You spend years planning your career, working hard and building your skills. You dedicate long hours to earn recognition over time and sacrifice a lot along the way. At LSG we believe your livelihood, after you have cemented your career, deserves the same attention. Insure your most important asset, Your Income
LSG MULTI-BENEFIT PLAN POLICY WORDING 2 OPERATIVE CLAUSE 2 PROVISOS 2 EXTENSIONS 2 EXCLUSIONS 3 CONDITIONS 4 NOTICE OF RIGHT TO EXAMINE YOUR POLICY 4 SCHEDULE OF PERMANENT DISABILITY BENEFITS 5 OPTIONAL EXTENSIONS 5 DEFINITIONS 5 CANCER 6 MATERNITY EXTENSION 7 EXCLUSIONS APPLICABLE TO ALL EXTENSIONS 7
Whereas the Insured Person named in the schedule has applied to The Hollard Insurance Company Limited (the Insurer) for the insurance described herein, the Insurer agrees to provide such insurance subject to:
- Any proposal or other information supplied by or on behalf of the Insured Person disclosing all facts that are material to the insurance and known to the Insured and forming the basis of this insurance.
- The payment of the premium as stated herein.
- The terms, conditions, provisions and exceptions setoutherein or contained in any endorsements attached hereto or subsequently included in this policy.
If, during the period of insurance an Insured Person sustains Bodily Injury as the result of an Accident which directly results, within 24 (twenty-four) calendar months, in Death or Disability as further described, the Insurer will pay to the Insured Person or his legal personal representative the Compensation stated in the Policy Schedule.
The following words or phrases shall bear the meaning stated below:
|"Insured Person"||means||the person who is identified as such in the Policy Schedule.|
|"Accident"||means||a fortuitous unexpected event occurring at an identifiable place and time.|
|"Bodily Injury"||means||traumatic bodily injury caused by an Accident and shall be deemed to include bodily injury caused by starvation, thirst and exposure to the elements as a result of an accidental occurrence.|
|"Loss"||used in reference to limb, hand or foot means the loss by physical severance or total and permanent loss of use of such member|
|"Permanent Total Disability"||means||Bodily Injury resulting in total and absolute disability preventing the Insured Person from following the usual occupation or any other occupation for which he is suited by education or training.|
|Provided always that:|
- The Insurer shall not be liable to pay for Death or Disability resulting from an accident or series of accidents arising from one cause in respect of any one Insured Person, more than the Compensation payable for Death or Disability (whichever is the higher). If a benefit is paid for loss of use of a member, then benefits for individual parts of the same member cannot also be claimed.
- No amount under this policy shall carry interest.
- The Insurer reserves the rightto change or increase premiums from time to time or to amend the terms, conditions and exclusions of cover in respect of all policies issued under this plan, subject to 30 days notice in writing.
- The Insured Person shall not be insured under more than one Multi-benefit Protection Plan with the Insurer. Should more than one policy be in force for the same Insured Person and a claim be lodged for the same benefit, then only the policy with the highest insured amount for the claimed benefit can be called upon to indemnify the Insured Person.
Disappearance: If after a suitable period of time of the disappearance of an Insured Person, it is reasonable to believe that such Insured 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 Insurer.
Disfigurement: The Permanent Disability schedule is hereby extended to include Bodily Injury resulting in permanent disfigurement of:
- The head, neck and hands – provided the total area affected exceeds 20% (twenty percent) of the total area.
- All other areas of the body – provided the total area affected exceeds 5% (five percent) of the total area of the body.
Compensation payable for the above is a percentage of Compensation in direct proportion to the area affected.
The benefits payable in terms of i) and ii) above shall apply independently and be cumulative, but the overall liability of the Insurers for Permanent disfigurement resulting from an accident or series of accidents arising from one cause for any one Insured Person shall not exceed 100% (one hundred percent) of the amount payable for Permanent Total Disability.
