9
• This benet does not apply to the extent that trade or economic sanctions or
other laws or regulations prohibit the provision of insurance, including, but not
limited to, the payment of claims.
For more information about the benet described in this guide, call the
B
enet A
dministrator at 1-800-825-4062, or call collect outside the U.S.
at 1-804-965-8071.
FORM #LUGOPT – 2017 (04/17) LL-3/5-Os
Worldwide Automatic Travel Accident Insurance
THE PLAN: As a Visa Signature® cardholder of Capital One, you will be
automatically insured up to two hundred and fty thousand dollars ($250,000.00)
against accidental loss of life, limb, sight, speech or hearing while riding as a
passenger in, entering or exiting any licensed common carrier, provided the
entire cost of the passenger fare(s), less redeemable certicates, vouchers or
coupons, has been charged to your Visa Signature Card account. If the entire
cost of the passenger fare has been charged to your Visa Signature Card account
prior to departure for the airport, terminal or station, coverage is also provided
for common carrier travel (including taxi, bus, train or airport limousine, including
courtesy transportation); immediately, a) preceding your departure, directly to
the airport, terminal or station, b) while at the airport, terminal or station, and
c) immediately following your arrival at the airport, terminal or station of your
destination.
If the entire cost of the passenger fare has not been charged prior
to your arrival at the airport, terminal or station, coverage begins at the time the
entire cost of the travel passenger fare is charged to your Visa Signature Card
account. Common Carrier means any land, water or air conveyance operated
by those whose occupation or business is the transportation of persons without
discrimination and for hire.
ELIGIBILITY: This travel insurance plan is provided to Visa Signature Card cardholders
of Capital One, automatically when the entire cost of the passenger fare(s) are charged
to your Visa Signature Card account while the insurance is eective. It is not necessary
for you to notify Capital One, the administrator or the Company, when tickets are
purchased.
THE COST: This travel insurance plan is provided at no additional cost to eligible Visa
Signature Card cardholders of Capital One. Capital One pays the premium for the
insurance.
BENEFICIARY: The Loss of Life benet will be paid to the beneciary designated by
the insured. If no such designation has been made, that benet will be paid to the rst
surviving beneciary in the following order: a) the Insured’s spouse, b) the Insured’s
children, c) the Insured’s parents, d) the Insured’s brothers and sisters, e) the Insured’s
estate. All other indemnities will be paid to the Insured.
THE BENEFITS: The full Benet Amount of two hundred and fty thousand dollars
($250,000.00) is payable for accidental loss of life, two or more members, sight of both
eyes, speech and hearing or any combination thereof. One half of the Benet Amount
is payable for accidental loss of: one member, sight of one eye, speech or hearing.
One quarter of the Benet Amount is payable for the accidental loss of the thumb and
index nger of the same hand.
Member means hand or foot. Loss means, with respect to a hand, complete
severance through or above the knuckle joints of at least 4 ngers on the same
hand; with respect to a foot, complete severance through or above the ankle joint.
The Company will consider it a loss of hand or foot even if they are later reattached.
Benet Amount means the Loss amount applicable at the time the entire cost
of the passenger fare is charged to your Visa Signature Card account. Accident or
Accidental means a sudden, unforeseen and unexpected event happening by
chance. Accidental Bodily Injury(ies) means bodily injury which is Accidental, is the
direct source of a Loss, is independent of disease, illness or other cause and occurs
while this policy is in force. Covered Trip means travel on a Common Carrier when the
entire cost of the passenger fare for such transportation, less redeemable certicates,
vouchers or coupons, has been charged to an Insured Person’s Account issued by the
Policyholder. Insured Person means the individual or entity to whom the Policyholder
has issued an Account, as well as authorized users of the Account registered with the
Policyholder.
The loss must occur within one year of the accident. The Company will pay the single
largest applicable Benet Amount. In no event will duplicate request forms or multiple
charge cards obligate the Company in excess of the stated Benet Amounts for any
one loss sustained by any one individual insured as the result of any one accident. In
the event of multiple accidental deaths per account arising from any one accident, the
Company’s liability for all such losses will be subject to a maximum limit of insurance
equal to two times the Benet Amount for loss of life. Benets will be proportionately
divided among the Insured Persons up to the maximum limit of insurance.
