Analysis of LMA5500

About LMA5500

Drafted by the Lloyd’s Market Association (LMA) for use on consumer and commercial Accident/Accident & Illness policies, LMA5500 is an infectious or contagious disease exclusion which is triggered by a Public Health Emergency Of International Concern (PHEIC).

LMA5500: the exclusion

Clause 1 of LMA5500 excludes claims that result from an outbreak of an ‘infectious or contagious disease’ that has been declared a PHEIC by the World Health Organization (WHO).

What is a PHEIC?

Under the International Health Regulations (2005), a Public Health Emergency Of International Concern (PHEIC) is defined as “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response”. This definition implies a situation that is:

• serious, sudden, unusual or unexpected;
• carries implications for public health beyond the affected State’s national border; and
• may require immediate international action.

To date, there have been six PHEIC declarations:

1. the 2009 swine flu declaration;
2. the 2014 polio declaration;
3. the 2014 Ebola declaration;
4. the 2016 Zika virus declaration;
5. the 2019 Kivu Ebola declaration; and,
6. the 2020 COVID-19 declaration.

LMA5500 is therefore only likely to exclude particularly serious diseases.

LMA5500: Clauses 2 and 3

Clause 2 of LMA5500 states that the exclusion of Clause 1 shall apply to claims made:

• after the date of the PHEIC declaration; and,
• where the disease has been diagnosed by a qualified medical practitioner prior to such declaration.

Clause 3 states that the exclusion shall apply until the WHO ‘cancels or withdraws any relevant PHEIC’. These words are not entirely accurate since the WHO cannot cancel or withdraw a PHEIC, but the WHO can declare that a PHEIC no longer exists. For an example of such a declaration, see Fifth meeting of the Emergency Committee under the International Health Regulations (2005) regarding microcephaly, other neurological disorders and Zika virus.

LMA5500: definition of ‘infectious or contagious disease’

In Clause 4, LMA5500 defines ‘infectious or contagious disease’ as ‘any disease capable of being transmitted from an infected person, animal or species to another person, animal or species by any means’. Strictly speaking, however, it is pathogens which are transmitted between organisms and pathogens which cause diseases (since the disease is the condition that affects the organism).