Terms And Conditions
1. Introduction
1.1 These Terms of Service (“Terms”) govern your access to and use of services provided by Accisure (Pty) Ltd (“Accisure”, “we”, “us”, “our”).
1.2 These Terms apply to all users, members and customers who access or use Accisure services, including through our website, WhatsApp Business Platform, telephone, SMS, email or other electronic communication channels.
1.3 By accessing our website, communicating with us electronically or using any Accisure service, you agree to be bound by these Terms.
1.4 If you do not agree to these Terms, you must refrain from using Accisure services.
2. Important Consumer Protection Disclosures
2.1 If you are a consumer as defined in the Consumer Protection Act 68 of 2008 (“Consumer Protection Act”), Accisure is required to draw your attention to certain important terms.
2.2 Limitations of Risk, Legal Responsibilities and Liability
2.2.1 Clauses under the AcciDrive, AcciMed and AcciMed+ Terms and Conditions, including clause 1.7, are important as they limit or exclude obligations, liabilities and legal responsibilities that Accisure may otherwise have to you.
2.2.2 As a result, your rights and remedies against Accisure and other related persons or entities may be limited or excluded.
2.2.3 These clauses may also limit or exclude your right to recover or make claims for losses, damages, liability or harm suffered by you or others.
2.3 Assumption of Risk, Legal Responsibilities and Liability
2.3.1 Clause 9 of the General Terms and Conditions is important as you assume certain risks, legal responsibilities and liabilities.
2.3.2 You may therefore be responsible for claims and other amounts arising from these risks.
2.3.3 You accept responsibility for risks, damages, harm and injuries which may be suffered by you or others as described in these clauses.
3. Membership
3.1 Accisure services are provided on a membership basis.
3.2 Any person aged 18 years or older may apply for membership.
3.3 Services become available once required consent and personal information have been received.
3.4 Consent and Information Sharing
3.4.1 By providing consent, the member authorises Accisure to access and share:
3.4.1.1 Official documentation relating to an accident, including the Official Accident Report (OAR) from the South African Police Service (SAPS) and ambulance reports;
3.4.1.2 Any additional personal information reasonably required to render the Services.
3.5 Upon successful onboarding, Accisure will issue a digital membership card via electronic or digital communication channels to the contact number provided.
3.6 A member qualifies for the Services only once all prescribed data has been received and onboarding has been successfully completed.
4. Changes to These Terms and Conditions
4.1 Accisure may amend these Terms and Conditions at any time.
4.2 Changes will be communicated via email, SMS or other contact details provided to Accisure.
5. Consumer Protection Act Compliance
5.1 Nothing in these Terms:
5.1.1 Limits or exempts Accisure from liability where such limitation is not permitted by law, including liability for gross negligence;
5.1.2 Requires you to assume risk or liability where the law does not permit this; or
5.1.3 Limits or excludes warranties or obligations implied by applicable law where such limitation is not permitted.
5.2 These Terms and any services provided under them are governed by the Consumer Protection Act.
5.3 All provisions must be interpreted to ensure compliance with the Consumer Protection Act.
6. WhatsApp and Electronic Communications
6.1 By communicating with Accisure via WhatsApp or any other electronic communication channel, you:
6.1.1 Consent to receiving service-related communications electronically;
6.1.2 Acknowledge that messages, voice notes, images and documents may be stored and processed for service delivery, legal, regulatory and audit purposes;
6.1.3 Understand that WhatsApp communications are processed via Meta Platforms Inc. systems and are subject to Meta’s terms and privacy practices.
6.2 Accisure will not send marketing or promotional communications via WhatsApp without your explicit opt-in consent.
6.3 You may opt out at any time by replying “STOP” or contacting Accisure directly.
7. Privacy and Data Protection
7.1 Accisure processes personal information in accordance with the Protection of Personal Information Act, 2013 (POPIA).
7.2 Personal information is collected and used solely for:
7.2.1 Providing Accisure services;
7.2.2 Communicating with you;
7.2.3 Complying with legal obligations;
7.2.4 Improving service delivery.
8. User Data Deletion
8.1 You may request deletion of your personal data at any time.
8.2 Requests may be submitted by:
8.2.1 Emailing info@accisure.co.za; or
8.2.2 Sending a WhatsApp message stating: “REQUEST DATA DELETION”.
8.3 Accisure may require reasonable proof of identity before processing a request.
8.4 Requests are processed within 30 days.
8.5 Certain information may be retained where required by law, including medical, claims, financial or regulatory records.
