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GTI Accident/Liability
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Consumer informations/ Important notes
Terms and Conditions of the Group Liability Insurance Care Discover of HanseMerkur Reiseversicherung AG VB-Haft 2015 (CHV-G)
Designelement 1 zur Versicherung für weltweite Reisende § 1 Insured Persons and Insurability
Designelement 1 zur Versicherung für weltweite Reisende § 2 Conclusion and Termination of the Insurance Contract, Membership in the Group Insurance Contract
Designelement 1 zur Versicherung für weltweite Reisende § 3 Termination
Designelement 1 zur Versicherung für weltweite Reisende § 4 Premium/Fees
Designelement 1 zur Versicherung für weltweite Reisende § 5 The Right to Premium Adjustments
Designelement 1 zur Versicherung für weltweite Reisende § 6 Object of the Insurance Cover and Scope of Benefits
Designelement 1 zur Versicherung für weltweite Reisende § 7 Scope of Application, Commencement, Duration and End of Insurance Cover
Designelement 1 zur Versicherung für weltweite Reisende § 8 Minimum and Maximum Insurance Term/Membership Term in the Group Insurance Policy
Designelement 1 zur Versicherung für weltweite Reisende § 9 Description of Insurance Cover
Designelement 1 zur Versicherung für weltweite Reisende § 10 Scope of Benefits
Designelement 1 zur Versicherung für weltweite Reisende § 11 Limitations of the Duty to provide Benefits and Exclusions to Benefits
Designelement 1 zur Versicherung für weltweite Reisende § 12 Obligations and the Consequences of their Breaches
Designelement 1 zur Versicherung für weltweite Reisende § 13 Conditions for the payment of Insurance Benefits
Designelement 1 zur Versicherung für weltweite Reisende § 14 Authority of the Insurer
Designelement 1 zur Versicherung für weltweite Reisende § 15 Offsetting
Designelement 1 zur Versicherung für weltweite Reisende § 16 Compensation from other Insurance Policies and Claims Against Third Parties
Designelement 1 zur Versicherung für weltweite Reisende § 17 Declarations of Intent and Notifications
Designelement 1 zur Versicherung für weltweite Reisende § 18 Limitation Period
Designelement 1 zur Versicherung für weltweite Reisende § 19 Applicable Law, Contract Language, Applicability for Insured Persons
Designelement 1 zur Versicherung für weltweite Reisende Auszug aus dem Versicherungsvertragsgesetz
Designelement 1 zur Versicherung für weltweite Reisende Allgemeine Versicherungsbedingungen herunterladen
§ 1 Insured Persons and Insurability
Unless otherwise agreed, the following applies:
  1. Insured are the insurable individuals listed by name on a separately maintained list and for whom the agreed premium has been paid.
  2. Insurable persons are individuals,
    1. who are located abroad worldwide. In this respect, a country is not deemed as abroad when it is a country of which the insured person is a citizen and/or in which the person has his or her permanent residence (home countries);
    2. who have German or Austrian citizenship and have had their permanent residence abroad for more than 2 years, and have only stayed temporarily in the Federal Republic of Germany, Austria, the countries of the European Union, the member states of the Schengen Agreement or in Liechtenstein, or
    3. who have German or Austrian citizenship and have a permanent residence in the Federal Republic of Germany or Austria, or the citizenship of one of the member states of the European Union or of a member state of the Schengen Agreement and Liechtenstein, with a permanent residence in the Federal Republic of Germany or Austria and stay abroad only temporarily, or
    4. who have another citizenship and are located abroad only temporarily, provided that they have had their permanent residence in the Federal Republic of Germany or Austria for at least the previous two years.
  3. Not insurable and not insured despite payment of a premium are individuals, who
    1. at the beginning of the insurance cover or at the time an application to extend insurance cover is made (associated membership), have reached the age of 66. (had their 66th birthday);
    2. play competitive sports or who engage in physical activity during the course of their trip in one of the occupations listed in Appendix 1 or carry out a sports activity against payment. Appendix 1 is an integral part of these terms and conditions;
    3. have entered into or reside illegally in the country of residence;
    4. need permanent care. A person is considered to need permanent care when he or she is primarily dependent on help from others for activities of daily life
    5. who permanently reside abroad.

