Generali Accident Insurance Policy Conditions (English Translation)

Information Clause ↑ top

This clause fulfils the insurer's duty to inform under Article 96.1 of Law 20/2015 and Article 122 of Royal Decree 1060/2015. Insurer: GENERALI España de Seguros y Reaseguros S.A., registered office Pl. de Manuel Gómez-Moreno 5, 28020 Madrid (NIF A48037642; Madrid Mercantile Registry, sheet M-377257). Supervisor: the Directorate-General for Insurance and Pension Funds (DGSFP). Complaints: Generali's Claims & Complaints Service (Pl. de Manuel Gómez-Moreno 5, 28020 Madrid; reclamaciones.es@generali.com) resolves within two months; you may then escalate to the DGSFP (Paseo de la Castellana 44, 28046 Madrid) or go to the courts. Applicable law: Law 50/1980 on Insurance Contracts, Law 20/2015 and RD 1060/2015.

Basic concepts & definitions ↑ top

Key terms used throughout the policy:

• Policyholder (Tomador): the person who takes out and pays for the insurance.
• Insured (Asegurado): the person whose life or bodily integrity is insured.
• Beneficiary: the person(s) designated to receive the benefit in the event of a claim.
• Accident: a bodily injury from a violent, sudden, external cause beyond the Insured's control, producing temporary disability, permanent disability or death.
• Myocardial infarction (heart attack): occlusion of one or more coronary arteries causing irreversible death of heart muscle.
• Cerebrovascular accident (stroke): sudden cessation of brain function from infarction, haemorrhage or embolism.
• Traffic accident: a sudden, violent, external event causing death or permanent disability while a pedestrian (hit by a land vehicle), a driver/passenger of a land vehicle, or a user of public transport (land, sea or air).
• Recommended Medical Centre: a centre on Generali's list (at its offices or www.generali.es).
• Waiting period (carencia): a period from the policy's effective date during which a given guarantee is not yet in force.
• Excess in days (franquicia): days after a claim during which no benefit is payable, as set in the Particular Conditions.
• Pre-existing: conditions, injuries or defects with evident symptoms or reasonable suspicion before the effective date of each guarantee.

Article 1 — What accidents does this insurance cover? ↑ top

The Company pays the benefits set out in the Particular Conditions when the Insured suffers bodily injury from a covered Accident. Accidents are covered anywhere and from any cause, during both the declared profession and ordinary non-professional life, within the limits and exceptions of these conditions. In particular, the following are treated as accidents:

• Muscle or tendon tears/strains from a sudden effort.
• Poisoning, asphyxia or burns from the involuntary inhalation of gases/vapours, or accidental/criminal ingestion of toxic substances (excluding spoiled food, or alcohol/drug abuse).
• Lightning strike, sunstroke and frostbite, and effects of prolonged heat/cold the Insured could not escape due to a covered accident.
• Asphyxia by immersion (scuba/free-diving and spearfishing excluded unless agreed with an extra premium).
• Medical/surgical costs from a doctor's proven negligence (confirmed by final court ruling) treating a covered accident.
• Assaults, civil commotion and acts of self-defence (if not provoked by, or actively joined by, the Insured).
• Acts of human solidarity (helping others).
• Traumatic injuries from apoplexy, fainting, syncope, epileptic seizures or sleepwalking (not caused by intoxication/drugs).
• Bites from any animal and insect stings.
• Injuries while playing any sport as an amateur (except the high-risk sports listed in Article 2.4/2.13).
• Injuries riding mopeds/motorcycles of any engine size (if declared in the policy and an extra premium paid).

Article 2 — What accidents are NOT covered? ↑ top

The following are expressly excluded:

• Bad faith, self-harm, suicide or attempted suicide.
• Wilful or criminal acts by the Insured/Beneficiary, or with their cooperation.
• Accidents in a state of obvious intoxication (blood-alcohol above the legal road limit for traffic accidents, or 0.5 g/l for other accidents), mental derangement or drug use.
• Boxing, wrestling/martial arts, bobsleigh, and motor speed/endurance trials (including training).
• War, terrorism, insurrection, riots, military/security-force actions in peacetime, and natural catastrophes (earthquakes, floods, volcanic eruptions, atypical cyclonic storm, falling celestial bodies) — except as covered under Art. 1.3.
• Nuclear radiation and radioactive contamination.
• Surgery or medical treatment (unless arising from a covered accident).
• Illnesses of any kind — including heart attack and stroke — unless that specific cover is added in the Particular Conditions with an extra premium.
• Accidents before the policy's effective date; pre-existing/chronic conditions; degenerative injuries.
• For severe myopia (8+ dioptres): eye clots/haemorrhages and retinal detachment.
• Aviation accidents in group travel (sports teams, choirs, etc.) or in privately-owned aircraft.
• Risks covered by the Consorcio de Compensación de Seguros, and events classed as a "national catastrophe".
• High-risk activities: climbing, caving, mountaineering, parachuting, ballooning, gliding, microlights, hang-gliding, bungee jumping, canyoning, rafting, hydrospeed, paragliding, scuba below 20 m, polo, rugby, hockey, and any of equal or greater danger.
• Any sport practised professionally.
• Acting as pilot/student-pilot/crew of any aircraft (civil or military).
• Purely psychological effects.
• Reckless/grossly negligent acts (so declared by a court); duels, brawls (unless self-defence/rescue); driving without the correct, valid licence.

