. If PZU SA concluded the and making a payment of an insurance premium ((in the case of
insurance contract despite lack of answers to some of the a change in a quantity of persons belonging to this group within
questions, the omitted circumstances are treated as irrelevant. a term of the insurance contract).
6. Within a term of the insurance contract, the Policyholder is
obliged to report any changes to the circumstances listed in § 34
section 5. The Policyholder is obliged to notify PZU SA of such 1. Subject to sec. 2-3, the liability of PZU SA commences on the
changes promptly upon receiving information about them. day following the conclusion of the insurance contract, but no
7. In case of concluding the insurance contract for someone’s earlier than the day following the payment of an insurance
behalf, the obligations defined in sections 5 and 6 rests with premium or its first instalment, unless otherwise agreed.
both the Policyholder, and the Insured, unless the Insured was 2. In the case when in the insurance contract is specified a day of
unaware of the contract concluded on his/her behalf. commencing an insurance term that is preceding to a date on
8. PZU SA shall not be liable for consequences of the which an insurance premium or its first instalment should be
circumstances, which under a breach of sections 5-7 failed to be paid, the liability of PZU SA commences on a date specified in
communicated to him/her. If the breach of provisions contained the insurance contract as a beginning of the insurance term.
in sections 5-7 was caused by intentional fault, in case of any 3. In the case when in the insurance contract is specified a day of
doubts it is assumed that the insurance accident provided for commencing an insurance term that is after a date on which an
under the contract and its consequences result from the insurance premium or its first instalment should be paid, and
circumstances described in the preceding sentence. the insurance premium or its first instalment was not paid to a
date preceding the first day of the insurance term, the insurance
contract is terminated on this date.
§ 31
A conclusion of the insurance contract is confirmed by an insurance
document by PZU SA. INSURANCE PREMIUM
§ 32 § 35
1. If in response to a submitted offer PZU SA delivers to the 1. An insurance premium is determined on the basis of the
Policyholder an insurance document, which provisions deviate to premium tariff as of a date of concluding the insurance contract.
an disadvantage of the Policyholder or the Insured in respect of The premium is calculated for the period of liability of PZU SA.
a content of an offer submitted to the policyholder, PZU SA is 2. An amount of the insurance premium is calculated depending
obliged to pay attention to the above in the written form while on:
delivering this document, giving him/her at least 7-day deadline 1) a type of school or establishment;
to object. In the case of a failure to perform this obligation the
changes made to the disadvantage to the Policyholder or the 2) a sum insured;
Insured are not effective, and the insurance contract is 3) a liability limit;
concluded according to the conditions of the offer.
2. In the case of a failure to object, the insurance contract is 4) an insurance period;
effective according to a content of the insurance document on
the next day upon an expiry of the deadline specified to object. 5) an insurance option;
§ 33 6) a scope of insurance;
1. The insurance contract is concluded for an indefinite period of 7) a postal code of the Insured or a place of residence of the
time. Insured.
2. The insurance contract is concluded as an individual contract or
§ 36
a group contract in a named or unnamed form.
3. While concluding the insurance contract in a named form, the 1. Subject to sec. 2 and 3, the premium is paid at the time of
Policyholder is obliged to deliver to PZU SA a list of the given concluding the insurance contract, unless other manner and
names and surnames of the Insured. In this case the insurance dates were set forth in the insurance contract.
covers only, the persons specified in the list. In the case of a 2. In the case of the direct contract, a payment deadline of an
conclusion of a group insurance contract by means of distance insurance premium is determined on a date at the latest
communication, the above-mentioned list, the Policyholder is preceding a date of commencing an insurance period
obliged to present it to PZU SA in a manner agreed by the determined in the insurance contract.
parties. 3. On request of the Policyholder, it is permitted to make a
4. The group insurance contract can be concluded in a unnamed payment of the insurance premium in instalments, subject to
form only in the case when it includes in its insurance cover all sec. 4, The deadlines to pay the respective instalments of the
persons included in a group of persons specified in this contract. insurance premium are determined from a date of concluding
