Note: This website is not related with cruise lines. The tours sold through this website are independent tours and are not products of any cruise line.
CUSTOMER SERVICE AND INFORMATION
- All Shore excursions and tours will depart from the cruise passenger terminal in Port of Koper. The meeting point is at passenger terminal close to the Istranka stand with indication ACCESSIBLE SLOVENIA, only 10 yards from the exit.
- Please, keep your voucher till the end of the tour. The voucher will be your ticket and includes important information about your tour.
- Your tour purchases will be completely refunded if the cruise line cancels the cruise or if your ship is unable to arrive in Port of Koper.
- We can provide guides for individuals/groups with already a set program, for individuals/groups with already a tour leader and for individuals/groups that would like an introduction to the area. Our guides are trained and selected by our team.
RESERVATIONS AND PAYMENT
After your email confirmation by Accessible Slovenia you will get proforma invoice, issued by Istranka d.o.o. which has to be paid in advance at least 10 days prior the arrival date.
DOCUMENTS
Within 48 hours after the payment, you will receive an email set with invoice from Istranka d.o.o. and voucher from Accessible Slovenia. It’s your responsibility to print and carry this voucher with you. You are responsible for contacting Acessible Slovenia if you have misplaced or cannot retrieve your voucher.
PRICING
All prices are in euro (EUR) per group, unless otherwise stated program at the time of publication. Prices may change at any time based on changes in vendor pricing.
CANCELLATION AND REFUNDS
Unless otherwise noted within the tour description, customers can cancel a tour up to 10 days before the date of arrival and receive a full refund except 35 EUR to cover our bank and administration coasts. All tours are non-refundable if they are not canceled by customers 10 days before tour departure. In case of unusual event that Accessible Slovenia have to cancel your tour reservation payment will be refunded in full.
CHANGES IN THE PROGRAM
If you’d like to change any of the details on your allready booked tour after we have confirmed it, we will do our all the best to help you, although we can not guarantee that we will be able to do this. We charge 25 EUR for each booking you want to change to cover our administration costs. However, if you wish to make any changes within 10 days before arrival date, we may ask you to pay cancellation charges.
INVOLUNTARY CANCELLATIONS
The tour you are confirmed on, is not operate in the case of weather restrictions or late your ship arrival, you will be eligible for a full refund. Please request refunds in writing within 30 days ofter completion for services cancelled or altered by a specific vendor.
RESPONSIBILITIES / PHYSICAL LIMITATIONS
Accessible Slovenia does not accept responsibility for any accident regarding theft or damages during the tours.
All personal items, including coats, cameras, handbags and similar personal articles should remain at all times through the tour under your personal control. Accessible Slovenia is not responsible for the loss, theft, or damage of personal items while you are on tour.
Accessible Slovenia and Tourist Agency Istranka Koper
GENERAL TERMS AND CONDITIONS OF ACCIDENT INSURANCE
In accordance with Article 15 of the Statute of ADRIATIC zavarovalna družba d.d. Koper, the Management Board adopted at its regular session dated 11 June 1997 the following
GENERAL TERMS AND CONDITIONS OF ACCIDENT INSURANCE (O-NEZ-SPL-01)
GENERAL PROVISIONS
Article 1: Content
The General Terms and Conditions of Accident Insurance (hereinafter: General Terms and Conditions) regulate the relations between ADRIATIC zavarovalna družba d.d. Koper (Insurer, hereinafter: Insurance Company) and the entity taking out the insurance (hereinafter: Policyholder), the Insured and the Beneficiary, and are an integral part of the insurance contract.
The General Terms and Conditions determine types of insurance, contents of coverage, Insurance Company’s guarantee and other provisions necessary for taking out and implementing the accident insurance.
The Adriatic Chart of Disablement is an integral part of these General Terms and Conditions.
The expressions in these General Terms and Conditions shall have the following meanings:
Proposer is the person wishing to conclude the insurance contract and who submits a proposal for this purpose,
Policyholder is the person who has concluded the insurance contract,
Insured is the person insured against injury, disablement or death,
Beneficiary is the person to whose benefit the insurance is taken out,
Medical Examiner is a medical doctor authorised by the Insurance Company,
Premium is the amount paid by the Policyholder to the Insurance Company,
Sum insured is the maximum amount guaranteed by the Insurance Company,
Benefit is the amount as payment of the sum insured or its proportionate part under the insurance contract for an individual insured event,
franchise is the amount of deducted benefit: if franchise is deductible, the benefit shall be reduced by its amount; if the franchise is integral, the benefit lower than its sum is not paid out, and when the benefit exceeds the franchise, it is paid out in total,
Deferment period is the waiting period in which the Insurance Company does not provide any guarantee for the agreed coverage,
Disablement is permanent physical deformation as a result of an accident in accordance with the Adriatic Chart of Disablement,
Article 2: Relations between the Policyholder and Insurance Company
Relations between the Policyholder and Insurance Company, including all their rights and obligations, are determined with a written contract. The following are integral parts of the contract:
These General Terms and Conditions,
Additional Terms and Conditions, which regulate riders and special features of individual types of insurance,
Special Terms and Conditions, which regulate special types of insurance,
Additional Terms and Conditions determine elements for taking out individual type of insurance and are specified in price lists,
Proposal/policy with supplements and statements,
Any possible special written statements by contractual parties as well as other appendices and supplements to the policy.
