Die grondslag van enige versekering - Verstaanbaarheid, Eerlikheid en Eenvoud.

Persoonlike polis voorbeelde | Personal Insurance examples.

1  Bestuur onder die invloed

Daar is geen dekking vir verlies of skade, beserings of aanspreeklikheid wat ontstaan wanneer jy ‘n voertuig bestuur of sleep terwyl:

jy onder die invloed van bedwelmende drank of verdowingsmiddels is

of die alkohol inhoud in jou bloed die wetlike perk oorskry.

Dit is ongeag die metode wat gebruik word om die graad van bedwelming te meet – byvoorbeeld ‘n asem- of ‘n bloedtoets. Hierdie uitsondering is ook van toepassing op enige persoon wat jou voertuig met jou toestemming bestuur of sleep.

1  Driving under the influence

There is no cover for loss, damage, injury, death or liability that arises when you are driving or towing your vehicle while:

under the influence of intoxicating liquor or drugs

or the alcohol content in your blood exceeds the legal limit.

This is irrespective of the method used to determine the degree of intoxication - for example, a breathalyser test or a blood test. This also applies to any other person who may be driving or towing your vehicle with your permission.

2  Wat gebeur as jy onderverseker is?

As jy iets vir minder as die waarde daarvan verseker – met ander woorde jy is onderverseker – dan moet jy ’n deel van die verlies self dra in geval van ‘n eis. By die berekening daarvan, sal die beginsel van eweredigheid toepas word. Die versekeraar sal onder geen omstandighede meer as die versekerde bedrag betaal nie.

Voorbeeld

Jou huisinhoud is verseker vir R200 000, maar die vervangingskoste van al die items is R400 000. Dit beteken jy is vir die helfte (50%) onderverseker. Anders gestel, jy is slegs vir die helfte van ’n eis verseker. As R50 000 van jou inhoud dus gesteel word, betaal die maatskappy slegs die helfte van R50 000 - of R25 000.

Dit is wat bedoel word met die beginsel van eweredigheid. Die uitbetaling word altyd verminder met die eerste bedrag betaalbaar Onthou, met elke eis moet jy die eerste bedrag, ook bekend as die bybetaling, betaal.

Byvoorbeeld, as die bybetaling R1 000 is en die eis R20 000, word R19 000 aan jou uitbetaal. Die bybetalings verskyn in die bybetalingskedule.

Wag eers voordat jy ontslae raak van beskadigde eiendom

As daar beskadigde items is as gevolg van ’n eis, moet jy nie daarvan afstand doen of ontslae raak voordat daar toestemming gegee is nie. Die beskadigde items word die eiendom van die versekeraar.

2  What happens if you are under-insured?

If you insure something for less than its value - i.e. you are under insured - then you will have to bear a proportion of any loss in the event of a claim. In calculating this, the insurer will apply the principle of average. Under no circumstances will they ever pay out more than the sum insured.

Example

Your household contents are insured with us for R200 000, but the cost to replace all the items is R400 000. This means you are under-insured by half (or 50%). Put another way, you are only insured for half of any claim you make. So if R50 000 of your contents is stolen, they will compensate you for half of R50 000 - which is R25 000.

This is referred to as the principle of "average". The compensation is always reduced by the excess Don't forget that for every valid claim, you will always have to pay the first amount, also known as the excess.

For example, if there is an excess of R1 000 on a R20 000 claim, then you will receive R19 000 from the insurer. 

Wait before disposing of damaged property

If there are damaged items as a result of an insured event, you must not abandon them or get rid of them until the insurer agree that you can do so. The salvage becomes the property of the insurer.

3  Wat is Persoonlike Aanspreeklikheid

Dit is doodeenvoudig geld wat jy moet betaal aan ander persone (derdepartye), sou jy die oorsaak wees van enige besering,verlies of skade as gevolg van ‘n ongeluk of deur jou eie nalatigheid.

Aanspreeklikheid - Wanneer jy wetlik aanspreeklik gehou word vir toevallige verlies of skade aan eiendom, of dood of liggaamlike beserings aan derdepartye

3  What is personal liability

It is simply money that you may have to pay other people (third parties), if you should cause them any injury, loss or damage by accident, or through your own negligence.

