• In case of an accident, can the Insured advance payment to the Third Party and ask for reimbursement expense?

 

Except in case of emergency medical expenses, this procedure should be avoided as it may lead to problems if the Insurer finds that the Insured is not legally liable or that the amount settled is excessive.

 

• What is COC? Is this different from CTPL?

 

This means Certificate of Cover. It refers to the document presented to the Land Transportation Office for registration of the vehicle as evidence of a CTPL cover.

 

 

• How do we determine the amount of Loss and Damage cover?

 

The amount of the Loss and Damage cover of the vehicle is based on the Fair Market Value Table prepared by the Motor Unit of the Company. The Table is regularly updated and values are referred from major dailies and/or Buy and Sell magazines.

 

• What is No Fault Indemnity?

 

This is the maximum amount the insurance company is required to pay a third party injured or killed in an accident involving the insured vehicle without the necessity of proving fault or negligence on the part of the insured. The limit under this benefit is Ps.10,000.00 per person.A third party claims under the No Fault Indemnity but actual expenses exceed Ps.10,000.00.

 

• May the third party still claim further?

 

Settlement under the no fault provision does not prevent the third party from pursuing his claim further. A third party claimant is not required to sign a “quit claim” if settlement is under the no fault provision.

 

• How does one claim under the No Fault Indemnity?

 

The following documents have to be presented:i. Police report or accident or any evidence sufficient to establish the accident, and ii. Medical report and evidence of medical or hospital expenses and/or; iii. Death Certificate and evidence sufficient to establish the proper payee

 

• What types of damages are covered?

 

Damages due to the following:

a) Accidental collision or overturning

b) Fire, external explosion, self-ignition

c) Lightning

d) Burglary, housebreaking or theft

e) malicious acts other than those caused by the insured, a member of his family or person in his service.

 

• What damages are NOT covered?

 

Damages due to the following:

a) Losses within the policy deductible

b) Consequential Loss

c) Damage to tires (unless the Scheduled Vehicle is damaged at the same time)

d) Any malicious damage caused by the Insured, member of his family, or person under    his service

e) Losses due to Acts of Nature (unless covered under Total Protector, Auto Mas Total or by additional Endorsement)

f) Damaged caused by overloading (For commercial vehicles only)

g) Damage caused by explosion of any boiler forming part of, attached to or on the Scheduled Vehicle.

 

• Is the vehicle covered while being transported?

 

Coverage continues during transit by land, inland waterway, lift or elevator. Coverage does not extend to transit by inter-island vessels navigating on open seas or by aircraft.

 

• Is the vehicle covered while being towed?

 

The vehicle continues to be covered while being towed provided the damage is due to the causes listed above (Item 1). Note that collision damage should be accidental. Thus, if the damage is due to improper towing this cannot be considered accidental.

 

• What does “excess” or “voluntary” liability mean?

 

This refers to the amount “in excess” of or exceeding the coverage provided by CTPL.

 

• What is the meaning of deductible?

 

This refers to the amount of loss or damage below for which the Company shall not be liable.

 

The following are the standard deductibles under the Motor Tariff:

Private Car 0.5% of Sum Insured under Sec. III – Loss & damage, minimum of PhP 2,000. Commercial Vehicles 1.0% of sum insured under Sec. II – Loss and damage, minimum of PhP 3,000. Land Transportation Operators 1.25% of sum insured under Sec. II – Loss and damage, minimum of PhP 4,000. Motorcycles 1.0% of sum insured under Sec. II – Loss and damage, minimum of PhP 500.

 

• Can the deductible be reduced or increased?

 

The deductible may not be reduced as this is the minimum amount prescribed by the tariff but this may be increased. If the deductible is increased, the insured may be entitled to a discount on the premium rate. The number of deductibles applicable is based on the number of incidents. If the specific circumstances of an incident are not known, the adjuster shall base the number of deductibles applicable on the logical appreciation of the nature and characteristics of the damages.

 

• Can I use surplus parts to avoid paying depreciation?

 

Yes, surplus parts are not subject to depreciation. An insured shall inform the adjuster if he prefers to use surplus parts to avoid paying depreciation; however, this is only recommended for collision parts (e.g. fender, bumper, door), and not for mechanical parts (e.g. suspension, tire rod, fuel tank, transmission, engine).

 

• Can I get a refund on my deductible and/or depreciation?

