Terms

My Family 247


By selecting this option, the Main member and 4 x dependents will enjoy the listed assist services.WAITING PERIOD subject to a 1 month waiting period.  No claims prior to the inception of this policy will be entertained.





My Family 247 +


By selecting this option, the Main member and 4 x dependents (M+4) will enjoy the listed  assist services. Main member plus 1 x dependent (M+1)  will gain access to Stabilization &  Evacuation (R35.000 per person) as well as Hospitalization in a Private Hospital (R100.000 + other benefits per person).WAITING PERIOD subject to a 1 month waiting period.  No claims prior to the inception of this policy will be entertained.





My Family 247 + GOLD


By selecting this option, the Main member and 4 x dependents (M+4) will enjoy the listed assist services. Main member plus 4 x dependents (M+4) will each gain access to Stabilization &Evacuation (R35.000 per person) as well as Hospitalization in a Private Hospital (R100.000 + other benefits per person)

WAITING PERIOD subject to a 1 month waiting period.  No claims prior to the inception of this policy will be entertained.




CRIME & SECURITY ASSIST


This is a 24-hour crisis management product to assist the beneficiary in the event of a home invasion. We will assist with the following:

In the case of the beneficiary’s cell phone being stolen from your home in a home invasion, we will provide the beneficiary with a cell phone loaded with pre-paid airtime to the value of R100, which will courier to the beneficiary.




HOME ASSISTANCE


Available 24-hours a day 365-days a year

Our Home Assistance programme provides assistance to the beneficiary when you are involved in a Home Emergency.  A Home Emergency means any sudden, unexpected and/or unforeseen event at the eligible resident requiring the immediate and/ or urgent services of a domestic tradesman to limit/ minimise or prevent further damage to the home.


This benefit is restricted to home emergencies and only applies the eligible premises/primary place of permanent residence, within the Republic of South Africa and used for domestic purposes, including outbuildings.


Emergency Services Notification and Call-out

At the beneficiary’s request our Assist Call Centre will relay a notification of emergencies to the Police, Traffic, Fire Brigade, Ambulance, Security or any other emergency service provider.


Mobile Notification Services

The beneficiary will receive an SMS notifying them of the update on your active case.

The below details will be sent to the beneficiary mobile phone after lodging a case:



Please note that each benefit will be managed on an individual basis and is highly dependent on traffic, weather and correct information received i.e. address or area of incident.


The Home Assistance programme shall entail the following emergency services to customers:


  1. Plumbers
  2. Glaziers
  3. Electricians
  4. Locksmiths
  5. Tree Felling
  6. Bee Keepers and Pest Controllers
  7. Appliances (beneficiary will be assisted but on a beneficiary-to-pay basis only)


Terms and Conditions


Exclusions:


PLUMBERS

Assistance shall be provided to the beneficiary in circumstances where they have requested access to the service where the emergency is any of the following:


Exclusions:


GLAZIERS


ELECTRICIANS

Assistance shall be provided to beneficiaries in circumstances where they have requested access to the service where the emergency is any of the following:




Exclusions:


LOCKSMITHS


Exclusions:


Additional benefits also included are:



BEE KEEPERS AND PEST CONTROLLERS

Assistance will be provided for the below pests:

HOME AND CONVENIENCE DRIVE


Home Drive

Home Drive is available through our friendly call centre or via a Mobile App (if this forms part of the benefit entitlement). The service includes automated SMS communication services, which will SMS the beneficiary’s driver’s name and mobile number to them on the afternoon of their booking so that, should they wish to change their collection detail, the beneficiary is able to directly contact their driver at any time. The driving team consists of a back-up driver and vehicle, and lead driver who will drive the beneficiary home in their own vehicle or if preferred, in the vehicle dispatched.  The back-up driver will follow and collect the lead driver from the beneficiary’s house.



