DOMESTERE - DOMESTIC PERSONAL ACCIDENT INSURANCE CLAIMS ADMINISTRATION GUIDELINE

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1 DOMESTERE - DOMESTIC PERSONAL ACCIDENT INSURANCE CLAIMS ADMINISTRATION GUIDELINE A 24 hour Personal Accident policy provides a benefit to your Domestic Worker in the event of her/him suffering accidental bodily injury. Accidental Bodily Injury could be the result of any of the following: - Motor vehicle / bus accident - Sports Injuries - Injuries on Duty - Injuries at home - Murder and Assault - Snake or dog bites - And many more. ABOUT THE INSURER The Domestic Insurance Personal Accident facility is Underwritten by Guardrisk Allied Products and Services (Pty) Ltd (GAPS). GAPS is an Authorised Financial Services Provider with FSP number The Company Registration Number is 2007/016202/07. HOW DO YOU SUBMIT A CLAIM? All claims must be submitted to Guardrisk Allied Products & Services (Pty) Ltd. Complete the claim form and send it to either of the following: Address : Telephone Number : (011) /1038 All claims must be notified within 180 days from the date of the injury. Failure to do so will result in the claim being declined for late notification.

2 EXCLUSIONS There is a list of Exclusions that you must be aware of, which are as follows: The Insurers shall not be liable to pay any claim under this Policy in respect of any Insured Person (in this case, your Domestic Worker) 1. whilst engaging in flying as pilot or member of the crew. This exception does not apply to Insured Persons engaging in motorised ballooning, hang-gliding, paragliding and parachuting, provided that such activities are solely for social and/or pleasure purposes and not of a competitive nature or for reward 2. caused by the Insured Person's suicide or intentional self-injury 3. caused solely by an existing physical defect or other infirmity of the Insured Person 4. as a result of the influence of alcohol, drugs or narcotics upon the Insured Person unless administered by a member of the medical profession (other than himself) or unless prescribed by and taken in accordance with the instructions of a member of the medical profession (other than himself) 5. caused by the Insured Person's participation in any riot or civil commotion 6. arising from war, invasion, act of foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection, military or usurped power 7. as a result of the Insured Person's deliberate exposure to exceptional danger (except in an attempt to save human life) or the Insured Person's own criminal act 8. while participating in sport as a professional player. SUICIDE CLAIMS You will note that suicide is excluded on the 24 hour Accident Policy. However, if you have reason to believe that your Domestic Worker committed suicide, you must still follow the procedure for the Death claim. Following a suspected suicide attempt, the police do a full investigation to determine the events that lead to the Death and there are times where suspected suicides are found to be constructed murder cases. This investigation does however take a long time and we would prefer to advise the Insurer of the possible claim within the 180 days, just to prevent the claim being declined for late notification 2 years later when we find out the actual cause of the death. 24 HOUR CLAIMS DOCUMENTS Once the claim has been submitted to the Insurers they will advise exactly what documentation is required to fully assess the claim. The documentation required for each claim varies on the circumstances of the claim. A useful guide to the claim requirements is as follows: DEATH CLAIMS 1) Motor Vehicle Accident - Blood Alcohol Results (if driving the vehicle)

3 2) Death as a result of Murder, Hijack or Assault 3) Pedestrians killed whilst crossing a road PERMANENT DISABILITY CLAIMS This is a unique benefit and the claims requirements differ for every single claim that is submitted, as the Insurers need to get specialist medical reports from the attending doctors. The basic requirements are as follows: 1) Motor Vehicle Accident 2) Injuries resulting from an Assault or Hijacking - Newspaper reports (if any are issued) 3) Pedestrians injured whilst crossing a road 4) Sports Injuries or Injuries at home

