The below mentioned conditions and exceptions apply for all the policy benefits.
4.1 Unless otherwise specifically stated, the sums insured stated on the policy (front page) for the individual part-coverage’s (clauses) form the maximum limit of Gouda’s liability to pay out damages per holder of the insurance per event insured.
4.2 The holder of the insurance and the insured are obliged to provide and submit information which by Gouda is considered necessary in order to decide whether the injury is entitled to coverage and to which extent. The above includes police statements, third party statements from for example hotel personnel and so on, but is not limited to such.
4.3 For every injury:
4.3.1 Gouda’s physician has the right to seek information about the insured’s health and treatment from physicians or hospitals that have treated the insured and, if necessary, to discuss the conditions as informed to Gouda with them. Gouda guarantees full discretion for such information.
4.3.2 Gouda has the right to demand that the insured allows him-/herself to be examined by Gouda’s physician or by a physician appointed by Gouda. In case of death Gouda has the right to demand a post-mortem examination. In this occasion Gouda will cover all costs for the above mentioned.
4.3.3 It is a condition for coverage that the clauses described in Chapter A ”Conditions in case of accident” are observed. These conditions form an integrated part of the policy conditions.
4.3.4 Expenses for transportation, which has not been arranged by Gouda, are at a maximum covered by the expenses Gouda would have had by arranging the equivalent transportation. However, a maximum amount equal to the ticket price for ”business-class” on scheduled flights is paid.
4.3.5 Rights in accordance to this insurance cannot be mortgaged or transferred without Gouda’s written consent.
4.3.6 In the case of payments in accordance with the present policy, Gouda enters into all the insured’s rights in that respect. Gouda is entitled to have recourse against third party as far as Gouda has paid out compensation. Gouda covers the costs in connection with an eventual recourse claim.
4.3.7 Compensation is paid out immediately after Gouda has received the information regarded necessary in order to determine Gouda’s obligations and the size of the compensation.
4.4 The insurance does not cover claims:
4.4.1 - provoked by the insured by intention or by gross negligence, during self-inflicted intoxication or under the influence of drugs, medication or another euphoriant, unless it can be substantiated that the injury has no connection herewith. This exception applies for any coverage under this policy irrespective of the insured’s state of mind at the time of the injury, see FAL §§4-9, 13-8 and 13-9.
4.4.2 - occurred in connection with the insured’s participation in scientific expeditions.
4.5 The insurance does not cover:
4.5.1 Claims occurring as a direct or indirect consequence of: strike, lockout, detention, confiscation or other interventions carried out by a public authority.
4.5.2 Claims for damages covered by another insurance or by the Danish social security system.
4.5.3 The insurance does not cover damage occurring directly or indirectly as a consequence of war or warlike actions, revolt or civil unrest.
4.5.4 The insurance does not cover damage occurring directly or indirectly as a consequence of usage or handling of radioactive material.
4.6 Gouda can cancel the policy with 2 months notice after claim is made.
The company can likewise dismiss the policy within the same respite, if the policyholder the last 12 months has made 3 claims or more, or the course of the claim shows a large divergence from normal.
4.7 Notification time limits and statutory limitations
4.7.1 Loss/damage shall be reported to Gouda without delay, see FAL §§ 4-10 or 13-11. The beneficiary loses the right to compensation should the claim not be reported to the company within a year of the insured learning of the conditions which form its basis, see FAL §§ 8-5 or 18-5.
4.7.2 The beneficiary’s claim may also expire according to the provisions in FAL §§ 8-6 or 18-6.
4.7.3 Gouda is freed from liability if the beneficiary has not lodged a claim or demanded a tribunal hearing within six months of the insured receiving written notification that the company does not regard itself as liable and where he or she is concurrently reminded of the time limit, when the time limit falls, and the consequence of exceeding it, see FAL §§ 8-5, 18-5, 20-1.
4.8 Extension and refund of the travel insurance
a) Gouda may, but is not obliged to extend a travel insurance. An extension must be made before the end of the insurance period, and the minimum premium for the extension is DKK 50. Extensions can be made for 12 or 18 months total.
b) If the travel insurance is terminated in writing before it expires, the difference between the premium which would have been payable for the shorter cover
period and the premium paid will be paid after deduction of an administration fee of DKK 100 per policy.
Amounts of DKK 100 and less will not be repaid. Refund of unused insurance period can be made up to full month insurance period.
For persons who have been repatriated or have returned home on Gouda's account the refund will cover no more than the premium for the part of the insurance period starting more than 31 days after the arrival home. It is a requirement that the termination is forwarded to Gouda no later than 14 days after the arrival home.
c) If the travel insurance has not become effective and if Gouda receives the notice of termination before the effective date, the full premium less an administrative fee of DKK 100 will be refunded.
If you - after having discussed the problem with us - continue to not agree with our claims processing or the results thereof, you may file an appeal with our person responsible for complaints:
Attn.: Unit responsible for complaints
A.C. Meyers Vænge 9
DK-2450 Copenhagen SV
If you continue to not be in agreement with our decision, you have the possibility to complain to:
Insurance Appeals Board
Anker Heegaardsgade 2
DK-1572 Copenhagen V
(+45) 33 15 89 00 weekdays between 10:00 and 1:00 pm
The complaint must be made on a special complaints form which can be obtained from the Insurance Appeals Board. You also have the possibility to complain online. You can read more about your possibilities at www.ankeforsikring.dk.
Legal action against Gouda must be initiated before the Copenhagen City Court or the Eastern Division of the High Court in Copenhagen.
4.10.1 Any person guilty of deception against Gouda loses all right of compensation from Gouda under this and other insurance contracts in the matter of the same occurrence, and Gouda may cancel any and every insurance contract with the insured, see FAL §§ 4-2, 4-3, 8-1 or 13-2, 13-3 and 18-1.
4.10.2 Other Insurance
If, at the time that loss or damage insured by this certificate shall occur, there is any other insurance against such loss or damage or any part thereof, the underwriter shall be liable under this certificate for its proportional share of loss or damage only. (This provision applies in circumstances where the case is decided according to foreign law).