Convenience Drive

If the beneficiary requires a driver's assistance to get them from point A to point B in one of the Home Drive vehicles, our professional team of standby drivers will be at their service. Whether the beneficiary is running between meetings, needs an airport transfer, their car has been booked in for a service and they need to be collected from the dealership, or their child needs to be collected from school, they can rely on Home Drive for assistance. Pre-booking of this service 24 hours prior is highly preferred, in order to guarantee pick-up time.



Professional Assistance is guaranteed and the beneficiaries are driven by:


Service Centres:

Johannesburg
Pretoria
Cape Town
George
Port Elizabeth
Durban
East London
Nelspruit
Bloemfontein


Number of incidents covered is dependent on the package agreed and is totally flexible.

 

The benefit includes Home and Convenience incidents to a radius of 50km per incident. Any additional kilometres travelled will be charged at R9.00 per km. Should the beneficiary require additional trips, which are in excess of their annual trip entitlement, the call centre will facilitate the booking on a beneficiary to pay basis. For these trips, the beneficiary will receive a discount on the full fare fee, as follows:



Additional passengers/ drop off:

Service is available to a valid beneficiary and limited to their specified vehicles only. Up to 4 additional passengers can be transported at no cost provided that the entire trip is no longer than 50km and takes no longer than 1 hour and are ALL transported to one/main booked address.

An additional cost of R50.00 per additional /unplanned drop off will be charged. This arrangement needs to be discussed and authorized by our call centre to ensure efficient planning and upfront payment (warding off the potential threat to our drivers, when carrying cash).




Booking times:

Pre-bookings are preferred and should be arranged prior to 20:00 each day. Ad hoc or last minute requests (day and night) can be accommodated on a best-effort basis and, beneficiaries should expect a potential time delay of a minimum of one hour. This is subject to the availability of standby team members at the time of requests


Cut-off time for new and last minute bookings is 02:00

Public holidays – pre-bookings need to be made before 17:00 on the day, prior to the public holiday.


Collection:

Cancellation Fees:


Terms & Conditions:


EMERGENCY ROADSIDE ASSISTANCE

These services are available 24/7/365

Road Patrols

The objective is to get the beneficiary mobile on the roadside. These services are covered nationally including Lesotho and Swaziland. These services are limited to R500.



Services Include:

Locksmith Services

In the event that keys are locked inside the beneficiary’s vehicle, an accredited locksmith will be dispatched by the call centre, to the incident scene to open the vehicle. The service is limited up to R800. The Service Provider will not cover the cost for repairs, the replacement of a lock or ignition switch or the cutting of keys.

Mechanical and Electrical Breakdowns

The primary objective of the Service Provider is to tow a vehicle to the nearest franchised dealer (if under warranty) or to the nearest repairer. The cost of the first 60km round-trip is covered (starting from point of dispatch) thereafter a charge of R6.00 ex vat per km is applicable and will be charged to the beneficiary.

 * Toll fees are not inclusive within the benefit entitlement, and such costs, will be for the beneficiary’s account.

Car Hire

In the event that a vehicle has broken down more than 100km from the beneficiary’s home, the call centre will arrange and pay for 24-hour, group-B car hire for the beneficiary to complete his or her journey or to return home. This service is subject to availability and the driver must be in possession of a valid credit card and driver’s license. The service is limited to R500 and includes the costs of the daily car rental, unlimited kilometre allowance, insurance fees and the delivery or collection charges of the vehicle to a maximum of 25km respectively. The cost of fuel will be for the beneficiary’s account.

Overnight Accommodation

Instead of the car-rental option, arrangements can be made for overnight accommodation for the driver and four passengers. The service is limited to R500.

Vehicle Repatriation

Should the beneficiary choose the car-rental option and continue his or her journey while the vehicle is being repaired, the Service Provider will pay towards the costs of providing the beneficiary with a 24-hour, group-B car hire to collect the vehicle after repairs. Alternatively, a flight ticket can be arranged. This service is limited to R500 and includes the costs of the daily car rental, unlimited kilometre allowance, insurance fees, and the delivery/collection charges of the vehicle to a maximum of 25km respectively. The cost of fuel will be for the beneficiary’s account.