 

If liability for the accident is attributable to an identified third party, the Company’s legal unit shall, upon settlement of the own damage claim, initiate recovery action against the erring third party or third party insurer. The assured’s participation (i.e., deductible and depreciation) shall be included in the claim and if successful, the same shall be refunded to the insured. The Company, however, shall have prior rights to the amount recovered and does not in any way guarantee the return of the assured’s participation. If the accident is clearly due to the negligence of the third party it is recommended that the assured pursue his claim against the third party’s insurer. In this instance, we shall issue the assured a Certificate of No Claim, to avoid incurring expenses for the deductible and depreciation.

 

• May the insured insist on the mode of settlement of his claim?

 

No, the decision to either pay in cash the amount of loss or damage, repair or replace the scheduled vehicle is the option of the insurer. (Condition 2, Section III)

 

• If the insured unit were carnapped or declared a total loss, could the insured insist on settlement based on the limit of liability under Section 1-Loss and Damage?

 

In case of a total loss of the insured vehicle, the amount of settlement shall be based on the fair market value of the unit at the time of loss but not to exceed the limit of liability under the policy. If the fair market value at the time of loss is less than the policy limit, the insurer should only pay the amount equivalent to the estimated fair market value.

 

• In the event the Insured sells the insured vehicle, does the insurance cover go with it?

 

Only the CTPL cover will automatically be transferred to the new owner. An insurance policy is a personal contract and does not transfer automatically with the change of ownership. In order to avail of the policy benefits, the original Insured has to make a written request to transfer the policy to the new owner. Such request has to be approved by the Insurance Company and an endorsement to the policy has to be issued reflecting the new owner as the new named Insured.

 

• Are accessories of one’s car insured?

 

Standard accessories are covered. However, the company shall not be liable for any claim in respect of loss or damage to accessories of the insured vehicle other than standard factory equipment and any other non-standard factory-fitted accessories unless such accessories are specifically declared to the Company and noted in the policy with individual sums insured applicable to each item. In respect of loss or damage to the standard factory-fitted accessories, the Company has the option to replace these accessories with an equivalent model of the same brand not necessarily bearing the car manufacturer’s name.  Also, the company will not be liable in respect of loss or damage to “hubcaps” whether such are factory or non-factory fitted. 

 

FIRE INSURANCE COVERAGE.

 

• Who may insure?

 

Owners and tenants who have insurable interest over the properties they want to insure.

 

• What factors affect the premium rate?

 

The following are the factors that can affect the premium rate:

 

1. • Construction

2. • Occupancy

3. • Location

4. • Exposure

 

• Under what circumstance can one file a claim?

 

The fire must have flame or ignition of sustaining velocity, be hostile, accidental origin, and must be the proximate cause of loss or damage..

 

• When is a cause proximate?

 

Proximate cause simply means the primary effective or root cause, or the cause that triggered a series of events.

 

• Can personal effects be covered?

 

Yes, personal effects such as clothes, bags, and the like are covered; however, works of art, jewelries, manuscripts, documents of any kind, collector’s items, and other valuable items are not.

 

•  Is there a way to compute for the value of my property?

 

Yes, we can give you “estimate” for the values of your property, on the building only.

 

Example:

·   Get the floor area of building 100 sq. m.

·   Multiply by reconstruction cost/sq.m. x P17,000

·   Equals the Replacement Value 1,700,000

·   Deduct Accumulated Depreciation - 170,000

·   Equals the Sound Value P 1,530,000

 

For your contents, a list of the items you want to insure with corresponding values will be required.

 

 

• If the insured is spouses, or multiple names, do they get the full amount for legal assistance and/or bereavement assistance if only one of them is affected?

 

The assured will receive the full amount as stated, whether only one or all are affected. These benefits, however, may only be used once collectively.

 

ACCIDENT INSURANCE COVERAGE

 

• If I missed to declare my designated beneficiary, which of my relatives are entitled to claim the Insurance proceeds in case of death?

 

In the absence of a named beneficiary, the beneficiary will be the estate of the insured or any relative by blood or connection by marriage who is deemed by the Company to be equitably entitled thereto.

 

• Is there a limitation to geographic scope of coverage?

 

No. The coverage is worldwide, 24 hours a day, 7 days a week, 365 days a year.

 

• Can I apply for more than one policy?

 

Yes. An insured may avail of more than one personal accident insurance provided that the limit of his coverage does not exceed the maximum benefit allowed based on the percentage of his Gross Annual Income.

 

• Is motorcycling automatically covered?

 

No. Motorcycling is not automatically covered. One may request subject to underwriting approval.

 

• Up to what age can I be allowed to get Personal Accident Insurance?

 

Individuals between 1-60 years old may avail of personal accident insurance. However, minors between 1-16 years old should be accompanied and represented by their guardian upon applying. Clients who wish to renew their policies may do so until they reach 65 years old.