Any applications and statements submitted by the Insurance Company, Policyholder, Insured or any other person with regard to the contract or a change of contract must be provided in a written form in accordance with the provisions of these General Terms and Conditions, and shall take effect as of the moment when received by the addressee. If sent by mail, the date of reception shall be the date when such registered letter was submitted at a post office.
With the accident insurance contract, the Policyholder or Insured undertake to make regular payments of the premium to the Insurance Company in the way and form as specified in the policy; the Insurance Company undertakes to pay the sum insured or its proportionate part or the benefit to the Beneficiary upon the occurrence of an insured event.
Article 3: Proposal/Policy
The proposal/policy is a form provided by the Insurance Company. When signed by the Policyholder, it is considered a proposal and constitutes an insurance contract proposal; when signed also by Insurance Company’s representative, it becomes a policy and a proof of concluded insurance company.
Should the Insurance Company not accept the proposal within 10 (ten) days from the receipt of the proposal, the contract shall be considered as not concluded.
The Insurance Company may reject the proposal without indicating reasons for it; it must, however, inform the Proposer about the rejection of the proposal in writing.
The proposal/policy contains data about the Policyholder, Insured, Beneficiary, types of insurance, insurance duration, sums insured and the premium; furthermore, it includes the date of issuing and in accordance with the first paragraph of this Article also signatures of both contracting parties.
An integral part of the proposal/policy in group insurance is the list of Insured, if determined so by the Terms and Conditions.
Article 4: Definition of Accident
An accident is any sudden, unpredictable event whereby the Insured, independent of his/her will, is suddenly struck by external force affecting his/her body and resulting in injures requiring medical care; consequences may be Insured’s temporary inability to work, disablement or death.
In accordance with the previous paragraph, an accident shall particularly mean any of the following events: run-over by vehicle, collision, blow with an object or against an object, electric current or lightning stroke, fall, slip, wounds caused by weapons or various other objects and with explosives, stabbing, blow or bite.
An accident shall also be taken to mean the following:
Bacteriologically verified intoxication through food or chemical substances,
Infection of an injury resulting from the accident,
Burns caused by an accident,
Insect sting or bite by an animal, which causes immediate reactions, but not if causing an infectious disease,
Tearing of muscles or ligaments, dislocation of joints, fracture of healthy bones if occurred as result of sudden body movements and an unpredictable external event and established in hospital or health institution immediately after an injury,
Consequences of temperature or weather, provided the Insured was exposed to such circumstances due to an accident that happened just before this, or if the Insured was exposed to such circumstances as a result of rescuing a human life,
Accidental strangulation and drowning,
Accidental choking or suffocation caused by inhalation,
Sudden radiation, and
Loss or fracture or permanent healthy teeth resulting from an accident.
Article 5: What Is Not An Accident
In accordance with these Terms and Conditions, an accident shall not be any of the following:
Any disease, including infectious, occupational and degenerative,
Any accidents occurred due to mental influences, any changes in conscience, influence of alcohol, narcotics or medications,
Stomach, navel, water and other types of hernia other than those caused by a direct injury of the stomach wall as a direct result of an external mechanical force, provided that apart from hernia, an injury of soft parts of the stomach wall in this area was also established after the injury,
Any infections caused by cutting or tearing of blisters, nail and cuticle care and other types of skin protuberances, and any types of allergy,
Anaphylactic shock other than that occurred as result of treatment due to an accident,
Spinal disc herniation (hernia disci intervertebralis), all types of lumbago, discopathy, sacralgia, myofascitis, cocygodinia, ischialgia, fibrositis and all spinal degenerations marked with analogous definitions, even if their symptoms appear only after an injury,
Retinal detachment (ablation retinae), excluding such appearing after a direct hit on a healthy eye and established in hospital,
Three and more times recurring injury or new total or partial dislocation or sprain of the same joint,
Consequences of chronic consummation of alcohol or other intoxicating substances,
Consequences of medical, special surgical procedures other than those occurred as a result of proven medical error,
pathological modification on bones, cartilage, skeleton and locomotor apparatus (muscles, ligaments, synovial membrane), teeth and pathological epiphysiolyses and apiphysiolyses, and
tearing of ligaments other than in case of direct hits.
