| Personal accident

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Cover section: Personal accident

Index

1. Definitions that apply to your Personal accident section 2

2. What we cover 3

3. Conditions for cover 3

4. Main benefits 4

5. Additional benefits 5

6. Specific exclusions 7

7. Claiming for the personal accident benefits 9

8. When cover for an insured ends 10

9. Service benefits 10

10. Optional benefits 11

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Cover section: Personal accident

Cover section: Personal accident

Your Personal accident section explains the types of benefits that are available to you. You must read this section
together with the general terms and conditions and your policy schedule.

This cover section includes General personal accident and En route personal accident benefits. Please read your policy
schedule to see which benefits apply to you.

1. Definitions that apply to your Personal accident section

The following definitions are used in the Personal accident section of this policy.

Insureds If you chose General personal accident, Insureds will mean:

You, your partner and your children as set out in the policy schedule.
If you chose En-route personal accident, Insureds will mean:

The driver of the car and the passengers. We will only cover the number of
occupants that the car is licensed to carry, up to a maximum of ten occupants,
including the driver.
The rider of a motorbike and one passenger.
If you chose both benefits, Insureds will mean all of the above.
Partner A person who is the permanent life partner (whether in a heterosexual or homosexual
partnership) or spouse or civil union partner of a policyholder in accordance with:

the Marriage Act, 68 of 1961;

the Recognition of Customary Marriages Act, 68 of 1997;
the Civil Union Act, 17 of 2006; or
the tenets of any Asiatic religion.
A permanent life partner is a partner who you live with for longer than 12 months.

A maximum of one partner will be covered for benefits under the General personal
accident section of this policy at any one time.
Child Will mean an unmarried, financially dependent child of the policyholder who has not
yet attained the age of 18, and will include:

a biological child, a posthumous child, a stepchild, a grandchild; and

a legally fostered child and an adopted child.
While the policyholder is eligible for cover under this policy, the age may (at our
discretion), be extended to a child who has reached age 24, in respect of:

an unmarried child who is a full time student at a registered educational

institution. Being a full time student means the child must attend lectures and
the course must be at least 12 months in duration. A full time student does not
include studies via correspondence; and
an unmarried, financially dependent child of the policyholder who is mentally
disabled or permanently, totally physically disabled, while the policyholder is
eligible for cover under this policy.
A maximum of six children will be covered under the General personal accident
section of this policy during the entire period of the policyholders cover under this
policy.
Accident An unfortunate incident the insured could not foresee that happens unexpectedly
and unintentionally at an identifiable time and place and results in death or bodily
injury.
Bodily injury Physical injury to a persons body caused by violent, accidental, external and visible
means. This includes starvation, thirst, exposure to the elements and hijacking.

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Cover section: Personal accident

2. What we cover
You could choose General personal accident or En route personal accident benefits, or both. Depending on your
choice, certain benefits or services set out in the Personal accident section of this policy will not apply to you.

2.1 If you chose the General personal accident benefit

a. Main benefits. We will cover the insureds for all the main benefits.
b. Additional benefits. We will cover the insureds for all the additional benefits.
c. Service benefits. You have access to the Trauma and HIV assistance helpline.
d. Optional benefit. You may choose to be covered for the optional benefit.

2.2 If you chose the En route personal accident benefit

a. Main benefits. We will cover the insureds for all the main benefits.
b. Additional benefits. We will cover the insureds for only the following additional benefits:

Medical expenses
Trauma counselling

c. Service benefits. No service benefits are available.

d. Optional benefit. No optional benefit is available.

2.3 If you chose both benefits

If you chose both benefits, the insureds will be covered under both benefits, unless we say differently.
For example: If an insured dies, we will pay the death benefit amount under the General personal accident
section, plus the death benefit amount under the En route personal accident section.