§ 2 Conclusion and Termination of the Insurance Contract, Membership in the Group Insurance Contract
  1. The group insurance contract is concluded between the policyholder and Hanse-Merkur.
  2. The group insurance contract can be terminated by giving notice three months prior to the end of the year. Termination by the policyholder is only effective if the insured persons affected by the termination have been notified of the termination and the policyholder can prove that such notification has been given. The insured persons affected by the termination have the right to continue the insurance contract under the terms and conditions of a single policy by appointing a new policyholder. A statement to this effect must be made within 2 months of receipt of an offer to continue cover.
  3. Applications for group policy membership are contingent on the insured person having cover. for the entire length of residency abroad.
  4. The insured person is considered to be accepted in the group policy once the insurer explicitly accepts him or her as of the cover date, provided that
    1. the application for acceptance into the group policy is completed on Hanse-Merkur’s valid form (registration list) provided for this purpose or via the secure online tool provided for this purpose;
    2. the printed form or the online application is properly completed and received by Hanse-Merkur, and the initial or single premium has been paid. The printed form or online application is considered to have been properly completed if it contains clear and complete information about the starting date and the term of the group policy contract, as well as information about the persons to be insured.
  5. If the length of a stay is extended without exceeding the maximum duration of insurance, continued cover for the further stay abroad that has not been insured initially, can be arranged in the form of a legally independent associated membership (extended membership) under the following conditions:
    1. The application for extended membership must be submitted using the valid form provided by Hanse-Merkur for this purpose or the secure online tool provided for this purpose;
    2. The application for extended membership must be submitted to Hanse-Merkur before the expiration of the initial term of the policy;
    3. The maximum policy term intended is not exceeded by the extension;
    4. HanseMerkur must explicitly approve the application for extension. In the event a policy is not explicitly accepted for which a premium has already been paid, any amounts paid – less expenses the insurer has incurred – will be reimbursed.
  6. If the initial insurance cover is extended through a legally independent associate membership within the maximum term, insurance cover is available only for insured events that occurred subsequent to the submission of the application for the extension (the date and time of the postmark or the receipt of the application on the HanseMerkur or Care Concept AG server).
  7. Unless otherwise agreed, the legal effects of an associated membership are the same as those of a primary membership.
  8. Group policy members are required to give three months notice in writing (email, fax, post) if they wish to terminate their own participation or the participation of others who are insured with them in the group policy. Termination by the member of the group insurance policy will only be effective if the insured person affected by the termination has been informed of the termination and the policyholder can prove that such notification has been given.
  9. Elimination of the Insured Risk
    If insured risks disappear entirely and permanently, the insurance regarding this risk expires. Notwithstanding § 4, HanseMerkur is entitled to the amount that it could have charged, if it had only insured these risks up to the date at which it became aware the risk has been eliminated.
§ 3 Termination
  1. Ordinary Termination
    The group insurance contract can be terminated by the policyholder, by giving notice three months prior to the end of the year. Termination by the policyholder is only effective if the insured persons affected by the termination have been notified of the termination and the policyholder can prove that such notification has been given. The insured persons affected by the termination have the right to continue the insurance contract under the terms and conditions of a single policy by appointing a new policyholder. A statement to this effect must be made within two months of receipt of an offer to continue cover. The insurer waives his ordinary termination rights.

  2. Extraordinary Termination
    The statutory provisions regarding extraordinary termination remain unaffected to both the policyholder and the insurer.
§ 4 Premium/Fees
  1. The policy holder shall pay HanseMerkur the premium for this insurance policy. The group policy member is obliged to pay the corresponding premium for the group policy to the policyholder or to someone named by the policyholder (e.g. a collection agency). The failure to pay the premium for the group insurance policy leads to the loss of the insurance cover in accordance with statutory regulations.
