FW: STURGE Medical form x 4 - Myla Trestiza - 16/237
Hi Allan,
Please find attached the completed STURGE Claim form (total 4 pages) as signed by Myla & Capt. James 4th September 2016
Hi Clem
Finally received the attached form is this what you are looking for
Best Regards
Allan Wilson
Wilson Yacht Management
UK Office
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UK Office Hessle I East Yorkshire I HU13 OAH USA Office Fort Lauderdale I Florida 3331
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CONFIDENTIALITY NOTICE: This email (including all attachments) is for the intended recipient only and may contain confidential information, some of which may be privileged. Please be advised that any disclosure, copying, distribution or use of any part of the information contained is prohibited. If you received this email in error, please destroy the original email and its attachment and notify me immediately. Thank you
Hi Allan
Many thanks for your swift response on this and the attached claim form.
I am pleased to advise that we have now arranged urgent settlement of the Makati clinic invoice and payment has today been authorised.
As mentioned in my email of 14th December 2016, the total outstanding costs for the Makati clinic were PHP 121,972.73 however, included within these costs are breast clinic costs totalling PHP 7,245.00 which do not appear to be related to the claim at this stage. CEGA are trying to obtain further information directly from Myla regarding these costs in order that the balance of PHP 7,245.00 can be assessed further.
Due to the fact that the breast clinic costs cannot be confirmed as claim related, the sum of PHP 7,245.00 has been excluded by insurers from the settlement to Makati clinic. The total transferred to the clinic is therefore the net sum of PHP 114,547.72. Myla therefore may be approached directly by the clinic for the balance of PHP 7,245.00. If Myla is asked to settle the costs directly and would like the costs considered as part of the claim, I would be very grateful if you could please forward the proof of payment along with clarification regarding the reasons for these costs, in order that this matter can be considered further.
In the meantime, I note from the claim form that the Insured have listed 4 separate costs which have been incurred. Are you able to provide receipts for the costs incurred by the Insured so that I can add this to the claim for consideration by insurers, less the USD 200.00 medical expenses excess?
I look forward to hearing from you in due course.
Kind regards
Clem
Clementine Kingstone ACII
Claims Handler
Sturge Taylor & Associates Ltd
Sturge Taylor & Associates Ltd
Notebeme House, [REDACTED]
Southampton, SO14 2NT, United Kingdom
Tel: [REDACTED]
Fax: [REDACTED]
IMPORTANT NOTICE —THE (UK) INSURANCE ACT 2015
On the 12th August 2016 the new (UK) Insurance Act came into force and we need to inform you of the following changes that we are highlighting to all of our clients.
The Insurance Act (The Act) will apply to all new insurances, renewals and any changes to insurance requirements effective on or after the 12th August 2016. The Act requires that a fair presentation of the risk is made as failure to do so could result in avoidance of the policy and retention of the premium (if failure to make a fair presentation is deliberate or reckless), or of different terms being adopted to consider how the risk would have been underwritten had fair presentation been made, which could result in only partial payment of any relevant claim. As your Broker we have a key role in ensuring that you are aware of and comply with the updated requirements.
Insurance Law for contracts subject to the laws of England & Wales has changed since your last renewal and, in order that you may comply with your obligations please be advised of the undernoted requirements, which differ to those previously in place:
Duty of Disclosure
You have a duty to make a fair presentation of the risk to the insurer, via Sturge Taylor & Assoc, of every material circumstance which you ( or a member of your organisation, employee, Captain, Crew, management team etc ) know or ought to know in relation to the risk placed and this duty is applicable before the cover is placed, when it is renewed and at any time throughout the contract if the risk changes. A circumstance is material if it would influence the judgement of an Insurer / Reinsurer in determining whether to take the risk and, if so, on what terms. If you are in any doubt whether a circumstance is material we recommend that it should be disclosed.
Disclosure will be considered fair if it is made in a manner that is reasonably clear and accessible and the facts represented are correct and made in good faith. Failure to disclose a material circumstance may entitle an insurer to impose different terms on your cover or proportionately reduce the amount of any claim payable. In the event that non-disclosure was deliberate or reckless an insurer will be entitled to avoid the policy from inception and retain the premium paid. This would result in any claims under the policy not being paid.
Conditions Precedent
You must also take particular note of any conditions precedent that appear in the policy. If a condition precedent to the validity of this policy or to the commencement of the risk is not complied with, the insurer will not come on risk. If a condition precedent to the Insurers liability under this policy is not complied with, the insurer may not be liable for the loss in question. A condition precedent may exist in the policy using other terminology and without reference to the words 'condition precedent'.
It is very important that you read the full policy carefully when it is received and, if you are unsure of, or are unable to comply with any provisions therein, please let Sturge Taylor & Assoc know immediately.
Contracting Out
Some Insurers have exercised their right to opt out of the requirements of the new act. In the event that this affects the insurances we have placed for you we will advise you accordingly.
We have produced a simple guide to help you through some of the changes within the Insurance Act which, if not attached to this email it is available on request. If you would like further information please contact us and we will endeavour to help.
Registered Office: Sturge Taylor & Associates Ltd.,
Highfield Court, Tollgate, Chandlers Ford, Eastleigh, Hampshire 5O14 3TY
Registered in England No. 37064804
Authorised and Regulated by the Financial Conduct Authority
IMPORTANT: This e-mail (including all attachments) is confidential and may be privileged. It may be read, copied and used only by the intended recipients, and must not be re-transmitted in an amended form without our consent. If you have received it in error, please contact us immediately by return e-mail or by telephone. Please then delete it and do not disclose its contents to any other person.