8.6 Full details are available in the Privacy Policy at: https://www.accisure.co.za/privacy-policy
9. Exclusion of Liability
9.1 Neither Accisure nor its directors, employees, representatives, agents or shareholders shall be liable for any loss, liability, damage, expense or penalty suffered directly or indirectly, except where directly attributable to fraud, dishonesty or gross negligence.
9.2 To the maximum extent permitted by law, Accisure’s total liability shall be limited to the value of membership fees received.
10. Force Majeure
10.1 Accisure shall not be liable for failure or delay in performing the Services due to a Force Majeure Event.
10.2 A Force Majeure Event includes circumstances beyond Accisure’s reasonable control, including but not limited to:
10.2.1 War, civil unrest, acts of state, sanctions or border closures;
10.2.2 Natural disasters including floods, fires, droughts or earthquakes;
10.2.3 Industrial action or interruption of electricity supply.
11. Miscellaneous
11.1 These Terms constitute the entire agreement between you and Accisure in respect of the Services.
11.2 You may not transfer or assign any rights or obligations under these Terms.
11.3 Accisure may transfer, cede, delegate or subcontract its rights or obligations without your consent, subject to notification where required.
11.4 These Terms are governed by the laws of the Republic of South Africa.
11.5 Failure by Accisure to enforce any provision shall not constitute a waiver.
11.6 If any provision is found unenforceable or invalid, the remaining provisions shall remain valid and enforceable.
12. Interpretation and Definitions
12.1 Headings are for convenience only and do not affect interpretation.
12.2 Unless the context indicates otherwise:
12.2.1 The singular includes the plural and vice versa;
12.2.2 Gender-neutral terms include all genders;
12.2.3 Defined or capitalised terms have the same meaning wherever used;
12.2.4 “Including” means “including but not limited to”.
12.3 Where a number of days is specified, the first day is excluded and the last day included.
13. Whole Agreement
13.1 These Terms contain all terms agreed between the member and Accisure in respect of the Services.
13.2 The member waives the right to rely on any terms not expressly contained in these Terms.
1.1. Accisure provides to its members, administrative support, information storage and facility services ("Services") subject to the terms and conditions stipulated in these Terms and Conditions ("T&C").
1.2. In providing the Services, Accisure shall use the Member's information with consent to obtain legal documents confirming the incident where a member was injured, place the Member in contact with an appropriate medical treatment facility ("Medical Facility") in the event that the Member was involved in an accident as a passenger in a motor-vehicle and qualify for medical treatment as described in the RAF Act. 56 of 1996.
1.3. Accisure will facilitate the admission to the Medical Facility by providing the necessary information to the Medical Facility in order to expedite the transfer to the Medical Facility and the admission of the Member to the Medical Facility.
1.4. Admission of any member is subjected to the member agreeing with the terms and conditions of the various service providers.
2. Use of Services
2.1. The member will be able to use the Services if they were injured.
2.2. as passenger in a motor-vehicle accident qualifying for 100% compensation as described by the RAF on the RAF Act. 56 of 1996 and require medical treatment.
2.3. The member or a person on their behalf, will phone 0861 ACCISURE (0861 222 47873) to inform Accisure of the incident and injuries sustained.
2.4. The member or the person activating the Services on your behalf, will be requested to provide the following information:
2.4.1. membership number as displayed on the Membership Card or identification number.
2.4.2. details regarding the accident, location, time, registration numbers of vehicles involved, and names and ID numbers of injured persons as legally required to be captured on the Official Accident Report (OAR) by the South African Police services (SAPS).
2.5. Accisure will provide through its call centre agents and area representative all reasonable assistance to collect the completed OAR and assure accuracy.
