The ONE Personal Accident Policy is designed to provide cover for accidental death, temporary or permanent disablement and medical expenses.

Definitions:

  • Accidental Death: The proximate cause must be as a result of an accident e.g. if a person is in a road accident and is exposed to the elements, develops pneumonia and as a result of which dies. The policy will pay as long as there is no break in the chain of events from the accident.
  • Permanent Disability: Pays up to 100% of the sum insured in the event that as a result of an accident the insured person can no longer be employed or alternatively there is a “continental Scale of Benefits” which allows a certain percentage of the sum insured to be paid – depending on the degree of disability.
  • Temporary Disability: In the event that a person is temporary disabled from working the policy pays the sum insured stated in the schedule – either a fixed amount or the actual earnings up to certain period of time as specifically elected. Could be from 13 weeks to 156 weeks (maximum allowed). There is usually a franchise or an excess. The amount paid is reduced by what is recoverable from COID if the injury occurred during working hours.
  • Temporary Partial Disability: As per above but 40% of the benefit is paid. Partial meaning if the Insured Person cannot apply himself 100% to his normal duties – i.e. a driver cannot drive but can still attend to the admin side of his/her employment. A salesperson cannot attend to the public as his face is all bandaged up and his appearance could have an impact on his sales.
  • Medical Expenses: Medical costs incurred as a result of the accident will be re-imbursed to the Insured. According to legislation this policy cannot respond in the same manner as a medical aid and therefore the benefit is paid to the insured and not a service provider. When settlement of a claim is calculated the excess and all amounts reimbursed by a medical aid and/or COID will be deducted.

All benefits will only be considered in the event that they occur within 24 months of the accident. The accident must be reported within 180 days of the event. Spider bites and snake bites are considered an accident – not a mosquito as you cannot identify the date, time and place.

Optional Extensions

  • Disappearance and Exposure: The death benefit is payable should the insured person disappear and not be found within 12 months of the event.
  • Life Support: The 24 month period is only calculated after the 3rd day that the person is on Life Support.
  • Repatriation: In the event of a valid death claim the policy will pay the reasonable costs of transporting the body to his normal place of residence for burial.
  • Abduction/Hijacking/Kidnapping: In the event of this occurring and the Insured purchased the temporary disability benefit, the policy will respond by paying the weekly benefit up to a maximum period of 8 weeks.
  • Death Expenses: This is an addition death benefit to provide funds for stonework, urns and cremation.
  • Trauma: Counselling cover is provided in the event that the insured person and/or immediate family members are traumatized due to an act of violence by persons unknown to them.
  • Drivers Extension: In the event that the temporary dis ability benefit is purchased and the person is injured, can return to work but is unable to drive e.g. suffers a broken leg, then the policy pays the costs of employing a driver to transport them to and from work.
  • Mobility: A benefit is payable if a person is permanently disabled and requires a wheelchair and/or prosthesis and/or modifications to the home/vehicle.
  • Disfigurement: Dependant on the area of the body which is disfigured a percentage of the sum insured will be paid out, not exceeding 100% of the permanent disability benefit.
  • Relocation: Should the employer need to replace a staff member due to death or permanent disability the policy will pay the costs of relocation as long as the distance is more than 100kms from their normal place of residence.
  • Rehabilitation: A benefit is payable If an insured person has suffered a permanent disability but can be re trained to follow the same or similar occupation.
  • Credit Protection: In the event of a death or permanent total disability the policy will pay outstanding debts which were in place at the time of the accident.
  • Life Support Equipment: Reasonable costs for the hiring of such equipment up to a limit of R10 000 is included.
  • Childcare: A benefit is payable should an insured person’s child sustains a disability that requires regular care whereby the insured person would have to take time off work to care for the child, for a childminder or transport costs of a relative to assist the family.
  • Family/Domestic Workers Medical Expenses: A benefit is payable if any person(s) permanently residing with the insured person including domestic workers are involved in a motor accident owned/hired and being driven by the insured person.
  • Seat Belt: If it can be proven that the insured person was wearing a seat belt at the time of the accident the policy will pay an additional benefit.
  • Crime: an additional benefit is payable if the insured person is injured as a result of a criminal act of violence
  • Post Mortem: In the event of the accidental death of an insured person and sufficient evidence is produced satisfactory to the Insurers that leads them inevitably to the conclusion that there are no extenuating circum stances that would warrant a post mortem report the insurers shall forthwith pay the accidental death benefit without the post mortem report. In the event that the circumstances do warrant a post mortem report the insurers will pay 25% of the accidental death benefit subject to a limit, provided that the person or persons to whom such sum is paid shall sign an undertaking to refund such sum to the insurers if according to the post mortem report the circumstances that caused the death are not covered within the terms and conditions of the policy.
  • Business Travel: Where the annual policy premium exceeds R50 000, the policy is extended to include events due to accident or illness on business travel (outside RSA) up to R1 million, subject to the policy excess. 

Cover does not exclude motor cycling, water and or snow and any other sporting activities (non professional)

Exclusion Free Buy Out: The insured can purchase up to 50% of the underlying benefit which would be paid in the event that the circumstances of the claim would have normally been excluded. The only two exclusions that would still apply is active participation in war and the nuclear/biological exclusion.

Main Exclusions

  • Suicide, Alcohol (flexible – premium loading), abuse of drugs, pre-existing, professional sport, racing by the use of power driven vehicle/vessel, mental disorders, active participation in war, riots etc. Nuclear /Biological /Chemical, whilst driving a vehicle and not being the holder of a valid driver’s license, whilst participating in any criminal act. 

Additional covers available

  • Expatriate cover: This product provides a benefit to cover employees or contracted staff, seconded outside of South Africa, for emergency medical expenses due to an accident or illness including evacuation to an appropriate medical facility capable of treating the condition. This benefit can be extended to include family members. The emergency assistance is provided by International SOS.
  • Dread Disease: Heart Attack, Chronic Coronary Heart Disease, Stroke, Cancer, Kidney Failure, Major Organ Transplant, Paraplegia, Blindness and Multiple Sclerosis.
  • Scheme business: All of the above can be tailored to a scheme.

Other products available

  • Car Sales/Rental Enhancements/Mortgage: Repayment protection
  • Short Period High Accumulation Cover: for Business Conferences, abroad and local – short period
  • Spectator personal accident insurance: On premises, single event cover
  • Customers / Visitors: whilst on premises
  • Personal Accident cover for Film Crew, Actors, Actresses
  • Edu Emergency Assist
  • Voluntary Family Accident Plan

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