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
1. The terms used in the General Conditions shall have the
meaning specified below:
1) acts of terrorism – individual or group actions directed
against population or property to cause chaos, intimidate
the general public, disorganize public life, public
transportation, service or manufacturing facilities – all in
order to achieve economic, political or social aims;
2) fight – a conflict of three or more persons dealing blows to
each other, with each of them having a double role – as the
assailed and assailant
3) Emergency Centre – the Emergency Centre working for
PZU SA, providing services defined in the General
Conditions; the Emergency Centre operates 24 hours a day
7 days a week and it is the location where the Insurer or a
person acting on his/her behalf is obliged to report the
insurance accident; the phone number of the PZU
Emergency Centre is provided in the insurance contract;
the phone number of the PZU Emergency Centre is
provided in the insurance document. In the case of the
insurance contracts concluded by means of distance
communication, pone number of Emergency Centre is also
provided by electronic means.
4) illness – an organism reaction to a disease-causing agent
manifesting by function disorders and organism structure
damage that causes adverse effects;
5) severe bodily injuries – the following injuries arising as a
result of insurance accident, confirmed in medical
documentation:
a) complete and permanent loss of vision, hearing,
speech, reproductive capacity or
b) permanent and serious impairment, or loss of function of
an important organ or organs, and specifically: one-eyed
blindness, serious two-sided sight impairment, loss of lower
limb at least on the level of the shank, loss of an important
internal organ, stiffness of one of the major joints
(shoulder, elbow, hip, knee, ankle) especially in an
unfavourable position, loss of prehensile ability of the hand
(loss of at least three fingers, including the thumb), paresis
or paralysis of at least one limb;
6) temporary inability to study – a temporary inability of
the Insured to participate in all school classes, arising in
consequence of insurance accident; a physician’s leave
from physical education classes does not mean inability to
study under these General Conditions;
7) temporary inability to work – a temporary inability of
the Insured to gainful employment, arising as the
consequence of the insurance accident, documented with a
medical certificate on temporary inability to work, issued in
line with current legal provisions;
8) insurance document – the policy, certificate or another
document confirming the conclusion of insurance contract;
in the case of an individual insurance contract, one
document may confirm a conclusion of more than one
insurance contract;
9) acts of war – actions of armed forces aiming at
destroying the enemy armed forces on land, in the air or
on sea;
10) children – persons up to 25. years old, studying or
staying in establishment, whereas a child within a meaning
of these General Conditions is also a child until going to a
nursery school, kindergarten or school and a child that
does not attend a school due to the health reasons or who
has individual educational programme;
11) occupational exposure to contagious material
– a subjection of the insured to virus infection while
performing his/her professional work of medical nature as a
result of a direct contact with potentially infected blood or
another potentially infectious material, as a consequence of
prick, splash, scratch, cut, score, bite by a patient;
12) hospitalization - insured’s stay at the hospital in
consequence of an insurance accident, uninterrupted and
lasting for more than one day, tied to treatment of
conditions which arose as a result of insurance accident
GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident
and for whom outpatient treatment is not possible; under
these General Conditions a day of hospital stay is a
calendar day during which the Insured was staying at the
hospital, regardless of the actual length of stay during that
given day; the first day of hospitalization is the day of
admission and the last one – the day of discharge;;
13) consumer – a natural person performing a legal
activity not directly related to its business or professional
activity;
14) intra-cranial haemorrhage – extravasation of
blood into the craniocerebral cavity;
15) treatment – physicians’ visits and consultations,
outpatient treatment, hospital treatment, outpatient
procedures, surgical procedures, tests ordered by the
physician, taking medication and applying dressings,
transport from the location of accident to the hospital or
outpatient clinic, rehabilitation;
16) outpatient treatment – treatment other than
hospitalization;
17) surgical treatment of a fracture – internal or
external stabilization of a fracture tied to a surgical
procedure which interrupts tissue continuity;
18) consequences of the insurer’s accident – body
injury, detriment to health or death;
19) insurance accident – a sudden event caused by
an external reason, in consequence of which the Insured,
regardless of his/her will, sustained bodily injury,
disturbance of health or died;
20) malicious tumour – a disease manifesting itself by
the presence of a malicious tumour (i.e. a tumour that is
not encapsulated and is able to invade tissues and create
remote metastases); within a meaning of these General
Conditions the term “malicious tumour” includes leukaemia
and malicious diseases of the lymphatic system, which is
Hodgkin's lymphoma (Hodgkin's disease) or non-Hodgkin
lymphoma; within a meaning of these General Conditions
malicious tumours are not:
a) skin tumours, apart from malignant melanoma,
b) tumours, in the case when upon a histopathological
examination is diagnosed a precancerous or
preinvasive condition,
c) neoplasms with changes of carcinoma in situ type,
d) Hodgkin’s disease in its first stage,
e) neoplasms linked to AIDS or HIV virus infection;
21) frostbite – damage of the skin and subcutaneous
tissues due to low temperature;
22) insurance term – the period of PZU SA liability
defined in the insurance contract;
23) burn – damage of the skin and subcutaneous
tissues due to action of high temperature, chemicals,
ionizing radiation or electric current;
24) surgeries – a medical procedure performed at a
medical facility by a physician authorized to perform it,
under general or local anaesthesia, necessary to eliminate
or alleviate the illness effects resulting from an insurance
accident and conducted with a) the open or b) endoscope
method; within a meaning of these General Conditions the
surgery excludes: punctures, biopsies, injections,
paracenteses, catharizing, tubing, cannulations, dialyses,
blockades, venesections, tamponades, endoscopy;
25) country located in the region of the world at
risk of acts of terrorism, acts of war, martial law or
state of emergency – country which, as at the date of
the insurance agreement, is entered in the list of countries
to which travel is not advised due to threats of acts of
terrorism, acts of war, martial law or state of emergency,
published on the official website of the Ministry of Foreign
Affairs of the Republic of Poland, with “Do not travel” or
“Leave immediately” advisories;
26) personnel – teaching and administrative employees
of the given school or other institution;
27) establishment– nursery school, kindergarten,
primary school, lower secondary school, general secondary
school, occupational general secondary school, technical
insurance) PZU EDUKACJA INSURANCE
3
 secondary school, basic vocational school, school complex,
educational centre, orphanage, sport schools of all levels,
post-secondary school, high school or the other not
mentioned above establishments, in that employment
establishments;
28) medical establishment – a healthcare entity
within a meaning of the Act on healthcare activity;
29) educational entity – nursery school, kindergarten,
primary school, lower secondary school, general secondary
school, occupational general secondary school, technical
secondary school, basic vocational school, school complex,
educational centre, orphanage, sport schools of all levels,
post-secondary school, high school;
30) serious bodily harm – a bodily harm occurring as
a result of the insured’s accident, which resulted in one of
the consequences listed below, confirmed by medical
documentation:
a) hospitalization commenced up to 3
days after the trauma and lasting
without interruption for at least 14
days,
b) an urgent surgical procedure (up to 7
days from admission to hospital),
c) qualification of the insured for a
planned surgical procedure,
d) permanent neurological deficit after
damage to the brain, spinal cord or
nerve roots,
e) permanent worsening of acuity of
vision or permanent narrowing of the
field of vision,
f) permanent worsening of the auditory
acuity,
g) partial amputation of limbs,
h) partial loss of internal organs;
2) Serious bodily harm excludes invasive examinations
(even conducted as a part of a surgical procedure
within a meaning of these General Provisions) aimed
at diagnosing an illness or a confirmation of an
illness existence;
31) serious illness – an existence in the Insured the
following illness:
a) cerebral stroke – a sudden n focused or general
disorder of brain activity, leading to permanent
neurological deficiencies, caused only by vascular
reasons as brain vessel lumen or transmural rupture
of a brain vessel, excluding vascular reasons caused
by brain or injury factors, or
b) renal failure – a final stage of renal failure in a
form of irreversible impairment of activity of both
kidneys, as a consequence of which are performed
regular, permanent dialyses or surgery procedure
consisting in kidney transplantation, or
c) -Creutzfeldt-Jakob diseases– diseases that
disable a performance by the insured minimum
three of five below mentioned activities of everyday
life:
-moving at home – moving between rooms at
house, without necessity to assist by another
person,
-controlling physiological activities – self-control
within a scope of defecation and urination, and
maintaining personal hygiene,
-dressing up – independent dressing up and
undressing, without necessity to assist by another
person,
-washing and toilet – an independent performance
of activities related to washing and personal
hygiene, without necessity to assist by another
person,
-eating – activities connected with independent
eating of ready meals or
GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE
d) HIV infection during blood transplantation –
complications of blood or blood-related preparations
transplantation in person not suffering for
haemophilia, or
e) meningioma – histopathologic confirmed diagnosis
of brain meningioma; excluding: the other changes
in central nervous system, cysts, coccus, vascular
malformations, pituitary and spinal cord tumour, or
f) Parkinson’s disease – chronic disease of
extrapyramidal system, caused by primary
degeneration of nervous cells of substantia nigra,
leading to a decrease in a quantity of neurons that
produce dopamine, which results in an occurrence
of at least two of three classical axial symptoms of
this disease: passive tremor, slowness of movement,
plastic quality hypertonia (muscular rigidity), that
decrease upon an administration of drugs
stimulating a dopaminergic system, in particular L-
DOPA; excluding symptomatic parkinsonism, or
g) vision loss caused by disease – confirmed by
ophthalmic examination and static examination of
vision field, binocular vision acuity loss below 5/50,
not a subject to correction or binocular narrowing of
a field of vision below20;
32) gainful work – a form of performing work for
remuneration:
1)under:
a) a civil law contract or
b) an employment relationship or
c) an official relationship of administrative
and legal nature, or
2)within performance of business activity
under own name, including the running of
a farmstead;
33) orthopaedic objects and auxiliary materials –
medical devices necessary from the medical standpoint,
replacing lost systems (organs) or supporting the lost or
worsened functions of organs; a list of orthopaedic objects
and auxiliary materials is included in Regulation of Minister
of Health of 6 December 2013 on a list of medical devices
issued on order;
34) statutory representative – a person whose
empowerment to act on behalf of a person without legal
capacity or with limited legal capacity, results from law
provisions;
35) Rules and Regulations – relevant rules and
regulations governing electronic service provision;
36) rehabilitation – treatment necessary from the
medical standpoint, restoring functions and capacity after
the insurance accident, performed by persons who possess
the necessary qualifications and licenses;
37) RP – the Republic of Poland;
38) sepsis – in other words septicaemia – systemic
inflammatory response syndrome (SIRS) caused by
infection;
39) state of emergency – an emergency state of a
state, which introduction results in a restriction of some
rights and civil freedoms;
40) hospital – a medical facility providing round-the-
clock care for patients in terms of diagnostics and
treatment, with qualified team of physicians and nurses;
under these General Conditions, this term does not include
a nursing home, hospice, a rehabilitation centre,
sanatorium or spa, preventorium or sanatorium hospital
unless hospitalization is connected with a treatment of
consequences of an insurance accident;
41) coma – a condition resulting from the insurance
accident, lasting continually for at least 30 days and
requiring the use of a life support system, entailing the
presence of deep, quantitative disturbances of
consciousness, having the form of lack of reaction to
external verbal and pain stimuli, tied to severe brain
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

GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE
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
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 establishment - is due as 100% of the sum insured.
6 for fractures of bones or dislocations of bones (Table no. 5)
7 for consequences other than those listed in Tables no. 4, 5, 7 and 8 –
specified in Table no. 6
8 for burns or frostbite (Table no. 7)
9 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
materials, as well as the cost of dental reconstruction of permanent teeth
11
12 for refund of the costs of vocational retraining of disabled persons
§ 12
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.
2. Benefit for death of the Insured in the area of educational
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
than within 24 months from the date of the insurance accident.
4. Benefit for permanent disturbance of health - is due in an amount
corresponding to such percent of the sum insured in which the Insured
sustained a permanent disturbance of health, and that permanent
disturbance of health is determined:
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
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
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.
5. This benefit is the permanent disturbance of health occurred not later than
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
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

materials, as well as the cost of dental reconstruction of permanent teeth
11

GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE
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
b) one or multiple, open
2
4
8 Dislocation of the elbow joint 3

Fractures of the hand bones,

excluding finger bones:
a) one or multiple (other than open)
9
b) one or multiple, open
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
a) one or multiple (other than open)
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:
a) one or multiple (other than open)
21
b) one or multiple, open
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

GENERAL TERMS AND CONDITIONS OF THE PZU NNW (personal accident insurance) PZU EDUKACJA INSURANCE
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 -
10. Benefit for bites and stings is due is due as 10%
of the sum insured, if the Insured was hospitalized with relation to
a bite or sting.
11. Refund of the costs of purchasing orthopaedic
objects and auxiliary materials, as well as the cost of
dental reconstruction of permanent teeth is due is due
in the amount of up to 25% of the sum insured, if the need to
incur these costs arose within 24 months from the date of the
insurance accident, and the refund of costs of dental
reconstruction of permanent teeth cannot exceed PLN 200.00
per tooth.
12. Refund of the costs of vocational retraining of
disabled is due in the amount of up to 25% of the sum
insured, if the need to incur these costs within the territory of
Poland arose within 24 months from the date of the insurance
accident.
