Excluded Cases Clause Samples
The 'Excluded Cases' clause defines specific situations or types of claims that are not covered by the agreement or contract. In practice, this clause lists particular scenarios—such as losses resulting from force majeure events, pre-existing conditions, or certain types of misconduct—that are expressly carved out from the parties' obligations or liabilities. By clearly identifying these exceptions, the clause helps prevent disputes over coverage and ensures that both parties understand the boundaries of their responsibilities, thereby reducing ambiguity and managing risk.
Excluded Cases. Provided that IPA has first sought an agreement with the Insured and his/her Close Relative if the Insured and/or his/her Close Relative shall themselves be responsible for all reasonable costs incurred for such assistance, IPA will not be required to provide assistance to the following: • Pre-existing Illness or disabilities for which treatment are received prior to effective date of the Policy • Injuries due to insanity or self-infliction or conditions related to functional disorders of the mind; rest cure or sanatorium care; drug addiction or alcoholism; communicable diseases requiring by law isolation or quarantine • Congenital Abnormalities • Pregnancy and Maternity • Injuries arising directly or indirectly as a result of participation in any professional or competitive sports. • Injuries sustained contracted as a result of participation in illegal acts • Services rendered without the authorization and/or intervention of IPA • Costs which would have been payable if the event giving rise to the intervention of IPA had not occurred • Any expense more specifically covered under other insurance policy • Cases of minor Illness or injury which in the opinion of the IPA’s doctor can be adequately treated locally and which do not prevent the Insured from continuing their travels or work • Expenses incurred where the Insured in the opinion of the IPA’s doctor is physically able to return to his/her Place of Residence sitting as a normal passenger and without medical escort, unless deemed necessary by the IPA’s doctor • Cases related to psychiatric disorders • The Insured engages in any form of aerial flight except as a fare paying passenger on a regular scheduled airline or licensed charter aircraft over an established route • Infectious or Contagious Disease Exclusion during a PHEIC
a) This policy does not cover claims in any way caused by or resulting from an infectious or contagious disease, an outbreak of which has been declared a Public Health Emergency of International Concern (PHEIC) by the World Health Organization (WHO).
b) This exclusion shall apply to claims made after the date of any such declaration(s), other than where a relevant diagnosis has been made by a qualified medical practitioner before the date of any such declaration(s).
c) This exclusion will continue to apply until the WHO cancels or withdraws any relevant PHEIC.
d) Infectious or contagious disease means any disease capable of being transmitted from an infected person, animal or spec...
Excluded Cases. Services and assistance under this Section H shall not be available with respect to Bodily Injury or Sudden Illness of the Member arising from:
(a) Pre-existing Conditions and any illness the symptoms of which would cause an ordinary prudent person to seek diagnosis, care or treatment before the Coverage Commencement Date, or a condition for which medical advice or treatment was recommended by a medical practitioner before the Coverage Commencement Date.
(b) Any services rendered without the authorisation and / or intervention of IPA.
(c) Childbirth, pregnancy or any complications within three (3) months before delivery date notwithstanding that such event may have been accelerated or induced by Accident.
(d) Bodily Injuries arising directly or indirectly as a result of participation in any professional or competitive sports, water sports, winter sports, racing, rallies, potholing, rock climbing or mountaineering normally involving the use of ropes of guides, parachuting or martial arts.
(e) Costs, which would have been payable if the event giving rise to the intervention of IPA, had not occurred.
(f) All other exclusions of the Contract.
Excluded Cases. Services and assistance under this Section D shall not be available with respect to Bodily Injury or Sudden Illness of the Member arising from:
(a) Pre-existing Conditions and any illness the symptoms of which would cause an ordinary prudent person to seek diagnosis, care or treatment before the Member's Coverage Commencement Date, or a condition for which medical advice or treatment was recommended by a medical practitioner before the Member's Coverage Commencement Date.
(b) Any services rendered without the authorisation and/or intervention of the Service Provider(s).
(c) Childbirth, pregnancy or any complications within three (3) months from delivery date notwithstanding that such event may have been accelerated or induced by Accident.
(d) Bodily Injuries arising directly or indirectly as a result of participation in any professional or competitive sports, water sports, winter sports, racing, rallies, potholing, rock climbing or mountaineering normally involving the use of ropes of guides, parachuting or martial arts.
(e) Costs, which would have been payable if the event giving rise to the intervention of the Service Provider(s), had not occurred.
(f) All other exclusions of the Contract.
Excluded Cases. This release shall not apply to any pending or future claim, overpayment request or other action to recover for fraud, waste, abuse, or overpayment against any third person, including any vendor, contractor, provider or Class Member, except as set forth in Section 12.6.A above, Section 12.8 below and Section 12.9 below. A list of pending actions to which this exclusion applies is attached as Exhibit F.