These are the conditions applying to your Direct Line Life Cover with Critical Illness.
  • Please read them carefully and keep in a safe place.
  • Should you require another copy of these conditions, a copy will be supplied to you on request.
  • If they do not meet your requirements, please phone us at once.
  • Any enquiry about your Life Cover with Critical Illness should be addressed to the office whose address and phone number is shown on the insurance schedule.
OUR PROMISE TO YOU

...is that we will always be fair and reasonable. We will also act quickly to provide the benefit of the protection this cover gives you.

Should there ever be an occasion when you feel we have failed to honour our promise, please contact the company at the address shown on the insurance schedule. You can phone or write in with your complaint to us.

Upon receipt of your complaint we will investigate it promptly.

At the completion of the investigation into your complaint we will send you a letter explaining the outcome of the investigation.

We will also give you details of the Financial Ombudsman Services, to whom you can write if you are not satisfied with the outcome of our investigation.

Should our investigation not be complete within two months we will write to you informing you of the position in relation to your complaint and your right to refer your complaint to the Financial Ombudsman Services if you are not satisfied with our investigation. Please note that the Financial Ombudsman Services can only investigate your complaint after we have had the opportunity to do so. The address of the Financial Ombudsman Services is available on request.

Direct Line Life Insurance Company Limited is Authorised and Regulated by the Financial Services Authority.


CONTENTS

Introduction

About your cover

Direct Line Fixed Term Life Cover

Direct Line Mortgage Life Cover

Critical Illness Benefit

Critical Illness Definitions

Exclusions

Suicide

Specific Exclusion Relating to Critical Illness Benefit

Terminal Illness Benefit

Specific Exclusion Relating to Terminal Illness Benefit

Optional Benefit

Joint Lives - First Death or First Diagnosis

Conditions

Truthful Disclosure and Compliance with Conditions

Random Sampling

Payment of Premiums

Reinstatement of Lapsed Policy

Claims

Special Provisions for the Critical Illness Claims

Special Provisions for the Terminal Illness Claims

Surrender

Alterations

Policy Alterations

Variation to Premium Level

Other Misrepresentations

Notice of Assignment or Assignation

Currency of Payments

Applicable Law

General

Meanings of words

INTRODUCTION

This document provides details for a policy providing Fixed Term Life Cover or Mortgage Life Cover with Critical Illness Benefit. Taken together with your insurance schedule and any endorsement(s) it forms the terms of the contract between us, Direct Line Life Insurance Company Ltd, and you, our customer. The information contained in the proposal form and in any other supplementary proposals signed by you forms the basis of the contract.

We will provide cover as shown in the insurance schedule during the period of insurance on the terms set out in this document in return for the payment of the premiums as set out in the insurance schedule.

Payment of the claims made under this cover depend upon it being proved to the Company's satisfaction that:

i.) the date of birth of the life insured is as shown in the insurance schedule;

ii.) during the period of insurance, which cannot be beyond the age of 70, the life insured suffers an insured event;

iii.) the insurance schedule shows that cover has been taken out with us for that event;

iv.) the claimant is legally entitled to the policy proceeds;

v.) best endeavours have been made to ensure that statements made in support of the proposal for insurance are complete and correct and that all other factors which may be material in respect of the cover given have been disclosed; and

vi.) the policy is still in force.

The words 'he', 'him', and 'his' should read 'she', 'her', and 'hers' where appropriate. The words 'life insured' should read 'lives insured' where appropriate.

Commentary

Meanings of words:

Please read this document and insurance schedule carefully and keep them safe. To help you understand the cover, insurance schedule and any endorsement, somewords (which are listed at the beginning of each section) have been given a particular meaning. If you wish to know what these words are and their meaning please refer to the section headed Meaning of words.

Notes to help you understand your policy:

This is a legal document and although it may seem complicated we have provided explanations in the right-hand margin (just like this information you are reading now). However, please note these explanatory notes are here to help you understand your cover. They do not form part of the contract between us.

ABOUT YOUR COVER

Your insurance schedule will indicate the cover you have chosen.

You have selected one or more policies from Direct Line Life Insurance Company Limited. Information on each type of policy is listed below.

Commentary

Your choice of cover is shown in the insurance schedule. If this does not now meet your requirements, please phone us at once on the Helpline.

As the aim of the cover is to help to protect your family's lifestyle rather than to act as a form of investment, the policies do not have any cash-in-value.


DIRECT LINE FIXED TERM LIFE COVER

The words below, which are used in this section, have special meanings, defined in the meanings of words section:
  • us/we/our
  • you
  • insured event
  • life insured
  • period of insurance
  • sum insured

Fixed Term Life Cover is designed to provide a fixed lump sum if the life insured should die during the period of insurance.

We will pay the sum insured on the death of the life insured within the period of insurance. (But see instead the section headed Optional Benefits if there are two lives insured).

Fixed Term Life Cover has no cash-in value nor is there any return at the end of the period of insurance.