TYPES OF INSURANCE AND SCOPE OF COVERAGE
Article 6: Types Of Insurance
Accident insurance comprises the following types of insurance:
Personal accident insurance of persons in performing regular profession and outside,
Vehicle personal accident insurance,
Personal accident insurance of persons engaged in sports activity,
Personal accident insurance of persons performing special activities,
Children’s/students’ personal accident insurance,
Guests’, visitors’ and excursionists’ personal accident insurance,
Consumers’, clients’ and investors’ personal accident insurance,
Other types of special accident insurance, and
Public transport passengers’ mandatory personal accident insurance.
The above-indicated types of accident insurance are taken out in accordance with the provisions in these General Terms and Conditions, and Special Terms and Conditions.
Other types of special accident insurance are taken out in accordance with the General Terms and Conditions and general terms and conditions determined by the Insurance Company for individually agreed special insurance.
Article 7: Types of Coverage
Accident insurance comprises two general types of coverage, riders and special types of coverage.
General types of coverage:
Accidental disablement and Accidental death.
General types of coverage constitute the general coverage and condition for taking out the accident insurance. They may be included in the accident insurance only together, not separately.
Riders:
Death resulting from a traffic accident,
Death resulting from an illness,
Daily benefit due to an accident,
Daily hospital benefit due to an accident,
Daily health resort benefit due to an accident,
Costs of medical treatment due to an accident, and
Funeral grant due to an accident.
Riders may be included in the accident insurance only when general types of coverage are included together.
Additional Terms and Conditions determine which riders may be included in the insurance.
Riders are determined and regulated in Additional Terms and Conditions and Special Terms and Conditions.
In group insurance, all Insured must have the same coverage unless determined differently in the Additional Terms and Conditions.
Article 8: Determination of General Types of Coverage and Riders
General types of coverage in accident insurance mean the following:
Accidental disablement is the coverage for the case of partial or total disablement resulting from Insured’s accident. It is determined on the basis of the Adriatic Chart of Disablement. It can be concluded with or without the franchise.
Accidental death is the coverage for the case of Insured’s death due to an accident.
Riders in accident insurance mean the following:
Death resulting from a traffic accident is a rider for the case of Insured’s death as a road user.
Death resulting from an illness is a rider for the case of Insured’s death due to an illness and has a six-month deferment period in taking out the insurance, unless in death resulting from pregnancy or labour and in uninterrupted conclusions of the existing insurance.
Daily benefit due to an accident is a rider for each day of active treatment of injuries suffered in an accident, for a maximum of 200 days per an insured event. It can be taken out with or without franchise.
Daily hospital benefit due to an accident is a rider for each day of hospital treatment of injuries suffered in an accident (hospitalisation), for a maximum of 360 days per an insured event.
Daily health resort benefit due to an accident is a rider for each day of treatment of injuries suffered in an accident with a stay in a health resort (stationary treatment with referral), for a maximum of 30 days per an insured event.
Costs of medical treatment due to an accident is a rider for urgent costs that incurred during active treatment of injuries suffered in an accident and which were not covered by health insurance or any other way, and it can be proved that they were settled by the Insured.
Funeral grant due to an accident is a rider for the amount paid to the Beneficiary in case of Insured’s accidental death.
Article 9: Limitations to Insurance Company’s Liabilities
If not explicitly agreed and if the corresponding increased premium is not paid, the agreed sums insured shall be lowered in proportion between the premium that should have been paid and the actually paid premium in the case of Insured’s accident in any of the following high-risk activities:
During parachuting and management or operation of aircraft, other than public transport passengers,
During trainings and competitions for this,
During trainings and participation in public sports competitions in sports ranked higher than including the 6th risk class of sport as per the price list of the Insurance Company, where the Insured participates as a registered member, and
During participation in war events of any kind outside the borders of the Republic of Slovenia, unless the accident happened within a period of 14 days from the first occurrence of such events in the country of the Insured’s whereabouts, provided that such events happened unexpectedly and the Insured did not take an active participation in these events.
If an Insured aged under 14 dies resulting from an accident, the Insurance Company shall reimburse funeral costs to a maximum of the sum insured for the case of death.
If an Insured in group insurance is aged above 70 during an accident, the Insurance Company shall pay only 50% of the amount of agreed coverage, unless in pensioners’ group insurance.