13. Post-accident assistance benefits rendered in
the territory of the Republic of Poland
The assistance services referred to in items 1–6 are rendered
by the PZU Emergency Centre within the territory of the
Republic of Poland with relation to the occurrence of an
insurance accident during the insurance period, with the
reservation that with relation to services referred to in item 3,
assistance services are provided with relation to an accident.
Depending on the insurance accident, at the request of the
Insured or a person acting on his/her behalf, PZU SA
organizes and covers the costs of the following assistance
services:
1) Medical assistance
PZU SA organizes and covers the costs of medical
assistance, up to PLN 2 000.00 for all the services listed
below, with relation to each insurance accident:
a) physician’s house call– organization of a single
physician’s call at the Insured’s place of stay and cover
the costs of physician’s fee and travel costs, PZU SA does
not cover the costs of additional diagnostic tests ordered
by the physician during such visit, or,
b) medical consultations of the Insured at a medical
facility– organizing a physician’s visit of the Insured at a
medical facility designated by the PZU Emergency Centre
and covering the physician’s fee; PZU SA does not cover
the costs of additional diagnostic tests ordered by the
physician during such visit; at the request of the Insured
PZU SA organizes transport to the medical facility and
covers its cost,
c) nurse’s house call– if the Insured’s condition requires
a nurse’s visit at his/her place of stay, PZU SA
organizes and covers the cost of the nurse’s commute
to the Insured’s home and her fees; this service includes
the performance of medical procedures ordered
by the attending physician,
d) transport – organizing and covering the costs of
transporting the Insured:
- to an appropriate medical facility from
the location of the Insured’s stay or the
location of the insurance accident,
- between medical facilities where
medical assistance was provided or if
the Insured is referred to specialist
tests or surgical procedure at another
medical facility,
to another hospital, if the medical
facility where the Insured is being
hospitalized does not guarantee
appropriate care for the Insured’s
condition,
- from the medical facility to the
Insured’s place of stay after providing
medical assistance, if according to the
orders of the attending physician the
Insured should not use own transport
means or local public transport;
2) Rehabilitation and nursing care
PZU SA ensures:
a) organization of the rehabilitation process – if the
attending physician ordered rehabilitation procedures,
PZU SA organizes and covers the cost of a physical
therapist’s visits (therapist’s fee and costs of commute) at
the Insured’s place of stay or organizes and covers the
costs of transporting the Insured to a rehabilitation
outpatient clinic and the costs of rehabilitation procedures
performed at that outpatient clinic; this benefit is
provided up to the total amount of PLN 500.00 per each
insurance accident and the location where the procedures
are performed is determined by the attending physician of
the Insured;
b) delivery of small rehabilitation or medical
equipment – if the Insured, according to
recommendations of the attending physician, should use
certain rehabilitation or medical equipment at home, PZU
SA organizes and covers the costs of an information
service regarding the stores or rental stores offering
rehabilitation equipment. PZU SA also organizes and
covers the cost of transporting small rehabilitation
equipment to the Insured’s place of stay; this benefit is
provided up to the total amount of PLN 300.00 and the
cost of renting or purchasing the equipment is covered by
the Insured;
c) delivery of drugs prescribed by a doctor to the
d) Insured’s place of stay – if according to the physician’s
order the Insured has to stay at home, PZU SA organizes
and covers the costs of delivering the necessary drugs
prescribed by the doctor if they are available in the
Republic of Poland; if the Insured needs also OTC drugs
which are available at the same location as the
prescription drugs, PZU SA shall deliver the OTC drugs
indicated by the Insured; this benefit is performed up to
the amount of PLN 300.00 and the costs of the drugs are
covered by the Insured;
e) home nursing care after hospitalization – if the
Insured is hospitalized for longer than 2 days in
consequence of the insurance accident, PZU SA organizes
and covers the cost of nurse’s care (costs of nurse’s
commute and her fees) following the completion of
hospitalization, at the Insured’s place of stay; The
justification for the home nursing is determined by the
attending physician of the Insured; the service is
performed up to the amount of PLN 1 000.00 per each
insurance accident;;
3) Psychological assistance
If as the result of the accident covered by PZU SA liability
the Insured suffers severe bodily injuries, or as the result
of the accident in which the Insured participated the
following occurs:
 a) death of the Insured’s spouse, or
b) death of the Insured’s child, or
c) death of the parents of the Insured or of the Insured’s
spouse,
d) death of a pupil from the Insured’s class and the Insured
reports the need for psychological assistance, PZU SA
organizes and covers the costs of the Insured’s
consultations with a psychologist, in a number
recommended by the psychologist during the first such
visit, up to the total amount of PLN 1 500.00. If as the
result of the insurance accident covered by PZU SA
liability the Insured dies, the spouse, children and parents
of the Insured are entitled to the psychological assistance
described above; PZU SA organizes and covers the costs
of that person’s consultations with a psychologist, in a
number recommended by the psychologist during the first
such visit, up to the total amount of PLN 1 500.00 per
each such person;
4) Private tuition for students of primary schools, lower
secondary schools and upper secondary schools,
excluding students of post-secondary schools
pursuant to the Act on the education system – if due to
an insurance accident the student is unable to attend school
for more than 10 days from the date of the insurance
accident, PZU SA organizes and covers the costs of individual
tuition on up to 2 selected subjects covered by the school
syllabus, up to PLN 400.00 per each insurance accident;;
5) Medical hotline and telephone consultations with
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
Centre, who within his/her professional capacity provides
verbal information to the Insured regarding proceedings tied
to medical care. This information does not cover issues of
diagnosis and treatment.
BENEFITS IN EXTENDED INSURANCE COVER SCOPE
ADDITIONAL BENEFITS
§ 13
At the request of the Policyholder the insurance contract concluded
under option I or option Ii or option II Bis may include the following
additional benefits upon the payment of additional premium:
1) refund of treatment costs – including rehabilitation
costs, in the amount specified in the insurance contract;
2) lump-sum benefit for the period of a temporary
inability to study or work – for one day of inability in the
amount specified in the insurance contract;
3) hospital per diem as a result of an accident– per one
day of a stay in hospital in the amount specified in the
insurance contract;
4) hospital per diem as a result of an illness– per one
day of a stay in hospital in the amount specified in the
insurance contract;
5) refund of flat adoption costs to permanent disturbance
of health resulting from an insurance accident in the
amount specified in an insurance contract;
6) one-time benefit due to sepsis occurrence - in the
amount specified in an insurance contract;
7) one-time benefit in the case of a death of the
Insured
8) caused by a malicious tumour – in the amount specified
in an insurance contract;
9) one-time benefit in the case of a death of a child due
to a congenital cardiac defect – in the amount specified
in an insurance contract;
10) one-time benefit in the case of amputation of a
limb or a part of a limb caused by a malicious
tumour in a child– in the amount specified in an
insurance contract;
11) one-time benefit in the case of death of a statutory
representative due to an accident – in the amount
specified in an insurance contract;
12) one-time benefit in the case of death as result of a
traffic accident – in the amount specified in an insurance
contract;
13) one-time benefit in the case of an occurrence of a
serious illness – in the amount specified in an insurance
contract;
14) one-time benefit in the case of an occurrence of a
virus infection due to an occupational exposure to a
contagious material – in the amount specified in an
insurance contract;
15) refund of treatment costs incurred due to an
occupational exposition to a contagious material – in
the amount specified in an insurance contract.