Once a policy has been set up the level of cover cannot be changed.

We will pay interest on any money payable for Fixed Term Life Cover following the death of the life insured if we are not able to establish to our satisfaction evidence of the insured event and ownership of the policy proceeds within a two month period from the date of the notification of the claim. Interest will be payable from the date of notification of the claim at a rate of 2% p.a. below the base rate as quoted by The Royal Bank of Scotland plc. Any such interest payment will be subject to income tax as appropriate.

Commentary

The policy provides cover for the period of years specified in the insurance schedule. Death of the person covered during this period gives rise to an insurance claim. It could be used to pay off a mortgage.

No payments are made nor are premiums reimbursed if you end the cover before the end of the period of years specified in the insurance schedule, nor is there any payment at the end of that period.

In certain circumstances,if there is a delay of more than two months in paying a claim, we will pay interest on the claim when it is finally paid.


DIRECT LINE MORTGAGE LIFE COVER

The words below, which are used in this section, have special meanings, defined in the meanings of words section:
  • we/our
  • you/your
  • insured event
  • life insured
  • period of insurance
  • sum insured

Mortgage Life Cover is designed to pay, on death of the life insured during the period of insurance, the sum insured as defined in the insurance schedule based on the date of death. (But see instead the section headed Optional Benefits if there are two lives insured).

The cover should provide a sum sufficient to pay off the outstanding balance of your mortgage if the life insured dies during the period of insurance as long as:

a) the mortgage interest rate for the period covered does not exceed 12% a year; and

b) the original sum insured and the policy term equalled the original mortgage and mortgage term, neither have subsequently been altered; and

c) the mortgage payments are up to date at the time of death.

Mortgage Life Cover has no cash-in value nor is there any return at the end of the period of insurance.

Once a policy has been set up, the level of cover or the period of cover, cannot be changed.

We will pay interest on any money payable for Mortgage Life Cover following the death of the life insured if we are not able to establish to our satisfaction evidence of the insured event and ownership of the policy proceeds within a two month period from the notification of the claim. Interest will be payable from the date of notification of the claim at a rate of 2% p.a. below the base rate as quoted by The Royal Bank of Scotland plc. Any such interest payment will be subject to income tax as appropriate.

Commentary

This policy provides cover for the period of years specified in the insurance schedule which should coincide with the period of your mortgage. Death during this period may give rise to an insurance claim which could be used to repay, or to help repay, your mortgage. The policy can be used to protect a repayment mortgage where the amount of your mortgage decreases over the policy term.

If the amount of your mortgage has increased, for example if you have added outstanding arrears, then the amount paid if you should make a claim may not cover the full balance of your loan. No payments are made or premiums reimbursed if you end the cover before the end of the period in years specified in the insurance schedule, nor is there any payment at the end of that period.

If in the future you require a change to your cover, it will be necessary to take out an additional or replacement policy. This will involve us asking again the questions you originally answered and we may request further medical information. We do not guarantee that we will be able to offer additional cover. Premiums will depend on your health and circumstances at the time.

We do not guarantee that you will be able to increase your cover. Premiums will increase to pay for any increased cover.

In certain circumstances, if there is any delay of more than two months in paying a claim, we will pay interest on the claim when it is finally paid.


CRITICAL ILLNESS BENEFIT

The words below, which are used in this section, have special meanings, defined in the meanings of words section:
  • company/us/we/our
  • you
  • insured event
  • life insured
  • period of insurance
  • sum insured
  • critical illness

On proof to the company's satisfaction that the life insured is suffering from a critical illness, we will bring forward the payment of the sum insured.

For joint lives, first death policies the payment will be brought forward on proof to the Company's satisfaction that one of the lives insured has been diagnosed as suffering from a critical illness.

No benefit will be payable on any subsequent occurrence of a critical illness.

No death benefit will be payable if a claim has been paid on occurrence of a critical illness.

Commentary

Benefits which are payable on the death of the life insured may be paid early if the critical illness (as defined in the section Critical Illness Definitions) is diagnosed. No payment will then be made on the death of the life insured as the policy stops on the date on which the sum insured is paid.


CRITICAL ILLNESS DEFINITIONS

This section gives full details of the illnesses covered and their formal definitions, and are the only illnesses covered by this policy.

Where the Association of British Insurers has critical illness definitions within their Statement of Best Practice, we have used them.

Alzheimer's Disease

A global impairment of brain function such that permanent supervision or assistance by a third party is required. The diagnosis must be made by an appropriate consultant who should be satisfied that there is no other discernible cause.

 

 

 

Angioplasty

The undergoing of any interventional technique, on the advice of a consultant cardiologist involving the use of transluminal coronary catheters to correct significant stenosis at least 50% diameter narrowing of two or more coronary arteries as part of a single procedure. Angiographic evidence to support the necessity for the above operation will be required.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Aorta Graft Surgery

Undergoing surgery for disease of the aorta needing excision and surgical replacement of a portion of the diseased aorta with a graft. For this definition, aorta means the thoracic and abdominal aorta but not its branches.