Liability -  When you can be held legally liable for accidental loss or damage to property, or death or bodily injury to third parties

4  Sleutelbegrippe om te verstaan:

Skedule:  Die gedeelte verduidelik waarvoor jy gedek is, en vir hoeveel

Eis:  Wanneer jy  vra dat die versekeraar jou moet vergoed vir ’n verlies of skade

Versekerde gebeurtenis:  Wanneer iets gebeur waarvoor jy toegelaat word om te eis

Eerste bedrag betaalbaar:  Die bedrag wat jy moet betaal vir enige eis

Jy/Jou:  Sluit in jouself, jou eggenoot en enige lid van jou familie wat normaalweg by jou woon en wat finansieël afhanklik is van jou

Versekerbare belang:

Jy kan slegs eis vir items waarin jy ’n versekerbare belang het – byvoorbeeld items wat, indien dit verloor of beskadig is, veroorsaak dat jy finansieël in ’n swakker posisie is.

Jy het byvoorbeeld ’n versekerbare belang in jou eie woning, want as dit beskadig word, veroorsaak dit vir jou ’n verlies. Maar as jou buurman se huis beskadig word, laat dit jou nie finansieël in ’n swakker posisie nie, jy het dus geen versekerbare belang daarin nie, en kan dus nie daarvoor eis nie.

Derdeparty

Iemand anders as jyself wat betrokke is by ’n versekerde gebeurtenis – byvoorbeeld ‘n beseerde voetganger of die bestuurder van ‘n voertuig wat in ‘n ongeluk met jou betrokke was

4  Key terms to understand:

Schedule:  This section explains what you're covered for, and for how much

Claim:  When you ask the insurer to compensate you for loss or damage

Insured event:  When something happens that you are allowed to claim for

Excess:  The amount that you must pay for any claim

You / Your:  Includes yourself, your spouse and any members of your immediate family who normally reside with you, and are financially dependent on you

Insurable interest:

You can only claim for items in which you have an insurable interest - it is items which, if lost or damaged, cause you to be worse off financially.

For example, you have an insurable interest in your own house, because if it is damaged, it results in a loss for you. However, damage to your neighbour's house does not leave you financially worse off; so you have no insurable interest in it, and therefore cannot claim for it.

Third party

Someone other than yourself who is involved in an insured event - for example, an injured pedestrian or the driver of a car that is involved in an accident with you

 5  Voorkom/beperk verlies of skade

Jy moet alle redelike stappe neem om verlies of skade aan jou versekerde eiendom te voorkom ná ’n gebeurtenis want die versekeraar mag jou dalk nie vergoed vir enige verlies of skade nie.

Byvoorbeeld,

As jy ’n lekkende pyp het en dit veroorsaak waterskade in jou huis, is dit jou verantwoordelikheid om ’n loodgieter te kry om die watervloei uit die pyp af te draai. Jy kan dit nie net bloot ignoreer nie.

6  Jy kan nie vir meer as die versekerde bedrag eis nie

Om jou oorspronklike finansiële posisie te herstel, sal die uitbetaling op die waarde (soos hierbo) van die verlore goedere gebaseer wees, maar nooit meer as die versekerde bedrag nie.

Byvoorbeeld

As jou nuwe motor gesteel is, mag die versekeraar vir jou ’n nuwe een koop of jou uitbetaal vir ’n nuwe een. Die bedrag wat hul jou vergoed sal nooit meer wees as die versekerde bedrag of die nuwe prys soos gelys nie, wat ook al die laagste bedrag is.

‘n Nuwe voertuig is ‘n voertuig waarvan jy die eerste geregistreerde eienaar is.

As jou 3-jaaroue televisiestel gesteel is, mag die versekeraar vir jou ’n nuwe een koop of jou uitbetaal vir ’n nuwe stel maar nie meer as die vervangingswaarde nie. As jou foto album of digitale kamera gesteel is, mag hulle die album of kamera vervang, maar nie die sentimentele waarde van die foto’s nie.