* Toll fees are not inclusive within the benefit entitlement, and such costs, will be for the beneficiary’s account.

Accident Tow

In the event of an accident, the call centre will arrange for the vehicle to be towed to the nearest insurance approved motor body repairer (MBR) or beneficiary nominated repairer from the accident scene. The cost of the first 60km round-trip is covered (starting from point of dispatch) thereafter a charge of R6.00 ex vat per km is applicable and will be charged to the beneficiary. * Toll fees are not inclusive within the benefit entitlement, and such costs, will be for the beneficiary’s account.

Message-Relay Service

In the event of an electrical / mechanical breakdown or an accident, the call centre will on request relay any urgent messages to friends, colleagues or family members to advise them of the beneficiary’s circumstances.

Storage

Should it be required, arrangements will be made for the safe storage of the vehicle overnight or for weekends including public holidays up to a maximum of 4 days. On the next working day, the vehicle will be re-located to the nearest approved dealer or competent repairer. Thereafter the cost of a second tow will be for the beneficiary’s own account subject to the beneficiary taking direct control of the vehicle to an alternative destination which results in a second tow being required.

Mobile Notification Services

As a beneficiary you will receive an SMS notifying you of the update on your active case.

The below details will be sent to your mobile phone after lodging a case:



General Terms & Conditions

The Beneficiary will not be entitled to service where:


The service provider does not refund:

Road Runner

In the event a member is involved in a roadside event (accident or breakdown), while the member waits for their roadside services, an accident runner will be dispatched to the roadside event within 30 minutes. The response vehicle will stay with the driver, to ensure as much as possible a safe surrounding, until their roadside services have arrived. This service is for the beneficiary’s own account.

LEGAL ASSIST, ADVICE AND ACCESS

This is a powerful, dynamic product which provides a comprehensive legal assistance service to the beneficiary and his/her immediate family.

24-hour Legal Assistance

Qualified lawyers and legal consultants as well as academics provide the service. The service comprises:



Advice

Beneficiaries and their immediate families have on-going access to a 24-hour legal advisory service on any aspect of the law such as criminal law, family law, insurance law, child law, labour law, motor law, etc. The beneficiary and his immediate family is entitled to utilise the advice service as frequently as required provided that the assistance shall be furnished to the beneficiary directly and only on legal matters pertaining to the beneficiary, and, in his or her personal capacity.


Free standard legal documents

If a beneficiary requires a purchase/sale, lease agreement, power-of-attorney, will, domestic employment agreement, ante-nuptial agreement, etc., we will provide these free at his or her request.  The beneficiary will also be advised on the application of each of these documents and the procedures and principles that apply.   


30-minute free consultation

This service involves a free initial 30-minute consultation should any matter require legal action. The beneficiary will then be referred to a lawyer who forms part of our national network for a direct free 30-minute consultation. After the 30-minute consultation, the beneficiary can then elect whether or not to continue with that specific lawyer’s services at a fee structure agreed to between himself and the lawyer. Such fees will be for the beneficiary’s account. The free 30-minute consultation service is available at a lawyer that is situated within the magisterial district where the beneficiary resides. This consultation facility is limited to one consultation per matter.


Letter of demand

The lawyer or consultant will write a letter of demand on behalf the beneficiary.  This is limited to one letter per event.


Find a Lawyer

If a matter is of such a nature that the beneficiary has to consider litigation, the team of experts will assess all the facts and circumstances and research the matter thoroughly, in order to ascertain which way a case should be approached, and will then suggest 2 top attorney’s firms which will be the best for the job. This benefit includes expert investigation and research into the matter in order to empower a beneficiary to make the correct decision when choosing an attorney.


Our hassle-free service procedure


Our lawyers are available 24-hours a day, 365-days of the year.

Assistance is available and accessible 24- hours per day, 365- days a year through a dedicated 0861-number.  


Who is entitled to the service?