Further specific exclusions apply to each guarantee — e.g. for traffic-accident, permanent-disability and hospitalisation cover (pre-existing conditions, waiting periods, pandemic Phase 5+, etc.). See the Spanish original, Art. 2.18–2.21, for the full per-guarantee detail.

Article 3 — Geographic scope ↑ top

The Insured is covered while their habitual residence is in Spain (more than 183 days a year); cover is suspended at the next annual renewal if they move abroad. Death, Permanent Disability and Travel Assistance are covered worldwide; the other guarantees apply only within the EU and the USA; Personal Assistance applies only in Spain. A sanctions-exclusion clause applies (UN/EU/UK/US sanctions).

Article 4 — Non-insurable persons ↑ top

The following cannot be insured: people with blindness or severe myopia (over 12 dioptres), complete deafness, immunodeficiency illnesses, paralysis, epilepsy, mental derangement, alcoholism, or who have had apoplexy or "delirium tremens", and others with serious/chronic conditions that aggravate the risk; people over 70; and children under 14 and the legally incapacitated (for death-by-accident cover).

Death by Accident (5A & 5B) ↑ top

Basic death cover (5A): if the Insured dies as a direct result of a covered accident within five years of it, the Company pays the designated Beneficiaries the Death Capital in the Particular Conditions. Included as standard (unless shown as excluded) are: a personalised probate/admin service (gestoría) for the beneficiaries; an advance of the death capital for immediate funeral costs; extra capital if death results from an assault (robbery, kidnapping, etc.); automatic surviving-spouse cover until the next renewal; and an uplift if both spouses die in the same accident leaving children under 18 (or disabled).

Complementary death cover (5B), if contracted: death by heart attack or stroke (B.1 — only where it is the sole, immediate cause and not pre-existing; not cumulative with other death cover); and additional capital for death by a traffic accident (B.2), payable within five years of the accident.

Permanent Disability by Accident (5C & 5D) ↑ top

If, within five years of a covered accident, the Insured is left permanently disabled (absolute or partial), the Company pays according to the degree of disability and the option contracted.

Absolute Permanent Disability = an irreversible condition leaving the Insured totally and permanently unable to do any paid work and their normal daily activities (certified by the Company's Medical Service). Partial Permanent Disability = an irreversible loss of a limb/organ or its function, paid as a percentage of the disability sum insured per the scale below:

Key rules: partial loss reduces the percentage proportionally; left-handers swap the right/left figures; multiple losses are added up to a maximum of 100%; pre-existing defects are deducted; and the assessment ignores the Insured's profession and any Social Security disability rating. The Company notifies the degree and amount within 15 days of the medical review.

Standard additionals (unless excluded): +10% if the disability results from an assault; first prosthesis (hip/internal) costs; surviving-spouse cover and a both-spouses uplift; and home/vehicle adaptation costs where a disability requires it.

Complementary disability cover (5D), if contracted: additional capital for Absolute disability (125%, 250% or 400% of the sum, by option); additional capital for Total disability (permanently unable to do your own declared profession); Gran Invalidez (needing a third person's help for at least three of six daily acts — getting up, dressing, washing, eating, and bowel/bladder control); and absolute disability by heart attack/stroke or by traffic accident.

Temporary Disability & Self-Employed Support (5E.1–E.2) ↑ top

Temporary Disability (E.1): if a covered accident leaves you totally unable to do your declared profession, the Company pays the daily benefit in the Particular Conditions for the duration of the incapacity, up to a maximum of 12 months, less any contracted excess (franquicia). It is paid per calendar day and stops when you can resume work (even partially).

Self-employed fee support (E.2): if contracted, a monthly amount per 30 consecutive days of incapacity, while you remain registered as autónomo, up to a maximum of 6 months.

Medical Expenses, Hospital Daily Benefit & Cosmetic Surgery (5E.3–E.5) ↑ top

Medical assistance (E.3): medical, pharmacy, hospitalisation, treatment and rehabilitation costs from a covered accident — either at Generali Recommended Centres (no monetary limit, for up to 2 years) or at free-choice centres up to the contracted limit (one option per accident). Includes ambulance transfer and first prostheses, hearing aids, glasses/contact lenses made necessary by the accident.