7  WAT IS HUISHOUDELIKE INHOUD

Dit is jou huishoudelike goedere, persoonlike besittings en toerusting, geld en verhandelbare dokumente, en dit kan ook verskeie los en vaste toebehore insluit as jy die dekking daarvoor gevra het.

Neem kennis dat die teenwoordigheid van jou huishoudelike werknemers op die perseel beteken nie bewoon nie al bly hul ook in enige van die buitegeboue of huishoudelike woon kwartiere.

Indien ’n alarm ’n vereiste is en jou alarm is nie in werking en geaktiveer nie, sal jou eis geweier word.

Jy sal  vergoed  word gebaseer op die vervangingskoste van enige verlore of beskadigde inhoud.

Voorbeeld

As jy eis vir ’n meubelstuk wat R10 000 kos om te vervang, sal die versekeraar jou R10 000 uitbetaal, of die item vervang of herstel vir tot R10 000 - al is die meubelstuk oud en minder werd.

Jy is gedek teen verlies of skade aan die inhoud van jou huis veroorsaak deur skielike impak.

Voorbeeld

 'n Boom wat op jou huis val, of ’n muur wat op ’n deel van jou huis ineenstort. Die dekking is nie van toepassing in gevalle waar die skade byvoorbeeld veroorsaak is deur ’n kontrakteur wat bome afkap of ’n bouer wat werk verrig nie.

8  WAT IS ALLE RISIKO’S

Dit dek ‘n wye reeks van toevallige verlies of skade wat tipies plaasvind weg van jou huis. Dit behels gewoonlik items wat jy dra of wat saamgedra word soos horlosies, handsakke of bykomstighede.

Ongespesifiseerde besittings

Klerasie en persoonlike besittings wat deur jou gedra of saamgedra word. Dis gewoonlik lae waarde items soos penne, grimering en handsakke.

Ongespesifiseerde besittings sluit ook sport toerusting in.

Gespesifiseerde besittings

Enige item of besitting wat spesifiek gespesifiseer is op jou skedule. Dis gewoonlik items van hoë waardes soos juwele, horlosies en draagbare rekenaars

Voorbeeld

Ongespesifiseerde besittings

As jy jou horlosie verloor wat R1 000 kos om te vervang en die limiet is R1 500, betaal ons R1 000. Hierdie bedrag sal nooit die bedrag in die LIMIET AFDELING oorskry nie.

Gespesifiseerde besittings

As jy jou ring verloor wat R20 000 kos om te vervang en dis verseker vir R20 000, betaal ons R20 000 of vervang die ring. As die ring vir slegs R16000 gespesifiseer is, betaal die versekeraar slegs R16 000

9  WAT WORD BEDOEL MET GEBOU

Die gebou is hoofsaaklik die struktuur van jou huis – vanaf die fondamente en vloere tot die mure, plafon en dak. Dit sluit alle soliede infrastrukture op die perseel in, vanaf hekke tot swembaddens, asook pype, vaste uitrustings en toebehore wat daaraan geheg is.

Voorbeeld

As jy eis vir ‘n nuwe muur wat R10 000 kos om te vervang, sal hul R10 000 betaal sodat jy ’n nuwe een kan bou, al is die beskadigde muur oud en veel minder werd.

Voorbeeld

Jou gebou is vir R200 000 verseker, maar die vervangingskoste is R400 000. Dit beteken jy is net vir die helfte verseker en dus 50% onderverseker. Anders gestel, jy is vir alle eise slegs vir die helfte verseker. As jou gebou dus beskadig word tydens ‘n storm en dit kos R50 000 om te herstel, sal jy slegs die helfte uitbetaal word, naamlik R25 000.

Nuwe huis wat nog nie geregistreer is nie

As jy ‘n kontrak geteken het om ‘n nuwe huis te koop en dis nog nie op jou naam geregistreer nie, is jy gedek vir skade aan die huis, mits jy die maatskappy voorsien van volle besonderhede en hulle bepalings en voorwaardes aanvaar.