2.6. This information will be used by Accisure to verify the member was involved in a legal road accident that will entitle the member to receive private medical care that will be paid for by the Road Accident Fund.
2.7. You or a person on your behalf will give information on the nature of your injuries sustained to the Accisure consultant who determine the nature of the medical treatment the member might need.
2.8. Accisure will then:
2.8.1. identify the nearest suitable Medical Facility to the member that will be able to provide further ongoing medical support to the member.
2.8.2. Accisure will contact the Medical Facility and provide them with the information stored by Accisure as well as any other relevant information provided in the OAR, ambulance report or medical report required to admit the member under the RAF Act.
2.8.3. once confirmed that the Medical Facility will accept the member, the transfer to the Medical Facility will be facilitated by Accisure by providing your information, location as well as the member’s relevant medical records to the Medical Facility.
2.8.4. if the Medical Facility is unable to accept the member all reasonable steps will be taken to identify the next available Medical Facility.
2.8.5. Once the member is accepted at the Medical Facility all medical treatment required by the member will be determined by the different service providers until full recovery.
2.8.6. All medical expenses will be claimed by the individual service providers from the RAF.
3. Exclusions of Services
3.1. If the member was involved in criminal activity at the time of the accident.
3.2. Undocumented foreigners that are illegally in the country at the time of the accident, expired work permit, expired visa, or any other reason.
3.3. If member was the driver at the time of the accident.
3.4. if member as a passenger was the cause of the accident as indicated on the OAR.
3.5. If the accident occurred outside the borders of South Africa (RSA).
4. Services not provided by Accisure
4.1. Accisure will under no circumstances whatsoever cover any of the costs associated with the member being admitted to or treated at or conveyed to the identified Medical Facility.
4.2. The Services of Accisure are limited to verifying the incident with the relevant documentation supplied and to facilitate transfer and admission to the Medical Facility. Accisure is not liable for any errors that arise due to inaccurate or incomplete documentation or reports that are provided by the member or a person acting on your behalf including the SAPS.
4.3. Admission to and further care at the Medical Facility will be provided to the member in terms of a separate agreement that will be entered into between the member and the relevant Medical Facility.
4.4. Accisure is neither associated nor affiliated to any such Medical Facilities and is in no way responsible to the member in respect of any services provided or not provided at the identified Medical Facility.
4.5. Accisure is not liable in any matter whatsoever to settle the member’s accounts with the Medical Facility so identified. Exclusion of Liability under General Terms and Conditions Clause 6.
1.1. Accisure provides to its members, claims administration, and claims management support services to assist with the member’s claim against the RAF if the member was injured, survived by a legal dependent, or the deceased member’s close relative responsible for the funeral expenses as a result of a motor vehicle accident.
1.2. Accisure refers the member to a legal practitioner who will assess the merits of the member’s claim against the RAF.
1.3. If merits to claim from the RAF is determined, the legal practitioner will provide claims and administration assistance for the duration of the RAF claims process at no cost to the member.
2. Use of Services
2.1. The member/close relative or legal dependent will be able to use the services if:
2.1.1. member was injured in a motor vehicle accident.
2.1.2. If the member was survived by a legal dependent.
2.1.3. when close relative is responsible for funeral expenses.
2.2. The member or a person on their behalf/close relative/legal dependent, will phone 0861 ACCISURE (0861 222 47873) to log the potential claim.
2.3. The member/close relative or legal dependent will be requested to provide the following information:
2.3.1. membership number as displayed on the Membership Card or identification number.
2.3.2. details regarding the accident, location, time, registration numbers of vehicles involved, and names and ID numbers of injured persons as legally required to be captured on the Official Accident Report (OAR) by the South African Police services (SAPS).
2.4. member’s claim will be logged and allocated to a legal practitioner who will arrange an assessment/consultation to assess the claims validity and merit.
2.5. If the member’s claim is invalid or no merit is determined the member will be informed of the outcome by means of telephonic consultation and or email.
2.6. If the member’s claim is valid and the member wishes to continue with the administration and claims process the legal practitioner will provide claims administration and claims management assistance to submit the claim against the RAF.