EXCLUSIONS: This insurance does not cover loss resulting from: 1) an Insured’s
emotional trauma, mental or physical illness, disease, pregnancy, childbirth or
miscarriage, bacterial or viral infection (except bacterial infection caused by
an accident or from accidental consumption of a substance contaminated by
bacteria), or bodily malfunctions; 2) suicide, attempted suicide or intentionally
self-inicted injuries; 3) declared or undeclared war, but war does not include acts
of terrorism; 4) travel between the Insured Person’s residence and regular place of
employment. This insurance also does not apply to an accident occurring while an
Insured is in, entering, or exiting any aircraft owned, leased, or operated by Capital
One; or any aircraft while acting or training as a pilot or crew member, but this
exclusion does not apply to passengers who temporarily perform pilot or crew
functions in a life-threatening emergency.
CLAIM NOTICE: Written claim notice must be given to the Company within
twenty (20) days after the occurrence of any loss covered by this policy or
as soon as reasonably possible. Failure to give notice within 20 days will not
invalidate or reduce any otherwise valid claim if notice is given as soon as
reasonably possible.
CLAIM FORMS: When the Company receives notice of a claim, the Company
will send you forms for giving Proof of Loss to us within 15 days. If you do
not receive the forms, you should send the Company a written description of
the loss.
CLAIM PROOF OF LOSS: For all claims, complete proof of loss must be given to
us within 90 days after the date of loss, or as soon as reasonably possible. Failure
to give complete Proof of Loss within these time frames will not invalidate any
otherwise valid claim if notice is given as soon as reasonably possible and in no
event later than 1 year after the deadline to submit complete Proof of Loss.
CLAIM PAYMENT: For benets payable involving disability, we will pay the
Insured Person or beneciary the applicable Benet Amount no less frequently
than monthly during the continuance of the period for which we are liable. At
the end of this period, we will immediately pay any remaining balance of the
Benet Amount. All payments by us are subject to receipt of written Proof of
Loss. For all benets payable under this policy except those for disability, we will
pay the Insured Person or beneciary the applicable Benet Amount within sixty
(60) days after we receive a complete Proof of Loss, if the Insured Person and
Policyholder have complied with all the terms of this policy.
EFFECTIVE DATE: This insurance is eective on the date that you become an
eligible cardholder, whichever is latest; and will cease on the date the Master
Policy 6478-06-65 is terminated or on the date your Visa Signature Card account
ceases to be in good standing, whichever occurs rst.
HOW TO FILE A CLAIM: FOR CLAIMS-RELATED MATTERS ONLY—you may
submit a claim directly to Federal Insurance Company. To le a claim directly
with Federal Insurance Company, contact the Claim Administrator, Broadspire,
a Crawford company. Complete all items on the required claim form, attach all
appropriate documents, and mail or fax to: Broadspire, a Crawford company, P.O.
Box 459084 Sunrise, FL 33345 PHONE: 855-307-9248, FAX: 855-830-3728.
ALL CUSTOMER SERVICE RELATED ISSUES INCLUDING BUT NOT LIMITED
TO GENERAL QUESTIONS & CARD SERVICE INQUIRIES SHOULD BE
DIRECTED TO THE PLAN ADMINISTRATOR NOTED BELOW AND NOT
FEDERAL INSURANCE COMPANY.
GOVERNING JURISDICTION AND CONFORMANCE WITH STATUTES: This
insurance is governed by the laws of the jurisdiction in which it is delivered
to the Policyholder. Any terms of this insurance which are in conict with the
applicable statutes, laws or regulations of the jurisdiction in which the master
policy is delivered are amended to conform to such statutes, laws or regulations.
Any terms of a Description of Coverage which are in conict with the applicable
statutes, laws or regulations of the jurisdiction in which the Description
of Coverage is delivered are amended to conform to the statutes, laws or
regulations of the jurisdiction.
Answers to specic questions can be obtained by writing the Plan Administrator.
Plan Administrator
cbsi
550 Mamaroneck Ave.
Harrison, NY 10528
As a handy reference guide, please read this and keep it in a safe place with
your other insurance documents. This information is a brief description of
the important features of this insurance plan. It is not an insurance contract.
Insurance benets are underwritten by Federal Insurance Company. Coverage
may not be available in all states or certain terms may be dierent where required
by state law. Chubb NA is the U.S.-based operating division of the Chubb Group
Capital One Signature Guide to Benets