  2. Details of the Payment of Premiums/Fees
    1. The payment for the initial or subsequent premium, or the initial or subsequent fee may be made via SEPA direct debit, bank transfer, credit card or PayPal.
    2. If the premium or membership fee is requested by SEPA direct debit from a bank or credit card account, the payment is deemed to have been made on time if the premium can be withdrawn on the day the debit takes place and neither the policyholder nor (in cases in which the policyholder is not the account holder) the policyholder and/or the account holder does/do not object to the payment request. If, by no fault of the policyholder, the premium could not be debited, the payment shall be considered to have been paid on time, if payment is made immediately after the insurer has issued a payment request in text form (e.g. by email, fax or post).
§ 5 The Right to Premium Adjustments
  1. During the contractual period of cover, the benefits provided by the insurer may alter, f. ex. due to an increase in medical treatment costs or in the number of claims. Accordingly, the insurer compares the insurance benefits calculated using the required calculation bases with the insurance benefits calculated using the technical calculation bases. If the comparison establishes a variance of more than 5%, the insurer reserves the right to review and, as far as necessary, adjust the premiums. Under the same conditions, an agreed premium supplement can also be adjusted accordingly (as well as the maximum amount of benefits envisaged according to the tariffs).
  2. The adjustments in accordance with paragraph 1 of this section become effective at the beginning of the second month following notification of the policyholder.
  3. If the insurer increases the premium based on paragraph 1 of this section, the policyholder has the right to terminate the insurance relationship regarding the affected insured person within one month after receipt of the change notification. Such termination shall take effect at the effective date of the change. Termination by the policyholder is only effective if the insured persons affected by the termination have been notified of the termination and the policyholder can prove that such notification has been given. The insured persons affected by the termination have the right to continue the insurance contract under the terms and conditions of a single policy by appointing a new policyholder. A statement to this effect must be made within 2 months of receipt of an offer to continue cover.
§ 6 Object of the Insurance Cover and Scope of Benefits
The object and scope of the insurance cover is defined in the group policy, the membership certificate, other separately written agreements, these general terms and conditions of insurance, if appropriate the provisions of each agreed rates, (special insurance conditions as well as the statutory provisions of the Federal Republic of Germany. The sum insured for personal injury and property damage is €1,500,000.00.
§ 7 Scope of Application, Commencement, Duration and End of Insurance Cover
Unless otherwise agreed, the following applies:

  1. Scope of Application

    1. Within the scope of this contract, HanseMerkur offers insurance cover during a stay abroad in accordance with these terms and conditions to persons whose stay abroad during a trip is only temporary.
    2. In the context of these terms and conditions, abroad refers to all countries and territories of which the insured person is not a citizen and/or in which the insured person does not have a permanent residence:

      - for foreign nationals with permanent residence abroad: the Federal Republic of Germany and any other country of which the insured person is not a citizen (or in which the person does not have permanent residence;
      - for persons with German nationality and permanent residence in the Federal Republic of Germany: all countries and territories outside of the Federal Republic of Germany;
      - for persons with a different nationality, if their permanent residence has been in the Federal Republic of Germany for at least two years: all countries and territories outside the Federal Republic of Germany.
    3. Notwithstanding b, cover is also in place in the insured person’s home country under the following conditions:

      - With a membership term of at least one year, there is also cover if the insured person returns to his or home country temporarily. The cover in the home country is limited to a maximum of six weeks per insurance year for all stays in the home country. An insurance year is a twelve month period of time, beginning with the start date of the insurance cover, including all extensions of the contract.
      - Based on these terms and conditions of insurance, home country refers to the country of which the insured person is a citizen and/or in which the insured person has their permanent residence.
