Disability Insurance for Professional Athletes-Individual Sports

 

Professional athletes participating in an individual sport who are highly ranked may insure themselves in the event of a career ending injury or illness. Below is the contract language explaining the way the policy works.

 

Here is a partial list of the individual sports covered:

• Boxing
• Cycling
• Swimming
• Running
• Olympic Athletes
• Triathletes
• UFC Ultimate Fighting Champion
• Tae Kwon Do
• Tennis
• Auto Racing
• Wrestling
• Dancing
• Ballet
• Horseback Riding
• Horse Racing
• Judo
• Body Building
• Skiing
• Fencing
• Golf
• Gymnastics
• Martial Arts
• Motorsports
• Auto Racing
• Skating
• Speed Skating
• Ice Skating
• Snow Boarding
• Track and Field

 

PART ONE-INSURING AGREEMENT

In the event that the Insured sustains Bodily Injury caused in and of itself by an Accident

occurring during the Certificate period and which, solely and independently of any other

cause, results in the Total Disablement directly culminating in the Permanent Total

Disablement of the Insured and providing the Total Disablement commenced within

twelve (12) months of the date of such Accident, then the Insurers agree to pay the benefits

stated in the Schedule to the Insured.

In the event that the Insured sustains any Sickness or Disease which first manifests itself

during the Certificate period and which solely and independently of any other cause results in

the Total Disablement directly culminating in the Permanent Total Disablement of the

Insured and providing the Total Disablement commenced within twelve (12) months of the

date of such first manifestation, then the Insurers agree to pay the benefits stated in the

Schedule to the Insured.

PART TWO – DEFINITIONS

For the purposes of this Insurance:

1. Insured shall mean the person identified in the Schedule as such.

2. Bodily Injury shall mean a specific physical injury caused by an Accident, which

occurs while this Certificate is in force.

3. Accident shall mean a single sudden and unexpected event, which occurs at an

identifiable time and place and which causes unexpected Bodily Injury at the time it

occurs.

4. Total Disablement shall mean the Insured’s complete and total physical inability to

Participate in his occupation as stated in the Schedule.

5. Permanent Total Disablement shall mean that the Insured has suffered continuous

Total Disablement for the Waiting Period stated in the Schedule, and that as a result

of the Accidental Bodily Injury or Sickness or Disease giving rise to the Total

Disablement, the Insured has no likely hope of improvement, sufficient to

Participate ever again in his occupation as stated in the Schedule.

6. Waiting Period shall mean the continuous period of time stated in the Schedule

during which the Insured must be Totally Disabled before any claim for Permanent

Total Disablement will be considered. No covered claim shall exist and no benefit

shall be due or payable under this Certificate unless and until the Insured has suffered

Total Disablement for the continuous period as stated in the Schedule, culminating in

Permanent Total Disablement.

7. Sickness or Disease shall mean physical illness or malady.

8. Manifest, or Manifestation shall mean the date when a Sickness or Disease is

reasonably capable of diagnosis by a Physician.

9. Participate, Participation or Participating shall mean that the Insured is available

and/or physically able to practice or perform in his occupation as stated in the

Schedule.

10. Physician shall mean a health care practitioner (other than the Insured or a member

of the Insured’s immediate family) licensed to practice medicine, prescribe or

administer drugs and perform surgery.

 

PART THREE – EXCLUSIONS

This Certificate does not cover disability wholly or partially, directly or indirectly caused by,

contributed to by or aggravated by:

1. war or any act of war, whether war is declared or not;

2. suicide, self-destruction, attempted suicide or self destruction, or intentionally self inflicted

injury, while sane or insane;

3. the Insured’s own criminal or felonious act as defined by the laws of the jurisdiction

where the crime takes place, which results in a conviction of the Insured;

4. the death of the Insured, howsoever caused. No covered claim shall exist and no

benefit shall be due or payable under this Certificate in the event of the death of the

Insured whether or not such death is caused directly or indirectly by the Accidental

Bodily Injury or Sickness or Disease and whether or not such death occurs during

the Waiting Period. No claim shall be assumed nor payable under this Certificate in

the event of the disappearance of the Insured;

5. the Insured;

(a) being under the influence of drugs or narcotics that are not lawfully available,

unless prescribed for the Insured by a qualified Physician;

(b) using any drugs or substances in violation of the rules or regulations of the

governing body of the sport in which the Insured performs;

(c) using any performance enhancing anabolic steroids, stimulants and

corticosteroids, unless prescribed for the Insured by a qualified Physician;

6. conditions of psychotic, psychoneurotic or epileptic origin;

 

6 PTDNonTeamPIU121512Amended7

PART FOUR – CONDITIONS AND OTHER PROVISIONS

1. CONDITIONS PRECEDENT TO RECOVERY: The conditions and provisions set

forth herein are conditions precedent to the obligation of the Insurers to pay any

benefits hereunder. Any exclusions, terms or conditions of coverage under this

Certificate do not preclude the Insurers from imposing other exclusions, terms or

conditions on any other Temporary or Permanent Total Disablement Certificate or

any other Certificate issued by the Insurers on the same Insured.

2. NOTICE OF ACCIDENTAL BODILY INJURY or SICKNESS or DISEASE:

Notice of any Accidental Bodily Injury or Sickness or Disease which may give rise

to a claim under this Certificate, together with full particulars, shall be given to the

Insurers, through their representatives as stated in the Schedule, within twenty (20)

days after its occurrence.

