Accidental Death Policy Wording. This is your Hollard Policy Wording. Hollard has set out the details of the policy for your information.

Transcription

1 Accidental Death Policy Wording This is your Hollard Policy Wording. Hollard has set out the details of the policy for your information. Hollard has appointed Finrite Administrators (Pty) Limited ( Finrite ) to administer this policy. Finrite is an authorised Financial Services Provider. This policy is underwritten by Hollard Life Assurance Company Limited (Hollard). Hollard is an authorised Financial Services Provider that holds Professional Indemnity and Fidelity Insurance. Hollard is authorised to sell insurance products. Hollard agrees to accept any eligible person who has successfully applied for this cover and will, in the event of a valid claim, pay the benefit to your Beneficiary or to your estate subject to the terms and conditions of this policy. There is no premium payable under this policy. This policy wording (as may be amended from time to time) the declarations you accepted when you applied for the cover and the Welcome SMS will form the basis of this insurance contract. BENEFITS ACCIDENTAL DEATH BENEFIT The Accidental Death Benefit provides a lump sum payment as set out on the Welcome SMS, in the event of an Insured Person dying as a result of an Accident during the Period of Insurance. The Inception Date will be the date that the Insured Person receives a Welcome SMS stating they are covered for this benefit under this policy. This benefit does not acquire any surrender value or paid-up value. NOMINATION OF BENEFICIARY OR BENEFICIARIES You were asked to nominate a person as a Beneficiary when you applied for this cover on your cell phone. The Beneficiary will receive the benefit upon your death. Once a beneficiary nomination has been made, it remains in force until you inform Hollard of any change. If no Beneficiary has been nominated or if the Beneficiary is not alive when you die, Hollard will pay the benefit amount to the first of the following people that contacts Hollard to make a claim: your partner, your child, your parent, your brother or your sister. The person who makes the claim must be over the age of 18 and must provide Hollard with proof (as specified by Hollard at that time) that they are your partner, child, parent, brother or sister. If there is no Beneficiary, or if someone other than your Beneficiary, partner, child, parent, brother or sister contacts Hollard to make a claim, then Hollard will pay the benefit to your estate. SPECIFIC RESTRICTIONS, EXCLUSIONS, PROVISIONS AND CONDITIONS ELIGIBILITY The Insured Person is eligible to be covered provided they are over the age of 18 (eighteen), below the age of 65 (sixty five) on the Inception Date, The Insured Person can only be covered for this policy once during his lifetime. RESTRICTIONS ON THE NUMBER OF INSURED PERSONS Only the Insured Person is covered. TERMINATION OF BENEFITS The Accidental Death Benefit will cease on the earlier of: the death of the Insured Person; the end of the Period of Insurance (30 days from the Inception Date); or the Insured Person s 65th birthday. HOL TAXI FREE AD JAN 2016 HOLLARD LIFE ASSURANCE PAGE 1 OF 5