3. Exclusions of Services
3.1. If member as driver was the sole cause of the accident.
3.2. If the member was involved in criminal activity at the time of the accident.
3.3. if member as a foreigner is illegally in the country at the time of the accident, expired work permit, expired visa, or any other reason.
3.4. if member as a passenger was the cause of the accident as indicated on the OAR.
3.5. If the accident occurred outside the borders of South Africa (RSA).
4. Services Limitations
4.1. Accisure will limit the services if the legal practitioner determines the case does not warrant a claim against the RAF.
4.2. Accisure is not liable for any costs incurred by the member if external advice or services were used.
4.3. Should the member use an external legal practitioner to manage the RAF claim, Accisure will not pay for any services rendered by the external legal practitioner.
4.4. Accisure does not guarantee settlement from the RAF.
4.5. The member must comply with all the all the legal and regulatory requirements matter as prescribed by the RAF Act to qualify for the service.
1.1. Accisure provides, through a third-party service provider, Employers administrative services related to the Compensation for Occupational and Disease Act 130 of 1993 (COIDA).
1.2. The Employer will be required to authorise the third-party service provider to access the Employer’s Compensation Fund profile. Refer to 4.8 for details required to authorise access to profile.
1.3. Employer assistance with the following services:
1.3.1. Registration of Employers with the Compensation Fund.
1.3.2. Reviewing of the allocation of the Business Category to ensure appropriateness in terms of risk and classification, if required, submission of application for reclassification of the business.
1.3.3. Accisure and its the third-party service provider will assess nature of business and initiate the process to transfer the Employer to RMA or FEM where applicable i.e., should they be found to be falling under Mining, Iron, Steel, Metals, Building and Construction industries.
1.3.4. Reviewing the annual assessment to ensure accuracy and appropriateness of the assessment.
1.3.5. Submission of Return of Earnings and obtaining the Letter of Good Standing.
1.3.6. Submission of Name Change requests in cases where the business has rebranded and/or renamed.
1.4. Claims management services include:
1.4.1. An end-to-end claims management service for injury on duty and occupational diseases claims, on behalf of the Employer and Employees who are registered with Workman’s Compensation Fund, RMA, FEM, which include:
1.4.1.1. Reporting injured Employee claims to the Compensation Fund, RMA, or FEM.
1.4.1.2. Arranging for Injured Employees to receive medical treatment through our 24-Hour emergency line.
1.4.1.3. Ensure that injured Employees receive appropriate medical treatment at suitable facilities.
1.4.1.4. Ensuring that all required documents from the Employer and Medical Service Providers are completed and submitted in the required format.
1.4.1.5. Ensuring that Employees and Employers receive their Temporary Total Disablement payments (Income replacement) from the Compensation Fund, RMA or FEM.
1.4.1.6. Ensuring that Employees and Employers receive all the benefits to which they are entitled in terms of the COID Act.
1.4.1.7. Ensuring that injured Employees, or their dependents receive their correct compensation for permanent disablement i.e., Lump Sum or Monthly Pension.
1.4.1.8. Tracing, completion, and submission of documents for the spouse/s and children, to ensure that they receive the death benefits as dictated by the COID Act.
1.4.1.9. Ensuring that Employees are properly rehabilitated, reskilled, and socially integrated following the Occupational Injury or Disease.
1.5. Case management services:
1.5.1. Accisure provides case management to assist with assessing and adjudication treatment requested for all injuries and diseases in medical facilities which include:
1.5.1.1. Liaising with hospital case managers for updates of treatment, procedures, and costs management.
1.5.1.2. Monitoring high risk high-cost acute claims, reviewing treatment plans, assessments, and medical reports.
1.5.1.3. Adjudicating requests for medical treatment and facilitate pre-authorisation through relevant Administrator.
1.5.1.4. MMI (Maximum medical improvement), support to claims staff; facilitating interdisciplinary approaches; arranging for rehabilitation and re-skilling.
