The Personal Accident policy provides you with invaluable cover in the event of injury, hospitalisation, disablement or death resulting from an accident. You will also receive assistance through the insurer’s partner Road Protect, in recovering money owed to you by the Road Accident Fund (RAF), after a motor vehicle accident.
Benefits of the Personal Accident policy
A discount on the additional premium if you add your partner/spouse.
No medical examinations.
Hospitalisation cover commences from the first day of hospitalisation.
Tax-free payout in the event of disablement or death.
Legal representation and claims and administration management, to claim from the RAF.
Your Personal Accident policy gives you monthly cover and your premium is deducted in advance on the date stated on your schedule. Your policy will only commence upon receipt of the first premium.
For your premium obligations, refer to the paragraph headed “Payment Details” on your schedule. This will give you details regarding the premium payable, the manner of payment of premiums and the due date for payment of your premiums.
Please take note that it was agreed to collect the monthly payment for your policy by debit order, and your initial debit will include your commencement premium and an administration fee. A deduction will be made on the same date every month. Should this date fall on a weekend or public holiday, the deduction will be made either on the last working day prior to or the first working day after the weekend or public holiday. If we do not receive your premium on your preferred deduction date, we may attempt to collect your premium on a more suitable date in an effort to keep you covered. If payment is not received for three consecutive months, the policy will be cancelled immediately.
If this is the first value-added product you have purchased from this company, you will pay a commencement fee as stated on your schedule. However, if it is not the first value-added product you are purchasing, you will not be charged a commencement fee.
The definition of an accident
An accident is an unexpected and unintentional event, caused by violent, external and visible means, commonly leading to injury and/or resulting in hospitalisation, disablement or death within 12 months of the event.
The definition of total permanent disablement
This is a disablement that entirely prevents the insured from gaining employment of any kind, and that is likely to last for the remainder of the insured’s life. This condition must be substantiated by medical evidence.
Total permanent disablement cover
Should the insured suffer a disablement as the result of an accident, he/she will be compensated according to the scale of benefits and level of cover chosen – see the scale of benefits table below.
Scale of benefits for disablement
Total permanent dissablement
Permanent and incurable paralysis of all limbs
Loss of both hands or both feet
Loss of entire sight in both eyes
Permanent loss of hearing
Permanent and total loss of speech
Loss of one limb, one hand, one foot, or entire sight in one eye
Loss of four fingers on either hand
Loss of thumb
Loss of fingers on either hand
Loss of toes on either foot
All, one foot
Big toe, both joints
Big toe, one joint
Other than the big toe (each)
If you claim for more than one of the above injuries/losses, your total payout when added up, will be limited to 100%.
Should the insured require hospitalisation as the result of an accident, cover will be provided from day one for a maximum of 104 weeks, unless compensation in respect of disablement or death becomes payable, whereupon compensation under this benefit will cease.
Should the insured die as the result of an accident, his/her nominated beneficiary/ies or estate will be compensated according to the level of cover chosen. Compensation for total permanent disablement or death will be paid in five equal annual instalments, or may be capitalised
– at 100% of the cover selected. Payment will be tax-free.
What the Personal Accident policy does not cover
Hospitalisation, disablement or death as a result of a hazardous pursuit.
Hospitalisation, disablement or death as a result of alcohol and drug abuse.
Disablement as a result of a pre-existing condition (a mental or physical illness that you had before taking out this policy).
Disablement resulting from any illness.
Death as a result of natural causes.
Qualifying for cover
This cover will only be sold to clients under the age of 65.
The importance of Road Protect
Each year an average of 550 000 accidents occur on South African roads, which account for 220 000 injuries and fatalities. The Road Accident Fund (RAF) was set up to provide compensation and support to victims of motor vehicle accidents, arising from a third party’s negligent driving.
Victims are faced with huge challenges when processing a claim through the RAF.
The process is extremely costly, long, complicated and confusing.
Seven out of ten claims are fraudulent, leading to longer claim turnaround times, as everything must be checked first.
In most instances, injured victims are unaware of the advantages offered by the RAF.
The Road Protect solution
New legislation has moved the legal community away from processing claims as they no longer have the right to take any of the settlement amounts as fees. With the Road Protect benefit, you enjoy:
legal representation from an attorney on the insurer’s panel;
administration and claims management;
medico-legal reports, from Road Protect medical experts, when needed;
future loss-of-income reports, when required;
accident reconstruction; and
full payout from the RAF as no fees will be deducted and kept by Road Protect, provided that the claim was successful.