4 HOW TO OBTAIN THE RELEVANT INFORMATION / DOCUMENTATION It is important to note that the quicker you start asking for the information, the easier it will be to obtain the documentation. Most death claims are delayed because nobody knows where to obtain the information and this can be avoided by being a bit more proactive, as follows: As soon as you have been notified that your Domestic Worker has died from Accidental Bodily Injury, you should get in contact with the family immediately and tell them that you need certain documentation to process the Death claim. Police Case Number All unnatural deaths are reported to the police and they are all investigated by the police. The family must advise which police station the case was reported to, the case number and the name of the investigating officer immediately after they report the case to the police. These details must then be given to GAPS, who will then start requesting the necessary documentation from the police. Death Certificate The family has to report the death to the police and to the Home Affairs offices. Request that they provide you with a certified copy of the death certificate. This will speed up the claims process. Post Mortem Report If someone dies from Unnatural Causes, a post mortem report is always done, as they need to determine the cause of the death. This report is usually only available 4-6 weeks after the date of the death and the family should advise the police that they require a copy of the report as soon as it becomes available. It is important that you remind the family to follow up with the police for these documents, as it will speed up the claims process. GAPS will also follow up with the police, as it is always best to have as many people pressurizing the police for the same documents. Traffic Collision Report All motor vehicle accidents must be reported to the police within 24 hours of the occurrence of a motor vehicle accident. This report is usually completed on the day of the accident and should be available to the family within 5 days of the accident. The family should again advise the police that they require this report for an insurance claim and follow up with the police until they get the report. Police Report In the event of a death resulting from an assault, murder or hijacking situation, the police will issue a report detailing the information that they have regarding the incident. This report generally takes a bit longer to obtain, as there are usually a number of witnesses that the police need to talk to before they can be sure of the exact circumstances surrounding the incident. GAPS will send the police a form which they can complete, so again, it is important that she is given the police station name, the case number and the name of the investigating officer. Newspaper Clippings/Reports In most cases there will not be any newspaper reports of the incident. However, there are times where there are reports in the local newspapers about the incident. Ask the family of they have seen any reports and if they have a copy of the report. This is very useful in the assessment of the claim and will certainly speed up the claims process.

5 MEDICAL EXPENSES It important to remember that this policy also offers a Medical Expenses benefit. In order to claim under this section, any medical accounts incurred by your Domestic Worker, as a result of an Accident, should be submitted to the Insurer. It is important to remember than an excess of R750 will be applicable per claim, and that this benefit will only cover the cost not met by a registered Medical Scheme, should your Domestic be a member of such a scheme (this excludes any amounts paid from the Medical Savings Account, which is recoverable under this facility). INCOME REPLACEMENT / TEMPORARY TOTAL DISABILITY In the event of your Domestic Worker being injured and having to take some time off work to recover from her/his injuries, a benefit will be payable under the policy for a maximum of one year. The benefit is payable as a loss of income after taking into consideration any potential payments from the Commissioner of Occupational Injuries & Diseases, ensuring that there is no financial gain from the employee being off work. A copy of a Dr s note must be provided substantiating the time taken off work. ACCIDENT EXPERT The Insured Person will have access to assistance with all claims management and handling in respect of the following : Road Accident Fund Act (RAF) Assistance Legal Assistance needed following a road accident The Insured Person, or a her/his Representative, will be required to contact direct, for assistance. GENERAL Remember that the family has the easiest access to the information that is required and if they are proactive, the claim will be assessed far quicker. GAPS will do their best to assist the family to obtain the necessary information, but in order to do so, we will require the name of the police station, the case number, and the name of the investigating officer. Once your Domestic Worker (or their family) has advised you of a claim, you have to give her/him a copy of the Medical Report attached to the claim form and request that her/ his doctor completes the form. This will make it a lot easier for GAPS to deal directly with the doctors in order to get the information they require to assess the claim fully. It is important to note that these claims can take up to 24 months to finalise, as the Insurer always has to make provision for sufficient healing time and also time for possible deterioration of your Domestic Worker s condition.

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