The Insurance Company has the right to assess the benefit based on medical examiner’s opinion:
When the Insured fails to comply with doctor’s instructions during the time of treatment, which unnecessarily prolonged the treatment or when the consequences of accident are bigger than they would be otherwise,
When treatment was prolonged due to any different reason,
When treatment lasted longer than usual, and
For other similar cases.
In recurring injuries on the same body part, daily benefits decrease by 1/3 per insured event.
Article 10: Exclusions of Liability Attaching to the Insurance Company
All liabilities attaching to the Insurance Company shall be excluded for accidents arising:
From an earthquake,
From war events in the Republic of Slovenia,
From active participation in armed actions unless the Insured participated due to carrying out his/her regular work and tasks or on the call by authorised bodies of the Republic of Slovenia,
During the operation of aircraft, water vessels, motor or other vehicles without the necessary valid permit for operation or driving or without the owner’s permit to use it; it shall be considered that the Insured has a valid driver license when he/she operates a vehicle in the process of obtaining driver license, under supervision by a competent person,
From an attempt of committing or actually committing suicide,
From an accident intentionally caused by the Insured, Policyholder or Beneficiary; in case of several beneficiaries, the Insurance shall have no liability towards the beneficiary who intentionally caused the accident,
From the attempt, participation or commitment of an intentional criminal offence and escape after such deed; during a fight except in the case of self-defence or extreme urgency proved by a final court order,
From the Insured’s influence of alcohol or narcotics during the accident; it shall be considered that an accident occurred due to the influence of alcohol when the vehicle operator (land, vessel, aircraft or other) had during the accident a concentration of alcohol in blood exceeding 10.8 mil. mol (0.5‰) or exceeding 21.6 mil. mol (1%o) during other accidents or if the alcohol test is positive and the Insured fails to enable the precise determination of the level of alcohol in blood with blood analysis, or if the Insured refuses or avoids the determination of the level of alcoholicity,
Consequences proven to arise under the influence of alcohol or other intoxicating substances,
Traffic accident of which the police were not immediately informed.
In case of an accident in the event when the Insured operated a vehicle, working machine or another machine, which did not have a valid license for operation and the Insured was familiar or should have been familiar with this, the Insured Company shall have no liabilities towards the Beneficiary.
All liabilities attaching to the Insurance Company shall be entirely excluded if false data were provided in the report of an insured event.
All liabilities attaching to the Insurance Company shall be excluded in the matter of insured event maturity. Beneficiary’s claims mature within three years starting from the first day after the termination of the calendar year in which such claim occurred.
If the Insured had no guarantee, the Insurance Company shall have no liability to pay the benefit.
TAKING OUT INSURANCE
Article 11: Who Can Be Insured
Persons aged 14 to 70 years can be insured. Persons below the age of 14 and above the age of 70 may be insured only under special terms and conditions.
Persons from the previous paragraph may be insured regardless of the health condition, except the persons who are exclusively excluded by these General Terms and Conditions and Additional Terms and Conditions.
Persons who are suffering from cerebral veins disease, epilepsy, alcoholism, drug abuse, mental retardation, schizophrenia, depression and paranoia cannot be insured.
Persons unfit to work can also not be insured, unless when arranged differently with corresponding acts.
Article 12: Obligation to Report
Upon the conclusion of the contract, the Policyholder and/or Insured must report to the Insurance Company all circumstances relevant for the estimation of risk and which he/she is or should be aware of.
The insurance contract shall be null and void if the insured event had already occurred, was in the process of occurring or it was certain that it would occur before the contract was concluded. The already paid premium less the cost of Insurance Company shall be reimbursed.
Article 13: Form of Conclusion
Insurance can be taken out for an individual or group.
Group insurance is taken out with or without name indication of all Insured.
In group insurance with name indication of all Insured, the list of Insured is an integral part of the proposal/policy. For new Insured in group insurance with name indication of all Insured, the insurance is taken out on the basis of a written report and entry of an Insured to the list of Insured.
In group insurance without name indication of Insured, all persons who are in a proven legal relationship required for a valid insurance are insured.
Article 14: Liabilities Attaching to the Policyholder or Insured
The Policyholder or Insured is bound to pay the premium to the Insurance Company on a regular basis in the way and form as agreed in the policy.
The Policyholder or Insured is bound to inform the Insurance Company on a regular basis about all changes, particularly changes of the risks affecting the premium and changes regarding the application and deletion of Insured.
By signing the proposal/policy and report of an accident, the Policyholder or Insured gives permission for his/her personal data, including the personal identification or tax number to be collected, kept, processed and submitted with regard to any procedure of the Insurance Company. He/she also gives permission for the Insurance Company’s authorised medical doctor to have an insight in the Insured’s medical record and other medical documentation kept by his/her selected medical doctor or certain health institution. At the same time, he/she authorises the Insurance Company to verify certain data.