Road Protect terms and conditions
If you are involved in a motor vehicle accident and you are injured, you may claim from the RAF. All you have to do is call the Road Protect Claims number. Professional consultants will provide you with the right advice to lodge a claim with the RAF.
Services offered by Road Protect
Telephonic assistance and advice, during office hours, to explain what you need in order to prepare your claim for presentation to the RAF.
Qualified and experienced Road Protect assessors will be available should you need an initial assessment.
Assistance and advice to help you obtain all legal reports and assessments, as required.
Assistance and advice to obtain all medico-legal assessments and reports.
Case management of your claim.
All administration required for the presentation of a bona fide claim as determined and arranged by Road Protect.
For assistance with an RAF claim, please provide the following:
The date and time that the accident occurred.
Your accident report/s and the case number/s, from the SAPS and/or traffic department.
The medical report from the first doctor who examined you after the accident.
The names, addresses and telephone numbers of all the witnesses.
Photographs of the accident and your injuries, if possible.
Your comprehensive insurance details, if applicable.
All your medical and hospital accounts.
Certified copies of your ID documents.
RAF claims procedure
Make sure that you have as much of the above-mentioned information as possible, then:
Call the Road Protect Claims number.
After the consultation you will be informed by the Road Protect practitioner of the merits of your claim and advice will be given as to the proceedings of the claim.
Based on the Road Protect practitioner’s advice, if you wish to proceed with the claim, Road Protect will arrange all the necessary consultations and opinions you require for your claim. This may include additional legal consultations and reports, medico-legal opinions, medico-legal reports and actuarial opinions for loss of earnings, consequent to your injuries.
Road Protect will assist you with all the necessary administrative requirements and the preparation of the documents that would be needed to submit your claim.
An assessment of your medical expenses incurred as a direct result of your injury will be conducted to ensure a balanced and fair medical claim.
Your claim will then be finalised and collated, and with your permission, presented on your behalf to the RAF for consideration and settlement.
Road Protect will attend to all reasonable queries or requests for further particulars that the RAF might require in pursuit of the settlement of the claim.
Limits of Road Protect service
Service will be limited where it is found that the assessor, with the relevant evidence, is of the opinion that the merits of the case do not warrant a claim. If this is in conflict with your view, or there is a material conflict between your assessment and that of the Road Protect assessors, the case will be referred to the Road Protect advisory panel for review.
Road Protect is not responsible for any costs incurred by you, the insured, for point one above.
You are free to receive advice from sources other than Road Protect. However, the cost of these external sources will not be covered by Road Protect, unless prior approval has been obtained, in writing, from Road Protect.
You are not obliged to use the services of Road Protect. In the event that you use a party other than Road Protect, Road Protect will not be liable for any costs incurred.
The Road Protect service is only available for accidents that occur in South Africa.
If your premiums are not up to date at the time of the motor vehicle accident, Road Protect will not handle your claim.
If you did not comply with all laws governing the RAF at the time of the accident, Road Protect will not process your claim.
Road Protect does not guarantee the performance you receive from the RAF.
You must disclose all material facts accurately and completely. All answers, statements and any other information you provide are your own responsibility.
Incorrect information or non-disclosure or misrepresentation of information may influence the insurer on any claims arising from your contract of insurance and may influence the insurer’s decision to provide the benefits in terms of your policy, or to accept or terminate your policy.
If any of the details on your schedule change, make it known as soon as possible. Failure to do so could result in your claim being declined.
Benefits may also not be provided if you fail to carry out your obligations in terms of your contract of insurance.
After you are informed of the decision made on a claim, you will be allowed 90 days to make the appropriate representations about the decision made. If you do not comply with this time limit, the disputed claim will not be reconsidered. If representations have been received, the decision will then be reviewed and the outcome communicated to you.
If, after review, you are not indemnified for a claim or any part of it and you wish to challenge the decision made, you must serve legal process within six months calculated from the expiry of the 90-day period referred to above. If you do not comply with this time limit, you will be prevented from proceeding with legal process.
This is not a medical scheme and the cover is not the same as that of a medical scheme. This policy is not a substitute for medical scheme membership.