Hospitalisation daily benefit (E.4): a cash sum for each full 24 hours of hospital stay (accident or illness, if contracted), with an additional sum for ICU stays, up to the period in the Particular Conditions. Waiting periods apply for illness (e.g. 3–12 months; 8 months for pregnancy/childbirth) but are waived if the cause is an accident.

Cosmetic surgery (E.5): if a covered accident leaves a permanent disfigurement, the costs of corrective cosmetic surgery up to the contracted limit (surgery within one year of medical discharge).

Personal & Travel Assistance (5E.6–E.7) ↑ top

Personal Assistance (E.6, in Spain): triggered by a covered accident with 24h+ hospitalisation — transport of the deceased and family, companion's hotel stay, search/rescue costs, home help and home nursing (up to 8 days), childcare/elder-care, night pharmacy delivery, pet (dog/cat) vet assistance, and legal advice on succession.

Travel Assistance (E.7, worldwide, if contracted): for trips up to 90 days — medical expenses abroad up to €25,000 (emergency dental up to €800), medical repatriation, repatriation of remains, family travel and accompaniment, hotel-stay extension, medicine dispatch, private civil liability up to €30,000, legal-fee and bail advances abroad, baggage tracing, interpreter line, and a 24h information service. (Detailed sub-limits are in the Spanish original.)

Articles 6–15 — The contract & premiums ↑ top

Cover starts once the policy is signed and the first premium paid (Art. 6); the policy runs for the agreed term and renews annually by tacit agreement, with either party able to object in writing before renewal (Arts. 7–8). The Policyholder must answer the risk questionnaire accurately and report changes that aggravate the risk (Arts. 9–10); discrepancies in the policy can be corrected within a month (Art. 11). Premiums must be paid when due, with the statutory grace period; non-payment can suspend cover and terminate the contract (Art. 13). Communications follow the rules in Art. 14, and benefit amounts can be kept updated/revalued (Art. 15).

Article 16 — What to do in the event of a claim ↑ top

Notify the Company within seven days of the accident (Art. 16 of Law 50/1980). Take all reasonable steps to limit the consequences — seek prompt medical treatment, follow medical advice, and allow examination by the Company's doctors (who are not bound by other bodies' assessments). Provide the documents required for each benefit, for example:

• Death: literal death certificate, proof of beneficiary status (will or intestate-heirs declaration), and Inheritance Tax payment/exemption.
• Permanent disability: a medical certificate stating the cause and type of disability (plus original invoices for any home/vehicle adaptation).
• Temporary disability: accident declaration within 7 days, a medical certificate of incapacity (with likely duration) and the discharge certificate.
• Medical assistance: original invoices (free-choice centres) — at Recommended Centres the Company pays the centre directly.

Articles 17–18 — How benefits are paid ↑ top

The Company pays for the direct and exclusive consequences of the accident, independent of any pre-existing or supervening physical/medical conditions (the accident's effect on those, and their effect on recovery, are not indemnifiable). On disagreement, the parties submit to medical experts under Arts. 38–39 of the Insurance Contract Act. Benefits are paid in Spain, in euros; if the Company has not paid within three months without justified cause, statutory default interest is added (Art. 17).

One accident cannot pay both Death and Permanent Disability (Art. 18). If a disability benefit has been paid and the Insured later dies of the same accident, only the difference is paid where the death capital is higher. Heart-attack/stroke benefits are not cumulative with other death or disability cover.

Articles 19–20 — Limitation & jurisdiction ↑ top

Actions arising from the insurance are time-barred after five years (Art. 19). The contract is subject to Spanish law and jurisdiction, the competent court being that of the Policyholder's domicile in Spain (Art. 20).

Article 21 — Extraordinary risks (Consorcio de Compensación de Seguros) ↑ top

Losses from extraordinary events — earthquakes and tidal waves, extraordinary floods, volcanic eruptions, atypical cyclonic storms (gusts over 120 km/h, tornadoes), falling celestial bodies; and events caused violently by terrorism, rebellion, sedition, riot, or peacetime acts of the Armed/Security Forces — are covered by the public Consorcio de Compensación de Seguros, funded by a compulsory surcharge on the policy, on the same persons and sums insured as the ordinary cover. Claims are made to the Consorcio (902/900 222 665 or www.consorseguros.es). Standard exclusions apply (war, nuclear energy, bad faith, claims before the first premium, events classed as a national catastrophe).

Generali's note: these General Conditions were written in simplified form for ease of understanding — please read them carefully and ask your intermediary or any Generali branch for clarification. GENERALI España de Seguros y Reaseguros S.A., Pl. de Manuel Gómez-Moreno 5, 28020 Madrid (NIF A48037642). Document ref. G51632, edition 01/2026.