Help and FAQ's

General enquiries

Tel: 011 731 3600

E-mail: info@santam.co.za

What are the policy exclusions?

Exclusions vary depending on the structure of every policy, but here are some important, regularly applied exclusions to be aware of:

 

  • While engaging in flying as a pilot or member of the aircrew. This exclusion does not apply to Insured Persons engaging in 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.
  • Caused by the Insured Person's suicide or intentional self-injury.
  • Caused solely by an existing physical defect or other infirmity of the Insured Person.
  • As a result of the influence of drugs or narcotics on 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).
  • For Bodily Injury to the Insured Person arising whilst the Insured Person is driving or operating any motorised or mechanically operated vehicle under the influence of alcohol. For the purposes of this exception, the term “under the influence of alcohol” means having a blood alcohol level concentration greater than the statutory limit at the time of the accident.
  • Caused by the Insured Person's participation in any riot or civil commotion.
  • As a result of the Insured Person's deliberate exposure to exceptional danger (except in an attempt to save human life) or a criminal act committed by the Insured Person.
  • While participating in sport as a professional player.
  • Directly or indirectly caused by or contributed to by ionising radiations or contamination by radioactivity from a nuclear fuel or nuclear waste from the combustion of nuclear fuel or nuclear weapons material. For this exception only, combustion shall include any self-sustaining process of nuclear fission.
  • For venereal disease or Acquired Immune Deficiency Syndrome (AIDS) or AIDS-related complex (ARC), regardless of how the syndrome was acquired or may be named.
  • For any mental and/or nervous disorders, or any similar condition caused by stress or stress-related situations, other than those caused by accident as defined in this policy.
  • Insurers will not indemnify, be liable to pay any claims or provide any benefits if doing so would break any laws, sanctions, regulations, or restrictions set by the United Nations, the European Union, United Kingdom, or the United States of America – even if those laws are not part of the local law where the claim is made.
  • Insurers will not indemnify, be liable to pay any claims or provide any benefits if doing so would break any laws, sanctions, regulations, or restrictions set by the United Nations, the European Union, United Kingdom, or the United States of America – even if those laws are not part of the local law where the claim is made.

How soon after an incident should I submit my claim?

Personal Accident claims must be notified as soon as possible, within 180 days of the injury. Failure to do so may result in the claim being declined due to late notification.

 

Where supporting documents are not immediately available, please ensure a fully completed claim form is submitted to register the claim within the notification period.  Thereafter, supporting documents can be forwarded as they are received.

Does the temporary total disability benefit/Income Protection cover the whole family?

Temporary Disability/Income Protection only offers cover for the employee whose name the policy has been issued in and who is gainfully employed by the business when the accidental bodily injury occurs.

How does Employee Injury Assist work?

Exclusions vary depending on the structure of every policy, but here are some important, regularly applied exclusions to be aware of:

 

  • While engaging in flying as a pilot or member of the aircrew. This exclusion does not apply to Insured Persons engaging in 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.
  • Caused by the Insured Person's suicide or intentional self-injury.