5. In the case of a conclusion of the group insurance contract, the the insurance contract.
Policyholder is obliged to inform PZU SA about a given name, 4. The insurance premium is paid in cash or, subject to agreement
surname and a phone number of a person who maintains the with PZU SA, in non-cash form.
list. 5. If the payment of premium is made in the non-cash form, the
date of payment is deemed to be the date when the full due
6. Unless stated otherwise in the insurance contract, in the case of amount of premium is posted in the account of PZU SA.
concluding the insurance contract I an unnamed form, its
6. The insurance premium is not subject to indexation. from the insurance contract by making a written statement
within this scope is of 30 days from a date of providing to
§ 37 him/her information, which should be conveyed to a consumer
In case of revealing circumstances which significantly change the on the basis of the provisions on concluding the distance
probability of an insurance event, each of the parties may demand contracts, if this deadline is later. The deadline is deemed to be
an appropriate change in the level of premium, starting from the observed, if a statement about a withdrawal from the insurance
contract was submitted prior to its expiry.
day the said circumstance occurred, but not earlier than from the
start of the current insurance period. If such request is submitted, § 40
the other party may terminate the insurance contract within 14 If the insurance cover expires before an end of period for which the
days, with immediate effect, by making a statement within this contract had been concluded, the Policyholder is entitled to a
scope. refund of the insurance premium for the unused cover period.
TERMINATION OF INSURANCE CONTRACT AND END OF
CHAPTER IV
LIABILITY
REFUND OF A PREMIUM PERFORMANCE OF INSURANCE CONTRACT
§ 38 PROCEDURE IN THE EVENT OF AN INSURANCE ACCIDENT
1. The insurance cover expires: OBLIGATIONS OF THE INSURED
1) upon the expiry of the insurance period, defined in the
insurance document; § 41
2) on the date, on which PZU SA is served a statement of the
1. In the case of an insurance accident, the Insured is obliged
Policyholder about a withdrawal from the insurance contract in
to:
the case mentioned in § 39;
1) attempt to alleviate the results of the accident by
3) on the date, on which is served a statement about a withdrawal
immediately seeking medical care and following the
from the insurance contract in the case mentioned in § 39;
recommended treatment;
4) on the date of serving to the Policyholder a statement of PZU SA
2) notify PZU SA of the occurrence of insurance accident and
about a withdrawal from the insurance cover with immediate
deliver:
effect in the case when PZU SA is liable even prior to a payment
a) a description of the reasons for and course of the
of the insurance premium or its first instalment, and the
accident,
insurance premium or its first instalment was not paid within a
b) medical documentation confirming the bodily harm or
deadline;
disturbance of health suffered by the Insured in
5) upon an expiry of 7 days from serving to the Policyholder a
consequence of the insurance accident,
notice to pay a subsequent instalment of the insurance
c) documents necessary to establish a justification for and
premium, sent after its due date, with the information that a
the amount of the claim;
lack of payment within 7 days from notice delivery would
d) invoices and proofs of payments of costs covered by the
cause termination of liability,
insurance scope;
6) on the date, on which PZU SA is served a statement of the
e) if the Insured was driving a vehicle at the time of the
policyholder about a withdrawal from the insurance contract
accident – the driver’s license of the Insured;
with immediate effect in the case mentioned in sec. 3;
3) enable PZU SA to obtain information tied to circumstances
7) on the date of a termination by mutual agreement;
described in documents listed in item 2, in particular from
8) with regard to the given Insured, on the date, on which the
the doctors who took care of the Insured, both before and
Insured passes away.
after the accident.
2. The insurance contract can be terminated at any time by mutual
2. In the case of death of the Insured, the beneficiary is obliged to
agreement.
present to PZU SA for inspection a copy of the Insured’s death
3. The Insurer may terminate the insurance contract with
certificate, copy of the death statistical document or copies of
immediate effect at any time by making a statement within this
medical documentation confirming the reason for death, if
scope.
he/she is entitled to obtain such documents, and document
§ 39 confirming his/her identity. If no beneficiary is named, the
person requesting a payment of benefit, referred to in § 49
1. The Policyholder may withdraw from the insurance contract
section 2 is obliged to submit in addition official documents
within 30 days, if the contract is signed for a period longer than
confirming his/her marriage with or relationship to the Insured,