In group insurance without a list of names, the Policyholder is obliged to keep corresponding records and ensure the Insurance Company an insight in them, especially as regards the establishment of the actual number of Insured.
Article 15: Beneficiary
The Beneficiary is the Insured unless agreed otherwise.
The Beneficiary for the benefit in case of death is as a rule determined by the Insured during taking out of insurance.
The Beneficiary from the previous paragraph is simultaneously also the Beneficiary for the funeral grant, if applicable.
When a Beneficiary is not determined, the following become beneficiaries in case of Insured’s death:
The Insured’s children and spouse in equal shares,
In the absence of a spouse, the Insured’s children in equal shares,
In the absence of children, the spouse and Insured’s parents. In such case, the spouse receives a half of the sum insured, and the parents (or the living parent) the other half,
If the Insured’s parents had died before the Insured, the total sum insured goes to the spouse,
In the absence of a spouse and children, the Insured’s parents in equal shares. In only one of the parents is alive, he/she receives the total sum insured,
In the absence of the above-indicated persons, Insured’s heirs based on a final court decision.
Should the Beneficiary be a minor, the benefit shall be paid to his/her parents or custodians.
Article 16: Insurance Duration
Insurance duration may be limited or unlimited.
In limited insurance duration, the inception and termination dates are specified in the proposal/policy. In unlimited insurance duration, only the inception date is specified.
The insurance shall take effect at 00:00 of the date indicated in the proposal/policy as the inception date of the insurance and it shall terminate at 00:00 of the date indicated in the proposal /policy as the date of the termination of insurance, unless when agreed and specified otherwise in the proposal /policy.
For each individual Insured regardless of the agreed duration, insurance shall terminate at 00:00 of the date when:
Death of the Insured occurs,
100% disablement of the Insured is established,
The Insured’s capability for work is entirely taken from him/her,
The Insured falls ill and accident insurance may not be taken out for such illness,
The policy year ends when the Insured has turned 70 years of age, unless in cases when otherwise agreed in Additional Terms and Conditions,
Premium is not paid in accordance with these General Terms and Conditions, and
The period of notice ends.
Article 17: Types of Guarantee
Accident insurance can have total or partial guarantee.
Total guarantee refers to accidents which occur to the Insured regardless of the situation, activity, tasks, space, time and circumstances, other than when and where exclusively excluded by the General Terms and Conditions or Additional Terms and Conditions.
Partial guarantee refers only to accidents, which occur to the Insured in precisely determined conditions, activities, tasks or activities, or according to a precisely determined space, time and circumstances in accordance with the Additional Terms and Conditions and concluded insurance.
Article 18: Duration of Guarantee
In insurance with full guarantee, the guarantee duration is bound to the insurance duration and shall take effect at 00:00 of the date indicated in the policy as the inception date of the insurance but not before 00:00 of the day when the premium is paid unless agreed otherwise in the policy, and it shall terminate at 00:00 of the date indicated in the policy as the date of the termination of insurance.
In insurance with partial guarantee, guarantee for an individual Insured shall begin and terminate with the beginning and termination of precisely determined situation, tasks or activities at a precisely determined place, time and circumstances, in accordance with the Additional Terms and Conditions and concluded insurance.
In group insurance with a name indication of all Insured, the guarantee for each new Insured shall take effect at 00:00 of the date when the Insurance Company received a written application for such Insured, and it shall terminate at 00:00 of the date indicated in the notice of termination or when Insured’s legal relationship with the Policyholder terminated (e.g. termination of employment relationship), whichever occurs first.
In group insurance without a name indication of Insured, the guarantee for an individual Insured shall take effect or terminate:
In the moment of establishment or termination of legal relationship with the Policyholder, or
At 00:00 of the date of establishment or termination of such relationship, or
With the beginning or termination of certain situation, activities or tasks at a precisely determined place, time and circumstances, in accordance with Additional Terms and Conditions and concluded insurance.
PREMIUM
Article 19: Agreement about the Premium
Sums insured and premiums shall be determined upon taking out insurance, and they must be specified in the proposal/policy.
The amount, type and premium payment method are determined upon taking out the insurance.
Persons engaged in high-risk activities may be insured with proportionately higher premium, in accordance with Additional Terms and Conditions.
Any particularities as regards the accounting and payment of the premium in individual types of insurance are determined in Additional Terms and Conditions and Special Terms and Conditions.
Turnover tax, the amount of which is subject to statutory changes, is paid to the premium.
The Insurance Company is obliged to accept premium from each person who expresses interest in its payment.
Article 20: Premium Payment
Premium is paid in advance and in a single sum for a policy year other than as agreed otherwise.