 

 

 

 

 

Balloon Valvuloplasty

The actual insertion on the advice of a consultant cardiologist of a balloon catheter through the orifice of one of the valves of the heart and the inflation of the balloon to relieve valvular abnormalites.

 

 

 

 

Benign Brain Tumour

A non-malignant tumour in the brain, resulting in permanent deficit to the neurological system. Tumours or lesions in the pituitary gland are not covered.

 

 

 

 

 

 

 

 

Blindness

Total permanent and irreversible loss of all sight in both eyes.

 

 

 

 

Cancer

Any malignant tumour characterised by the uncontrolled growth and spread of malignant cells and invasion of tissue. The term cancer includes leukaemia and Hodgkins's disease - but the following are excluded:

  • All tumours which are histologically described as pre-malignant, as non-invasive or as cancer in situ

  • All tumours of the prostate unless histologically classified as having a Gleason score greater than 6 or having progressed to at least TNM classification T2N0m0.

  • All forms of lymphoma in the presence of any Human Immunodeficiency Virus.

  • Kaposi's sarcoma in the presence of any Human Immunodeficiency Virus.

  • Any skin cancer other than invasive malignant melanoma.

 

 

 

 

 

 

 

 

 

Coma

A state of unconsciousness with no reaction to external stimuli or internal needs, persisting continuously with the use of life support systems for a period of at least 96 hours and resulting in permanent neurological deficit. Coma secondary to alcohol or drug misuse is not covered.

 

 

 

Coronary Artery By-Pass Surgery

The undergoing of open heart surgery on the advice of a consultant cardiologist to correct narrowing or blockage of one or more coronary arteries with by-pass grafts but excluding angioplasty, laser relief or any other procedures.

 

 

 

 

Deafness

Total permanent and irreversible loss of all hearing in both ears.

 

 

 

 

Heart Attack

The death of a portion of the heart muscle, due to inadequate blood supply, that has resulted in all the following evidence of acute myocardial infarction:

  • Typical chest pain.

  • New characteristic electrocardiographic changes.

  • The characteristic rise of cardiac enzymes, troponins or other biochemical markers.

Where all the above shows a definite acute myocardial infarction. Other acute coronary syndromes, including but not limited to angina, are not covered under this definition.

 

 

 

 

 

 

 

 

 

 

 

 

 

Heart Valve replacement or Repair

Undergoing open-heart surgery from medical necessity to replace or repair one or more heart valves.

 

 

 

 

HIV/AIDS - Accidental Exposure (needlestick injury, etc)

Benefits will be payable to medical and other personnel, upon the diagnosis of HIV infection provided that such infection was considered by the medical authorities involved to be caused by a needlestick/sharp injury or by mucous membrane exposure to blood or bloodstained body fluid which occurred during the 12 months preceding diagnosis and during the currency of the policy. The accident must have occurred whilst the insured was following his normal occupational duties and reported in accordance with the established occupational procedures for such accidents. The life insured must, within five days of the accident, have undergone a blood test indicating the absence of HIV or its antibodies but a further blood test performed within 12 months of the accident must indicate the presence of HIV or its antibodies.

 

 

 

HIV/AIDS via Blood Transfusion

Infection by any Human Immuno Deficiency Virus provided that the Company, on the advice of its Chief Medical Officer, is satisfied that the infection was due to a blood transfusion given as part of medical treatment after the commencement of the policy.

Kidney Failure

End stage renal failure presenting as chronic irreversible failure of both kidneys to function, as a result of which either regular renal dialysis or renal transplant is initiated.

 

 

 

 

Loss of Limbs

The permanent physical severance of two or more limbs from above the wrist or ankle joint.

Loss of speech

Total permanent and irreversible loss of the ability to speak as a result of physical injury or disease.

 

 

 

 

 

 

 

 

 

Major Head Trauma

Accidental injury to the head resulting in residual brain damage. There must be permanent neurological deficit causing significant functional impairment as defined by a consultant neurologist using standard measures of head injury (for example, the insured must score 5 or less on the Eight Point Glasgow Outcome Scale for Head Injuries).

 

 

 

 

 

Major Organ Transplant

The actual undergoing as a recipient of, or inclusion on an official UK waiting list, for a transplant of a heart, liver, pancreas or bone marrow.

 

 

 

 

 

 

 

 

 

 

 

Motor Neurone Disease

Confirmation by a consultant neurologist of a definite diagnosis of Motor Neurone Disease.

 

 

 

 

 

 

Multiple Sclerosis (MS)

A definite diagnosis by a consultant neurologist of Multiple Sclerosis, which satisfies all of the following criteria:

  • There must be current impairment of motor or sensory function, which must have persisted for a continuous period of at least 6 months.

  • The diagnosis must be confirmed by diagnostic techniques current at the time of the claim.

 

Open Heart Surgery

The undergoing of open heart surgery, on the advice of a consultant cardiologist, to correct valvular and structural abnormalities.