6 months, and when the Policyholder is an entrepreneur - within
or documents confirming that he/she was caring for the Insured
7 days form a date of concluding the insurance contract by
making a proper statement. If at the latest upon concluding the as at the date of his/her death.
insurance contract, PZU SA did not informed the Policyholder § 42
who is a consumer about his/her right to withdraw from the
insurance contract, a deadline of 30 days shall run from a date, PZU SA reserves the right to verify the provided documentation and
on which the Policyholder who is a consumer learned about this to seek opinion of specialist physicians.
right. A withdrawal from the contract does not release the
Policyholder from an obligation to pay an insurance premium for § 43
a period, within which PZU SA provided an insurance cover. 1. In order to use the assistance benefits referred to in § 12 sec.
2. In the case of concluding the insurance contract by means of 13, the Insured (or the person acting on his/her behalf)
distance communication, in which the Policyholder is a should, immediately upon the occurrence of the insurance
consumer a deadline within which he/she is entitled to withdraw accident and before undertaking any actions on his/her own
account, notify the PZU Emergency Centre by telephone of the reported claims. Such examination is performed by the
insurance accident and state the following information: physicians designated by PZU SA.
1) given name, surname and address of residence of the
4. A degree (percentage) of permanent disturbance of health is
Insured and given name and surname or business name of
determined on the basis of the “Table of percentage evaluation
the Policyholder;
of a disturbance of health of PZU SA” approved by a resolution
2) telephone number at which the PZU Emergency Centre can
adopted by the Management Board of Powszechny Zakład
contact the Insured or his/her representative;
Ubezpieczeń Spółka Akcyjna and applicable on a date of
3) a brief description of the event and type of required
concluding the insurance contract, which is available in the
assistance;
organisational units of PZU Sa and on the web sites of PZU SA.
4) follow the recommendations of the PZU Emergency Centre,
providing information and the necessary powers of attorney. § 45
2. If the Insured or the person acting on his/her behalf were not
1. A degree (percentage) of permanent disturbance of health
able to contact the PZU Emergency Centre by telephone in the
should be determined promptly upon a completion of treatment,
manner referred to in section 1 for reasons beyond his/her
considering a rehabilitation recommended by a physician, and in
control, and on his/her own organized and paid for the
the case of a longer treatment at the latest in the 24th month
assistance services referred to in section 1, he/she shall be
from an occurrence of the insurance accident. The further
obliged to provide notification of the insurance accident within 7
change in a degree of permanent disturbance of health
days from the date on which contacting PZU Emergency Centre
(improving or worsening) is not the basis for a change of the
became possible. Furthermore, the Insured or the person acting
benefit amount.
on his/her behalf is obliged to state the reason for inability to
2. When establishing the degree (percentage) of permanent
contact PZU Emergency Centre.
disturbance of health, a type of work, an occupation or actions
3. If the Insured as a result of a failure to contact the Emergency
performed by the Insured are not taken into consideration.
Centre in the case referred to in section 2, organised on his/her
3. If in consequence of the insurance accident the Insured sustains
own assistance services and bore their costs, PZU SA is obliged
more than one bodily harm, the amount of benefit for
to refund to the Insured the costs he/she incurred up to their
permanent
actual amount, but not more than up to the liability limit set
disturbance of health, or for permanent bodily harm or for
under these General Conditions for the given assistance service,
fractures and dislocations consist of the sum of benefits due for
and if such limit had not been set – up to the average price for
each bodily harm, but not more than up to the amount of the
performing such service in the location where such service had
sum insured set in the insurance contract.
been performed – maximally to the amount corresponding to an
4. In connection with § 44 sec. 1 – in the case of the insurance
average price of a performance of the service of this type in the
accident contributes to a previously existing illness or medical
territory of a locality, in which the service has been rendered.
condition not covered by the insurance contract is of a size of
The basis for consideration of the submitted claim is the delivery
the accident consequences – benefits due on the basis of the
by the Insured of documentation necessary to establish
insurance contract are balanced by an impact of this illness or