  2. Commencement
    Insurance cover begins when the registration list or the online form is completed (technical commencement), however
    1. not before insurance confirmation has been received;
    2. not before the insured person has crossed the border to enter the foreign country;
    3. not before the premium/the membership fee has been paid;
    4. not before any potential waiting periods have expired;

  3. End of Cover
    Unless otherwise agreed, the following applies: Insurance cover also ends for insured events that have not yet been closed
    1. at a mutually agreed point in time;
    2. at the latest, once the trip abroad has ended;
    3. if the conditions of a temporary stay abroad no longer exist;
    4. if the conditions for the insurability of the insured person no longer exist. The condition also no longer applies if the person in question has obtained the citizenship of the destination country or has transferred his or her permanent residence to the destination country;
    5. once the group insurance contract has ended;
    6. once the membership in the group contract has ended.
§ 8 Minimum and Maximum Insurance Term/Membership Term in the Group Insurance Policy
  1. The minimum term of the insurance/minimum term of the membership in the group insurance policy is one month.
  2. The maximum term of the policy/of the membership in the group policy, including all extensions to cover through independent associated policies, is three years.
§ 9 Description of Insurance Cover
  1. HanseMerkur provides insurance cover to the insured person during trips abroad in the event that, based on statutory liability provisions under private law, the insured person is held responsible by a third party for the consequences of a loss event (insured event) that occurs during the term of insurance, resulting in personal injury, property damage or financial losses. A loss event is thereby an event that has directly caused damage to the third party. The specific time of the occurrence of the damage or whether the third party is aware that the damage has occurred is irrelevant.
  2. Non-Insured Risks
    Unless otherwise agreed, there is no insurance cover:
    1. for claims – even in cases for which there is a statutory entitlement –
      1. related to the fulfilment of contracts, supplementary performance, self-remedy, withdrawal from contracts, price reductions, compensation offered in lieu of performance;
      2. due to damage caused to enable supplementary performance;
      3. due to the fact that the object of the contract cannot be used or due to the lack of success owed as a result of the contractual services;
      4. for the reimbursement of wasted costs incurred in reliance upon proper contractfulfilment;
      5. for the reimbursement of financial losses caused by delay in the performance;
      6. due to substitute performances provided in place of fulfilment;
      7. due to substitute performances that are also of punitive nature (punitive damages);
    2. for liability claims that go beyond the scope of statutory requirements;
    3. for liability claims that result from any of the following sports events or from participation in the preparation (training) of such events
      1. Races (with horses, bicycles and cars);
      2. Boxing/wrestling;
      3. Martial arts (e.g. judo, karate);
    4. for liability claims due to damage to third party items that the insured person has rented, leased, borrowed or obtained by illegal interference. Insofar as expressly agreed, liability claims against an insured person who, while travelling temporarily, uses rented accommodation in buildings for personal purposes (e.g. hotels, rooms in guest houses, holiday apartments, bungalows), as well as the dwelling/house of the host family, are also insured. Liability claims are excluded if they arise out of the following:
      1. Damage to movable objects, such as pictures, furniture, television sets, dishes, etc.,
      2. Damage due to wear-and-tear, deterioration, overuse,
      3. Damage to heating systems, machine installations, boiler systems, water heating equipment as well as electrical and gas appliances,
      4. recourse claims falling within the scope of the general damage events to which the recourse waiver agreement with fire insurers applies.