3. Conditions for cover

a. Conditions specific to General personal accident benefits:

We cover the insureds anywhere in the world, but your home must be within the borders of South
Africa.
An accident refers to any kind of accident including a car or motorbike accident.

b. Conditions specific to En route personal accident benefits:

Your car or your motorbike must be insured with us under this policy.
We cover the insureds for accidents that involves your car or your motorbike, within the countries
set out in the car or motorbike section of this policy.
An accident refers to only to an accident with a car or motorbike that is insured with us under this
policy.

c. An insured must be 6 months or older, but not older than 80 years at the date of an accident.
d. An accident must happen during the period of insurance.
e. Death, total and permanent disability or partial disability must happen within 12 months of the date of the
accident.
f. In the event of a claim an insured must undergo a medical examination if we ask him to. We will pay the
cost of the examination.
g. You must tell us of any physical illness or disability that you know of at any time during the period of
insurance.

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Cover section: Personal accident

4. Main benefits
We cover the insureds for death or permanent disability that are caused directly by an accident.
4.1 Death benefit
If an insured dies because of an accident during the period of insurance, we will pay 100% of the sum
insured.
4.2 Permanent disability benefit
If an insured suffers a permanent disability, we will pay a percentage of the sum insured as set out below.
If an insured suffers more than one kind of disability, the total benefit payable will not exceed 100%
of the sum insured per incident.
We will only pay one benefit per limb. For example, if we pay a benefit for losing an arm, we will not
pay the benefit for loss of the hand and fingers as well.

Disability Percentage of
sum insured
Total and permanent loss of function, or the physical separation of both arms 100%
or both legs
Total and permanent loss of function, or the physical separation of one arm and 100%
one leg
Total and permanent loss of function, or the physical separation of one arm or 50%
one leg
Total and permanent loss of function, or the physical separation of one hand 100%
and one foot
Total and permanent loss of function, or the physical separation of one hand 75%
Total and permanent loss of function, or the physical separation of one foot 50%
Loss of fingers:
four fingers on one hand 70%
thumb 30%
any finger other than thumb 5%
Loss of toes:
all toes on one foot 30%
great toe 10%
any other toe 2%
Complete and irreversible loss of hearing:
in both ears 100%
in one ear 25%
Complete and irreversible loss of sight:
in both eyes 100%
in one eye 50%
Loss of speech 100%
Total and incurable paralysis or being permanently bedridden 100%
Total and permanent loss of intellectual capacity. 100%

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Cover section: Personal accident

4.3 Disappearance
If an insured disappears during the period of insurance, we will assume the insureds death and will pay the
death benefit as set out above. The following conditions apply to this benefit:
The insureds disappearance must be because of an accident which caused bodily injury that could
have resulted in death.
We will assume the insureds death, if in our opinion a reasonable amount of time has passed.
We will not consider a claim for the disappearance benefit before 12 months after the date of the
disappearance.
If we have paid the disappearance benefit and the insured is later found to be alive, you must pay
back the death benefit amount that we have paid.
4.4 Terrorism
We will also cover the death or disability of an insured because of acts of terrorism. We will pay the death
or disability benefits as set out above.
Acts of terrorism means:
The use of threat, violence or force for political, religious, personal or ideological reasons.
This may or may not include an act that is harmful to human life.
It could be committed by any person or group of persons, acting alone, on behalf of or with any
organisation or government.
It includes any act committed with the intention to influence any government or inspire fear in the
public.
4.5 Limitation of benefits
We may increase the maximum amounts from time to time, or when legislation changes. If we limit the
claim amount to the maximums below, we will refund the premiums we received for any cover we did not
provide.
If an insured becomes disabled and then dies because of the same accident, we will pay the higher
of the death or disability sum insured.
If an insured is covered under more than one personal accident policy issued by us, we only pay a
benefit under the policy with the highest benefit amount. We will refund the premiums that we
received under the other policy for the claim that we do not pay.
Benefits for children are subject to a maximum amount as allowed by legislation. The total amount
that we will pay on all policies issued by us is subject to:
R10 000 (ten thousand Rand) if the child is under six years of age; or
R30 000 (thirty thousand Rand) if the child is over the age of 6 years and under the age of
14years.