Mobility costs: In the eventthat the Insured Person suffers Permanent Disability of such a nature that he/she needs, and can operate, a self-powered, climbing wheelchair and/or his/her motor vehicle with the controls suitably adjusted, then the Insurers will indemnify the Insured Person for 95% (ninety-five percent) of the costs of such wheelchair and/or suitable adjustments, including wheelchair loading equipment if necessary, up to a maximum liability of R100 000 (one hundred thousand Rand) per Insured Person.
Additional Death Benefit: The Insurer will in addition to the Accidental Death Benefit and on production of a valid Death Certificate of an Insured Person pay the Insured an amount of R15 000 (fifteen thousand Rand) per Insured Person.
The Insurer shall not be liable to pay Compensation for any claim directly or indirectly consequent upon:
- war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, military or usurped power or whilst the Insured Person is on active service with the military, naval, air or police services of any nation
- participation in labour disturbances, riot, strikes, lock out or the Insured Person's commission of a criminal offence;
- wilful exposure to danger (except in an attempt to save human life) intentional self-inflicted injury, suicide or attempt thereat, or the Insured Person being in a state of insanity
- the Insured Person engaging in aviation, gliding, parachuting or any form of aerial flight other than as a passenger in a fully licensed aircraft provided that the term "passenger" shall not include any person who is a member of the crew of the aircraft or who is in such aircraft for the purpose of undertaking any trade or technical operation therein
- the bodily injury being caused by or contributed to by or arising from nuclear weapons material ionising radiations or contamination by radioactivity from any nuclear fuel or from any nuclear waste from combustion of nuclear fuel sustained during the course of such Insured Person's employment. For the purpose of this exclusion only, combustion shall include any self-sustaining process of nuclear fission
- or caused by or contributed to by any pre-existing physical defect or deformity or sickness or disease or any condition for which the Insured Person had received treatment, or medical advice, prior to the inception of the policy
- the Insured Person engaging in racing or speed or duration tests of any kind, or whilst travelling by a motor propelled cycle either as a rider or passenger. The term motor propelled cycle is deemed to include 3 (three) and 4 (four) wheel cycles for which the driver only requires a motorcycle license to drive on public roads
- a) The Insured Person being under the influence of alcohol, drugs or narcotics unless such drugs or narcotics were administered by a qualified medical practitioner or unless prescribed by and taken in accordance with the directions of a qualified medical practitioner;
b) the Insured Person driving a motor vehicle with more than the legal limit of alcohol in his/her blood;
- the Insured Person engaging in mining, underground work or work with explosives
- infection from venereal disease or Acquired Immune Deficiency Syndrome (AIDS), or AIDS related Complex (ARC) howsoever this syndrome has been acquired or may be named
- the Insured Person being under 18 (eighteen) or over 65 (sixty five) years of age
- participation in sport as a professional player, hang-gliding or microlighting.
- The Policy Wording and the Schedule shall be read together as one contract and any word or expression to which a specific meaning has been attached in any part of this Policy or the Schedule shall bear such specific meaning wherever it may appear.
- This Policy will be governed by the laws of the Republic of South Africa, whose courts shall have jurisdiction in any dispute arising hereunder.
- The Insured Person shall take all reasonable precautions to prevent accidents.
- Notice must be given to the Insurer in writing within 30 (thirty) days of any occurrence which may give rise to a claim under this Policy but notice of Death must be given forthwith.
- 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 and undergo any treatment specified. The Insurer shall not be liable to make any payment unless this Condition is complied with to their satisfaction.
All certificates, information and evidence required by the Insurer shall be furnished in the form prescribed and without expense to the Insurer. The Insured Person shall submit to medical examination on behalf of and at the expense of the company as often as shall be required in connection with any claim.
Qualified medical advice shall be sought and followed promptly on the occurrence of any Bodily Injury and the Insurer shall not be liable for any part of any claim which in the opinion of this 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.