    5. für Haftpflichtansprüche wegen Schäden, die an fremden Sachen durch eine gewerbliche oder berufliche Tätigkeit der versicherten Person an oder mit diesen Sachen (z. B. Bearbeitung, Reparatur, Beförderung, Prüfung und dgl.) entstanden sind; bei Schäden an fremden unbeweglichen Sachen gilt dieser Ausschluss nur insoweit, als diese Sachen oder Teile von ihnen unmittelbar Gegenstand der Tätigkeit gewesen sind. Sind die Voraussetzungen der obigen Ausschlüsse in der Person von Angestellten, Arbeitern, Bediensteten, Bevollmächtigten oder Beauftragten des Versicherungsnehmers oder der versicherten Person gegeben, so entfällt gleichfalls der Versicherungsschutz und zwar sowohl für den Versicherungsnehmer wie für die durch den Versicherungsvertrag mitversicherten Personen;
    6. for liability claims arising out of damage caused to third party property due to the insured person’s commercial or professional activity in respect of such property (e.g. processing, repair, transportation, testing, etc.); in the case of damage caused to a third party’s immovable property, this exclusion shall only apply to the extent that such property or parts thereof were the direct object of the activity. In the event the exclusions mentioned above regarding the individual person being an employee, worker, servant, representative or agent of the policyholder or of the insured person, there likewise will be no insurance cover, neither for the policyholder nor for the persons insured under the insurance contract;
    7. for liability claims arising out of damage due to work or objects that the insured person manufactured or delivered (or had manufactured or delivered by a third party on their behalf or on their account), if the damage is caused by the manufacturing or delivery of those items;
    8. for liability claims due to damage directly or indirectly connected to high-energy ionising radiation (f. ex. alpha, beta and gamma rays from radioactive substances, as well as neutrons or radiation from particle accelerators), as well as laser or maser beams;
    9. for liability claims
      1. from family members of the insured person who live in the same household. The term family members is defined as spouses, parents and children, adopted parents and children, parents-in-law, brothers-in-law, sisters-in-law, stepparents, stepchildren, grandparents and grandchildren, siblings as well as foster parents, foster children (persons who have a family-like, long-term relationship similar to that of parents and children),
      2. between several insured persons within the same insurance policy,
      3. from the legal representatives of persons who are legally incompetent or who have limited legal competency,
      4. from partners of unincorporated companies who have unlimited personal liability,
      5. from legal representatives of legal entities of private or public law as well as unincorporated associations,
      6. from liquidators.
        The exclusions in b. – f. extend to liability claims from family members of those persons named, if they live together in the same household;
    10. for liability claims which can be attributed to the fact that the policyholder or the insured person has not removed particularly dangerous circumstances within a reasonable time period, where the removal of such circumstances could have been and has been reasonably requested by the insurer. A circumstance that has led to damage is automatically classified as particularly dangerous;
    11. for liability claims arising out of personal injury resulting from the transmission of a disease from the insured person, as well as property damage that occurs because of a disease that comes from an animal that belongs to, is held by, or is sold by the insured person;
    12. for liability of the owner, holder, keeper or driver of a motor vehicle, aircraft or watercraft (except watercraft listed in §11, paragraph 2, section 4a. and b. due to damage caused by the use of such vehicle. Motorised vehicles also include vehicles with motorised starting assistance or assisted pedalling (f. ex. pedelecs) as well as self-propelled machines such as fork lift trucks etc. Self-propelled wheelchairs do not qualify as vehicles;
    13. for the liability as owner, keeper or guardian of animals;
    14. for liability while hunting;
    15. for liability related to performing duties in, being an officer of (including volunteer duties) or working for any kind of association;
    16. for liability of the insured person resulting from letting, lending or transferring an object to third parties;
    17. for liability arising out of professional activities. If the insured person works as an au pair under a written contract, the travel liability insurance does include professional liability for him or her. Liability cover only applies to activities that the insured person is permitted to exercise based on his or her level of education or training. This insurance cover only comes into effect if a claim is brought directly against the insured person and if the insured person has no alternative insurance cover or has insufficient insurance cover, f.ex. within the scope of the personal liability insurance of the host family. Liability is, however, excluded for damage to movable goods within the household of a host family, such as pictures, furniture, household goods, technical appliances, dishes, etc.
§ 10 Scope of Benefits
  1. for liability arising out of professional activities. If the insured person works as an au pair under a written contract, the travel liability insurance does include professional liability for him or her. Liability cover only applies to activities that the insured person is permitted to exercise based on his or her level of education or training. This insurance cover only comes into effect if a claim is brought directly against the insured person and if the insured person has no alternative insurance cover or has insufficient insurance cover, f.ex. within the scope of the personal liability insurance of the host family. Liability is, however, excluded for damage to movable goods within the household of a host family, such as pictures, furniture, household goods, technical appliances, dishes, etc.