justification for the claim and the amount of benefit: medical
medical condition on a size of the consequences of the
documentation confirming the occurrence of insurance accident
covered by PZU SA liability, as well as invoices issued in the insurance accident.
Insured’s name and proofs of their payment. 5. In the case of loss or damage to an organ or system whose
functions had already been impaired before the insurance
4. If the obligation to notify of the insurance accident within the
accident, the degree (percentage) of permanent disturbance of
deadline referred to in section 2 is breached intentionally or
health is determined as a difference between the degree
through gross negligence, PZU SA may reduce the benefit
(percentage) of permanent detriment to the given organ or
accordingly, if the breach made it impossible for PZU SA to
system after the accident, and the degree (percentage) of
establish the circumstances and consequences of the insurance
permanent disturbance of health which had existed before the
accident. The consequences of a failure to notify PZU SA of the
accident.
accident shall not occur if PZU SA, within the time defined in
6. If the insured, before the determination of permanent
section 2, received information of circumstances that should
disturbance of health caused by a serious bodily injury received
have been communicated to it.
a benefit for injury to the same organ under other titles (Table
4, 5, 7, 8), then in the case where the determination of
DETERMINATION AND A PAYMENT OF BENEFITS
permanent disturbance of health by the physicians designated
§ 44
by PZU SA would result in a higher benefit being granted, the
1. The types and amounts of vested benefits, when a subject of benefit granted under other titles (Table 4, 5, 7, 8) shall be
the insurance cover constitute the consequences of the credited against the benefit due for permanent disturbance, and
insurance accident, are determined upon establishing that there PZU SA shall pay the difference between the benefit for
exists a regular cause-and-effect relationship between the permanent disturbance and the benefit due under other titles
insurance accident and its covered consequences. (Table 4, 5, 7, 8).
2. The establishment of the regular cause and effect relationship, 7. Benefit for bites and stings referred to in § 12 section 10 is paid
referred to in section 1, and determination of the covered irrespective of benefits paid for other reasons.
consequence of the insurance accident and a fact of an
occurrence of the insurance accident, is done on the basis of 8. The benefit is due, if permanent disturbance of health occurred
delivered documents or information, listed in § 41 sec. 1, and on not later than within 24 months from a date of the occurrence
the basis of results of medical examinations. of the insurance accident.
3. The Insured is obliged to, upon a request of PZU SA and at its
expense, to undergo additional medical examinations or
examination necessary to determine a justification for the
§ 46 § 50
The one-time benefit in the case of no permanent disturbance of If PZU SA pays benefit for permanent disturbance of health and
health and any other consequences than those mentioned in the next, within 24 months from the date of the insurance accident,
Tables 4, 5, 7, 8, specified in Table 6 is due in the amount the Insured dies as a result of that insurance accident, PZU SA
corresponding to a percent of the sum insured, according to Table pays death benefit to the beneficiary, in an amount constituting
no. 6 provided that in option I, the benefit is due only when there the difference between the amount of death benefit set in the
is no permanent disturbance of health, and in option II Bis the insurance contract, and the amount of benefit paid earlier for
benefit is due only under item no 1 and no. 2 of Table no. 6. permanent disturbance of health.
§ 47 § 51
The refund of costs referred to in § 14 incurred outside the territory 1. In the case of death of the Insured not caused by the
of the Republic of Poland is done within the Republic of Poland in insurance accident, and before the Insured received the benefit
Polish zloty, converted according to the average exchange rate of for permanent disturbance of health, PZU SA pays the benefit
the NBP as of the date of determining the indemnity. for the permanent Detriment to the heirs of the Insured. If the
permanent disturbance of health had not been determined
§ 48 before the death of the Insured, the most probable degree of
If the Insured was covered under several contracts for casualty permanent disturbance of health is used to determine the
insurance concluded with PZU SA, benefits are vested under each amount of benefit, determined according to § 11 on the basis
of submitted medical documentation.
of such contracts, however, the refund of treatment costs, of
purchasing orthopaedic objects and auxiliary materials, and of 2. Subject to sec. 1, in the case of the death of the