1.5.1.5. Reviewing and confirm ICD10 codes from medical reports and update.
1.5.1.6. Liaise with MSP’s, Employers and Employees when required.
1.6. Web-based employer portal access:
1.6.1. The Employer will have access to a web-based system to:
1.6.1.1. Register Employer contact first time user.
1.6.1.2. Register company details.
1.6.1.3. Submit Return of Earnings.
1.6.1.4. Upload all required documents as prescribed by the COID Act.
1.6.1.5. Employee registrations.
1.6.1.6. Log an injury on duty claim – access to a digital form.
1.6.1.7. Upload of first medical report.
2. Roles and Responsibilities of the Employer as per the COID Act
2.1. Section 80 – Registration of the Employer.
2.1.1. An Employer carrying on business in RSA will register with the Compensation Fund, in the prescribed manner, supply particulars and documentation as required.
2.2. Section 81 – Records of Earnings and Employee Details.
2.2.1. An Employer will keep records of the earnings and details of all Employees.
2.3. Section 82 – Annual Return of Earnings.
2.3.1. An Employer shall by 31 March of each year, submit the annual return of earnings to the Commissioner, in the prescribed manner.
2.4. Section 39 – Reporting of an Occupational Injury.
2.4.1. An Employer will within 7 days of receiving notice of an accident, report the accident, in the prescribed manner.
2.5. Section 68 – Reporting of an Occupational Disease.
2.5.1. An Employer will within 14 days of receiving notice of an occupational disease, report the occupational disease, in the prescribed manner.
2.6. Section 47 – Temporary Total or Partial Disablement
2.6.1. If the Employee is booked off on medical treatment, it is the responsibility of the Employer to compensate the Employee for the days off.
2.6.2. The compensation referred to as Temporary Total (cannot perform light duty) of Temporary Partial (Light Duty) Disability.
2.6.3. The Employer will pay the Employee at 75% of earnings, tax free, to the maximum amount dictated by the COID Act, for the first 90 days.
2.6.4. On expiry of the 90 days, the monies paid to the Employee will be refunded by the Workman’s Compensation Fund to the Employer.
2.6.5. Should the Employee be off work in excess of 90 days, regular periodical payments, not exceed a period of 2 month, are to be made to the Employee until such time as the Employee reaches medical improvement.
2.6.6. These payments will also be claimed from the Workman’s Compensation Fund as a refund to the Employer.
2.6.7. These periodical payments can take place as long as the Temporary Total Disablement continues, but not for a period exceeding 24 months.
2.6.8. The Temporary Total or Partial Disablement is calculated on the earnings of the Employee over a period of 6 months, prior to the date of the accident or diagnosis of the occupation injury.
3. Use of Services
3.1. First time registration of Employer (Required Documents):
3.1.1. CIPC Certificate
3.1.2. SARS Certificate
3.1.3. Proof of Physical Address – not older than 90 days
3.1.4. Proof of Banking Details – not older than 90 days
3.1.5. Certified copy of Director’s ID/s – not older than 90 days
3.1.6. Was2 – Registration of Employer
3.1.7. Nomination Form - Template will be provided when Employer is onboarded for the AcciWork Service.
3.1.8. Power of Attorney on Company Letterhead – Template will be provided when Employer is onboarded for the AcciWork Service.
3.2. Compensation Fund Employer Profile access authorisation requirements:
3.2.1. CIPC Certificate
3.2.2. SARS Certificate
3.2.3. Proof of Physical Address – not older than 90 days
3.2.4. Proof of Banking Details – not older than 90 days
3.2.5. Certified copy of Director’s ID/s – not older than 90 days
3.2.6. Nomination Form - Template will be provided when Employer is onboarded for the AcciWork Service.
3.2.7. Power of Attorney on Company Letterhead – Template will be provided when Employer is onboarded for the AcciWork Service.
3.3. Return of Earnings Annually
3.3.1. All industry types have been categorised by the Compensation Fund.
3.3.2. The Employer will be required to complete the Return of Earnings on an annual basis and is assessed in terms of:
3.3.2.1. Industry Type
3.3.2.2. Number of Employees
3.3.2.3. Salaries and wages paid to the maximum limit set by the Workman’s Compensation Fund
3.3.2.4. Claims history
3.3.3. The Employer will be required to provide the earnings calculation based on the prescribed calculation required by the COID Act.