10  INSAKKING EN GRONDVERSKUIWING

Insakking beteken insak – dit is die vertikale, afwaartse beweging van grond. Dit sluit vassakking in, wat ‘n laterale beweging is.

Grondverskuiwing -  beteken massa grond wat afwaarts gly. Dit is in effek ‘n klein aardstorting en gebeur gewoonlik teen ‘n helling.

11  WAT IS JOU PERSOONLIKE REKENAAR

Dit verwys na jou rekenaar of skootrekenaar, so wel as verwante toerusting soos drukkers, skerms en sagteware. Die dekking is nie slegs vir toevallige skade nie, maar ook elektroniese breekskade, soos ‘n hardeskyf wat breek.

Toevallige verlies of skade

Jy is gedek teen toevallige verlies of skade, enige plek in die wêreld, deur enige oorsaak wat nie spesifiek uitgesluit is nie.

Voorbeeld,

Jy laat val die rekenaar en dit breek, jy stort koffie uit op jou sleutelbord, of die rekenaar word gesteel by jou huis of by die werk.

12  DIE VERHOGING IN NALATIGHEIDSKOSTE

In vandag se wêreld is mense meer en meer bewus van hul “regte”. Hul sal soms nie huiwer om jou te dagvaar vir verlies of skade wat hulle glo is as gevolg van jou nalatigheid nie.

Voorbeeld

Tipiese voorbeelde is dat jou hond ‘n verbyganger byt, of ‘n braai in jou agterplaas veroorsaak ‘n vuur wat jou buurman se huis afbrand.

Voorbeeld

Jou hond hardloop in die straat en byt ‘n verbyganger. Die persoon moet hospitaal toe gaan en het mediese kostes van R95 000. Die LIMIET AFDELING bepaal dat jy gedek is vir hierdie tipe gebeure tot R 5 miljoen.Jy kry dus die volle R95 000.

Jy betaal altyd die eerste bedrag (bybetaling) Jy betaal altyd die eerste bedrag van enige eiseskikking. Dit is ook bekend as bybetaling en verskyn in die bybetalingskedule.

Voorbeeld

As jy suksesvol eis vir R20 000, en die bybetaling vir die eis is R10 000, is die netto uitbetaling R10 000.

13  WAT IS ‘N PLESIERVAARTUIG

Dit kan ‘n motorboot of seilboot met gespesifiseerde toerusting en bybehore wees. Dit sluit ook waterponies en verbindingsbote (tenders) in.

Voorbeeld

Jou plesiervaartuig is verseker vir R200 000, maar die vervangingskoste is R400 000. Dit beteken jy is vir die helfte (50%) onderverseker. Anders gestel, jy is slegs vir die helfte van ’n eis verseker. As jou plesiervaartuig dus in ‘n storm beskadig is en die herstelkoste is R50 000, kan die versekeraar slegs die helfte van R50 000 – of R25 000 betaal.

Jy moet ’n lisensie hê en ouer as 16 jaar wees In die geval van ‘n eis, moet jy bewys dat jy ten tye van die voorval ouer as 16 jaar en in besit van ’n geldige skipperslisensie was. Dit is ook van toepassing op enige persoon wat met jou toestemming jou plesiervaartuig ten tye van die voorval stuur. As die plesiervaartuig oor land vervoer word, moet die persoon ‘n geldige rybewys hê.

14  WAT IS REGSKOSTE EN IDENTITEITSDIEFSTAL

Hierdie is koste wat jy mag aangaan as jy jouself in ‘n regsaksie moet verdedig, of as jy gedwing word om teen iemand anders regsaksie te neem.

Identiteitsdiefstal verwys na onwettige gebruik van jou identiteit.

Waarteen is jy verseker.

Siviele aksie

Enige siviele aksie deur jou of teen jou.

Kriminele klagte

Verdediging van enige kriminele klagte teen jou, uitgesluit ‘n boete of borgtog wat teen jou opgelê word.

Arbeidsverhoudinge

Enige regsaksie deur jou of teen jou in ‘n arbeidshof.

Gesinsaangeleenthede

Enige regsaksie wat verband hou met gesinsaangeleenthede soos egskeidings, toesig of onderhoud.