 

 

 

 

 

Paralysis/Paraplegia

Total irreversible loss of muscle function or sensation to the whole of any two limbs as a result of injury or disease. The disability must be permanent and supported by appropriate neurological evidence.

 

 

 

Parkinson's Disease

Confirmation by a consultant neurologist of a definite diagnosis of Parkinson's Disease. Parkinson's Disease secondary to alcohol or drug misuse is not covered.

 

 

 

 

 

 

 

 

Pulmonary Artery Surgery

The actual undergoing of surgery on the advice of a consultant cardiothoracic surgeon for a disease of the pulmonary artery to excise and replace the diseased pulmonary artery with a graft.

 

 

 

 

 

Stroke

A cerebrovascular incident resulting in permanent neurological damage. Transient Ischaemic Attacks are specifically excluded.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Third Degree Burns

Third degree burns covering at least 20% of the body surface area.

 

 

Total Permanent Disability (TPD)

A permanent inability to perform independently, three or more of the activities of daily work as detailed below, with or without the use of mechanical equipment, special devices or other aids. Confirmation must be received by a consultant physician and be supported by the Company's Chief Medical Officer.

Bending - You are unable to bend or kneel as if to pick up a weight of 1kg from the floor, and straighten up again without the assistance from another person.

Walking - You cannot walk a distance of more than 200 metres on flat ground without stopping.

Climbing - You cannot walk up and down a flight of 12 stairs with the use of the handrail within 90 seconds.

Rising from sitting - You are unable to rise from sitting in a dining table chair (with arms) to standing, using the arms of the chair if necessary, without assistance from another person.

Standing - You are unable to stand, with the aid of a walking stick if necessary, for more than 10 minutes before needing to sit.

Manual dexterity - Lack of physical ability to use a pen, pencil or keyboard with either hand (i.e either left or right) or any artificial aid.

Lifting and carrying -You cannot pick up from table height and carry for 5 metres a 2kg weight with either hand. Either hand means both hands have to fail the test separately in order to satisfy this activity.

Commentary

Alzheimer's Disease is a progressive and degenerative disease. The nerve cells in the brain deteriorate and the brain shrinks. The symptoms can include a severe loss of memory and concentration but there is an overall decline in all mental faculties.

The following treatments are a way of solving the problems caused by a narrowing of the coronary arteries.

Balloon angioplasty - where a balloon is fed into the affected artery and inflated to widen it.

Laser treatment - where the blockage in the artery is burnt away by a laser fed into the artery.

Atherectomy - this is another technique for removing obstructions from coronary arteries and requires the insertion of a catheter into the relevant artery.

Stent insertion - where a small ring of metallic mesh is fed into the artery and expanded to widen it.

Rotoblation - a rotating device is passed through the blocked artery, effectively scraping the artery wall to remove any blockage.

As these surgical techniques are much simpler than the by-pass operation, which requires full open heart surgery, the definition requires that two as opposed to one coronary arteries are treated if the claim is to be accepted.

The aorta is the main artery in the body, which carries the blood on the beginning of its journey around the body. The aorta may be weakened by an aneurysm - which is a thinning and bulging of the arterial wall, or it may become narrowed by fatty deposits. An operation can be carried out to correct the narrowing or to replace or repair the damaged part of the aorta wall.

Where the blood flow across the heart valves is restricted due to narrowing, usually of a congenital origin and less commonly post rheumatic fever or calcific lime deposits, a balloon valvuloplasty may be carried out. This involves passing a fine tube (catheter) across the narrowed valve and inflating a tiny balloon to enlarge the opening of the affected blood valve.

Benign tumours are localised and grow by expansion only. They do not invade and destroy the surrounding tissue and do not spread to other parts of the body. Once surgically removed they tend not to recur. However, a benign brain tumour can still be very dangerous as it can put pressure on the brain and lead to possible damage - haemorrhages and ulceration. Deficit to the neurological system means muscle weakness or sensory loss. Surgery to cure the condition may not always be possible.

Sight can be lost because of an accident or illness. In order for a claim to be accepted, the loss of sight must be total, permanent and irreversible. Therefore a claim would not be paid if the loss was only partial or was a temporary condition.

Cancer is a malignant tumour or a malignancy. It causes uncontrolled growth of abnormal cells which invade, damage and destroy surrounding bodily tissue. These cells can then spread and cause damage to other parts of the body.

Prostate cancers are relatively common in men and a low Gleason score indicates a more easily treated and less aggressive tumour. Those detailed in the exclusion group have an excellent long-term prognosis. Tumours with a higher Gleason score are included.

Non-invasive or cancer in situ is a very early stage cancer which has not invaded surrounding tissue and has not spread throughout the body. Treatment is relatively easy and successful. Cancers in situ are therefore not covered.

Most skin cancers are also easy to treat and also excluded. However, malignant melanoma is a very serious form of skin cancer which can very quickly spread throughout the body. This form of skin cancer is therefore included.