3.3.4. Earnings are calculated as an average across a period of not more than 12 months.
3.3.5. The earnings are used to calculate the following when a claim is registered with the Compensation Fund:
3.3.5.1. Temporary Total Disablement
3.3.5.2. Temporary Partial Disablement
3.3.5.3. Permanent Disablement – Lump sum
3.3.5.4. Permanent Disablement – Monthly pension
3.3.5.5. Fatal Benefits
3.4. Letter of Good Standing
3.4.1. Employer will receive a Letter of Good Standing only when annual assessments and payments are up to date.
3.4.2. The Letter of Good Standing is valid for a period of 12 months.
3.5. Reporting of claims
3.5.1. Login to the IntelliComp portal or phone 0861 ACCISURE (0861 222 47873) who will assist with the completion of the required forms.
3.5.2. Information required to log the claim:
3.5.2.1. Employer details
3.5.2.2. Employee Details including copy of ID or Passport (Non-SA Citizen) and payslip.
3.5.2.3. Accident Details
3.5.2.4. Earnings of Employee at the time of the accident (1 Month)
3.5.2.5. First Medical Report
3.5.2.6. Witnesses at the time of the accident if any
3.5.3. A claim number will be generated and provided by the Workman’s Compensation Fund on successful completion and registration of the claim.
4. Exclusions of Services
4.1. Accisure and the Third-Party service provider is not responsible for payments of the annual assessment fees and is payable by the Employer based on the return of earnings submission statement issued by the Compensation Fund.
4.2. Accisure and the Third-Party service provider is not responsible for any Medical Services accounts, prescribed Compensation Fund Benefit payments and will not be held responsible for payments. All benefits and payments are payable by the Compensation Fund.
4.3. If an occupational injury on duty or occupational disease is not reported within the prescribed period of 12 months, (Section 44 of COID Act), of the date of the event or the date of diagnosis the benefits will lapse.
4.4. Employer organised sporting events unless it was organised as a team building event.
4.5. Injuries sustained during a lunch break are not covered by the Workman’s Compensation Fund, unless the event which resulted in the injury, was within the course and scope of the Employee’s duties.
4.6. Employee injury outside working hours is not considered as an injury on duty.
4.7. If an Employee is injured in an accident on their commute to and from work, it is not considered as an injury on duty unless:
4.7.1. The vehicle used is provided by the Employer.
4.7.2. The vehicle was driven by the Employer.
4.7.3. The vehicle is only used to convey Employees to and from the workplace.
4.7.4. The cost of travel is free of the charge to the Employee.
5. Services Limitations
5.1. Should the Employer not authorise Accisure and/or the Third-Party service provider to gain access to the Employer’s Compensation Fund profile the services cannot be rendered.
5.2. Should the Employer fail to provide all required documentation as prescribed by the COID Act is not provided or uploaded to IntelliComp the service cannot be rendered.
5.3. Injuries sustained at an Employer organised social event will be considered taking all information into account and cannot guarantee if the injury will be accepted by the Compensation Fund.
5.4. Accisure is not liable for any costs incurred by the member if external advice or services were used.
1. Accisure Proprietary Limited
1.1. Accisure Proprietary Limited, registration number 2019/442795/07 ("Accisure")
2. AcciMed+
2.1. Accisure provides to its members, administrative support, information storage and facility services ("Services") subject to the terms and conditions stipulated in these Terms and Conditions ("T&C").
2.2. In providing the Services, Accisure shall use the Member's information with consent to obtain legal documents confirming the incident where a member was injured, place the Member in contact with an appropriate medical treatment facility ("Medical Facility") in the event that the Member was involved in an accident in a motor-vehicle and qualify for medical treatment as described in the RAF Act. 56 of 1996.
2.3. Accisure will facilitate the admission to the Medical Facility by providing the necessary information to the Medical Facility in order to expedite the transfer to the Medical Facility and the admission of the Member to the Medical Facility.