The service is provided to the beneficiary and his/her immediate family. Immediate family means the principal beneficiary’s spouse/partner and their biological and legally adopted dependent and unmarried children up to age 21.


Exclusions

The Service is limited to personal matters only. Business legal matters are excluded.

Terms and conditions are all stipulated above.


EMERGENCY MEDICAL ADVICE AND ASSIST HOTLINE


In addition to the general medical advice service, one call to the same number will trigger the call centre’s medical operators who will guide the member through a medical crisis situation, provide your member with emergency advice and organise for them to receive the support they need.

This program includes referrals to crisis lines in case of:


Please note: This product is underwritten by ACE Insurance Limited, a registered Financial Services Provider.



EVACUATION AND STABILIZATION – R35 000 per member per annum



This service is provided directly through Digicall.


1. Guaranteed Private Medical Treatment in the Casualty Ward, Evacuation & Stabilization or Hospital Admission

In the event of the member requiring private medical treatment in a casualty ward and/or hospital admission, the call centre will guarantee the below values of cover to the relevant hospital:




Medical Expenses



Remaining benefits applicable on the cover:




1. a insofar as it is reasonably possible notwithstanding that Permanent Disability may remain but shall in any event not be payable for more than the number of weeks stated in the Schedule to this Policy.

2. Any Compensation payable by the Insurers for any period of Temporary Total Disability or for the reimbursement of Medical Expenses shall be reduced by an amount equal to the Compensation received or receivable by or on behalf of the Insured Person under the terms of the Compensation for Occupational Injuries and Diseases Act, 1993 for Temporary Disability (partial or total) for the same or a lesser period and/or in respect of Medical Expenses.

3. Any compensation payable by the Insurers for any period of Temporary Disability (partial or total) shall not exceed the average weekly earnings earned by the Insured Person at the time of the accident.

4. Where amounts recoverable from the Insurers are delayed pending finalisation of any claim, payments on account can be made to the Insured, at the Insurers' discretion, on receipt by the Insurers of certification by a medical doctor appointed by the Insurers.

5. Upon payment of a claim under Items 1 to 2.4 (other than 2.2.1) or of 100% under Item 3 of the Schedule of Permanent Disability this policy shall be terminated in respect of the Insured Person for whom such payment is made.


SCHEDULE OF PERMANENT DISABILITY

The following percentages shall be payable in the event of Bodily Injury resulting in:

1. Permanent Total Disability    - 100%

2. Permanent and total loss of:

2.1 speech     - 100%

2.2 hearing in both ears    - 100%

2.2.1 hearing in one ear    - 35%

2.3 one or more limbs at or above the wrist or ankle  - 100%

2.4 sight in one or both eyes     - 100%

2.5 four fingers of either hand     - 75%

2.6 thumb, either hand - both phalanges   - 30%

one phalanx      - 15%

2.7 index finger, either hand

three phalanges     - 15%

two phalanges      - 10%

one phalanx     - 5%

2.8 any other finger, either hand

three phalanges     - 8%

two phalanges     - 5%

one phalanx     - 2%

2.9 toes all on one foot    - 35%

great, both phalanges    - 15%

great, one phalanx    - 5%

other than great, if more than one toe lost – each   - 5%


3. Permanent Disability not specified herein a percentage which in the opinion of the Insurers is consistent with the above insofar as possible.

In the event of Compensation being due under more than one of the benefits referred to above as a consequence of any one accident to any one Insured Person the maximum amount payable hereunder shall not exceed 100% in total under the Schedule of Permanent Disability Benefits.


EXTENSIONS

Subject to an Insured Person suffering accidental bodily injury which is the subject of a valid claim hereunder the following extensions are applicable:


Additional Death Benefit

The insurer will in addition to the accidental Death benefit and the production of a valid Death certificate of an insured Person pay the insured an amount of R15 000 per insured Person.

