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Group accident insurance exclusions and limitations

Benefits will be payable upon proof that the injury or loss was the result of a covered accident.

Benefits are never payable for an accident, injury or loss that is caused directly or indirectly by, results in whole or in part from or during, or there is contribution from any of the following: (1) self-inflicted injury, self-destruction, or autoeroticism, whether sane or insane; (2) suicide or attempted suicide, whether sane or insane; (3) an insured’s participation in, or attempt to commit, a crime, assault, felony, or any illegal activity, regardless of any legal proceedings thereto; (4) bodily or mental infirmity, illness, disease, or infection, other than infection occurring simultaneously with, and as a direct and independent result of, the injury; (5) the use of alcohol; (6) the use of prescription drugs, non-prescription drugs, illegal drugs, medications, poisons, gases, fumes or other substances taken, absorbed, inhaled, ingested or injected; (7) motor vehicle collision or accident where the insured is the operator of the motor vehicle and the insured’s blood alcohol level meets or exceeds the level at which intoxication is defined in the state where the collision or accident occurred, regardless of any legal proceedings thereto; (8) medical or surgical treatment or diagnostic procedures including any resulting complications, or when the outcome is not as planned or expected, including claims of medical malpractice; (9) travel in or descent from any aircraft, except as a fare-paying passenger on a regularly scheduled commercial flight on a licensed passenger aircraft; (10) war or any act of war, whether declared or undeclared; (11) participation in the following activities: scuba diving, bungee jumping, base jumping, hang gliding, sail gliding, parasailing, parakiting, or mountain climbing; (12) riding or driving in any motor-driven vehicle in a race, stunt show or speed test; (13) practicing for or participating in any semi-professional or professional competitive athletics; or (14) repetitive stress syndromes including but not limited to rotator cuff syndrome, bursitis, tendonitis, carpal tunnel syndrome, ulnar nerve syndrome, stress fractures, neuropathy, epicondylitis or neuritis.

Benefits are not payable for any care, treatment or diagnostic measures which were received outside of the United States or United States territory.

DOFU 2-2020