vocational training for disabled persons is done up to the amount Insured prior to receiving by him/her a benefit under the
of actual and documented costs, but up to the limits resulting from insurance contract, PZU SA pays this benefit to the Insured’s
the concluded insurance contracts. heirs.
§ 49 § 52
1. The benefit under the insurance contract is paid to the 1. PZU SA shall be obliged:
Insured, and with respect to minors – to his/her statutory Insured of that fact, if they are not the persons making that
representative. The benefits are paid in Polish zloty. notification, and to undertake actions meant to establish the
2. The benefit for the death of the Insured mentioned in § 12 facts of the case, the justification for the reported claims and
sec. 1, 2, 3, § 20, § 21, § 24 is paid to the beneficiary named amount of benefit; and also to inform the person putting forth
by the Insured, and if no beneficiary is named, to the persons the claim in writing or in another form that this person had
listed below according to the following order: approved on what documents are necessary to establish the
1) to a spouse; liability of PZU SA or the amount of indemnity, if this is
2) to the children in equal parts, and in the case where one of necessary for the further course of the proceedings;
the children died before the Insured’s death – the share that 2) if within the dates specified in sections 2 and 3 it does not pay
would be attributed to that child is attributed to the other benefit, to notify in writing:
children in equal parts; a) a person reporting the claim,
3) to the parents in equal parts, or whole to one of them if the b) the Insured in the case of the insurance contract concluded
other parent died before the Insured’s death or if only one of to the benefit of the third-party, if he/she is not a claimant
them has parental authority; if none of the parents has - on the reasons why his/her claims cannot be satisfied, in
parental authority or if the parents are unknown and whole or in part, and also to pay the unquestioned portion of
guardianship had been established for the Insured – to legal benefit;
guardians under the same rules as for the parents; 3) if the benefit is not due, or is due in an amount different from
4) to the natural persons entitled to inheritance by force of the one defined in the reported claim, to inform of this fact in
law, in parts attributed to them pursuant to provisions of the writing:
Civil Code regarding a statutory succession. The payment of a) a person reporting the claim,
the benefit to a person or persons belonging to the higher b) the Insured in the case of the insurance contract concluded
category excludes a payment of the benefit to a person or to the benefit of the third-party, if he/she is not a claimant
persons belonging to a lower r category (the highest category identifying the circumstances and a legal justification for the full
constitutes par.1) or partial refusal to pay the benefit, as well as informing the
The Insured may at any time specify or change the beneficiary claimant of the possibility to pursue the claim in court;
3. In the case of a lack of an entitled beneficiary under the death 4) to make available to the Policyholder, the Insured, the claimant
benefit due mentioned in sec. 1, PZU SA first refunds the and to the beneficiary under the insurance contract, information
documented costs of burial to the person who incurred them, and documents collected in order to determine the liability of
within the limits of the sum insured, unless these costs were PZU SA or the amount of benefit. These persons may demand a
covered by another insurance or another title. written confirmation of the information provided by PZU SA and
may make, at their expense, copies or photocopies of the claim
documentation, together with a confirmation of their compliance
with the original by PZU SA;
5) to make available to the persons referred to in item 4, and to the
beneficiary under the insurance contract, the information and
documents referred to in item 4 in electronic form
upon their request; 6. PZU SA’s reply to the complaint shall be delivered to the
6) upon a request of the Policyholder, the Insured, the beneficiary person who has filed it on paper or through other durable
or the person entitled under the insurance contract, to make carrier of information within the meaning of the Payment
available any information it possesses, tied to the insurance Services Act or by e-mail only at the request of such person.
accident and being the basis to determine the liability of PZU 7. The client referred to in sec. 1 shall be entitled to file an
SA, and to determine the circumstances of the insurance application with the Financial Ombudsman concerning:
accident, as well as the amount of benefit; 1) rejection of claims in the complaint examination procedure;
7) upon a request of the Policyholder, the Insured, the beneficiary 2) failure to perform activities resulting from a complaint
or the person entitled under the insurance contract, to make handled in accordance with such person’s will within the