In the event of the Insurer disclaiming liability in respect of any claim and an action or suit not being commenced within twelve months such claim shall be forfeited.
- The Insurer may cancel this Policy by giving 30 (thirty) days written notice to the Insured Person at his or her last known address in which event cover shall cease at 24h00 on the last day for which a premium has been paid.
- Cover in respect of the Insured Person shall terminate immediately on the first of the following dates:
- on the day before the Insured attains the age of 65 (sixty five) years, or
- upon payment of a claim under "Permanent Total Disability", or
- upon the non-payment of premium. lf a monthly premium debit is dishonoured, and if such premium is dishonoured a second time, all cover under this Policy shall cease at 24h00 hours on the last day for which premium has been paid.
- If any claim under this Policy shall be in any respect fraudulent or if any fraudulent means or devices shall be used by an Insured Person or anyone acting on the Insured Person's behalf to obtain benefit under this Policy the Insurer shall be under no liability in respect of such claim.
Failure to comply with any part of these Conditions shall render the claim null and void.
NOTICE OF RIGHT TO EXAMINE YOUR POLICY
You have to the right to examine this Policy at your leisure for 21 (twenty-one) days from the time you receive it. You may return it for cancellation, without obligation. If during this period you find it is not what you want, merely return the schedule to us marked “please cancel” with your signature and we will cancel it and refund you any premium which may have been paid.
SCHEDULE OF PERMANENT DISABILITY BENEFITS
The following percentages shall be payable in event of Accidental Bodily Injury resulting in:
Total and incurable paralysis 100% Permanent and total loss of all intellectual capacity 100% Loss of sight in both eyes 75% Loss of sight in one eye 25% Loss of one arm and one leg 75% Loss of one arm or one leg 25% Loss of both legs 75% Loss of both arms 75% Loss of both hands or both feet 50% Loss of one hand and one foot 37.5% Loss of one hand or one foot 25% Loss of hearing in both ears 25% Loss of speech 25%
OPTIONAL EXTENSIONS – If stated on the Policy Schedule to be included and as selected:
Weekly Cashflow Protector, Bond/Rent Protector, Vehicle Lease Protector and Overhead Expenses Protector (included only if indicated in the schedule of benefits)
The Insurer shall pay after the application of the waiting period the benefit shown in the schedule in respect of each selected extension up to the selected sum insured for any period of Temporary Total Disablement as herein defined resulting from Accidental Bodily Injury sustained, or Sickness contracted and commencing, during the period ofinsurance.
“Sickness” means sickness ordisease:
- which is contracted and manifests itself:
- during the period of insurance and
- within the limits of the United Kingdom, Europe, United States of America, Canada, Australia, New Zealand and Africa south of 15 degrees South latitude; or, for up to a maximum of 60 (sixty) days in any one year of insurance, whilst temporarily anywhere else in the world.
- for which an Insured Person is under the regular care and attendance of a qualified registered medical practitioner; and
- which is not of its nature or in origin psychotic or psychoneurotic.
“Weekly Cashflow” means the amount stated in the Policy Schedule but not exceeding the gross
average weekly earnings as defined.
“Bond/Rent” means the normal monthly bond or rent repayment due by the Insured Person, as stated in the statement or account immediately prior to the date when the Temporary Total Disablement benefit shall be deemed to have commenced, but not exceeding the amount stated in the Policy Schedule.
|“Vehicle Lease”||means||the normal vehicle lease repayment due by the Insured Person, as
stated in the statement or account immediately prior to the date when the Temporary Total Disablement benefit shall be deemed to have commenced, but not exceeding the amount stated in the Policy Schedule.