  2. If an insured event leads to a legal dispute regarding the claim between the insured person and the damaged party or its legal successors, the insurer shall conduct the legal dispute in the name of the insured person. The insurer assumes the costs incurred for this. If the amount of the liability claim is larger than the sum insured, the insurer is only required to assume legal costs in relation to the ratio of the sum insured to the overall amount of the claim, also in cases in which there are several actions that have arisen out of a single insured event. By payment of the sum insured and the share of the costs to date corresponding to the sum insured, the insurer has in such cases the right to be released from the requirement of providing further benefits. The insurer’s expenses are not considered benefits that fall within the scope of the sum insured. For claims within the US or US territories* and Canada, or for claims that are asserted within those territories, the insurer’s expenses fall within the scope of the sum insured. Costs are: Costs for solicitors, experts, witnesses, court fees, costs required to avert or minimise damage after an insured event occurs, damage assessment costs, and also travel expenses that are not incurred by the insurer directly. This also applies if the costs are incurred by instructions of the insurer. Insurance cover for claims for compensation with a penal nature remain excluded, i.e. punitive damages.
  3. If the insured person is required to make pension payments to the damaged party and the net present value of the pension payments exceeds the sum insured or the remaining balance of the sum insured after the deduction of all other benefits from the same insured event, the pension payments will only be covered by the insurer based on the ratio of the sum insured or the remaining balance to the net present value of the pension. For this purpose, the net present value of the pension payments will be calculated using current mortality table from the country of residence relating to the recipient of the pension and the interest rate usually applied for such calculationsin that country, which are applicable at the time of the calculation.
§ 11 Limitations of the Duty to provide Benefits and Exclusions to Benefits
  1. General Limitations to provide Benefits HanseMerkur is released from the obligation to provide benefits when:
    1. The policyholder or the insured person intentionally caused the insuredevent;
    2. The policyholder or the insured person acts in bad faith by attempting to wilfully deceive HanseMerkur about issues relevant to the circumstances, the reason or the amount of any benefits;
    3. Damages caused by strike, war, warlike events, active participation in riots, and nuclear energy.
  2. Exclusions
    Unless otherwise agreed, excluded from the insurance cover are the following:
    1. Claims in connection with the use of weapons (handguns, firearms, cut and thrust weapons);
    2. Claims related to the use and/or storage of explosives, provided they are legally available for sale according to the laws of the country in which the damage occurs (e.g. fireworks);
    3. Claims in connection with the use and/or utilisation of any type of projectile. Included are, however, claims due to possession/use of model planes, unmanned balloons and kites that are not powered by motors or drive assemblies, and which are not heavier than 5 kg and for which insurance is not compulsory;
    4. Claims connected to the use and/or the utilisation of any form of watercraft; however, the following claims are included:
      1. due to the ownership/utilisation of one’s own or a third party rowing boats and pedal boats, as well as other parties’ sailing boats, that are not powered by a motor (including outboard motors), or drive assemblies and for which insurance is not compulsory;
      2. due to the ownership, possession, keeping or stocking of surfboards for sporting activities; however, statutory liability of the insured person arising out of the hiring, leasing or lending to third parties is excluded;
    5. Claims arising from the disappearance of objects;
    6. Claims between a number of policyholders within the same insurance relationship;
    7. Claims between a number of insured person within the same insurance relationship;
    8. Claims in connection with sewage, insofar as it does not involve residential sewage;
    9. Claims due to collapsing land or mudslides;
    10. Claims that occur because of flooding of standing or moving bodies of water;
    11. Claims due to damage arising from the exchange, transmission or provision of electronic data, insofar as involves damage resulting from
      1. Deletion, suppression or disabling of data;
      2. The failure to capture or incorrect storage of data;
      3. Disruption of access to the electronic data exchange;
      4. the transmission of confidential data or information;
    12. Liability claims due to damage arising out of hostility, chicanery, harassment, unequal treatment or any other kind of discrimination.