5. Additional benefits
We will automatically cover an insured for the following additional benefits up to the limits set out in the policy
schedule.
5.1 Medical expenses
If an insured sustains bodily injury because of an accident, which (directly or indirectly, and independently
of any other cause) requires medical or surgical treatment, we will pay for the medical expenses.
Medical expenses are the necessary costs and expenses for medical treatment including:
surgical, dental, hospital, nursing and prescribed remedial expenses;
artificial aids and prostheses; or
doctors fees.
We will not pay medical expenses to a service provider under any circumstances.
If you are covered for both the General personal accident and En route personal accident benefits, we will
only pay for the medical expenses once.

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Cover section: Personal accident

5.2 Trauma counselling

We will pay the cost of professional counselling to help the insured cope with trauma if he is the victim of
an act of violence or a traumatic accident.

An act of violence includes an assault, robbery, rape or armed car hijack.

You must report the act of violence to the police and give us the case number.
This benefit includes counselling for the insureds immediate family members who were exposed to
the same act of violence or traumatic accident.
We will not pay if you are covered under another policy for a similar benefit.
If you are covered for both the General personal accident and En route personal accident benefits,
we will only pay for the trauma counselling costs once.

5.3 Life support machinery

If an insured sustains bodily injury because of an accident, we will pay the cost of life support machinery
or equipment needed.

5.4 Mobility cover

We will pay the cost of a prosthesis, or a manual or electric wheelchair if an insured is:

permanently and physically disabled;

because of a bodily injury caused by an accident;
which results in the need for a wheelchair or any other appliance for freedom of movement.

We will not pay if you are covered under another policy for a similar benefit. We must admit a disability
claim under this policy.

5.5 Rehabilitation costs

We will pay the costs of a rehabilitation programme, except for the costs covered by the insureds medical
aid. The benefit applies if:

we admit a valid disability claim under this cover section; and

in our opinion the insureds disability prevents him from performing the material and substantial
duties of his occupation at the time of the accident.

Rehabilitation programmes are re-skilling, re-training or medical treatment programmes to help the
insured become able to perform the duties of:

his own occupation; or

any occupation for which the insured has, or can reasonably be trained to have, the necessary
knowledge, skills or ability to return to work.

5.6 Search and rescue

If an insured sustains bodily injury because of an accident, we will pay the reasonable search and rescue
costs.

This benefit includes freeing and bringing the insured to a place of safety, or to prevent bodily injury.
If the insured is found in circumstances which are unlikely to have resulted in bodily injury, we may
ask you to pay back any benefit paid by us.

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Cover section: Personal accident

5.7 Emergency transportation costs

If an insured sustains bodily injury because of an accident, we will pay the costs and expenses necessary for
emergency transportation of an injured insured to the closest medical facility.

If the closest medical facility cannot provide the treatment required, we will pay the cost to transport the
insured to a different medical facility.

A qualified medical doctor, or if not available, the highest qualified medical practitioner must confirm that
emergency transportation to a different medical facility is necessary because:

the local medical facilities are inadequate for the treatment of the insureds injury; and
transporting the insured to a different medical facility will help the insured to recover faster.

5.8 Return of an injured person

If an insured sustains bodily injury because of an accident, we will pay the reasonable and necessary costs
to return an insured from the hospital to his normal place of residence. The following conditions apply to
this benefit:

You must ask us for our permission before you arrange for the return of an insured.
The insureds injury must be of such a serious nature that it prevents him to return home
unaccompanied.
We will not pay any benefit if the distance from the hospital to the normal place of residence is less
than 100 km.

5.9 Return of a body

If we admit a valid death claim under this cover section, we will pay the reasonable and necessary costs to
return the body of a deceased insured from the place of death to the place of burial. We will not pay any
benefit if the distance from the place of death to the place of burial is less than 100 km.

6. Specific exclusions
The exclusions set out in the General exclusions section do not apply to the benefits payable under your Personal
accident section. We will not pay a claim for any of the following:

6.1 Trade and economic sanctions

We cannot provide any cover if that means we would not comply with trade or economic sanctions. If we
find out that an insured is subject to such sanctions, we will cancel your policy from the policy start date
or the date that the insured becomes subject to sanctions. We will refund any premiums paid by you and
will not pay any claims.

6.2 Not because of an accident

We will not pay a claim for death or disability that is directly or indirectly related to physical disability or
illness.

6.3 Pre-existing conditions

We will not pay a claim for death or disability that was caused by an illness, medical condition, disability or
injury that existed at any time before the cover start date.