15  DIE VERSKIL TUSSEN ‘N SIVIELE AKSIE EN KRIMINELE AKSIE

‘n Siviele aksie -  is wanneer een persoon ‘n regsaksie teen ‘n ander persoon instel om hul regte te beskerm, of omdat hul glo hulle is ‘n onreg aangedoen. ‘n Suksesvolle beslissing is dat skadevergoeding toegeken word ten gunste van die begunstigde party.

n Kriminele aksie -  is wanneer regsaksies teen ‘n persoon ingestel word deur die staat omdat hul glo die persoon het ’n misdaad gepleeg. In geval van skuldigbevinding word die persoon gestraf met ‘n boete, tronkstraf, of albei.

16  WAT IS ‘N WOONWA EN SLEEPWA 

Dit is ‘n nie-selfaangedrewe voertuig wat ontwerp is om deur ‘n motorvoertuig gesleep te word. Dit sluit ook alle onderdele, permanente toebehore en sytente in.

Woonwa/sleepwa inhoud

Huishoudelike goedere wat aan jou behoort terwyl dit in die woonwa, sytent of sleepwa is.

Woonwa-/sleepwa-inhoud sluit nie permanente aanhegtings van die woonwa of sleepwa in nie.

Bron:Legacy Underwriting Managers.

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5   Prevent/minimise loss or damage

You must take reasonable steps to prevent loss or damage to your insured property after an event, or the insurer might not compensate you for any loss or damage.

For example, if you have a leak in your pipes that causes flooding in your home, you have a responsibility to call in a plumber to turn off the flow of water to prevent further flooding; you cannot just leave things as they are.

6  You cannot claim more than the sum insured:

To restore your original financial position, the compensation will be based on the value of the lost property, but never more than the sum insured.

Example

If your new car is stolen, the insurer may replace it with a similar model. The amount paid to you will never exceed the sum insured or the new list price, whichever is the lesser amount. New car is when you are the first registered owner.

If your three-year-old television set is stolen, they may buy you a new one or pay you the price of a new one but not more than the replacement cost. If your photo album or digital camera is stolen, the insurer may replace the album or camera, but not the sentimental value of the photos they contain.

7  What are household contents

These are your household goods, personal property and equipment, money and negotiable instruments, and may also include various fixtures and fittings if you ask for them to be covered.

Please note that the presence of your domestic worker on the property does not constitute occupation, even if they are living in any of the outbuildings or in their domestic quarters.

If an alarm is a requirement and your alarm is not operational and not activated, your claim will be rejected.

The insurer will compensate you based on the replacement cost of any damaged or lost contents.

Example

If you successfully claim for an item of furniture that costs R10 000 to replace, they will compensate you for R10 000 or they will replace or repair the item - even if the item in question is old and worth a lot less.

You are covered for loss or damage to the contents of your home that is caused by sudden impact.

Examples

A tree falling onto your home, or a wall collapsing onto a part of your building. However, the cover does not apply if the event is caused by for example, tree fellers or building contractors - in the course of work they are doing for you.

8  What is All risks

This covers a wide range of accidental loss or damage that typically occurs away from your home. It tends to involve items that you wear or carry, such as watches, handbags or accessories.

Unspecified property

Clothing and personal effects that are either worn or carried with you. These tend to be low value items such as pens, make-up and handbags.

Unspecified property may also include sport equipment

Specified property

Any item of property that is specifically listed in your schedule. These tend to be of high value and typically include jewellery, watches and laptops.

Example

Unspecified property

If you have lost a watch that costs R1 000 to replace, and your limit is R1 500, the insurer will compensate you for the full R1 000.This compensation will never exceed the amount in the LIMIT SECTION.

Specified property

If you have lost a ring that costs R20 000 to replace, and it is insured for R20 000, they will compensate you for the full R20 000. If the ring is specified for only R16 000, they will compensate you only for R16 000.

9  What is meant by building

The building is essentially the structure of your home - from the foundations and floors to the walls, ceilings and roof. It includes all solid infrastructure on the property, from gates to swimming pools, as well as the pipes, fixtures and fittings attached to them.