 

• Is Unprovoked Murder and Assault automatically covered?

 

No. Unprovoked murder and assault is subject to underwriting approval depending on the nature of occupation of the applicant.

 

• Can I automatically avail of a high coverage under Personal Accident?

 

The limit of coverage is normally based on the insured’s gross annual income and his/her occupation.

 

• What is a pre-existing illness? Is this covered?

 

Pre-existing illness is defined as any illness or medical condition already affecting the insured, whether known or unknown to the insured, before the effectivity date of his/her coverage. No. The company does not cover losses attributable to pre-existing illness.

 

• What is the maximum limit of benefits of the Company will provide for self-employed individuals?

 

For self employed individuals, the maximum coverage allowed will be determined based on the insured’s Gross Annual Income during the previous year, verifiable through his/her Income Tax Return (ITR)

 

A. ASAP

 

• I have 5 children , the eldest is graduating from college and the youngest just entering pre-school, will the coverage of my eldest transfer to my youngest child?

 

Yes. The coverage is intended to cover the educational expenses of ANY four (4) currently studying children for the first five years of the insured’s death.

 

• How do I claim monthly shelter allowance benefit? Monthly Pension?

 

The company shall pay the monthly shelter allowance and the monthly pension in full lump sum amount, which the beneficiaries may claim together with all the other benefits.

 

• If a dependent were hospitalized due to  sickness a year after the insured/s death, will he/she be covered?

 

Yes. If the insured dies, the Company will pay for the hospitalization expenses of his/her dependents up to the policy limit for the first five (5) years of his/her absence whether or not the dependent’s confinement is caused by an accident or sickness.

 

B. HELP

 

• Will my domestic employee be covered on her day off?

 

Yes. The domestic employee is covered for as long as he/she is employed with you. Coverage ceases to attach upon his/her termination or replacement.

 

• Is the coverage transferable in case my domestic employee resigns?

 

Yes. As soon as the previous domestic employee leaves her coverage automatically ceases. The coverage will be extended to your new domestic employee provided that you inform the insurance company of the changes made.

 

• How many times can I be allowed to transfer the coverage?

 

The insured may transfer the coverage to his/her new domestic employee up to two (2) times each year.

 

• How much can a domestic employee claim in case he/she dies whilst riding the employer’s vehicle?

 

A domestic employee is entitled to twice the face value in case he/she dies due to an accident whilst riding the employer’s vehicle.

 

C. HOSPITAL CASH PROTECTION PLAN

 

• Can I claim if I were treated as an outpatient?

 

No. The insured must be confined as a resident patient for atleast 24 hours in a licensed hospital or clinic registered with the Bureau of Medical Services in order to be entitled to the daily cash benefits.

 

• When will the benefits received?

 

The applicable cash benefits will be paid upon the covered person’s discharge from the hospital. However, advance payment may be requested for confinement exceeding 14 days.

 

• To whom will the Company pay the benefits?

 

Mapfre Insular pays all the cash payables directly to the insured and not to the hospital. This allows the insured to use the money in any way he wants – for medicines, laboratory fees, etc.

 

• If I were hospitalized due to a continuing sickness after the policy has expired, would I still be covered?

 

Yes, the Company will still pay for the daily benefits provided the confinement is within one year from the first confinement and is due to the same and continuing sickness.

 

• After earning 20% increase in hospitalization benefit limit for two (2) consecutive claim-free years, will my benefits revert to its original limit after a claim?

 

No. The increased hospital benefit limit shall remain the same.

 

TRAVEL INSURANCE

 

• How does cashless medical assistance work?

 

It is like having a Health Medical Organization (HMO) card with network of providers worldwide.

 

 

• What necessary steps do I have to take in case I contract a sickness during the course of my trip?

 

Requisite to availment of the benefits, the insured must immediately telephone the assigned hotline number (632) 4594727 and give the following information

1. Personal Information

2. Policy Number

3. Contact Numbers (mobile/hotel/residence)

4. Location

5. Sickness/injury

 

• If I lost my luggage deposited or checked-in during my flight, what steps should I take in order to claim?

 

Step 1: Immediately notify the Customer Service of the airline company

Step 2: Call the MAPFRE insular hotline number (632) 4594727  to report the incident. They will provide you with a step guide on how to formalize your claim.

 

• When does the policy start and cease to attach?

 

The policy starts an hour before the scheduled departure, continues during the course of his/her travel and ceases one hour after the scheduled or actual arrival whichever comes first.