2.4. Admission of any member is subjected to the member agreeing with the terms and conditions of the various service providers.
3. Use of Services
3.1. The member will be able to use the Services if they were injured.
3.2. as driver and / or passenger in a motor-vehicle accident qualifying for 100% compensation as described by the RAF on the RAF Act. 56 of 1996 and require medical treatment.
3.3. The member or a person on their behalf, will phone 0861 ACCISURE (0861 222 47873) to inform Accisure of the incident and injuries sustained.
3.4. The member or the person activating the Services on your behalf, will be requested to provide the following information:
3.4.1. membership number as displayed on the Membership Card or identification number.
3.4.2. details regarding the accident, location, time, registration numbers of vehicles involved, and names and ID numbers of injured persons as legally required to be captured on the Official Accident Report (OAR) by the South African Police services (SAPS).
3.5. Accisure will provide through its call centre agents and area representative all reasonable assistance to collect the completed OAR and assure accuracy.
3.6. This information will be used by Accisure to verify the member was involved in a legal road accident that will entitle the member to receive private medical care that will be paid for by the Road Accident Fund.
3.7. In case of a member being a driver of a vehicle, involved in a motor vehicle accident and requires medical treatment where the RAF is liable for such costs. The member will be transferred to the nearest government facility. Once Accisure is notified the administration team and area representative will collect all the supporting documents relating to the accident to determine the merits and possibility of apportionment as described in the RAF Act.
3.8. Only if a 100% liability of the RAF is determined by the merit department will the patient be transferred and admitted to a private network hospital for treatment.
3.9. Accisure has no responsibility to provide assistance or accesses to medical facility to a driver if any apportionment/liability of the driver is suspected/expected or possibly foreseen.
3.10. You or a person on your behalf will give information on the nature of your injuries sustained to the Accisure consultant who determine the nature of the medical treatment the member might need.
3.11. Accisure will then:
3.11.1. identify the nearest suitable Medical Facility to the member that will be able to provide further ongoing medical support to the member.
3.11.2. Accisure will contact the Medical Facility and provide them with the information stored by Accisure as well as any other relevant information provided in the OAR, ambulance report or medical report required to admit the member under the RAF Act.
3.11.3. once confirmed that the Medical Facility will accept the member, the transfer to the Medical Facility will be facilitated by Accisure by providing your information, location as well as the member’s relevant medical records to the Medical Facility.
3.11.4. if the Medical Facility is unable to accept the member all reasonable steps will be taken to identify the next available Medical Facility.
3.11.5. Once the member is accepted at the Medical Facility all medical treatment required by the member will be determined by the different service providers until full recovery.
3.11.6. All medical expenses will be claimed by the individual service providers from the RAF.
4. Exclusions of Services
4.1. If the member was involved in criminal activity at the time of the accident.
4.2. if member as a foreigner is illegally in the country at the time of the accident, expired work permit, expired visa, or any other reason.
4.3. If member as driver is the sole cause of the accident.
4.4. If member as driver has any apportionment/liability suspected/expected or possibly foreseen.
4.5. if member as a passenger was the cause of the accident as indicated on the OAR.
4.6. If the accident occurred outside the borders of South Africa (RSA).
5. Services not provided by Accisure
5.1. Accisure will under no circumstances whatsoever cover any of the costs associated with the member being admitted to or treated at or conveyed to the identified Medical Facility.
5.2. The Services of Accisure are limited to verifying the incident with the relevant documentation supplied and to facilitate transfer and admission to the Medical Facility. Accisure is not liable for any errors that arise due to inaccurate or incomplete documentation or reports that are provided by the member or a person acting on your behalf including the SAPS.
5.3. Admission to and further care at the Medical Facility will be provided to the member in terms of a separate agreement that will be entered into between the member and the relevant Medical Facility.
5.4. Accisure is neither associated nor affiliated to any such Medical Facilities and is in no way responsible to the member in respect of any services provided or not provided at the identified Medical Facility.
5.5. Accisure is not liable in any matter whatsoever to settle the member’s accounts with the Medical Facility so identified. Exclusion of Liability under General Terms and Conditions Clause.