available any information it possesses about the statements deadline specified in the reply to the complaint.
made at the stage of a conclusion of the insurance contract for 8. A complaint or grievance, which is not the complaint referred
the purposes of an assessment of the insurance risk or copies of to in sec. 1 shall be submitted in writing through any PZU SA’s
the documents drawn up at this stage. organizational unit.
2. PZU SA is obliged to pay the benefit within 30 days from the 9. Complaints and grievances shall be reviewed by the
date of receiving a notification of the insurance accident. organisational unit specified in PZU SA’s internal regulations
3. If within the timeframe specified above it is not possible to prevailing as of the date of the complaint or grievance. The
clarify all circumstances needed to establish the liability of PZU information in this respect shall be available in PZU SA’s
SA or the amount of benefit, the benefit should be provided organisational units.
within 14 days from the date when clarification of such 10. PZU SA shall respond to written complaints or grievances
circumstances became possible with due diligence. However, within 30 days of the date of receipt of such a complaint or
the unquestioned portion of benefit should be paid by PZU SA grievance.
within the timeframe defined in section 2. 11. The entity within a meaning of the Act on extrajudicial
settlement of consumer disputes, competent in respect of PZU
CHAPTER V SA for the purposes of extrajudicial settlement of disputes, is
FINAL PROVISIONS the Financial Ombudsmen, which web site has the following
address: www.rf.gov.pl.
§ 53 12. In the case of the insurance contracts concluded by means of
the Internet, the consumer has a right to use an extrajudicial
1. The policyholder, insured, beneficiary and person entitled under settlement of disputes and file a complaint with an
the insurance agreement who is a natural person shall have the intermediary of the Online Dispute Resolution Platform (ODR)
right to file a complaint within the meaning of the Act on according to the Regulation (EU) No 524/2013 of the European
Examination of Complaints by Financial Market Participants and Parliament and of the Council of 21 May 2013 – address:
on the Financial Ombudsman, i.e. the right of addressing a http://ec.europa.eu/consumers/odr/. The European
notice to PZU SA with concerns regarding any services provided Commission is responsible for operating the ODR Platform. A
by PZU SA. contact e-mail address of PZU SA is as follows:
2. The complaints or grievances should be addressed to the [email protected].
organisational unit of PZU SA that handles the client. 13. The policyholder, insured, beneficiary and person entitled
3. The compliant can be lodged in the following form: under the insurance agreement who is a consumer shall have
1) in writing – in person or sent by mail within the meaning of the right to request assistance from the Municipal and Regional
the Postal Law Act, for example by sending a letter to the Consumer Ombudsmen.
following address: PZU SA ul. Postępu 18A, 02-676 Warsaw 14. PZU SA is supervised by the Polish Financial Supervision
(mailing address only); Authority (KNF).
2) in spoken form – by telephone, for example by calling the
hotline number at 801-102-102, or in person for the record
during a visit of the person referred to in sec. 1 in the unit 15. The language used by PZU SA in the relations with the
referred to in sec. 2; consumer is Polish
3) electronically – by sending an e-mail to [email protected] or
by filling out an online form at www.pzu.pl.
§ 54
4. PZU SA shall review the complaint and reply to it without undue
delay but no later than within 30 days of the date of receipt of 1. Any litigation for claims under the insurance contract may be
the complaint, subject to sec. 5. initiated either pursuant to general jurisdiction regulations or
5. In particularly difficult cases preventing the examination of the before the court with jurisdiction over the place of residence or
complaint and the provision of a reply within the deadline registered office of the Policyholder, the Insured or the person
referred to in sec. 4, PZU SA shall provide the person who has entitled under the insurance contract.
filed the complaint with information in which it shall: 2. Any litigation for claims under the insurance contract may be
1) explain the reason for the delay; initiated either pursuant to general jurisdiction regulations or
2) indicate the circumstances that must be ascertained to before the court with jurisdiction over the place of residence of
enable the examination of the case; the Insured’s heir or the heir of the person entitled under the
3) specify the anticipated date of examination of the complaint insurance contract.
and provision of the reply, which date may not be later than
60 days after the date of receipt of the complaint.
801 102 102 pzu.pl PZU SA 7B13/II
Fee according to an operator tariff