3. SUBMISSION OF INCIDENT REPORT FORM: An Incident Report Form shall be

submitted to the Insurers, through their representatives as stated in the Schedule,

within ninety (90) days after the commencement of Total Disablement. The

completed Incident Report Form shall be accompanied by an executed general

medical record release signed by the Insured. Such forms shall be available through

the Insurers’ representatives as stated in the Schedule.

4. SUBMISSION OF PROOF OF PERMANENT TOTAL DISABLEMENT FORM:

Within twenty (20) days after the commencement of Permanent Total Disablement,

the Insured shall submit a Proof of Permanent Total Disablement Form, certifying

that the Insured has suffered Permanent Total Disablement as defined within this

Certificate. Such Form shall be available through the Insurers’ representatives as

stated in the Schedule. Such Form shall not be submitted until after the

commencement of Permanent Total Disablement, it being understood that no

covered claim shall exist and no benefits shall be due or payable hereunder until after

the completion of the Waiting Period as stated in the Schedule and satisfaction of all

Certificate terms and conditions.

5. INSURERS’ ACCESS TO ADDITIONAL MATERIALS: The Insured shall provide,

assist and cooperate with the Insurers, or their representatives as stated in the

Schedule, in obtaining any other records the Insurers deem necessary to evaluate the

incident or claim.

6. CLAIMS COOPERATION: In no event shall the Insurers be liable to pay any

benefits hereunder unless the Insured cooperates with the Insurers and their

representatives as stated in the Schedule in the investigation of the incident or claim.

7. RIGHT TO MEDICAL EXAMINATION: After initial notice of Accidental Bodily

Injury or Sickness or Disease the Insurers shall be allowed to secure the Insured’s

medical records, to monitor treatment and/or to send any medical examiner selected

by the Insurers to examine the Insured and every facility shall be given for such

examination.

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PART FOUR – CONDITIONS AND OTHER PROVISIONS (continued)

8. INSURERS’ DUTY TO PAY: Payment may be made under this Certificate only after

the Insured has submitted, through the Insurers’ representatives as stated in the

Schedule, the completed Incident Report Form, a general medical release signed by

the Insured, any other materials requested by the Insurers, or their representatives as

stated in the Schedule, and the Proof of Permanent Total Disablement Form, and only

after the Insurers and their representatives as stated in the Schedule have completed

an investigation of such incident or claim.

No benefits shall be payable under this Certificate if the Insured refuses to undergo

any reasonable and not inherently dangerous medical treatment to improve the

condition giving rise to the claimed inability to perform.

9. REHABILITATION: If, after a period of Total Disablement, the Insured

Participates in their occupation as shown in the Schedule and performs the duties

thereof on a full-time basis for a period of at least an aggregate of the number of

regular season or post season games/events and/or play-off or championship

games/events as shown in the Schedule, the Insured shall be deemed conclusively to

have been fully rehabilitated and no claim shall be payable hereunder.

10. CHANGE IN CONTRACT STATUS OF INSURED: No benefits shall be payable

hereunder if the Insured’s contract for their services in the occupation stated in the

Schedule is terminated prior to Total Disablement directly culminating in the

Permanent Total Disablement.

11. NO ASSIGNMENT OF CERTIFICATE: No assignment of this Certificate, or any

rights hereunder, shall be binding upon the Insurers unless the Insurers assent thereto

in writing.

12. NON DISCLOSURE: Any material misstatement, non-disclosure or concealment,

whether or not such are innocent or fraudulent, in relation to any matter affecting this

Insurance shall render this Certificate voidable at the option of the Insurers.

13. FRAUDULENT CLAIMS: The making by the Insured of any fraudulent claims

shall render this Certificate null and void as from the inception date, and all claims

hereunder shall be forfeited.

14. PAYMENT OF PREMIUM: In the event that the premium(s) as stated in the

Schedule, other than the initial payment, is (are) not paid within thirty-one (31) days

of its (their) due date then this Certificate shall automatically lapse from the date such

unpaid premium was due. The total premium is under all circumstances always fully

due in the event of any claim being paid hereunder.

PART FOUR – CONDITIONS AND OTHER PROVISIONS (continued)

15. LIMITATION OF ACTIONS: No action at law or in equity shall be brought to

recover under this Certificate prior to ninety (90) days from the submission, through

the Insurers’ representatives as stated in the Schedule, of a completed Proof of

Permanent Total Disablement Form, nor shall such action be brought unless the

Insured has complied with all of the terms and conditions of this Certificate, and in

no event after the expiration of two (2) years from the commencement of Permanent

Total Disablement.

16. ENTIRE CONTRACT: This Certificate, including any Schedule, Endorsement,

Rider, Contract Details between the Insured and the organization stated in the

Schedule, or Proposal, attached hereto, constitutes the entire contract of insurance. No

change in this Certificate shall be valid until approved by the Insurers in writing and

unless such approval be endorsed hereon or attached hereto. No agent has authority to

change this Certificate or to waive any of its provisions.

17. CONFORMITY WITH LAW: Any provision of this Certificate which, on its

effective date is in conflict with the laws or statutes of the state/province/country

governing this Certificate, is hereby amended to conform to the minimum

requirements of such laws or statutes.

18. CONSTRUCTION OF WORDS REGARDING GENDER: All aforesaid words which

are used in the masculine gender shall be understood to be feminine where applicable.

19. REFUND OF BENEFITS: In the event that the Insurers pay a claim under this

Certificate and the Insured subsequently recovers sufficiently to resume the

occupation stated in the Schedule, the Insured agrees to immediately refund all

monies paid to him hereunder by the Insurers.