A coma is a deep state of unconsciousness from which it is impossible to be aroused. The cause of the coma may be as a result of another illness such as a stroke and may be brought on by a serious accident. If the coma results in permanent damage to the nervous system, the claim will be paid.

If one or more of the coronary arteries which supply oxygenated blood to the heart becomes obstructed by the build-up of fatty deposits, angina can result and can even cause a heart attack. A coronary by-pass operation involves inserting a short length of vein, usually taken from the leg, around narrowed artery, thus restoring an adequate supply of blood to the heart.

Loss of hearing may be caused by illness, for example a stroke, or by a serious accident. The loss must be total, permanent and irreversible. Therefore a claim would not be paid if the loss was only partial or was a temporary condition.

The body needs oxygen to survive and it receives this from the blood. The heart is effectively a pump, which ensures that oxygenated blood circulates through the body to where it is needed. The heart itself also needs oxygen to continue to work effectively. If the supply of oxygen to the heart is cut off then a portion of the heart muscle is damaged. This can be caused by the blockage of a coronary artery. Arteries can become blocked by fatty material or by blood clots.

Damage to the heart muscle usually causes severe pain and results in an increase in cardiac enzymes, which are released into the blood. A heart attack will also result in electrocardiograph changes.

Angina produces similar symptoms to an actual heart attack, but is caused by a reduction in the supply of blood to the heart rather than a complete blockage. Heart muscle does not die as a result. Angina may be an early indication that a future heart attack is likely. Angina is not covered.

The valves of the heart open and close as part of the pumping action which circulates blood around the body. When these valves become diseased, the ability of the heart to pump properly is reduced. Surgery can be undertaken to either repair or replace the damaged valve.

Any incident which takes place whilst performing occupational duties, whether at your place of work or elsewhere which leads to infection with the HIV virus would be covered.

A claim would be paid out if, in conjunction with the procedures outlined above, it is proved that infection with HIV was a result of occupational duties.

The occupations included in this category are: Medical practitioner, consultant, specialist or any other medically trained person employed in a medical facility, Prison Officer, Dentist, Member of Fire, Ambulance or Police services.

A claim would be paid where there was evidence that the HIV infection was as a direct result of a blood transfusion.




The function of the kidneys is to remove waste material from the bloodstream. If they do not work properly there can be a build up of waste material in the blood, which can become life-threatening. The body can function perfectly well with only one kidney, but if both fail there will be a need for regular dialysis to clean the blood artificially, or for a kidney transplant.

Loss of limbs could be caused by an accident or because of an illness.

Loss of speech may be caused if the vocal chords are damaged in an accident. The loss must be total, permanent and irreversible. Therefore a claim would not be paid if the loss was only partial or was a temporary condition.

It is possible for the power of speech to be lost without physical damage to the vocal chords, possible because of a severe mental trauma or shock. However, in such cases it is nearly impossible to determine whether the loss is permanent and therefore a claim would not be paid.

Neurological deficit is where a part of the nervous system is not functioning properly and this is causing a persons inability to perform some actions. The level of this disability will be judged by a consultant neurologist. The Glasgow Outcome Scale for Head Injuries, which assesses motor and verbal responses as well as eye opening on command is one example of a standard evaluation procedure and is used in the early (acute) phase.

Sometimes a major organ of the body (such as the liver) becomes so diseased that is fails and becomes life threatening. It may therefore be essential to replace it with a healthy organ.

For some rare illnesses, such as aplastic anaemia, a major organ transplant (in this case of the bone marrow) may be the only long term cure available.

It can take a long time to find the right donor organ, and the waiting list for such operations is often long. The claim will be met therefore upon acceptance onto an official United Kingdom waiting list for the relevant transplant.

Motor Neurone Disease causes a rapid deterioration of the motor neurones. These are the nerve cells in the brain, brain stem and spinal cord, which are responsible for the movement of the body. The disease advances quite quickly and leads to severe disability and death, usually within 3-4 years.

Unfortunately, there is no treatment that can alter the outcome of this serious condition.

MS is an incurable disease of the central nervous system. Nerve fibres are normally covered by a myelin sheath, which protects and insulates them. In MS this sheath degenerates which interrupts the smooth transmission of nerve impulses around the body, leading to lack of co-ordination and sensory impairment.

The valves of the heart open and close as part of the pumping action which circulates blood around the body. When these valves become diseased, the ability of the heart to pump properly is reduced. Surgery can be undertaken to either repair or replace the damaged valve. Other structural defects may occasionally be discovered and repaired.

Paralysis or paraplegia of two or more limbs is evidenced by permanent and irreversible loss of movement and sensation. It could be caused by an accident or by an illness. Even more severe types of paralysis tetraplegia and quandriplegia would therefore be covered.

Parkinson's Disease causes a disturbance of voluntary movement. It causes tremors in the limbs and head and rigidity of the muscles. The condition usually takes a long time to progress and some drugs are available which can slow the process down even further. The treatment becomes less effective as time goes by. For a claim to be paid, the onset of Parkinson's Disease must be idiopathic. This means it must have developed naturally rather than because of some other medical treatment or illness.