General Terms and Conditions of The Pzu NNW (Personal Accident Insurance Pzu Edukacja Insurance

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General Terms and Conditions of The Pzu NNW (Personal Accident Insurance Pzu Edukacja Insurance

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GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance)

PZU EDUKACJA INSURANCE

Statutory information . . . . . . . . . . . . page 1 Exclusions of liability . . . . . . . . . . page 11

General provisions . . . . . . . . . . . . page 2

. . . . . . . . . . . . . . page 4 Termination of an insurance contract and an end of liability

Insurance cover term . . . . . . . . . . . . . . . page 4 . . . . . . . . . . . . . page 13

Insurance subject matter and scope . . . . . . . . page 4 Refund of a premium . . . . . . . . . . . . . . . page 13

Benefits in a basic scope of insurance cover

. . . . . . . . . . . . . . page 5 Chapter IV – Performance of an insurance contract

Options of insurance . . . . . . . . . . . . page 5 . . . . . . . . . . . . . . page 13

Detailed provisions regarding basic benefits Procedure in the event of an insurance

. . . . . . . . . . . . . . . page 5 accident . . . . . . . . . . . . . page 13

Benefits in an extended insurance cover Obligations of the Insured . . . . . . . . . . . page 13

. . . . . . . . . . . . . . page 8 Determination and payment of benefits . . . . . . . . . . page 14

Additional benefits . . . . . . . . . . . page 8

Rules to rewarding additional benefits Chapter V – Final provisions . . . . . . . page 15

one-time benefit in the case of lack of permanent disturbance of health and of

INSURANCE COVER TERM. INSURANCE SUBJECT MATTER AND SCOPE

Basic benefits under option II

DETAILED PROVISIONS REGARDING BASIC BENEFITS

13 post-accident assistance benefits rendered in the territory of the Republic of

Item Types of basic benefits

2 death benefit in the area of an educational establishment

3 death benefit as a consequence of sepsis

4 for permanent bodily harm (Table no. 4)

for permanent disturbance of health caused solely by myocardial

6 for fractures of bones or dislocations of bones (Table no. 5)

for consequences other than those listed in Tables no. 4, 5, 7 and 8 –

8 for burns or frostbite (Table no. 7)

for concussion or suspected concussion of the brain (Table no. 8)

10 for bites and stings

for refund of the costs of purchasing orthopaedic objects and auxiliary

2.0 for each fractured

Fracture of the humeral

Fractures of the hand bones,

c) Fractures of finger bones –

14 Unstable fracture of the pelvis 10

15 Stable fracture of the pelvis 4,5

16 Dislocation of the hip joint 10

17 Fracture of the femur bone 10

18 Fractures of the shank 7

19 Fracture of the patella 4

Dislocation of the knee joint,

23 Fractures of the toes – from 2 for each toe

24 Dislocation of the ankle 4

Fractures of the spine – of

27 Fractures of the coccyx 3.5

3 Complete loss of hand 50

4 Complete loss of the 2nd, 3rd, 8 – for each finger

5 Complete loss of thumb 22

Complete loss of lower limb

Complete loss of lower limb

8 Complete loss of foot 40

9 Complete loss of the 2nd, 3rd, 3 – for each finger

10 Complete loss of the large toe 15

11 Complete loss of vision in 50

12 Complete loss of vision in 100

Complete loss of hearing in