RULES OF AWARDING ADDITIONAL BENEFITS REFERRED
TO IN § 13
REFUND OF TREATMENT COSTS
§ 14
1. The treatment costs, in that rehabilitation costs, are refunded if
there were fulfilled cumulatively the following conditions:
1) They were incurred in connection with a treatment of the
consequences of:
a) an accident, bodily injuries caused as a result of an
attack of epilepsy or syncope other than a chronic
disease;
b) 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 world region threatened by
acts of terrorism, acts of war, martial law or state of
emergency, unless an insurance contract covers
consequences of an insurance contract of this type;
2) they were substantiated from a medical point of view;
3) a necessity to bear treatment costs arouse not later than
within a period of 24 months counted from a date of
events, referred to in par. 1;
4) in the case of rehabilitation – if a necessity of its
performance arouses not later than within a period of 6
months counted from a date of events, referred to in par.
1.
2. A refund of costs, mentioned in sec. 1 takes place on the basis
of invoices and proofs of their payment, however maximally up
to an amount of a limit determined in the insurance contract per
one insurance accident.
3. Within a frame of the limit, mentioned in sec. 2, are also
covered costs of:
 1) the Insurer’s accommodation within a rehabilitation period
in a locality, in which rehabilitation is performed, if a
rehabilitation centre is located at least 100 km from the
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
case of the Insured’s hospitalization after an insurance
accident in a hospital located at least 100 km from the
Insurer’s place of residence – up to an amount of 150 PLN
per 24h and max. up to 10 days and nights;
LUMP-SUM BENEFIT FOR THE PERIOD OF TEMPORARY
INABILITY TO STUDY OR WORK
§ 15
1. This lump sum is due to the Insured with regard to a
consequence of:
1) an accident, bodily injuries caused as a result of an attack of
epilepsy or syncope other than a chronic disease;
2. 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 world region threatened by acts of terrorism, acts
of war, martial law or state of emergency, unless an insurance
contract covers consequences of an insurance contract of this
type;
3. The lump sum is paid out for each day of inability, in this
inability to work or study lasts continuously longer than 14 days.
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
later than within a period of 24 month counted from a date of
an insurance accident.
6. The lump sum may be paid out on the basis of:
1) a certificate issued an attending physician, issued according
to the applicable law provisions or
2) an opinion issued by a medical examiner indicated by PZU SA
or
3) in the case of insured minors in the event of an inability to
study that lasts no longer than 30 days – a statement of the
statutory representative.
HOSPITAL PER DIEM AS A RESULT OF AN ACCIDENT
§ 16
1. The hospital per diem is paid out – for each day of a
hospitalisation, subject to sec. 3:
1) as a consequence of:
a) an accident, bodily injuries caused as a result of an attack of
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
world region threatened by acts of terrorism, acts of war,
martial law or state of emergency, unless an insurance contract
covers consequences of an insurance contract of this type;
2) if a necessity to hospitalise occurred not later than within
a period of 24 month counted from a date of an
insurance accident.
2. The hospital per diem is due maximally within a period of 60
days due to one and all events, referred to in par 1.
3. The hospital per diem is paid out from the 1st day of the
hospitalization of the Insured provided that, the hospitalization
lasts at least 3 days.
4. The hospital per diem is paid out on the basis of a Hospital
Discharge Summary Report issued by a hospital that confirms
the Insured’s hospitalisation.
HOSPITAL PER DIEM AS A RESULT OF AN ILLNESS
OTHER THAN A CHRONIC ILLNESS
§ 17
1. The hospital per diem is paid out – for each day of a
hospitalisation, subject to sec. 2.
2. The hospital per diem is paid out from the 1st day of the
hospitalization of the Insured provided that, the hospitalization
lasts at least 6 days and is paid out maximally within a period of
60 days due to one and all reasons of the hospitalization.
3. The hospital per diem is paid out on the basis of a Hospital
Discharge Summary Report issued by a hospital that confirms
the Insured’s hospitalization.
4. The hospital per diem is due, when a necessity of the
hospitalization arouses during an insurance term.
5. By a chronic illness should be understood an illness that
occurred (diagnosed or not diagnosed) prior to commencing the
insurance contract, with a long-term course usually lasting
throughout months or years, for which the insured suffered on a
date of concluding the insurance contract, whether it required a
medical intervention or not on the date of concluding the
insurance contract.
REFUND OF FLAT ADOPTION COSTS
§ 18
1. The refund of these costs is due if as a consequence of an
insurance accident the Insured is a subject to permanent
deterioration to health and with regard to this there is a
necessity to adopt its place of residence to the resulting
permanent deterioration to health.
2. The refund of the costs mentioned in sec. 1 is due, if a
necessity to adopt a place of residence occurs not later than
within 24 months counted from a date of determining a
permanent deterioration to health.
BENEFIT DUE TO SEPSIS OCCURENCE
§ 19
1. This benefit is due to the Insured in case when sepsis occurs in
him/her.
2. The benefit referred to in sec. 1, is paid out provided that a fact
of a sepsis occurrence took place within an insurance term.
ONE-TIME BENEFIT IN THE CASE OF DEATH OF THE
INSURED CAUSED BY A MALICIOUS TUMOUR
§ 20
1. The benefit is paid out to the beneficiary in the amount
specified in the insurance contract.
2. The benefit referred to in sec. 1, is paid out provided that a
death of the Insured took place within an insurance term.
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.
ONE-TIME BENEFIT IN THE CASE OF DEATH OF A CHILD
DUE TO A CONGENITAL CARDIAC DEFECT
§ 21
1. The benefit is paid out to the beneficiary in the amount
specified in the insurance contract.
2. The benefit referred to in sec. 1, is paid out provided that a
death of the Insured took place within an insurance term.
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.
ONE-TIME BENEFIT IN THE CASE OF AMPUTATION OF A
LIMB OR PART OF LIMB CAUSED BY A MALICIOUS TUMOUR
IN A CHILD
§ 22
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
amputation of a limb or a part of a limb in the Insured took
place within an insurance period.
3. The pay-out of the benefit mentioned sec. 1 is performed on the
basis of a medical documentation delivered to PZU SA that is
necessary to determine this health condition and an amputation
reason.