6.4 Mental conditions

We will not pay a claim for death or disability that was caused by insanity, neurosis or diagnosed mental
or nervous disorders.

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Cover section: Personal accident

6.5 Insureds actions cause death or disability

We will not pay a claim if the insureds death or disability is directly or indirectly caused by any of the
following:

a. Criminal activities

Criminal activity means the insured is:

under investigation for committing a crime;

being prosecuted for committing a crime; or
convicted by a Court of Law for having committed a crime.
We will delay our claims decision until the finalisation of the investigation, or the criminal
trial. You must give us proof of the outcome of the investigation or the criminal trial.

b. Military or police activities

The insured is in active service with the defence force, police services or correctional services.

c. Warlike activities

Nuclear, biological and chemical warfare or sabotage.

The insured actively taking part in:

any war, invasion, rebellion, revolution, uprising, riot, civil commotion, strike, or the seizing
of power; or
labour disturbance, including a riot, commotion or other form of public disorder in the work
place.

d. Irresponsible actions

The insured:

deliberately or negligently exposes himself to the risks and events that led to the claim,
except where the insured attempts to save a human life;
attempts or commits suicide or deliberately inflicts injury on himself;
refuses to seek and follow reasonable medical advice or treatment;
drives when over the legal alcohol limit;
takes illegal drugs or poison; or
is under the influence of medication, unless the medication was prescribed by a qualified
medical practitioner and taken in the correct dosage.

e. Dangerous activities

The insured:

participates in sport competitively or as a professional or for financial reward; or

participates in any kind of racing, speed tests or duration tests; or
is involved in aviation, gliding, micro-lighting, parachuting or travelling by air except as a fee-
paying passenger in a fully licenced aircraft.

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Cover section: Personal accident

7. Claiming for the personal accident benefits

The conditions set out in the section Claiming under this policy do not apply to the benefits payable under your
Personal accident section.

7.1 How to claim

If there is a claim for a benefit payable under this cover section, the person claiming the benefit for the
insured must:

a. Tell us of the death, disability or bodily injury in writing within six months from the date of the
accident. We will tell him what evidence and other documents we need to process the claim.
b. Send us the evidence and other documents we ask for within 30 days from the date that we ask for
it. The person must give us all information to us in the format we tell you.
c. If the steps above are not followed, or the person does not send us the information we ask for within
the time given above, he will lose the right to claim.

7.2 Undergo medical examinations or treatment

For a disability benefit claim, the insured must undergo medical examinations or treatment when we ask
him to, as often as required. We will pay the cost of the medical examinations or treatment.

7.3 If your claim is valid

If we assess your claim as valid, we will pay the benefit to you or to your estate. We will not pay any benefit
to a service provider.

7.4 Our responsibility ends after we have paid a claim

Once we have paid a claim, we have met our responsibilities to you in terms of this policy. We will not be
responsible for any other costs relating to that claim.

7.5 We will not pay any interest

Any amount due by us will not attract any interest.

7.6 If you do not agree with our claims decision

If we do not accept a claim, or we cancel this policy or if you dispute the amount of the claim, you may ask
us to review our decision.

We will only review our decision if you send us a written request to review within 90 days (the representa-
tion period) of the date that you receive our rejection letter.

Alternatively you may contact the Ombudsman for Short-term Insurance on the contact details set out
in the Quick reference guide. The Ombudsman is an independent office that was appointed to make
independent and fair decisions.

If you are not satisfied with the outcome of the complaint, you may also take legal action against us. To take
legal action, you must instruct a lawyer to give a document to the sheriff of the court, who must serve the
document on us. This is called serving a summons on us. Summons must be served on us within 180 days
of the expiry of the representation period.

You may also choose to take legal action against us without first requesting us toreview our decision or
to contact the Ombudsman. If you decide to do this, summons must be served on us within 270 days
of the date that you receive our rejection letter. If you take legal action against us before contacting
the Ombudsman, you can only approach the Ombudsman for assistance afteryou have withdrawn the
summons against us.

If you do not take legal action against us within the times given above, you will lose your right to take legal
action against us.

