Page 196 - Execuline - Classic Policy Wording

"En Route" – Personal accident
Paying out after a claim
How much we pay
We pay out the exact amount of cover that you chose when you signed up for this policy. So any claim is settled simply by referring to the schedule of compensation:
○ death −
○ medical expenses −
○ permanent disability -
○ temporary disability −
Certain pay-outs are limited
as stated in the schedule
up to the amount as stated in the schedule as shown in the disability table (page 195) the weekly benefit as stated in the schedule.
Under the following circumstances, we pay less than the benefits stated in the schedule:
Death
○ for children up to six years of age, we pay up to a maximum of R10 000
○ for children between six and 15 years of age, we pay up to a maximum R30 000
Temporary disability
○ for unemployed persons, we will pay up to 25% of the temporary-disability benefit
○ the following categories of people do not qualify for temporary-disability benefit:
− children under 15 years of age
− students who are not full-time employees
○ for the weekly temporary-disability benefit, the maximum we will pay is the average weekly earnings of the
person during the 12 months prior to the injury.
Death following permanent disability
If death follows after we have already paid out for permanent disability, we do not pay more than the highest limit for either death or permanent disability.
EXAMPLE: if your death limit is R150 000 and you die after we have already paid you R100 000 for permanent disability, we will pay out an additional R50 000. If, however, you received R150 000 for permanent disability, then no further pay-out will be made when you die.
Temporary-disability and medical expenses are extra
The payment of medical expenses and temporary-disability benefits are always in addition to any pay-out you receive for any death or permanent disability benefits.
Temporary-disability payments stop when injury has healed
When it is reasonably clear that your injury has healed, we stop paying your temporary-disability benefits, even if you remain permanently disabled afterwards.
194 HPL – Execuline – Classic Personal Insurance Policy – 6 July 2015