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Cover
The insurer’s hereby agree to pay on behalf of the insured
the costs of corrective surgery or treatment for post-operative
infection, which: -
- Arises from a valid claim brought under the policy,
- Has been incurred with the insurers written consent,
- Has been notified within the period of insurance within the
territorial limits,
- Relates to the following provisions and subject to the terms
and conditions of the policy.
(i) The cost of corrective treatment and/or surgery in the
event of insured developing capsular contracture (Baker Scale
III or IV) in one or both breasts following initial breast
augmentation surgery.
(ii) The cost of treatment of post-operative infection occurring
between sixty hours and six weeks after initial breast augmentation
surgery.
Conditions
- Diagnosis must be by a nominated specialist and the cost of
this consultation must be borne by the insured.
- Claims must be notified to the insurers agent at the address
below, within fourteen days of diagnosis by the nominated specialist.
- If a claim is made for the cost of treatment of post-operation
infection, the policy must be reinstated by the payment of a
further premium to provide ongoing cover for capsular contracture
(Baker Scale III or IV)
- All surgery and/or treatment must be carried out by an authorised/acceptable
surgeon.
- Cover must be purchased before surgery.
- The twelve-month period of insurance runs from completion
of surgery.
- Implants must be textured and conform to European safety standards,
carrying the relevant ISO or CE kitemark.
- In the event of the insured developing capsular contracture
Baker Scale III, treatment must initially be by means of anti-inflammatory
drugs, massage and physiotherapy before recourse to corrective
surgery.
- Insurers must have access to all medical files and records
in the event of claims.
Exclusions
- No cover is provided under this policy for pre-existing conditions.
- Specifically excluded from cover under this policy are claims
from patients who are/having had: -
(i) Radiotherapy to the breast, chest wall or axillia (armpit),
(ii) Compromised wound healing or pathalogically excessive scar
tissue formation
(iii) Congenital, acquired, neoplastic, auto immune or pharmacologically
induced immune compromise including – diabetes, mellitius,
HIV, leukaemia, steriod ingestion disorders (including anaemia,
anorexia and malnutrition).
- Any psychiatric disorders suffered by the patient must be
declared at the time at which cover is applied for.
- This policy does not cover implants in which the volume of
the
implant can be adjusted percutaneously in the post-operative
period (i.e. tissue expanders and the like)
- Claims arising following the insertion of faulty prostheses
are not covered under this policy.
- No claim is provided in respect of infection or other complications
arising as a result of post-operative body piercing or any pre
or post operative activity deemed the insurers and the nominated
specialist to be unreasonable, excessive or unlawful.
Cancellation
The insured may cancel the policy by giving the insurers agent
written instructions. The insurers may cancel the policy by sending
seven days notice by recorded delivery letter to the insured’s
last known address.
In the event of cancellation by either the insurers or the insured,
the insurers will return a proportionate refund of the premium
paid in respect of the unexpired term of this policy unless: -
- A claim or an incident likely to give rise to a claim has
occurred during the current period of insurance
- The cancellation is effective in the fist period of insurance
when an administration charge will be made and deducted from
the proportionate refund
Dispute Resolution
Any dispute, question or difference between the insurers and
the insured arising under or in connection with the policy shall
be submitted to a single arbitrator in accordance with the Short
Form Arbitration Rules of the Chartered Institute of Arbitrators.
The arbitrator shall be either a person agreed upon by both parties,
or failing agreement within four weeks of the date on which the
insured gives the insurers written notification of a dispute,
question or difference of vice versa, a person nominated by the
President of the Chartered Institute of Arbitrators.
Communications
All notices and communications from the insurers to the insured
under or in connection with the policy shall be writing and sent
by the insurers by first class post to the insured’s address
as specified in the schedule.
All notices and communications from the insured to the insurers
under or in connection with the policy shall be given in writing
and sent by first class post to:
Trafalgar Risk Management
The Lloyds Building
12 Leadenhall Street
London, EC3V 1LP
or facsimile to:
0845 685 2611
Templeton Insurance Limited is licensed and supervised by the
Isle of Man Government Insurance and Pensions Authority.
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