2 EXCLUSIONS Hollard will not be liable to pay a benefit if any claim arises directly or indirectly from or is traceable to: wilful exposure to danger (except in an attempt to save human life), intentional self-inflicted injury, suicide or attempt thereat; any Accident which resulted in the death of the Insured Person where the Accident occurred prior to the Inception Date; an Insured Person engaging in: - combat duties, military exercises or any active service within any military, naval, air, police or correctional services body; or - the active duties of the provision of security or protection services to/for any organisation/individual; or - a Terrorists Activity; or - labour disturbances, riot, strike or lock-out; or - hazardous or professional sports / activities more than once a month or on an income earning basis; the use of nuclear, biological, chemical or explosive weapons or any radioactive contamination; an Insured Person driving any type of vehicle when the Insured Person had a blood alcohol content that exceeded the legal limit allowed for driving by the laws of the country where the Accident occurred; the use of drugs by an Insured Person, unless it is proved that the drug was used in accordance with proper medical prescription and not for the treatment of a drug addiction; an Insured Person refusing medical treatment recommended by a Medical Practitioner. This means the regular or routine examination by, or consultation with, a Medical Practitioner for the purpose of monitoring existing medical conditions. the unreasonable or wilful neglect or failure of an Insured Person to seek and remain under the care of a Physician. GENERAL RESTRICTIONS, EXCLUSIONS, PROVISIONS AND CONDITIONS DISCLOSURE OF PRIVATE INFORMATION We respect the confidentiality of your personal information. However, it is essential for insurance companies to share claims and underwriting information with outside parties for the fair assessment and underwriting of risks, and to reduce the number of fraudulent claims. You gave us permission when you applied for this cover to communicate your personal information to other insurance companies, and to our service providers who assist us in managing your cover and our relationship with you. We will always do this as permitted by the relevant privacy legislation. TRANSFERABILITY / CESSIONABILITY No rights or benefits payable under this policy may be ceded or transferred to any third party, and any cession shall be null and void. You may exercise all rights provided for by this policy without the consent of any of the beneficiaries. CURRENCY AND LAW Benefits payable under this policy will be paid in the Republic of South Africa and in South African Rands only. This policy will be governed by and interpreted in accordance with South African Law in the courts of the Republic of South Africa. TERRITORY COVERED The Insured Person must be a South African citizen or a legal permanent resident and must ordinarily reside inside the Republic of South Africa. The Insured Person is only covered within the borders of the Republic of South Africa; there is no cover outside the borders of the Republic of South Africa. CRIMINAL ACTIVITIES All dealings about this policy must be done honestly and in good faith. Hollard will not accept any responsibility under this policy if you (or any person acting for you) is dishonest or misrepresents any information. Your Claimant will lose the right to claim if we are prejudiced or suffer a loss because of: dishonest behaviour; misrepresentation; or criminal activity. HOL TAXI FREE AD JAN 2016 HOLLARD LIFE ASSURANCE PAGE 2 OF 5

3 Hollard will cancel your policy from the Inception Date or from the date of the actions listed above. We will take legal steps to recover damages from you or the Claimant. MISREPRESENTATION, MISDESCRIPTION OR NON-DISCLOSURE Misrepresentation, misdescription or non-disclosure of any material fact or circumstances in connection with this policy, a claim or the application for this policy may result in a claim rejected or the policy cancelled from the Inception Date. In the event that a benefit has been paid as a result of any misrepresentation, non-disclosure, misdescription or fraudulent action by an Insured Person or by any person claiming any benefit under this policy, such person will be required to repay or return the benefit paid. Hollard will be entitled to take legal action to recover the benefit and any costs involved. TERMINATION OF POLICY The policy will cease on the earlier of: the end of the Period of Insurance (30 days from the Inception Date); or the death of the Insured Person. CLERICAL ERROR Hollard will always act in good faith in our mutual dealings. If Hollard makes an administration error, it will not take away any cover you have, or give you any cover that you do not have. COMMUNICATION METHOD Hollard may, at its sole discretion, accept communication by phone where such communication is voice logged by Hollard or on Hollard s behalf. HOLLARD S LIABILITY Hollard s liability in terms of this policy is conditional on you or anyone acting on your behalf, keeping to all the terms and conditions of this policy. All claim payments are subject to the verification of the validity of any claim. Payment by Hollard of the benefits provided in the event of a valid claim in terms of this policy will be a full and effective discharge by Hollard of its liability and obligations in terms of the policy. No benefit payable under this policy will carry interest. REJECTION OF CLAIM If Hollard declines liability for a claim made in terms of this policy, voids this policy, or if there is a dispute regarding the amount of the claim, representation may be made to Hollard within 90 (ninety) days (the representation period ) of the date of receipt of the letter of rejection or avoidance. Representation must be submitted in writing to the Hollard Claims Manager contact details for the claims department are reflected on the Information Page supplied with this Policy Wording. Alternatively, the Claimant may contact the Ombudsman for Long-term Insurance contact details for the Ombudsman are reflected on the Information Page supplied with this Policy Wording. If the dispute is not satisfactorily resolved in this manner, legal action may be instituted against Hollard for the enforcement of the claim by way of the service of summons against Hollard. Summons must be served on Hollard within 180 (one hundred and eighty) days of the expiry of the representation period, failing which all benefits in respect of such claim will be forfeited and no liability can arise in terms of such claim. The Claimant may also choose to take legal action against Hollard without first requesting Hollard to review their decision or to contact the Ombudsman. If he decides to do this, summons must be served on Hollard within 270 (two hundred and seventy) days of the date he received the rejection letter from Hollard. If he takes legal action against Hollard before contacting the Ombudsman, he can only approach the Ombudsman for assistance after he has withdrawn the summons against Hollard. CLAIM NOTIFICATION PERIOD On the happening of an event, which may result in a claim in terms of this policy then the Claimant will, at their own expense, submit the claim to Finrite on the contact details reflected on the Information Page supplied with this Policy wording. HOL TAXI FREE AD JAN 2016 HOLLARD LIFE ASSURANCE PAGE 3 OF 5