The pulmonary artery is the artery that carries the blood from the heart to the lungs. If the pulmonary artery becomes diseased an operation may be carried out to replace the weakened tissue with a man-made graft. In adult life this is a very rare condition, usually arising from congenital abnormalities and involving the pulmonary valve as well.

A stroke involves the death of part of the brain as a result of a reduction in the blood supply. It can be caused by a blood clot becoming caught in an artery of the brain or the bursting of one of the brain's blood vessels. The event that triggers the stroke may result from problems within the body, such as clogged up arteries, or weaknesses in the wall of a blood vessel.

After a true stroke there is always permanent brain damage which can cause paralysis to the right or left sides of the body, loss of speech or sight, and other effects such as loss of strength or mobility. In some cases, the damage may be quite minor, but it will depend upon which part of the brain was affected. Transient Ischaemic Attacks are often known as mini-strokes but do not result in permanent damage. They are therefore excluded.

Third degree burns are the most serious type of burn. They involve the destruction of the full thickness of the skin and can cause damage to the fat, muscle and bone.

This benefit is designed as a general disability benefit. Whilst some of the disabling diseases of older age, such as Alzheimer's Disease and Motor Neurone Disease, are covered separately, there are other conditions which can prove to be just as debilitating.

These could include conditions such as severe rheumatoid arthritis, which can prevent the sufferer from living without constant help and care.


EXCLUSIONS

The words below, which are used in this section, have special meanings, defined in the meanings of words section:
  • Company/we
  • life insured
These policies do not cover:

Below are examples of situations where the policy will not pay out.

Suicide

If the life insured commits suicide within twelve months of the date of commencement of the cover shown in the insurance schedule, we will not be able to make any payment under the policy except for the interest of any third party that has been notified to the Company before the date of the suicide and proved to the satisfaction of the Company to have been acquired for value.

Specific Exclusion Relating to Critical Illness Benefit

We will not pay a critical illness claim if it is caused directly or indirectly from any of the following:

Aviation

Taking part in any flying activity, other than as a passenger in a commercially licensed aircraft.

Criminal acts

Taking part in a criminal act.

Drug abuse

Alcohol or solvent abuse, or the taking of drugs except under the direction of a registered medical practitioner.

Failure to follow medical advice

Unreasonable failure to seek or follow medical advice

HIV/AIDS (except accidental needle stick/blood transfusion as defined previously)

Infection with Human Immunodeficiency Virus (HIV) or conditions due to any Acquired Immune Deficiency Syndrome (AIDS).

Self-inflicted injury

Intentional self inflicted injury.

War and civil commotion

War, invasion, hostilities (whether war is declared or not), civil war, rebellion, revolution or taking part in a riot or civil commotion.

The policy will not pay out:

Below are examples of situations where the policy will not pay out:

  • If the cause of the claim is specifically excluded by any specific terms we apply to your policy when we accept your application. If applicable we will show these in your acceptance letter and policy schedule.

  • On a claim for total permanent disability or cancer within a 14 day period if free cover applies.

  • If the claim is for total permanent disability and the cause arises while you are living outside of the UK, Western Europe, North America, Australia and New Zealand.

  • If you are not in the UK when you make a claim, you will have to return to the UK or to a country within the geographical limits set out below, so we can assess your claim, unless we say that it is not necessary: UK, Western Europe, North America, Australia and New Zealand.

  • If your claim arises within 3 months of a lapsed policy being reinstated.


TERMINAL ILLNESS BENEFIT

The words below, which are used in this section, have special meanings, defined in the meanings of words section:
  • Company/us/we/our
  • you/your
  • life insured
  • sum insured
  • terminal illness

On proof to the company's satisfaction that the life insured is diagnosed as suffering from a terminal illness we will bring forward the payment of the sum insured.

The definition of terminal illness is set out in the 'meaning of words' section at the end of this document.

For joint lives first death policies the payment will be brought forward on proof to the Company's satisfaction that one of the lives insured is suffering from a terminal illness.

No benefit will be payable on any subsequent occurrence.

No death benefit will be payable, if a claim has been paid upon diagnosis of a terminal illness.

Specific Exclusion Relating to Terminal Illness Benefit

No benefit will be payable in respect of a claim if the life insured is not resident in:

  • UK, Western Europe, North America, Australia and New Zealand.

  • And any other countries we may decide.

Commentary

Benefits which are payable on the death of the life insured may be paid early if they are diagnosed as having a terminal illness. No payment will then be made on the death of the life insured as the policy stops on the date on which the sum insured is paid.









We will not pay any claim under any of the covers where death is due to suicide within the first year of the policy.


OPTIONAL BENEFIT

The words below, which are used in this section, have special meanings, defined in the meanings of words section:
  • Company/we/our
  • you/your
  • life insured
  • period of insurance
  • sum insured
  • critical illness
  • terminal illness

Where it is indicated in the insurance schedule that you have chosen the optional benefit described below, the following will apply, as appropriate. This option may be selected only at the time of taking out the policy.