Childcare

In the event of accidental bodily injury to:


1. an Insured Person’s child resulting in disability which requires regular care and attendance;

2. an Insured Person or his spouse resulting in disability which prevents care being given to a child then the Insurers will pay to the Insured Person R150 per day during the period of such disability, provided that Insurers will:


Claims Preparation Costs

This Policy is extended to include costs reasonably incurred by the Insured in producing and certifying any particulars or details required by the Insurers to substantiate a claim, provided that the liability of the Insurers for such costs in respect of any one claim shall not exceed R25,000 (Twenty five thousand rand).


Crime benefit

In the event that the insured Person’s Death or Permanent Disability is as a direct consequence of a crime, the insures will pay an additional 5% of the Insured Person’s Death or Permanent Disability Benefit up to a maximum amount of R25 000.


Disappearance

If after a suitable period of time of the disappearance of an Insured Person it is reasonable to believe that such person has died as a result of bodily injury the Death benefit shall be payable provided that if such belief is incorrect such benefit shall be repaid to the Insurers.


Disfigurement

The Schedule of Permanent Disability Benefits is hereby extended to include Bodily Injury resulting in permanent disfigurement of:


Hospitalization

In the event of an insured being hospitalised as in in-patient in an Hospital as a result of Accidental Body injury the insured will pay R1,000 per day up to a maximum of 90 days per insured Person per policy. The insurers will not indemnify the insured against

1. Treatment of an insured for any nervous or mental conditions whatever the classification.

2.  Pregnancy or childbirth or any complications that may arise thereof

3. Rest or recovery periods in retirement homes, convalescence homes or detoxification or alcohol rehabilitation centres

4. Voluntary procedures of any nature

5. The first 24 hours in any covered medical facility

Family Medical Expenses

In the event of accidental bodily injury to any spouse, dependent child or domestic servant of an Insured Person (referred to in this extension as such person) as a result of a motor vehicle accident while such person is travelling with the Insured Person in any private motor vehicle owned, leased or hired by the Insured Person, Insurers will pay any consequent medical expenses incurred by such person, provided that:


1. The maximum amount payable by Insurers will be R20,000 any one such person each and every claim,  and subject to a maximum of R100,000 in any one 12 month period of insurance;

2. The Insurers will not be liable for the first R250 of each and every claim.

3. The Insurers will only be liable for the amounts in excess of amounts paid or payable under any other policy of insurance or under any Medical Aid Scheme, or Road Accident Fund or otherwise known, or as may be amended by legislation;

4. If the Business Hours Limitation is applicable, this extension does not apply.


Life Support Equipment

The Insurers will, pay reasonable costs and expenses incurred as a result of accidental Bodily Injury in respect of hire costs for life support machinery, equipment or apparatus provided that the liability of the Insurers under this Extension in respect of any one Insured Person shall be limited to R25,000 (Twenty five thousand rand).



Mobility Costs

When Insurers have admitted a claim for Permanent Disability, if as a direct result of that disability the Insured Person is permanently dependent on a wheelchair for mobility, the Insurers will, in addition to any amount payable for Permanent Disability, pay for:

1. a self-propelled wheelchair;

2. the fitting of wheelchair loading equipment and alterations to the Insured Person’s residence to facilitate the use of such wheelchair;

3. the modification of the controls of the Insured Person’s motor vehicle


Provided that the liability of the Insurers for such costs in respect of any one claim shall not exceed R100, 000 (one hundred thousand rand).

Per insured person.

Relocation Costs

In the event that it is necessary to replace as employee a deceased or permanently disabled Insured Person the Insurers will indemnify the Insured for the following costs not exceeding R50,000 incurred by the Insured in relation to any one Person who is required to move more than 100 km:

1. Relocation costs for such person, his family, furniture and pets; and

2. 75% (seventy five percent) of the actual loss caused following the forced sale of such person’s private dwelling subject to such loss being determined by an impartial valuer appointed and paid by the Insurers.