4 The Claimant must submit to Finrite the full details in writing of the claim as soon as reasonably possible up to a maximum of 180 (one hundred and eighty) days from the date of the event giving rise to the claim. Hollard will in no way whatsoever be liable to pay any benefit if the full details of the claim are not received within the maximum period as stipulated above. CLAIM PROCESS All certificates, information and evidence required by Hollard will be furnished in the form prescribed and without expense to Hollard. Hollard will be entitled to access any medical and hospital records in relation to an Insured Person s health and make copies of such records. Any receipt or discharge which your personal representatives or Beneficiary may give to Hollard for any benefit paid under this policy will be deemed as final and complete discharge of all liability of Hollard in respect of any and every contingency resulting to the Insured Person in consequence of the accidental death whether resulting before or after the date of such receipt or discharge. INTERPRETATION Words importing the singular will include the plural, and vice versa, words importing the masculine gender will include the feminine and neuter genders, and vice versa, and words importing natural persons will include legal persons, and vice versa. The clause headings in this policy are inserted for reference purposes only and will not affect the interpretation of any of the provisions to which they relate. DEFINITIONS Unless the contrary appears from the context, the following words and phrases will have the meanings assigned to them where they appear in this policy and in any documentation issued by Hollard in connection with this policy. The following words will have the meanings set out below. HOLLARD Hollard means Hollard Life Assurance Company Limited. ACCIDENT Accident means a sudden, fortuitous and uncertain event which is caused solely and directly by violent, external, physical and visible means independently of any other cause. ACCIDENTAL DEATH BENEFIT This is the lump sum payment as set out on the Welcome SMS that is payable under this policy in the event of an Insured Person dying as a result of an Accident during the Period of Insurance. CLAIMANT The claimant is the Beneficiary, or if someone other than your Beneficiary, your partner, child, parent, brother or sister, or court appointed Executor of your estate. BENEFICIARY Beneficiary means the person or persons who you nominated when you applied for this cover to receive the Accidental Death Benefit on your death. INCEPTION DATE The Inception Date is the date on which the cover under this policy starts and is the date that you received the Welcome SMS. PERIOD OF INSURANCE This is the period where the Insured Person will be covered under this policy. The period of insurance is 30 (thirty) days starting on the Inception Date. WELCOME SMS This is the electronic text message sent to your cell phone, where Hollard has accepted the risk to cover you for the Accidental Death Benefit during the Period of Insurance. HOL TAXI FREE AD JAN 2016 HOLLARD LIFE ASSURANCE PAGE 4 OF 5

5 INSURED PERSON (POLICYH0LDER) Insured Person, you or your refers to the person that applied for cover and who has been accepted by Hollard as the Insured Person in terms of this policy. This person is also the Policyholder. An Insured Person will only be covered subject to the terms and conditions of this policy. An Insured Person s cover will continue until you notify Hollard of any changes or until cover ceases in terms of the terms and conditions of this policy. Persons who are not reflected on the Welcome SMS will not be covered in terms of this policy. PHYSICIAN or MEDICAL PRACTITIONER Physician or Medical Practitioner means a person legally licensed and duly qualified to practise medicine and surgery (other than the Insured Person or a member of his family). TERRORIST ACTIVITY Terrorist Activity means an act involving the use of violence and/or intimidation, or the threat or the preparation thereof, which appears to be intended to disrupt, coerce or influence a government or the public or a section of the public, read together with Section 1 of the Protection of Constitutional Democracy Against Terrorist and Related Activities Act (Act 33 of 2004) as amended. HOL TAXI FREE AD JAN 2016 HOLLARD LIFE ASSURANCE PAGE 5 OF 5