If insurance lasts less than one year, the premium is settled with single payment.
Premium is paid to the Insurance Company. It shall be considered paid at 00:00 of the day specified in the payment document.
The Insurance Company has the right to deduct any unpaid and participating premiums during each payment of the benefit by the end of a policy year or the last day of insurance duration.
In insurance without a name indication of all Insured, the premium is paid as an advance at the beginning of insurance, and at the end of the agreed period an account is made based on the actual number of the Insured and in accordance with Additional Terms and Conditions.
Article 21: Consequences of Non-payment of Premium
Should a matured premium not be paid in the agreed term, the Insurance Company shall inform the Policyholder or the Insured about non-payment of premium with a registered letter, determining the date of payment, which may not be shorter than 30 (thirty) days.
In case a premium is not paid within the term specified in the letter, the insurance and guarantee shall be considered terminated as of date until when the premium was paid.
The insurance contract shall in any case terminate on the date until when it was paid, provided it is not paid within one year from its maturity.
The Insurance Company will charge default interest for any matured and unpaid premiums.
Article 22: Change of Risk
A change of risk during the time of insurance duration shall lead to immediate change in the premium.
The Policyholder or Insured shall immediately report any change of risk (e.g.: change of profession, job, workplace, sport, etc.).
With increased or decreased risk, the Insurance Company will require corresponding increase or decrease in the premium.
Should the Policyholder or Insured fail to report the change of risk or fail to agree with the change in the premium within 14 (fourteen) days from the receipt of the Insurance Company’s claim, the sums insured for the insured event shall change in proportion between the paid premium and the premium than should have been paid.
Article 23: Currency Clause
Premiums and sums insured may be agreed in a foreign currency.
If agreed in a foreign currency, the middle exchange rate of the Bank of Slovenia of the current month applicable the 10th (tenth) day before the beginning of the current month shall be used to translate the premium into tolar (SIT).
In insurance in a foreign currency, the benefit is accounted in the agreed currency and paid in tolar (SIT) at the foreign exchange rate determined in the way as set forth in the previous paragraph on the date of account.
RIGHTS ATTACHING TO THE INSURANCE
Article 24: Liabilities upon Insured’s Accident
The Insured who is injured as a result of an accident shall be obliged to:
immediately seek medical help and follow the doctor’s instructions and advice regarding the method of treatment;
report the accident to the Insurance Company within 30 (thirty) days after the accident, and only exceptionally later if he/she was hospitalised due to the accident in that period;
Indicate in the report of the accident to the Insurance Company all facts and provide the required evidence, especially on the location and time of the accident, a complete description of the event, name of any possible witnesses and the doctor who carried out the examination and sent him/her for treatment or who treats him; and data about previous equal accidents and related treatment.
If the Insured died as a result of an accident, the Beneficiary or any other interested person must immediately report the death.
In accordance with these General Terms and Conditions, Additional Terms and Conditions and Special Terms and Conditions, the Policyholder/Insured shall be liable to provide to the Insurance Company a detailed description of the accident and inform it in writing about all facts relevant for the clarification of the event and circumstances that have a decisive role for the establishment of the Insurance Company’s liability.
In group insurance, the Policyholder is obliged to issue a written certificate stating the Insured was in a legal relationship with him/her in the moment of the accident in the sense of the Additional Terms and Conditions and Special Terms and Conditions.
The Insured shall lose rights from the insurance if the consequences of the accident were not medically established immediately or not later than within three months after the accident.
If the Insured is injured in a traffic accident, he/she is unconditionally obliged to inform the police about the accident.
Article 25: Required Written Statement of Proof
Upon reporting the insured event and in the procedure of enforcing his/her rights, the Insured shall be obliged to submit the following documents at his/her own expense:
Proof of valid accident insurance,
Proof that he/she is the Beneficiary,
Report of the accident (Insurance Company’s form),
Medical documentation,
Medical diagnosis on the type and severity of injury, possible consequences, and data about deformities, defects and diseases that the Insured had prior to the occurrence of the accident,
Copies from the civil register of deaths in the case of the Insured’s death,
Proofs on the cause of death in the case of the Insured’s death, and
Other proofs on request by the Insurance Company.
Besides the above-mentioned documents, he/she must also submit written statements of proof and other documentation as determined with these General Terms and Conditions in the enforcement of rights from individual types of coverage.
The Insurance Company shall offer any needed help in filling in the accident report form.
Article 26: Additional Requirements of the Insurance Company
With regard to the reported insured event, the Insurance Company shall have the right to request further explanation, proof, medical and other documentation from the Policyholder, Insured or any other person, and at its own expense request additional medical examination of the Insured performed by medical doctors appointed by it.