Rehabilitation Costs

In the event that the Insured demonstrates, to the reasonable satisfaction of the Insurers, that an Insured Person has suffered Permanent Disability such that he/she cannot continue to be employed in the occupation in which he or she was employed at the time of the accident but may be retrained by the Insured, or by any registered training centre, the Insurers will contribute 80% (Eighty per cent) of such retraining costs up to a maximum liability of R100,000 (One hundred thousand rand) per person.


Seat Belt Benefit

The Insurers will pay an additional 10% of the Insured Person’s Death or Permanent Disability benefit, up to a maximum amount of R50, 000 (fifty thousand Rand), provided that the Insured Person was wearing a properly factory installed seat belt while operating or travelling as a passenger in a private motor vehicle when the Accident causing the Death or Total Disability occurs.


Verification of the actual use of the seat belt at the time of the accident must be a part of an official report of the accident or must be certified in writing by the investigating officer(s).


Terrorism

This policy is extended to cover Accidental Death or Disability of an Insured Person arising from acts of "terrorism" as defined in the Defence Act 1957 or as amended; provided that Insurers shall not be liable to pay compensation for Death or Disablement arising from:

1. The performance by such person of obligations in terms of the Defence Act or the Police Services Act of any country or at a place from which military or police actions are carried out, or

2. Consequent upon such person's engagement in any military or police actions against an enemy of the republic, combating "terrorism" as defined in the Defence Act or "operations in defence of the Republic” as defined in the Defence Act, 1957.



TRAUMA COUNSELLING

In the event of an Insured Person being subjected to an act of violence or a traumatic accident, the Insurers will reimburse such person for counselling fees actually incurred by such person as a result of the act of violence or traumatic accident, provided that:

1. the maximum amount payable by Insurers will be R500 per visit and R10,000 per annum for each Insured Person; and R100.000 in any one 12 month period of insurance;

2. act of violence shall mean an assault, robbery, rape or armed car hijack,

3. for the purpose of this extension only, Insured Person shall include immediate family members of such Insured Person, who are subjected to the same incident or occurrence of violence or traumatic accident as the Insured Person;

4. the act of violence has been reported to the police and a case number obtained.



TERRITORIAL LIMITS

Coverage applies anywhere in the World unless otherwise restricted by an endorsement and/or memorandum to this Policy.


OPERATING TIME

Coverage applies 24 hours a day, 7 days a week unless otherwise restricted by endorsement and/or memorandum to this Policy.


EXCLUSIONS

The Insurers shall not be liable to pay Compensation for Bodily Injury in respect of any Insured Person:

1. caused by such person's suicide, attempted suicide or intentional self-injury or deliberate exposure to obvious risk or injury (unless in an attempt to save human life).


2. Whose death or disability is directly or indirectly caused by, arising or resulting from or traceable to any physical defect or infirmity which existed prior to the accident, provided that if the disability of the Insured Person is merely aggravated by such pre-existing condition, the Insurers may in their discretion pay an amount which they consider would have been payable but for such aggravation.


3. under 16 or over 70 years of age.


4. whilst the Insured Person is travelling by air other than as a passenger (and a ‘passenger’ does not include a member of the crew or any person being conveyed for the purpose of any trade or technical operation relating to the aircraft)


5. as a direct result of the Insured person:

(a) being under the influence of alcohol, drugs or narcotics unless such drugs or narcotics were administered lawfully by a medical practitioner (other than the Insured Person) or unless prescribed by and taken in accordance with the directions of a medical practitioner (other than the Insured Person)

(b) driving a motor vehicle and having more than the legal limit of alcohol in his/her blood.


6. whilst participating in any riot, strike, civil commotion, public disorder, or as a result of deliberately committing a criminal offence.