ONE-TIME BENEFIT IN THE CASE OF DEATH OF STATUTORY
REPRESENTATIVE DUE TO AN ACCIDENT
§ 23
4. The one-time benefit in the case of death of statutory
representative due to an accident – is paid out to the Insured in
the amount specified in the insurance contract.
1. The benefit referred to in sec. 1, is paid out provided that a
death of the statutory representative took place as a result of an
insurance accident, which took place within an insurance period,
and the death took place within 24 months from a date of an
occurrence of the insurance accident.
2. 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.
ONE-TIME BENEFIT IN THE CASE OF DEATH AS A
RESULT OF TRAFFIC ACCIDENT
§ 24
1. The benefit is paid out to the beneficiary in the amount
specified in the insurance contract.
2. The benefit referred to in sec. 1, is paid out provided that a
death of the Insured took place within an insurance term.
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.
4. The benefit is not due when a death reason constituted a
participation of the Insured in the sport contests: aviation,
motor or motorboat ones.
ONE-TIME BENEFIT IN THE CASE OF AN OCCURRENCE OF A
SERIOUS ILLNESS
§ 25
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 a
fact of an illness occurrence took place within an insurance
period.
ONE-TIME BENEFIT IN THE CASE OF AN OCCURRENCE OF A
VIRUS INFECTION DUE TO AN OCCUPATIONAL EXPOSURE
TO A CONTAGIOUS MATERIAL
§ 26
1. The benefit is due to the Insured, who practices a medical
profession or is a pupil/student of a medical school, in the
amount specified in an insurance contract.
2. The benefit referred to in sec. 1, is paid out provided that a
virus infection was diagnosed within an insurance term.
REFUND OF TREATMENT COSTS INCURRED DUE TO AN
OCCUPATIONAL EXPOSITION TO A CONTAGIOUS
MATERIAL
§ 27
These costs are a subject of refund, if there the following conditions
are fulfilled cumulatively:
1) the costs were borne in connection with an exposition to a
contagious material, which took place within an insurance
period;
2) the costs were substantiated from a medical point of view;
3) the Insured practices a medical profession or is a pupil or a
student of a medical school.;
SUM INSURED AND LIMITS OF LIABILITY
§ 28
1. The sums insured and liability limits for basic benefits and
additional benefits included in the insurance contracts are
specified in the insurance contract.
2. The insured sums and liability limits are specified in respect of
each insurance case unless in these General Conditions is
specified otherwise with regard to a concerned benefit.
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.
4. An amendment of the insurance conditions referred to in sec. 3,
results in a necessity to recalculate a contribution for a period,
in which the amended conditions are to be applicable.
5. In the case of an amendment of the sum insured or a scope of
the insurance, PZU SA is liable under the limits of the amended
sum insured or liability scope, beginning from the first day of
making by PZU SA a statement about giving a consent for such
amendment.
EXCLUSIONS OF LIABILITY
§ 29
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
substances, psychotropic substances, new psychoactive
substances or replacement drugs within a meaning of the
 provisions on counteracting drug addiction, unless that had
no effect on the occurrence of the insurance accident;
2) as a result of an intoxication caused by nicotine, alcohol
consumption or use of abusive substances, psychotropic
substances, new psychoactive substances or replacement
drugs within a meaning of the provisions on counteracting
drug addiction, unless that had no effect on the occurrence
of the insurance accident;
3) as a result of participating in fights (excluding a defence in
necessity) by the Insured and in connection with committing
a suicide or an attempted suicide by the Insured;
4) as a result of participating by the Insured in strikes, unrests,
riots, protests, roadblocks or sabotage unless this
participation of the insured in strikes, riots, civil commotion,
protests, roadblocks or sabotage results from carrying out
official duties;
5) as a result of an accident resulting from acts of terrorism,
acts of war, war or state of emergency, which took place in a
territory of a country situated in the world region threatened
by acts of terrorism, acts of war, war or state of emergency,
unless this risk was included into the contract on the basis of
a separate insurance premium;
6) as a result of performing medical procedures, a performance
of which has an impact on a human organism regardless of
whom performed them, unless the performance of these
medical procedures was related to direct consequences of
the Insured’s accident;
7) while driving a motor vehicle by the Insured, if the Insured
did not have the license to drive the given vehicle, unless it
that had no effect on the occurrence of the insurance
accident;
8) while driving the other vehicle than a motor vehicle by the
Insured, if the Insured did not have the license to drive the
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
illnesses or medical conditions, even those, which occur
suddenly or were disclosed only as a consequence of the
insurance accident or constitute a reason of the insurance
accident, whereas an exclusion does not refer to the
consequences of bodily injuries caused as a result of an attack
of epilepsy or fainting due to the other reason than a chronic
illness, heart stroke, intra-cranial haemorrhage, sepsis,
occupational exposition to contagious material, unless the
insurance contract includes the consequences of this insurance
accident. The liability of PZU SA is also excluded for a fact of an
occurrence of the consequences of illnesses or medical
conditions, even those, which occur suddenly or was disclosed
only as a consequence of the insurance accident or constitute a
reason of the insurance accident, whereas an exclusion does not
refer to the consequences of an occurrence of sepsis, virus
infection upon an occupational exposition to contagious material
or a serious illness, unless the insurance contract includes a
fact of an occurrence of this insurance accident. If an illness of a
medical condition not covered by a liability of PZU SA has an
effect of an occurrence of an insurance accident, i.e. a reason of
the insurance accident is both an illness, and an external
reason, a liability of PZU SA includes bodily injuries, detriment to
health or death, which are a consequence of the external
reason, unless it is impossible to determine which bodily injuries
or detriment to health are exclusively a consequence of the
external reason; in this case it is assumed that the bodily
injuries or detriment to health are a consequence of the external
reason.
3. The PZU SA’s liability shall not include assistance services if the
event being the basis for organisation of such service arose:
1) with relation to or in consequence of circumstances referred
to in sec. 1, with a reservation that in the cases referred to in
sec. 1 par. 6 liability of PZU SA can be extended for the
payment of additional insurance premium;
2) as a result of illnesses or medical conditions even those,
which occur suddenly or were disclosed only as a
consequence of the insurance accident or constitute a reason
of the insurance accident, whereas an exclusion does not
refer to the consequences of an occurrence of an attack of
epilepsy or fainting due to the other reason than a chronic
illness, heart stroke, intra-cranial haemorrhage, sepsis,
occupational exposition to contagious material, unless the
insurance contract includes in its insurance cover bodily
injuries caused as a consequence of sepsis or an
occupational exposition to contagious material.
4. The liability of PZU SA shall not include liability for costs of
assistance services incurred by the Insured without any
consent of the Emergency Centre, unless getting in touch with
the Emergency Centre in a manner specified in § 43 sec. 1 was
not possible for reasons not attributable to the Insured.
