Page 297 - Agriculture Policy Wording Binder

Personal Accident
4. Notice must be given to the Company in writing on the prescribed claim form as soon as practicable but in any event within 12 (twelve) months of any occurrence which may give rise to a claim under this Section but notice of death must be given forthwith and the Company shall have the right to have a post mortem examination of the body.
All certificates, information and evidence required by the Company shall be furnished without expense to the Company within 30 (thirty) days of the Company notifying the Insured of their requirements.
After incurring Bodily Injury for which Compensation may be payable under this Section, the Insured Person shall, when reasonably required by the Company to do so, submit to medical examination on behalf of and at the expense of the Company and undergo any treatment specified. The Company 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 Company shall not be liable for any part of any claim which in the opinion of their medical adviser arises from the unreasonable or willful neglect or failure of an Insured Person to seek and remain under the care of a qualified member of the medical profession.
5. If any difference shall arise as to the amount to be paid under this Section (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 Company to make any payment under this Section.
6. In the event of the Company disclaiming liability in respect of any claim and an action or suit not being commenced within 12 (twelve) months after such disclaimer or, in the case of an arbitration taking place, within 12 (twelve) months after the Arbitrator shall have made his/her award, all benefits under this Section of the Policy in respect of such claim shall be forfeited.
7. 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 Company 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.
7.1 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 Section.
7.2 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.
8. This Section will be governed by the laws of the Republic of South Africa, whose courts shall have jurisdiction in any dispute arising hereunder.
OPTIONAL CLAUSES AND EXTENSIONS (if stated in the Schedule to be included) Accident Expert assistance
The Company will provide the Insured with the Accident Expert assistance provided by Roadcover in respect of assistance with claims under the Compensation for Occupational Injuries and Diseases Act (COIDA) or claims under the Road Accident Fund (RAF), as set out in the Annexure ‘1’ to the Policy Schedule
Provision of these services will be subject to the assistance services standard terms conditions provisions and procedures as described in the Annexure “1” attached to the Policy Schedule.
The following additional provisos are applicable in respect of the above mentioned Accident Expert assistance:
1. The injured person has to be an Insured Person in terms of this Section.
2. Any costs incurred by an injured Insured Person, being approached by an outside party without the written consent of Roadcover will not be covered.
3. The injured person is at all times free to get outside second opinions but the cost of these will not be covered unless approved in writing by Roadcover.
4. The injured person is not obliged to use these assistance services and may seek alternative assistance in the event of which the Company will not be liable for any incurred costs.
Policy Wording – Agriculture – Binder – Version 2 2023 Page | 295