Page 164 - Agriculture Policy Wording Binder

Specific Conditions
1. The Company is entitled to require any test to be duplicated by a registered medical practitioner of their choice.
2. If the result of any test carried out by the Insured Person’s registered medical practitioner is different from the test carried out by the Company's registered medical practitioner, then a final test shall be carried out by another registered medical practitioner who is acceptable to both parties or failing agreement, a registered medical practitioner will be appointed by the President of the Medical Association of South Africa and his/her determination shall be binding.
3. If the Insured Person so becomes infected with "HIV", the date of his/her infection shall be deemed the date of the accidental exposure unless the contrary is shown.
4. Following a notification of an Occurrence which could give rise to a claim in terms of this insurance, the Company shall at all times during and after the insurance period have access to the Insured Person’s medical records as held by the Insured.
Specific Exceptions
No claim shall be payable if:
1. the Insured Person takes or has taken drugs intravenously or subcutaneously unless in the course of medical treatment as prescribed by a registered medical practitioner;
2. it is directly or indirectly caused or contributed to by any medical condition which was known or reasonably ought to have been known to the Insured Person and which has not been declared to and noted by the Company prior to the inception of this insurance;
3. the Insured Person fails or refuses to promptly make himself or herself available for examination or the associated tests required;
4. the Insured Person is no longer in the employment of the Insured when the "HIV" positive diagnosis is made.
HIV/Aids Assistance
The Company will provide the Insured Person with HIV/Aids Assistance services in respect of all claims arising from Accidental exposure to HIV/Aids subject to the standard Terms, Conditions, Provisions and Exclusions as stated in Annexure “2” attached to the Policy Schedule. Such claims for Accidental exposure to HIV/Aids have to be reported to the emergency number provided within 24 (twenty four) hours of the Accidental exposure.
The emergency contact number is 0861 555 114
The following benefits provided and processes are more fully described in the Annexure “2” to the Policy Schedule:.
1. 24 (twenty four) hour access to the call centre for information, procedural instructions, advice and support;
2. appointment of a case manager, physician, or trained nurse;
3. counselling regarding the HIV exposure (if not previously done) and;
4. necessary medical protocol that needs to be followed.
Should the Insured Person be HIV positive at initial testing no further assistance will be provided.
Hospitalisation
If, during the period of insurance, an Insured Person is admitted to hospital as an in-patient as a result of Accidental Bodily Injury, the Company will pay the amount reflected in the Schedule per day for a period of hospitalisation up to 90 (ninety) days or the number of days reflected in the Schedule, whichever is the highest;
PROVIDED THAT:
1. the Company will not be liable for the first 24 (twenty four) hours of each and every period of hospitalisation;
2. successive periods of hospitalisation, due to the same or related causes, will be regarded as one accident.
Serious illness
Should an Insured Person be diagnosed during the period of insurance as suffering from a Serious Illness, symptoms of which were not present in such Insured Person up to 12 (twelve) months before inception of this Extension, the Company will pay the compensation as stated in the Policy Schedule.
Group Personal Accident
Page | 162 Policy Wording – Agriculture – Binder – Version 2 2023