5. The liability of PZU SA shall not include liability for a
compensation for an alleged pain, physical and moral suffering
and suffered damages, which consist in a los, damage or
destruction of property.
6. A fact of being in the state of inebriation or the fact of being
under the influence of abusive substances, psychotropic
substances, new psychoactive substances or replacement
drugs within a meaning of the provisions on counteracting
drug addiction, as well as the driver’s authorisation to drive the
vehicle shall be evaluated on the basis of the law of the state
in which the insurance accident occurred.
CHAPTER III
CONCLUSION OF INSURANCE CONTRACT AND ITS TERM
§ 30
1. The insurance contract can be concluded with a mutual
presence of both parties of this contract or by means of
electronic distance communication (direct contract or remote
contract).
2. The insurance contract is concluded on the basis of an
application of the Policyholder, which contains information
necessary to perform an individual risk assessment and to
determine the premium due.
3. A direct contract can be concluded provided that:
1) prior reading the Rules and Regulations and these General
and accepting them by the Policyholder;
2) a prior confirmation provided by PZU SA related to an
acceptance of the Policyholder’s application;
3) a payment of an insurance premium within a deadline
specified in the insurance contract.
A conclusion of the direct contract takes place upon a payment
of an insurance premium or its first instalment.
4. A remote contract is concluded upon a confirmation of an
acceptance of the Policyholder’s application by PZU SA and upon
a prior reading the Rules and Regulations and these General and
accepting them by the Policyholder.
5. The Insuring Party is obliged to inform PZU SA of all the
circumstances known to him/her about which PZU SA asked in
the offer form (application) or in other letters, before a
 conclusion of the insurance contract. If the Policyholder
concludes the insurance contract via a representative, this
obligation applies also to the representative and covers
circumstances known to him/her. If PZU SA concluded the
insurance contract despite lack of answers to some of the
questions, the omitted circumstances are treated as irrelevant.
6. Within a term of the insurance contract, the Policyholder is
obliged to report any changes to the circumstances listed in
section 5. The Policyholder is obliged to notify PZU SA of such
changes promptly upon receiving information about them.
7. In case of concluding the insurance contract for someone’s
behalf, the obligations defined in sections 5 and 6 rests with
both the Policyholder, and the Insured, unless the Insured was
unaware of the contract concluded on his/her behalf.
8. PZU SA shall not be liable for consequences of the
circumstances, which under a breach of sections 5-7 failed to be
communicated to him/her. If the breach of provisions contained
in sections 5-7 was caused by intentional fault, in case of any
doubts it is assumed that the insurance accident provided for
under the contract and its consequences result from the
circumstances described in the preceding sentence.
§ 31
A conclusion of the insurance contract is confirmed by an insurance
document by PZU SA.
§ 32
1. If in response to a submitted offer PZU SA delivers to the
Policyholder an insurance document, which provisions deviate to
an disadvantage of the Policyholder or the Insured in respect of
a content of an offer submitted to the policyholder, PZU SA is
obliged to pay attention to the above in the written form while
delivering this document, giving him/her at least 7-day deadline
to object. In the case of a failure to perform this obligation the
changes made to the disadvantage to the Policyholder or the
Insured are not effective, and the insurance contract is
concluded according to the conditions of the offer.
2. In the case of a failure to object, the insurance contract is
effective according to a content of the insurance document on
the next day upon an expiry of the deadline specified to object.
§ 33
1. The insurance contract is concluded for an indefinite period of
time.
2. The insurance contract is concluded as an individual contract or
a group contract in a named or unnamed form.
3. While concluding the insurance contract in a named form, the
Policyholder is obliged to deliver to PZU SA a list of the given
names and surnames of the Insured. In this case the insurance
covers only, the persons specified in the list. In the case of a
conclusion of a group insurance contract by means of distance
communication, the above-mentioned list, the Policyholder is
obliged to present it to PZU SA in a manner agreed by the
parties.
4. The group insurance contract can be concluded in a unnamed
form only in the case when it includes in its insurance cover all
persons included in a group of persons specified in this contract.
5. In the case of a conclusion of the group insurance contract, the
Policyholder is obliged to inform PZU SA about a given name,
surname and a phone number of a person who maintains the
list.
6. Unless stated otherwise in the insurance contract, in the case of
concluding the insurance contract I an unnamed form, its
insurance cover includes all persons belonging to a group
determined in the insurance contract without a need to file
applications to include by the insurance cover the new persons
and making a payment of an insurance premium ((in the case of
a change in a quantity of persons belonging to this group within
a term of the insurance contract).
§ 34
1. Subject to sec. 2-3, the liability of PZU SA commences on the
day following the conclusion of the insurance contract, but no
earlier than the day following the payment of an insurance
premium or its first instalment, unless otherwise agreed.
2. In the case when in the insurance contract is specified a day of
commencing an insurance term that is preceding to a date on
which an insurance premium or its first instalment should be
paid, the liability of PZU SA commences on a date specified in
the insurance contract as a beginning of the insurance term.
3. In the case when in the insurance contract is specified a day of
commencing an insurance term that is after a date on which an
insurance premium or its first instalment should be paid, and
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.
INSURANCE PREMIUM
§ 35
1. An insurance premium is determined on the basis of the
premium tariff as of a date of concluding the insurance contract.
The premium is calculated for the period of liability of PZU SA.
2. An amount of the insurance premium is calculated depending
on:
1) a type of school or establishment;
2) a sum insured;
3) a liability limit;
4) an insurance period;
5) an insurance option;
6) a scope of insurance;
7) a postal code of the Insured or a place of residence of the
Insured.
§ 36
1. Subject to sec. 2 and 3, the premium is paid at the time of
concluding the insurance contract, unless other manner and
dates were set forth in the insurance contract.
2. In the case of the direct contract, a payment deadline of an
insurance premium is determined on a date at the latest
preceding a date of commencing an insurance period
determined in the insurance contract.
3. On request of the Policyholder, it is permitted to make a
payment of the insurance premium in instalments, subject to
sec. 4, The deadlines to pay the respective instalments of the
insurance premium are determined from a date of concluding
the insurance contract.
4. The insurance premium is paid in cash or, subject to agreement
with PZU SA, in non-cash form.
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
amount of premium is posted in the account of PZU SA.
6. The insurance premium is not subject to indexation.
§ 37
In case of revealing circumstances which significantly change the
probability of an insurance event, each of the parties may demand
an appropriate change in the level of premium, starting from the
day the said circumstance occurred, but not earlier than from the
start of the current insurance period. If such request is submitted,
the other party may terminate the insurance contract within 14
days, with immediate effect, by making a statement within this
scope.