§ 12 Obligations and the Consequences of their Breaches
  1. Policyholders and insured members have the following obligations:
    1. To immediately inform HanseMerkur in text form if they become citizens of a destination country, of the issue of an unlimited residence permit or of the refusal of a residence permit for the destination country, as well as of the permanent residence in the destination country;
    2. The policyholder is required to register the beginning and the end of each trip to his or her home country during the term of the policy prior to the commencement of each trip and in the event of a claim, to present evidence of the same, if requested to do so by HanseMerkur.
  2. If an insured event occurs, the policyholder and the insured person are required to
    1. ensure to prevent and minimise the loss and to do everything that serves toclarify the circumstances of the claim, whilst considering the insurer’s instructions, provided that in doing so, not anything unreasonable is expected from them. The insured person is required to support the insurer in averting damage, investigating and processing the claim, and to give the insurer comprehensive and true information about the damage, all circumstances relating to the case, and to supply the insurer with all documentation that, in the insurer’s opinion, is of significance regarding the evaluation of the case;
    2. to permit HanseMerkur to carry out all reasonable investigations to determine the cause and the level of their duty to provide a benefit to be granted, to give them helpful information, and to submit original receipts;
    3. Every insured event (i.e. any insured event that may lead to a liability claim against the insured person) must be immediately reported to the insurer text form via the group policy member, however, no later than within one week. If preliminary proceedings have been instigated, or an order for punishment or order to pay has been issued, the insured person is required to inform the insurer immediately, even if the associated insurance claim itself has already been reported. If the damaged party does make a claim against the insured person, the insured person is required to report the claim in text form within one week after the claim has been made. If legal charges have been filed in court against the insured person, and he or she has applied for legal assistance or legal notification of the dispute has been announced, he or she is obligated to inform the insurer immediately of the situation. The same applies in the case of arrest, a preliminary injunction or proceedings for the preservation of evidence.
    4. If the liability claim proceeds to trial, the insured person is required to permit the insurer to conduct the legal proceedings, to authorise the solicitor appointed or designated by the insurer accordingly, and to provide all information deemed necessary by the solicitor or the insurer. If an order to pay is issued or orders for compensation are issued by administrative authorities, the insured person must raise an objection in due time without waiting for the instructions of the insurer, or adopt the necessary legal remedies.
    5. If, due to a change in circumstances, the insured person obtains the right to demand suspension or reduction of the payment of a pension due to be paid, the insured person has an obligation to allow the insurer to exercise this right in his or her name. The provisions of §4, paragraph 3 to 5 apply accordingly.
    6. In regards to the exercise of other claims for compensation, the additional obligation in §16, paragraph 2 applies.
  3. Consequences of Breaches of Obligations
    If the policyholder or the insured person intentionally breaches any of the contractual obligations, HanseMerkur does not have an obligation to provide benefits. In the event of a breach of an obligation caused by gross negligence, HanseMerkur has the right to reduce the benefits based on the gravity of the culpability of the policyholder/insured group policy member. The burden of proof to show that gross negligence was not involved rests with the policyholder.
§ 13 Conditions for the payment of Insurance Benefits
  1. Original invoices are to be submitted to
    Care Concept AG
    Postfach 30 02 62
    53182 Bonn
  2. HanseMerkur is only obliged to pay benefits if the following forms of proof are submitted, each of which will then become the property of HanseMerkur AG:
    1. Original documents in the official currency of the country of residence. If there is alternative insurance cover and this is utilised first, the duplicates of the receipts with reimbursement notes are sufficient evidence;
    2. if requested by HanseMerkur, proof of the beginning and the end of each stay in the Federal Republic of Germany;
    3. if requested by HanseMerkur, proof of the beginning and the end of each stay in the home country or in a third country;
    4. if requested or, at the latest, when an insurance event occurs, proof of having fulfilled the conditions for insurability in accordance with §1 no. 2, as well as a valid residence permit for the stay in the country of residence, to the extent that such a permit is required in that country;
    5. the insured person is not authorised to totally or partially accept a liability claim or to settle or satisfy such a claim without prior consent of the insurer. If such acceptance or settlement is made without the insurer’s approval, the liability claims will initially be reviewed in line with the legal position without consideration of the acceptance or settlement. In the event the liability certain claims could have been deflected, had such a commitment not been made, the insurer will not be responsible for any benefits whatsoever that go beyond the justified amount.