Joint Lives - First Death or First Diagnosis

We, will pay the sum insured on the first death or first diagnosis of a terminal illness or a critical illness to occur on either of the two lives insured named in the insurance schedule.

Commentary






If there is more than one named life insured in the insurance schedule, we will, pay out when the first one dies or suffers a terminal or critical illness.


CONDITIONS

The words below, which are used in this section, have special meanings, defined in the meanings of words section:
  • Company/us/we/our
  • you/your
  • endorsement
  • insured event
  • life insured
  • sum insured

Truthful Disclosure and Compliance with Conditions

We will provide cover as described in this document and the insurance schedule provided that:

a) the statements made and the information given to us by phone and in the proposal form, supplementary proposals and declarations which form part of the contract, are complete and correct to the best of your knowledge and belief; and

b) the statements made and the information given to us by phone or otherwise in connection with any claim are complete and correct to the best of your knowledge and belief; and

c) you have not withheld any information that may materially affect our providing cover; and

d) all conditions, limits and endorsements applying to the cover have been complied with.

Failure to comply with any of these conditions means we will not pay claims and you will not be entitled to any refund of premium and no payment will be due to you.

Random Sampling

As part of our Random Sampling policy, the life insured may be required during the first 6 months of inception of the policy, to have a medical examination and/or to authorise us to apply to your doctor to have access to your medical records for confirmation of the information you have supplied. If you are selected we will contact you and inform you of the necessary arrangements.

Payment of Premiums

We will allow 31 days of grace for the payment of premiums. If the life insured suffers an insured event during the days of grace any outstanding premiums will be deducted from any benefit payment.

If an outstanding premium is not paid before the expiry of the 31 days grace the policy will be cancelled and the cover will cease on the date 31 days after the date on which the premium was due as specified in the insurance schedule.

Monthly premiums must be paid to us by direct debit through a bank or building society.

Reinstatement of Lapsed Policy

If cover ceases for whatever reason during the term of the policy, it may be reinstated subject to such conditions as the Company may in its absolute discretion decide.

 

Claims

A maximum of one claim under each policy will be paid. You or your legal representative will be required to confirm the details of any claim by completing a claim form. The Company may request such information, including evidence of death, evidence of terminal illness, evidence of critical illness, evidence of age and all documents establishing ownership of the policy proceeds, as we deem necessary.

If a critical illness or terminal illness claim is not accepted because the definition is not satisfied, this would not prejudice any subsequent death claim. However no benefit will be paid where as a result of the Company not receiving the information requested, the Company is unable to establish satisfactory evidence of death, critical illness, terminal illness, age of life insured or ownership of claim proceeds.

In addition no benefits will be paid if the Company establishes satisfactory evidence that statements made in support of the proposal for insurance were not complete and correct to the best of your and the life insured's knowledge and belief, or that any material information was withheld.

 

 

 

 

 

 

 

Special Provisions for Critical Illness Claims

Failure to comply with this requirement means we will not pay claims.

The Company will seek medical or other information to confirm the diagnosis before a claim is paid. This may involve a medical examination at the Company's expense.

All diagnoses and medical opinions must be:

  • given by a medical specialist who holds an appointment as a consultant at a hospital in the UK

  • accepted by our Chief Medical Officer

Special Provisions for Terminal Illness Claims

Terminal illness claims should be notified to the Company within three months of the occurrence of the insured event and at least 18 months before the policy expires. When making a claim for terminal illness benefit, you must provide us with certificates from one or more medical practitioners, one of which must be the life insured's hospital consultant, confirming the terminal illness.

Failure to comply with this requirement means we will not pay claims.

Any costs incurred in providing the certificates or any other medical evidence which we request will be met by you. However, if your claim is accepted, we will refund these costs to you.

The company will seek medical or other information to confirm the diagnosis before a claim is paid.

If we require, the life insured must undergo a medical examination which will be carried out by an appointed medical practitioner. We will meet the costs of any such examination.

All diagnoses and medical opinions must be:

  • given by a medical specialist who holds an appointment as a consultant at a hospital in the UK

  • accepted by our Chief Medical Officer

Surrender

If the policy is cancelled by you no payment will be made by the Company and the policy will cease.

Alterations

The Company reserves the right to alter the policy as the Company reasonably considers appropriate if the policy or the Company are affected by a change in legislation or taxation or any judicial decision. The Company will give you written notice of any such alteration.

Policy Alterations

Once your policy is in force the amount of cover and policy term cannot be changed.

Variation to Premium Level

The company reserves the right to amend the premium payable during the policy term. These reviews will be carried out taking into consideration our claims experience, developments in medical technology and diagnosis and related expenses. You will be notified in writing 3 months before any change is introduced and your direct debit will be amended accordingly.