Example

If your claim is for a new wall that costs R10 000 to replace, you will be compensate for R10 000 so that you can have a new one built - even if the damaged wall is old and worth a lot less.

Example

Your building is insured for R200 000, but the cost to replace it is R400 000. This means you are under-insured by half (or 50%). Put another way, you are only ever insured for half of any claim you make. So if your building is damaged in a storm and it cost R50 000 to repair, you will be compensated for only half of R50 000- namely R25 000.

New house that is not yet registered

If you have signed a contract to purchase a new house and it hasn't yet been registered in your name, you are covered for the house, provided that you give the insurer all the details and accept their terms and conditions.

10  Subsidence and landslip

Subsidence means sinking – it is the vertical, downward movement of soil. It includes settlement, which is a lateral movement.

Landslip -  means the sliding down of a mass of land. It is, in effect, a small landslide, and it typically occurs on a slope.

11  What is your personal computer

This refers to your desktop or laptop, as well as associated accessories such as printers, screens and software. The cover here is not only for accidental damage, but also electronic breakdown, such as a hard-disk crash.

Accidental loss or damage

The insurer will cover you for accidental loss or damage anywhere in the world, from any cause that is not specifically excluded.

Example

You are covered if you drop your computer and break it, spill coffee on the keyboard or it is stolen at work or at home.

12  The increasing cost of negligence

In today's world, people are more and more aware of their "rights". They will often not hesitate to sue you for loss or damage which they believe is due to your negligence.

Example

Typical examples include your dog biting a passer-by, or a braai in your backyard starting a fire that burns your neighbour's house down.

Example

Your dog runs out into the street and bites a passer-by. He has to go to hospital, and incurs medical expenses of R95 000. The LIMIT SECTION states that you are covered for this kind of event up to a maximum of R5 million. So the compensation will be the full R95 000.

You always pay the first amount, or excess You will always have to pay the first part of any claim settlement. This is known as the excess, and is listed in the excess schedule.

Example

If you successfully claim R20 000 and the excess for that claim is R10 000, your net compensation from them will be R10 000.

13  What is pleasure-craft

This can be a motorboat or sailing boat, along with its specified equipment and accessories. It may also include jet-skis and tenders.

Example

Your pleasure-craft is insured with us for R200 000, but the cost to replace it is R400 000. This means you are under-insured by half (or 50%). Put another way, you are only ever insured for half of any claim you make. So if your pleasure-craft is damaged in a storm and it cost R50 000 to repair, the insurer can pay out only half of R50 000 - or R25 000.

You must have a skipper's licence, and be 16 or older In the event of a claim, you must be able to show us that you had a valid skipper's licence at the time, and are 16 years of age or older. This also applies to any person who may have been piloting your pleasure-craft at the time with your permission. If the pleasure-craft is conveyed on land, the driver must have a valid driver's licence.

14  What are legal costs and identity theft

These are costs that you may incur if ever you have to defend yourself against legal action, or if you are forced to take legal action against someone else.

Identity theft refers to the illegal use of your identity.

For what are you cover 

Civil action

Any civil action by you or against you.

Criminal charge

Defence of any criminal charge against you, excluding a fine or bail that is levied against you.

Labour relations

Any legal action by you or against you, in a labour court.

Family matters

Any legal action relating to family matters such as divorce, custody or maintenance.

15  Difference between civil action and criminal action

A civil action -  is when one person institutes legal proceedings against another person to protect their rights, or because they believe a wrong has been done to them. A successful outcome results in damages being awarded in favour of the winning party.

A criminal action -  is when legal proceedings are brought by the state against a person because they are believed to have committed a crime. If found guilty, the person is punished by a prison term, a fine, or both.

16  What is a caravan and trailer

It is an unpowered vehicle designed to be towed by a motor vehicle. It includes all parts, permanent accessories and side tents.

Caravan/trailer contents

Household goods which belong to you while in the caravan, attached tent or trailer.

Caravan/trailer contents do not include permanent fittings of the caravan or trailer.

Source:Legacy Underwriting Managers

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