7. a) arising from war, invasion, act of foreign enemy, hostilities or warlike operations (whether war be declared or not), civil war, mutiny, insurrection, rebellion, revolution, military or usurped power, or any events or causes which determine the proclamation or maintenance of martial law;

b) Whilst such Insured Person is on active service with the military, naval air or police services of any nation provided that this Insurance shall continue to apply in respect of Accidental Bodily Injury sustained independently of such contingencies


8. whose death or disability is directly or indirectly attributable to Human Immunodeficiency Virus (HIV and/or any HIV related illness) or Acquired Immune Deficiency Syndrome (AIDS) including derivatives or variations thereof howsoever caused. The onus of proof shall always be upon the Insured to show that death or disability of an Insured Person did not arise through or was not caused by AIDS or HIV.


9. whilst participating in sport as a professional player, hang gliding or micro lighting.


10. whose occupation involves underground mining or tunnelling or involving the use or handling of explosives or explosive devices.


CONDITIONS

1. This Policy may be cancelled at any time by the Insurers giving 30 days' notice in writing (or such other period as may be mutually agreed) or by the Insured giving immediate notice. From date of cancellation the Insured shall be entitled to a refund of premium paid pro rata for the unexpired Period of Insurance, subject to condition 10.


2. Cover under this Policy shall terminate immediately upon the non-payment of premium. If a monthly premium debit is dishonoured, all cover under this Policy shall cease at 24H00 on the last day of the month for which the premium has been paid.


3. This Policy is not assignable. Compensation shall be payable only to the Insured whose receipt shall effectually discharge the Insurers


4. No sum under this Policy shall carry interest.


5. This Policy shall be voidable in the event of misrepresentation, or miss-description or non-disclosure by or on behalf of the Insured or an Insured Person in any particular material to this Insurance.


6. Notice must be given to the Insurers in writing on the prescribed claim form as soon as practicable within three calendar months of any occurrence which may give rise to a claim under this Policy but notice of death must be given forthwith and the Insurers shall have the right to have a post mortem examination of the body.All certificates, information and evidence required by the Insurers shall be furnished without expense to the Insurers within 30 days of the Insurers notifying the Insured of their requirements. After incurring Bodily Injury for which Compensation may be payable under this Policy, the Insured Person shall, when reasonably required by the Insurers so to do, submit to medical examination on behalf of and at the expense of the Insurers and undergo any treatment specified. The Insurers shall not be liable to make payment unless this Condition is complied with to their satisfaction. Qualified medical advice shall be sought and followed promptly on the occurrence of any Bodily Injury and the Insurers shall not be liable for any part of any claim which in the opinion of their medical adviser arises from the unreasonable or wilful neglect or failure of an Insured Person to seek and remain under the care of a qualified member of the medical profession.


7. If any difference shall arise as to the amount to be paid under this Policy (liability being otherwise admitted) such difference shall be referred to arbitration in accordance with the statutory provisions for the time being in force and the making of an award shall be a condition precedent to any liability for the Insurers to make any payment under this Policy.


8. In the event of the Insurers disclaiming liability in respect of any claim and an action or suit not being commenced within twelve months after such disclaimer or, in the case of an arbitration taking place, within twelve months after the Arbitrator shall have made his award, all benefits under this Policy in respect of such claim shall be forfeited.

Medical Evacuation Scheme 1 Sept 2013 7


9. If any claim under this Policy be in any respect fraudulent or intentionally exaggerated or if any fraudulent means or devices are used by the Insured or Insured Person or anyone acting on his or her behalf to obtain any benefit under this Policy all benefit thereunder shall be forfeited in respect of such claim.


10. If the Premium is calculated on estimates supplied by the Insured an accurate record containing all relevant particulars must be maintained by the Insured to which the Insurers shall have the right of access. The Insured shall furnish such information within one month of the expiry of each Period of Insurance and the Premium shall be adjusted accordingly.

10.1 The estimates and declaration of total wages, earnings or salaries on which the premium hereunder is based shall include all items of remuneration which fall under the definition of "Annual Earnings" within this policy.

10.2 In the event that such allowances are not included in the estimated or declared earnings these amounts will not be included in the computation of any claim.


11.  This Policy will be governed by the laws of the Republic of South Africa, whose courts shall have jurisdiction in any dispute arising hereunder.