Article 27: Enforcing Rights from the Accidental Disablement Coverage
The process of enforcing and determining permanent disablement can only be commenced for the disablement, which occurred as a result of an accident, not later than within one year from the date when it occurred.
Accidental permanent disablement is established after finished treatment when the consequences of injuries alleviate and when, according to medical judgment, the condition cannot be expected to change, however not earlier than 6 (six) months after finished treatment. If this condition does not occur even three years after the accident, the condition is determined as final upon the termination of this period and the level of permanent disablement is determined afterwards. The medical examiner decides about the period of determining the final stage of permanent disablement within the upper time limit.
The Insured who requires the payment of benefit for permanent disablement due to an accident must undergo medical examination at a medical examiner for the establishment of the consequences and issuing of medical record about permanent disablement.
The level of permanent disablement is determined by the Insurance Company based on the Adriatic Chart of Disablement in accordance with concluded insurance and based on medical record about permanent disablement from the previous paragraph.
The Insured’s individual abilities, social position and professional ability, pain and swelling on the place of injury, decreased muscle strength and muscle atrophy, aesthetic consequences and scars without functional disorders shall not be considered during the determination of the level of permanent disablement.
If the Insured had been physically deformed already prior to the accident, the liability of the Insurance Company shall only be determined for new disablement, independent of the previous, unless if the Insured loses or injures a limb, organ or joint, which was already previously injured. In such case, the Insurance Company pays only the difference between the previous and the new level, as specified in the Adriatic Chart of Disablement.
When the Insured dies within three years after the accident due to the consequences of an illness or another accident and the level of disablement was not established yet, the disablement is established based on the existing medical documentation.
The permanent disablement level established for several injuries on the same limb, organ or joint cannot be higher than that determined for its total loss in the Adriatic Chart of Disablement.
In case of a loss or injury of several limbs, organs or joints resulting from one accident, individual percentages of disablement sum up.
If the sum of percentages of disablement for a loss or injury of several limbs, organs or joints suffered in one accident exceeds 100%, the Insurance Company shall not be liable to pay out more than the sum insured for total disablement.
Prior to final establishment of permanent disablement, the Insurance Company may pay out the advance of benefit based on the medical documentation and temporary undisputable assessment of disablement.
Article 28: Enforcing Rights from the Accidental Death Coverage
If the Insured dies from the consequences of the same accident before three years have passed, the Insurance Company shall pay the sum insured for accidental death or the possible difference between the sum insured for accidental death and the already paid disablement or advance; any liabilities shall cease to exist after this term.
Article 29: Enforcing Rights from the Coverage of Death due to Traffic Accident
The liability for payment of the sum insured for Insured’s death in a traffic accident shall be determined by the Insurance Company based on the findings of the police record about the traffic accident.
The Insurance Company shall pay the sum insured for Insured’s death in a traffic accident, provided the Insured dies of the consequences of the same traffic accident in the period prior to the termination of three years since the accident. The Insurance Company shall have no liability after this period.
Article 30: Enforcing Rights from the Coverage of Death Resulting From an Illness
The Insurance Company shall pay the sum insured for death resulting from an illness only in case the Insured died of an illness during the time of insurance duration and after the termination of the six-month deferment period.
The Insurance Company shall have no liability for payment if the Insured committed a suicide in the first year of insurance duration.
Article 31: Enforcing Rights from the Coverage of Daily Benefit Due to an Accident
The Insured is entitled to the payment of daily benefit due to an accident for a maximum period of 200 days starting the day after the beginning of active treatment by a medical doctor or in a health institution, and until including the last day of active treatment of injuries due to an accident for an insured event, provided the Insured:
Is in a regular employment relationship and is absent from work due to the accident; exceptionally it is recognised for the time of immobilisation with plaster even though the Insured was not absent from work in this time,
is unemployed: exclusively during the time of active treatment of the injury for the number of days approved by the medical examiner; in accordance with the provisions in the General Terms and Conditions and Additional Terms and Conditions and if the concluded policy is paid after finished treatment.
Primary or secondary school student: for the time when the student is unable to attend regular classes, unless in case of immobilisation with plaster;
and is in accordance with the provisions of the General and Additional Terms and Conditions and the concluded policy is paid out after finished treatment.
The eligibility for the payment of daily benefit due to an accident is determined by the Insurance Company based on the following expert grounds:
Active treatment of injuries or duration of sick leave,
Ordinary duration of individual injuries treatment,
Written report of the medical doctor (who is treating the Insured) about the course and duration of treatment, and
Medical examiner’s opinion.