We operate anti-virus programmes but you must take full responsibility for virus checking.
Dear Allan
Following on from my email of 21st December 2016 below, I have been informed by CEGA that Myla has advised them that the costs for the breast clinic were for a routine mammogram. I understand that this test was not linked to the subject matter of this claim.
With this in mind, as the costs are for a routine screening, regrettably, these costs will not be recoverable under the terms of the policy. Exclusion 3 of Section 2 (medical Expenses) specifically excludes 'Examinations for check-up purposes not incidental to, or necessary to diagnose Illness or Accidental Bodily Injury; general health examinations.' The outstanding clinic balance of PHP 7,245.00 for the breast screening will therefore be for Myla / the yacht's own account.
In order that we can proceed towards finalising this claim, I would enquire if there Insured have any further medical expenses that they would like to submit as part of the claim, less the medical expenses excess of USD 200.00? if no further costs are to be submitted, I can arrange for a debit note to be issued for the outstanding USD 200.00 medical expenses excess for settlement by the Insured.
I trust that you find this to be in order and now await your advices.
Kind regards
Clem
Clementine Kingstone ACII
Claims Handler
Sturge Taylor & Associates Ltd
Notebeme House, █████████, Southampton, SO14 2NT, United Kingdom
Tel ████████████
Fax ████████████
IMPORTANT NOTICE — THE (UK) INSURANCE ACT 2015
On the 12th August 2016 the new (UK) Insurance Act came into force and we need to inform you of the following changes that we are highlighting to all of our clients.
The Insurance Act (The Act) will apply to all new insurances, renewals and any changes to insurance requirements effective on or after the 12th August 2016. The Act requires that a fair presentation of the risk is made as failure to do so could result in avoidance of the policy and retention of the premium (if failure to make a fair presentation is deliberate or reckless), or of different terms being adopted to consider how the risk would have been underwritten had fair presentation been made, which could result in only partial payment of any relevant claim. As your Broker we have a key role in ensuring that you are aware of and comply with the updated requirements.
Insurance Law for contracts subject to the laws of England & Wales has changed since your last renewal and, in order that you may comply with your obligations please be advised of the undernoted requirements, which differ to those previously in place:
Duty of Disclosure
You have a duty to make a fair presentation of the risk to the insurer, via Sturge Taylor & Assoc, of every material circumstance which you ( or a member of your organisation, employee, Captain, Crew, management team etc ) know or ought to know in relation to the risk placed and this duty is applicable before the cover is placed, when it is renewed and at any time throughout the contract if the risk changes. A circumstance is material if it would influence the judgement of an Insurer / Reinsurer in determining whether to take the risk and, if so, on what terms. If you are in any doubt whether a circumstance is material we recommend that it should be disclosed.
Disclosure will be considered fair if it is made in a manner that is reasonably clear and accessible and the facts represented are correct and made in good faith. Failure to disclose a material circumstance may entitle an insurer to impose different terms on your cover or proportionately reduce the amount of any claim payable. In the event that non-disclosure was deliberate or reckless an insurer will be entitled to avoid the policy from inception and retain the premium paid. This would result in any claims under the policy not being paid.
Conditions Precedent
You must also take particular note of any conditions precedent that appear in the policy. If a condition precedent to the validity of this policy or to the commencement of the risk is not complied with, the insurer will not come on risk. If a condition precedent to the Insurers liability under this policy is not complied with, the insurer may not be liable for the loss in question. A condition precedent may exist in the policy using other terminology and without reference to the words 'condition precedent'.
It is very important that you read the full policy carefully when it is received and, if you are unsure of, or are unable to comply with any provisions therein, please let Sturge Taylor & Assoc know immediately.
Contracting Out
Some Insurers have exercised their right to opt out of the requirements of the new act. In the event that this affects the insurances we have placed for you we will advise you accordingly.
We have produced a simple guide to help you through some of the changes within the Insurance Act which, if not attached to this email it is available on request. If you would like further information please contact us and we will endeavour to help.
Registered Office: Sturge Taylor & Associates Ltd.,
Highfield Court, Tollgate, Chandlers Ford, Eastleigh, Hampshire 5O14 3TY
Registered in England No. 370648O
Authorised and Regulated by the Financial Conduct Authority
IMPORTANT: This e-mail (including all attachments) is confidential and may be privileged. It may be read, copied and used only by the intended recipients, and must not be re-transmitted in an amended form without our consent. If you have received it in error, please contact us immediately by return e-mail or by telephone. Please then delete it and do not disclose its contents to any other person.
We operate anti-virus programmes but you must take full responsibility for virus checking.
Hi Myla
Please see below email string regarding your medical claim. The outstanding clinic balance of PHP 7,245.00 for the breast screening as stated is not part of the claim and is for your account.
Also at this stage can you confirm that we can now close the claim and that you have not incurred any additional expenses.
Best Regards
Allan Wilson
Wilson Yacht Management
UK Office
The image displays contact information for a UK Office and a USA Office.
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Copyright © Wilson Yacht Management
CONFIDENTIALITY NOTICE: This email (including all attachments) is for the intended recipient only and may contain confidential information, some of which may be privileged. Please be advised that any disclosure, copying, distribution or use of any part of the information contained is prohibited. If you received this email in error, please destroy the original email and its attachment and notify me immediately. Thank you.