§ 14 Authority of the Insurer
The insured person is not authorised to totally or partially accept a liability claim or to settle or satisfy such a claim without prior consent of the insurer. If such acceptance or settlement is made without the insurer’s approval, the liability claims will initially be reviewed in line with the legal position without consideration of the acceptance or settlement. In the event the liability certain claims could have been deflected, had such a commitment not been made, the insurer will not be responsible for any benefits whatsoever that go beyond the justified amount.
§ 15 Offsetting
The policyholder or the insured person is only able to offset amounts owed to HanseMerkur, if the counterclaim is undisputed or has been legally established.
§ 16 Compensation from other Insurance Policies and Claims Against Third Parties
  1. If compensation from another insurance policy can be requested after an insured event has occurred, the other insurance policy shall take precedence. This also applies if one of the other insurance policies also contains a subordinate liability clause, regardless of when the other insurance contract was concluded. If an insured event is first reported to HanseMerkur, and HanseMerkur has already provided benefits in advance, it will contact the other insurance company directly, with the view to sharing the costs.
  2. If the policyholder or the group policy member has a claim for compensation against a third party, such a claim shall be transferred to the insurer, insofar as the insurer has already provided compensation for the loss. Such a transfer cannot be made to the detriment of the policyholder. The policyholder has to safeguard his claim for compensation or a right which serves to secure such a claim, while considering the current provisions on formality and deadlines, and to participate in the assertion of such claim by the insurer, insofar as this is necessary. The consequences of a breach of this obligation are determined by §12, paragraph 3 of these insurance terms and conditions.
§ 17 Declarations of Intent and Notifications
  1. All declarations of intent and notifications made to HanseMerkur and Care Concept AG must be made in text form.
  2. If the policyholder or the group policy member changes his/her address and does not inform the insurer, in relation to a declaration of intent to be given to the policyholder or the group policy member, it is sufficient to provide evidence of the note by the post office that letters to the address last known to the insurer were not deliverable. This declaration is considered to have been received three days after it was sent. Clauses 1 and 2 are to be applied in the same way in the event of a name change by the policyholder.
§ 18 Limitation Period
Any claims arising from this insurance contract lapse after three years. The limitation period begins at the end of the year in which any entitlement to benefits can be requested. If a policyholder has registered a claim with HanseMerkur, the limitation period regarding this claim is delayed until the decision from Hanse-Merkur has been received in text form.
§ 19 Applicable Law, Contract Language, Applicability for Insured Persons
German law applies, to the extent that it does not conflict with international law. The contract language is German. All agreed provisions shall apply correspondingly to the other insured persons. The exercise of rights and the assertion of claims arising from the insurance contract are reserved exclusively to the policyholder.
Appendix 1: Non-insurable professional activities in accordance with §1 Clause 3 b of the terms and conditions of insurance
Occupations Provisions on the Limits to exclusions
Artists All activities
Construction workers Selected activities Only the following activities are excluded:
Concrete workers
Roofers
Scaffolders
Building construction workers
Masons
Steel reinforced concrete constructors
Plasterers
Concrete labourers
Carpenters
Miners All activities
Professional soldiers All activities
Professional divers All activities
Animal trainers Selected activities Only to the extent that wild animals(feline predators, elephants, etc.) are trained
Parachutists All activities
Firemen/Firewomen All activities
Deep sea fishermen All activities
Butchers All activities
Offshore workers Selected activities Only those directly active in oil extraction
Pyrotechnists All activities
Security officers Selected activities Bodyguards
Security guards
Demolition experts All activities
Stuntmen Stuntwomen All activities
Surf instructors All activities
Diving instructors All activities
Slaughterhouse workers Selected activities Activities in the meat dismembering industry
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