Other Misrepresentations

Any other misrepresentation of, or failure to disclose, material facts in any document signed by you or the life insured which entitle the Company to alter, amend or cancel the policy having regard to the true facts. A material fact is any information which could influence the Company in the assessment of any proposal. If we cancel the policy you will not be entitled to any refund of premium and no payment will be due to you.

Notice of Assignment of Assignation

Any notice of assignment, or assignation in Scotland, should be sent direct to the company's Administration Department at:

Direct Line Life Insurance Company Limited, 14-18 Cadogan Street, Glasgow, G2 6QN.

Only at this address will notices of assignment of assignation be received and recorded.

Currency of payments

All premiums and all payments by the Company are payable in sterling or any currency applicable at that time, at the Company's head office.

Applicable Law

The policy covered in this document is governed by and subject to English Law.

General

For the purposes of the Contracts (Rights of Third Parties) Act 1999, the Customer and the Company agree that there is no intention to confer contractual rights on any third party who may benefit under the terms of policy.

Where appropriate, words in the masculine include the feminine and words in the singular include the plural and vica versa.

Commentary

This part describes your responsibilities and certain procedures.

You must observe the terms of the cover set out in this document and in any endorsement.

The contract between us is based on the information you have given to the company. If you have given incorrect information your cover may be affected.

 

 

 

 

 

 

 

 

 

 

 

 

If you fail to make payment of premiums due, we will allow time for you to bring your payments up to date.

 

However, after 31 days your cover will be cancelled.

 

 

 

If cover ceases, for example if you cease to pay the premiums, to reinstate the cover we may require further information, including medical information and we may decline to reinstate your cover.

Claims may be notified by phone but the claimant will be required to complete a form confirming that details of the claim are true and accurate.

This explains that we may require information to verify the claim.

If we do not receive the information which we require, we will be unable to pay your claim.

If your claim is for terminal illness, medical certificates will be necessary to confirm that the illness is terminal. You will have to pay the costs for this, but if we accept your claim, we will refund these costs.

We may ask the life insured to visit our own appointed doctor for an examination and if asked the life insured must attend or the claim will not be paid.

This explains how an adjustment to the claim payment will be made if the processing of a claim reveals that an incorrect date of birth has been given innocently.

This explains that we will require information to verify the claim.

A medical specialist is defined as someone who holds an appointment as a Consultant at a hospital in the UK, is accepted by our Chief Medical Officer, and whose specialism is appropriate to the cause of the claim.

 

 

 

This explains that we will require information to verify the claim.

 

 

 

 

 

 

 

 

 

A medical specialist is defined as someone who holds an appointment as a Consultant at a hospital in the UK, is accepted by our Chief Medical Officer, and whose specialism is appropriate to the cause of the claim.

 

 

 

 

 

 

 

 

 

 

 

 

Once your policy has been set up it cannot be changed.

 

Your Premium will not change just because your age has increased but it may increase as a result of adverse changes in the factors mentioned.

 

 

 

 

 

 

 

 

If you transfer the ownership of the policy proceeds, you must write to us at the address given.


MEANINGS OF WORDS

Company, us, we, our

Direct Line Life Insurance Company Limited

Customer, you, your

The person who takes out the policy The customer need not necessarily be the same person as the life insured but will need to have financial dependency on the life insured at the time of taking out the policy and any subsequent increases in cover.

Critical Illness

Is a medical condition which is diagnosed as one of the conditions covered by the policy (as set out in the section Critical Illness Definitions).

Endorsement

A change agreed in writing by us in the terms of the policy.

Insured Event

One of the following:

i) Death of the life insured; or

ii) Confirmation that the life insured has been diagnosed as suffering from a terminal illness; or

iii) Confirmation that the life insured has been diagnosed as suffering from a critical illness.

Life insured

The person(s) named as such in the insurance schedule.

Period of Insurance

The period shown in the insurance schedule for which we have agreed to provide cover, providing the premium is paid within the days of grace.

Sum Insured

The amount shown in the insurance schedule which is the cover we have agreed to give.

Terminal Illness

Advanced or rapidly progressing incurable illness where, in the opinion of an attending consultant and our chief medical officer, the life expectancy is no greater than 12 months. (AIDS is specifically excluded and not covered under this definition).

Customer Helpline 0845 2468 123

For your convenience, this helpline is open 8am-8pm weekdays and 9am-5pm Saturday. For your added security all telephone calls are recorded and the recording kept secure. We may also monitor telephone calls with the aim of improving our service to you.

Available to UK residents only. Direct Line Life Insurance Company Limited, 14-18 Cadogan Street, Glasgow, G2 6QN. Telephone number 0845 3000 233. Registered in England No. 2199286. Registered Office 3 Edridge Road, Croydon CR9 1AG.

Direct Line Life Insurance Company Limited is authorised and regulated by the Financial Services Authority and is entered on their register under Number 170956 (www.fsa.gov.uk/register). It markets only its own products and does not offer advice. Direct Line Life standard terms and conditions apply.