|“Overhead Expenses”||means||the sum of all business overhead expenses excluding the Insured Person’s earnings, and not exceeding amount stated in the Policy Schedule.|
|“Temporary Total Disability”||means||Bodily Injury or Sickness as defined, temporarily and totally preventing the Insured Person from engaging in or giving attention to his or her usual occupation.|
|“Waiting Period”||means||the initial period of Temporary Total Disability during which the benefit is not payable.|
|“Gross Average Monthly Earnings”||means||one twelfth part of the annual earnings of the Insured Person.|
|“Gross Average weekly Earnings”||means||one fifty second part of the annual earnings of the Insured Person.|
|“Earnings”||will be calculated on the gross salary or wages and any other regular allowances received by the Insured Person.|
|Provided always that:|
- all the terms, conditions, provisions and exclusions of the policy shall apply to all the extensions
- benefits shall not be payable in respect of the first 14 (fourteen) days of each period of Temporary Total Disability. This waiting period is reduced to 7 (seven) days in respect of Accidental Bodily Injury
- benefits shall not be payable under this section for more than 24 (twenty-four) months in respect of any one period of Total Disability after application of the Waiting Period
- successive periods of Total Disability resulting from the same injury or sickness or related causes and separated by less than 90 (ninety) days shall be considered to be one continuous period of TotalDisability
- benefits for periods of Total Disability of less than one full month after application of the Waiting Period will be paid at the rate of one-thirtieth of the monthly benefit stated in the Schedule per day, or one-seventh of the weekly benefit
- the Compensation specified for Temporary Total Disability shall cease as soon as the Accidental Bodily Injury causing the incapacity has healed insofar as it is reasonably possible notwithstanding that Permanent Disability may remain but shall in any event not be payable for more than the maximum number of months stated in the Schedule
- the maximum amount payable under one or more of these extensions shall not exceed the Gross Average Weekly or Gross Average Monthly earnings, of the Insured Person, as defined herein. This proviso does not apply to Overhead Expenses.
If, after the effective date but within the period of insurance, the Insured Person is diagnosed as suffering from Cancer as defined herein, the Insurer will pay the benefit as set out in the Policy Schedule.
“Cancer” means a disease manifested by the presence of malignant tumour characterised by the uncontrolled growth and spread of malignant cells, and the invasion of normal surrounding tissue.
The term “Cancer” includes Leukaemia and Hodgkin’s disease but specifically excludes:
- All skin cancers
- Cancer-in-situ, including melanoma-in-situ
- All cancers diagnosed and treated by primary biopsy only, that is, not requiring any further surgical, medical (chemotherapy, etc.) or radio therapy, or other modalities.
Cancer must be positively diagnosed while the Insured Person is alive upon the basis of microscopy of fixed tissues, or preparations of haemic systems.
The diagnosis shall be established after a study of the histocytologic architecture of the suspect tumour, tissue or specimen only and not be clinical diagnosis without histocytological evidence to support it.
The cover under this extension shall terminate upon payment of a claim under this extension.
After this Policy has been in force in respect of the Insured Person for 12 (twelve) consecutive months a maternity benefit – as specified in the Policy Schedule – will be paid upon such Insured giving birth to a child (children) in hospital.
EXCLUSIONS APPLICABLE TO ALL EXTENSIONS
No compensation shall be payable under this extension:
- In respect of sickness or disease for which the Insured Person had received treatment, or medical advice prior to the inception of this policy.
- For sickness manifesting itself within the first 30 (thirty) days after the inception of this cover.
- For the first 14 (fourteen) days of any period of Temporary Total Disability following sickness or the first 7 (seven) days of any period of Temporary Total Disability following Accidental Bodily Injury.
- In respect of:
- Venereal or other sexually transmitted diseases
- Congenital abnormalities and conditions arising out of or resulting therefrom
- Any mental and/or nervous disorders, or any like condition arising from or attributable to stress or stress- related situations.
f) An Insured Person who has been paid the compensation under the schedule of Permanent Disability benefits for Bodily Injury shall not be entitled to claim compensation under this extension for the same Bodily Injury or Disability.