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Cover section: Personal accident

8. When cover for an insured ends

Cover for an insured ends when any of the following happens:

a. premiums for the personal accident benefits are not paid;

b. the insured reaches the age of 80 years old;
c. we pay a claim for 100% of the disability benefit; or
d. the insured dies.

9. Service benefits
9.2 Trauma and HIV assistance helpline

This service gives you access to a 24 hour emergency assistance helpline to help you with any trauma
situation. You have to call our Helpline number set out in the Quick reference guide.

Professional nurses provide this emergency assistance service.

This service is available 24 hours a day for 365 days a year.
We will only provide these services within the borders of South Africa.
An insured can call the helpline in the event of the following traumatic events:

Traumatic accident
Act of violence, including an assault, robbery, rape or armed car hijack.

a. Trauma assistance helpline

We will arrange for emergency medical assistance if the insured sustains bodily injury.
We will arrange for psychological counselling at a public or private trauma counselling centre
if the insured is the victim of trauma or assault.
We will arrange emergency medical assistance and stabilisation of an insured who sustained
bodily injury.
We will also arrange for emergency medical transport to the closest, most appropriate
medical facility. We will not arrange for any inter-hospital transfers.
We will refer the insured to psychiatrists for psychiatric consultations if needed.
We will pay back the costs you have to pay up to the limits that apply to the following
Additional benefits set out above: Medical expenses, Trauma counselling and Emergency
transportation costs.

b. HIV assistance helpline

The HIV-protection service gives the insured access to diagnosis, hospital care, treatment and
counselling in the event of suspected HIV infection.
HIV infection can be suspected because of rape or accidental exposure, for example needle
prick with a contaminated needle.
The service includes 24-hours-a-day, 365-days-a-year telephonic access to an HIV counselling
centre for information, advice and support, as well as counselling for post-traumatic stress
disorder.

We will pay for certain HIV related benefits

We will pay for three consultations per incident with a general practitioner, trauma-trained
nurse or trauma counsellor if the insured is HIV positive at the time of the incident.
We will pay for three HIV blood tests per incident. The first blood test will be done immediately
after the incident.
If the insured tests HIV positive no further tests are covered.
If the insured tests HIV negative, the second test will be six weeks after the incident and the
third test will be three months after the incident.

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Cover section: Personal accident

If the insured tests HIV negative

If the insured tests HIV negative immediately after the incident, and the treating doctor prescribes
and advises it, we will pay for the following costs:

A 30-day starter pack of antiretroviral medication. We cannot pay for this medication if the
insured calls later than 72 hours after accidental HIV exposure. This is because antiretroviral
medication is only effective within 72 hours of accidental HIV exposure. The insured must call
our Helpline as soon as possible after exposure.
A seven-day course of STI (Sexually Transmitted Infections) medication.
A morning-after pill to prevent pregnancy in the case of rape.
Registration for an HIV-management programme.

If the insured tests HIV positive

If the insured tests HIV positive immediately after the incident, the insured will have access to the
following:

A seven-day course of STI (Sexually Transmitted Infections) medication.

A morning-after pill to prevent pregnancy in the case of rape.
Three consultations per incident with a general practitioner, trauma-trained nurse or trauma
counsellor.

c. How to call for assistance

An insured must call our Helpline and give details of the circumstances, immediate dangers and his
condition. The nurses will arrange for the necessary assistance, be it the police or the nearest local
emergency assistance services. The nurses will monitor the medical condition of the insured, and
should the situation develop into a medical emergency, the nurses will:

Arrange for emergency medical evacuation, either by road or air ambulance.

Arrange for the insured to be transported to a hospital with emergency facilities closest to
the scene of the incident.
Monitor the insureds transportation and condition.

10. Optional benefit

This is not an automatic benefit. You must choose to be covered for this benefit and pay the extra premium.

10.1 Rental car excess cover

We will pay you back the insurance excess you have to pay to a car rental company if you have an accident
with a rental car.

You must give us proof of the amount you paid.

We will only pay up to a maximum of the limit set out in the policy schedule.
This benefit does not apply to the insurance excess that you have to pay if you make use of the Car
hire benefit under the Car section of this policy.

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