TERMINATION OF INSURANCE CONTRACT AND END OF
LIABILITY
REFUND OF A PREMIUM
§ 38
1. The insurance cover expires:
1) upon the expiry of the insurance period, defined in the
insurance document;
2) on the date, on which PZU SA is served a statement of the
Policyholder about a withdrawal from the insurance contract in
the case mentioned in § 39;
3) on the date, on which is served a statement about a withdrawal
from the insurance contract in the case mentioned in § 39;
4) on the date of serving to the Policyholder a statement of PZU SA
about a withdrawal from the insurance cover with immediate
effect in the case when PZU SA is liable even prior to a payment
of the insurance premium or its first instalment, and the
insurance premium or its first instalment was not paid within a
deadline;
5) upon an expiry of 7 days from serving to the Policyholder a
notice to pay a subsequent instalment of the insurance
premium, sent after its due date, with the information that a
lack of payment within 7 days from notice delivery would
cause termination of liability,
6) on the date, on which PZU SA is served a statement of the
policyholder about a withdrawal from the insurance contract
with immediate effect in the case mentioned in sec. 3;
7) on the date of a termination by mutual agreement;
8) with regard to the given Insured, on the date, on which the
Insured passes away.
2. The insurance contract can be terminated at any time by mutual
agreement.
3. The Insurer may terminate the insurance contract with
immediate effect at any time by making a statement within this
scope.
§ 39
1. The Policyholder may withdraw from the insurance contract
within 30 days, if the contract is signed for a period longer than
6 months, and when the Policyholder is an entrepreneur - within
7 days form a date of concluding the insurance contract by
making a proper statement. If at the latest upon concluding the
insurance contract, PZU SA did not informed the Policyholder
who is a consumer about his/her right to withdraw from the
insurance contract, a deadline of 30 days shall run from a date,
on which the Policyholder who is a consumer learned about this
right. A withdrawal from the contract does not release the
Policyholder from an obligation to pay an insurance premium for
a period, within which PZU SA provided an insurance cover.
2. In the case of concluding the insurance contract by means of
distance communication, in which the Policyholder is a
consumer a deadline within which he/she is entitled to withdraw
from the insurance contract by making a written statement
within this scope is of 30 days from a date of providing to
him/her information, which should be conveyed to a consumer
on the basis of the provisions on concluding the distance
contracts, if this deadline is later. The deadline is deemed to be
observed, if a statement about a withdrawal from the insurance
contract was submitted prior to its expiry.
§ 40
If the insurance cover expires before an end of period for which the
contract had been concluded, the Policyholder is entitled to a
refund of the insurance premium for the unused cover period.
CHAPTER IV
PERFORMANCE OF INSURANCE CONTRACT
PROCEDURE IN THE EVENT OF AN INSURANCE ACCIDENT
OBLIGATIONS OF THE INSURED
§ 41
1. In the case of an insurance accident, the Insured is obliged
to:
1) attempt to alleviate the results of the accident by
immediately seeking medical care and following the
recommended treatment;
2) notify PZU SA of the occurrence of insurance accident and
deliver:
a) a description of the reasons for and course of the
accident,
b) medical documentation confirming the bodily harm or
disturbance of health suffered by the Insured in
consequence of the insurance accident,
c) documents necessary to establish a justification for and
the amount of the claim;
d) invoices and proofs of payments of costs covered by the
insurance scope;
e) if the Insured was driving a vehicle at the time of the
accident – the driver’s license of the Insured;
3) enable PZU SA to obtain information tied to circumstances
described in documents listed in item 2, in particular from
the doctors who took care of the Insured, both before and
after the accident.
2. In the case of death of the Insured, the beneficiary is obliged to
present to PZU SA for inspection a copy of the Insured’s death
certificate, copy of the death statistical document or copies of
medical documentation confirming the reason for death, if
he/she is entitled to obtain such documents, and document
confirming his/her identity. If no beneficiary is named, the
person requesting a payment of benefit, referred to in § 49
section 2 is obliged to submit in addition official documents
confirming his/her marriage with or relationship to the Insured,
or documents confirming that he/she was caring for the Insured
as at the date of his/her death.
§ 42
PZU SA reserves the right to verify the provided documentation and
to seek opinion of specialist physicians.
§ 43
1. In order to use the assistance benefits referred to in § 12 sec.
13, the Insured (or the person acting on his/her behalf)
should, immediately upon the occurrence of the insurance
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
The one-time benefit in the case of no permanent disturbance of
health and any other consequences than those mentioned in the
Tables 4, 5, 7, 8, specified in Table 6 is due in the amount
corresponding to a percent of the sum insured, according to Table
no. 6 provided that in option I, the benefit is due only when there
is no permanent disturbance of health, and in option II Bis the
benefit is due only under item no 1 and no. 2 of Table no. 6.
§ 47
The refund of costs referred to in § 14 incurred outside the territory
of the Republic of Poland is done within the Republic of Poland in
Polish zloty, converted according to the average exchange rate of
the NBP as of the date of determining the indemnity.
§ 48
If the Insured was covered under several contracts for casualty
insurance concluded with PZU SA, benefits are vested under each
of such contracts, however, the refund of treatment costs, of
purchasing orthopaedic objects and auxiliary materials, and of
vocational training for disabled persons is done up to the amount
of actual and documented costs, but up to the limits resulting from
the concluded insurance contracts.
§ 49
1. The benefit under the insurance contract is paid to the
Insured, and with respect to minors – to his/her statutory
representative. The benefits are paid in Polish zloty.
2. The benefit for the death of the Insured mentioned in § 12
sec. 1, 2, 3, § 20, § 21, § 24 is paid to the beneficiary named
by the Insured, and if no beneficiary is named, to the persons
listed below according to the following order:
1) to a spouse;
2) to the children in equal parts, and in the case where one of
the children died before the Insured’s death – the share that
would be attributed to that child is attributed to the other
children in equal parts;
3) to the parents in equal parts, or whole to one of them if the
other parent died before the Insured’s death or if only one of
them has parental authority; if none of the parents has
parental authority or if the parents are unknown and
guardianship had been established for the Insured – to legal
guardians under the same rules as for the parents;
4) to the natural persons entitled to inheritance by force of
law, in parts attributed to them pursuant to provisions of the
Civil Code regarding a statutory succession. The payment of
the benefit to a person or persons belonging to the higher
category excludes a payment of the benefit to a person or
persons belonging to a lower r category (the highest category
constitutes par.1)
The Insured may at any time specify or change the beneficiary
3. In the case of a lack of an entitled beneficiary under the death
benefit due mentioned in sec. 1, PZU SA first refunds the
documented costs of burial to the person who incurred them,
within the limits of the sum insured, unless these costs were
covered by another insurance or another title.
§ 50
If PZU SA pays benefit for permanent disturbance of health and
next, within 24 months from the date of the insurance accident,
the Insured dies as a result of that insurance accident, PZU SA
pays death benefit to the beneficiary, in an amount constituting
the difference between the amount of death benefit set in the
insurance contract, and the amount of benefit paid earlier for
permanent disturbance of health.