In cases of a longer treatment period than usual for the treatment of a certain injury, the Insurance Company recognises the number of days fordaily benefit due to an accident based on medical examiner’s opinion (active treatment).
The Insurance Company is not liable to pay the daily benefit due to an accident for the time when treatment was prolonged because the Insured was being treated or was suffering from a different illness during this time, and for the days after the determination of the final level of permanent disablement or death of the Insured.
Active treatment is not waiting for medical examinations and procedures, for disablement committee, admittance to hospital and similar.
Article 32: Enforcing Rights from the Coverage of Daily Hospital Benefit Due to an Accident
The eligibility for the payment of daily hospital benefit due to an accident shall be determined by the Insurance Company based on the following expert grounds:
Duration of hospital treatment,
Hospital discharge letter, and
Treatment process report.
The time of hospitalisation shall be recognised (including the first and last day) up to a maximum of 360 days per an insured event.
Article 33: Enforcing Rights from the Coverage of Daily Health Resort Benefit Due to an Accident
The eligibility for the payment of daily health resort benefit due to an accident shall be determined by the Insurance Company based on the following expert grounds:
Duration of health resort treatment,
Referral for stationary health resort treatment, and
Health resort’s receipt proving the duration of accommodation.
The time of stationary health resort treatment shall be recognised (including the first and last day) up to a maximum of 30 days per an insured event.
Article 34: Enforcing Rights from the Coverage of Costs of Medical Treatment Due to an Accident
The eligibility for the payment of costs of medical treatment due to an accident shall be determined by the Insurance Company based on the following documents:
Account of services,
Original invoice, and
Proof of invoice payment.
Only the costs incurred during the time of active treatment of injuries due to an accident shall be recognised to a maximum sum indicated in the policy.Article 35: Enforcing Rights from the Coverage of Funeral Grant Due to an Accident
The eligibility for the payment shall be determined by the Insurance Company based on Articles 28 and 29 of these Terms and Conditions.
Article 36: Payments by Insurance Contract
The sums insured specified in the policy are the maximum amounts of the Insurance Company’s liability for certain coverage and individual Insured per an insured event.
The Insurance Company has the liability to pay the benefit only if the insured event occurred during the time of insurance and guarantee duration.
The Insurance Company shall settle its liability within 14 (fourteen) days from the date when it received evidence on its existence and amount, or when the entire documentation was provided to it in accordance with the provisions of these General Terms and Conditions, Additional Terms and Conditions, and Special Terms and Conditions.
Article 37: Rescission of the Insurance Contract
Each contracting party may rescind the time unlimited insurance.
The insurance is rescinded in writing at least three months before the termination of the current policy year.
The Policyholder needs the Insured’s consent for the rescission of the insurance contract where the premium is paid by the Insured.
Article 38: Reimbursement of Cost
The Insurance Company shall not recognise any lawyer fees and other representation service costs incurred during the reporting and establishing of the insured event.
The Insurance Company shall not reimburse the costs for medical and other documentation, which it did not request, as well as travel and other costs or losses incurred to the Beneficiary in the process of enforcing his/her rights.
The Insurance Company shall reimburse the costs of medical records and other documentation, which it required, to the amount determined by it.
Article 39: Complaint Procedure
If the Beneficiary does not agree with the liquidation proposal, he/she may file a complaint to the appeal committee of the Insurance Company within 15 days. The committee shall decide about the issue within 30 days from receiving the complaint. The decision of the appeal committee is final.
Article 40: Arbitration Procedure
In case of a dispute or complaint, the Beneficiary or the Insurance Company may demand the arbitration procedure.
The Beneficiary or the Insurance Company shall each appoint its arbiter. When the findings of the two arbiters differ, they shall by mutual agreement appoint a third arbiter who will give his/her opinion only within the framework of their findings.
Each party shall settle the costs for the arbiter appointed by it, and each party shall bear one half of the costs for the third arbiter.
FINAL PROVISIONS
Article 41: Application of Law
The Insurance Company hereby undertakes to protect all data about the Policyholder, Insured and Beneficiary in accordance with the applicable laws.
Relationships between the Insurance Company, Policyholder, Insured, Beneficiary and other persons, which are not arranged with these Terms and Conditions, shall be governed by the law regulating obligation relationships, and other applicable laws.
Article 42: Competence in Case of Dispute
Any disputes between the Insurance Company, Policyholder, Insured and Beneficiary shall be settled by the competent court with regard to the place of insurance contract conclusion.
Article 43: Validity of General Terms and Conditions
(1)These General Terms and Conditions shall apply as of the date when confirmed by the Management Board of the Insurance Company, and are used as of 1 June 1998.
Tourist Agency Istranka in cooperation with ADRIATIC SLOVENICA d.d.