§ 51
1. In the case of death of the Insured not caused by the
insurance accident, and before the Insured received the benefit
for permanent disturbance of health, PZU SA pays the benefit
for the permanent Detriment to the heirs of the Insured. If the
permanent disturbance of health had not been determined
before the death of the Insured, the most probable degree of
permanent disturbance of health is used to determine the
amount of benefit, determined according to § 11 on the basis
of submitted medical documentation.
2. Subject to sec. 1, in the case of the death of the
Insured prior to receiving by him/her a benefit under the
insurance contract, PZU SA pays this benefit to the Insured’s
heirs.
§ 52
1. PZU SA shall be obliged:
Insured of that fact, if they are not the persons making that
notification, and to undertake actions meant to establish the
facts of the case, the justification for the reported claims and
amount of benefit; and also to inform the person putting forth
the claim in writing or in another form that this person had
approved on what documents are necessary to establish the
liability of PZU SA or the amount of indemnity, if this is
necessary for the further course of the proceedings;
2) if within the dates specified in sections 2 and 3 it does not pay
benefit, to notify in writing:
a) a person reporting the claim,
b) the Insured in the case of the insurance contract concluded
to the benefit of the third-party, if he/she is not a claimant
- on the reasons why his/her claims cannot be satisfied, in
whole or in part, and also to pay the unquestioned portion of
benefit;
3) if the benefit is not due, or is due in an amount different from
the one defined in the reported claim, to inform of this fact in
writing:
a) a person reporting the claim,
b) the Insured in the case of the insurance contract concluded
to the benefit of the third-party, if he/she is not a claimant
identifying the circumstances and a legal justification for the full
or partial refusal to pay the benefit, as well as informing the
claimant of the possibility to pursue the claim in court;
4) to make available to the Policyholder, the Insured, the claimant
and to the beneficiary under the insurance contract, information
and documents collected in order to determine the liability of
PZU SA or the amount of benefit. These persons may demand a
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) upon a request of the Policyholder, the Insured, the beneficiary
or the person entitled under the insurance contract, to make
available any information it possesses, tied to the insurance
accident and being the basis to determine the liability of PZU
SA, and to determine the circumstances of the insurance
accident, as well as the amount of benefit;
7) upon a request of the Policyholder, the Insured, the beneficiary
or the person entitled under the insurance contract, to make
available any information it possesses about the statements
made at the stage of a conclusion of the insurance contract for
the purposes of an assessment of the insurance risk or copies of
the documents drawn up at this stage.
2. PZU SA is obliged to pay the benefit within 30 days from the
date of receiving a notification of the insurance accident.
3. If within the timeframe specified above it is not possible to
clarify all circumstances needed to establish the liability of PZU
SA or the amount of benefit, the benefit should be provided
within 14 days from the date when clarification of such
circumstances became possible with due diligence. However,
the unquestioned portion of benefit should be paid by PZU SA
within the timeframe defined in section 2.
CHAPTER V
FINAL PROVISIONS
§ 53
1. The policyholder, insured, beneficiary and person entitled under
the insurance agreement who is a natural person shall have the
right to file a complaint within the meaning of the Act on
Examination of Complaints by Financial Market Participants and
on the Financial Ombudsman, i.e. the right of addressing a
notice to PZU SA with concerns regarding any services provided
by PZU SA.
2. The complaints or grievances should be addressed to the
organisational unit of PZU SA that handles the client.
3. The compliant can be lodged in the following form:
1) in writing – in person or sent by mail within the meaning of
the Postal Law Act, for example by sending a letter to the
following address: PZU SA ul. Postępu 18A, 02-676 Warsaw
(mailing address only);
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
referred to in sec. 2;
3) electronically – by sending an e-mail to reklamacje@pzu.pl or
by filling out an online form at www.pzu.pl.
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
the complaint, subject to sec. 5.
5. In particularly difficult cases preventing the examination of the
complaint and the provision of a reply within the deadline
referred to in sec. 4, PZU SA shall provide the person who has
filed the complaint with information in which it shall:
1) explain the reason for the delay;
2) indicate the circumstances that must be ascertained to
enable the examination of the case;
3) specify the anticipated date of examination of the complaint
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
Fee according to an operator tariff
6. PZU SA’s reply to the complaint shall be delivered to the
person who has filed it on paper or through other durable
carrier of information within the meaning of the Payment
Services Act or by e-mail only at the request of such person.
7. The client referred to in sec. 1 shall be entitled to file an
application with the Financial Ombudsman concerning:
1) rejection of claims in the complaint examination procedure;
2) failure to perform activities resulting from a complaint
handled in accordance with such person’s will within the
deadline specified in the reply to the complaint.
8. A complaint or grievance, which is not the complaint referred
to in sec. 1 shall be submitted in writing through any PZU SA’s
organizational unit.
9. Complaints and grievances shall be reviewed by the
organisational unit specified in PZU SA’s internal regulations
prevailing as of the date of the complaint or grievance. The
information in this respect shall be available in PZU SA’s
organisational units.
10. PZU SA shall respond to written complaints or grievances
within 30 days of the date of receipt of such a complaint or
grievance.
11. The entity within a meaning of the Act on extrajudicial
settlement of consumer disputes, competent in respect of PZU
SA for the purposes of extrajudicial settlement of disputes, is
the Financial Ombudsmen, which web site has the following
address: www.rf.gov.pl.
12. In the case of the insurance contracts concluded by means of
the Internet, the consumer has a right to use an extrajudicial
settlement of disputes and file a complaint with an
intermediary of the Online Dispute Resolution Platform (ODR)
according to the Regulation (EU) No 524/2013 of the European
Parliament and of the Council of 21 May 2013 – address:
http://ec.europa.eu/consumers/odr/. The European
Commission is responsible for operating the ODR Platform. A
contact e-mail address of PZU SA is as follows:
reklamacje@pzu.pl.
13. The policyholder, insured, beneficiary and person entitled
under the insurance agreement who is a consumer shall have
the right to request assistance from the Municipal and Regional
Consumer Ombudsmen.
14. PZU SA is supervised by the Polish Financial Supervision
Authority (KNF).
15. The language used by PZU SA in the relations with the
consumer is Polish
§ 54
1. Any litigation for claims under the insurance contract may be
initiated either pursuant to general jurisdiction regulations or
before the court with jurisdiction over the place of residence or
registered office of the Policyholder, the Insured or the person
entitled under the insurance contract.
2. Any litigation for claims under the insurance contract may be
initiated either pursuant to general jurisdiction regulations or
before the court with jurisdiction over the place of residence of
the Insured’s heir or the heir of the person entitled under the
insurance contract.
PZU SA 7B13/II