How to file a claim?

Your how-to when filing a claim for medical expenses related to a diving injury or a travel-related medical emergency covered under DAN-SA membership benefits. 
DAN-SA is a public benefit organisation that provides emergency medical advice and assistance for underwater diving injuries, and a wide range of research, education and training programmes that promote safe diving.  DAN-SA is the insured party of a group policy that offers coverage for diving injuries and a limited set of travel-related medical emergencies. DAN-SA members receive the coverage benefits by virtue of this policy. By proxy, DAN-SA is the beneficiary under the policy.

The DAN-SA Group Policy was established primarily to assure essential coverage for the emergency medical assessment, aeromedical evacuation (when medically justified), hospital admission, specialist examination, and recompression chamber treatment for decompression illness (DCI). The group policy also includes other travel medical benefits consistent with the typical needs and activities of divers.

Consequently, group policy terms and conditions were developed carefully and thoughtfully in conjunction with insurance experts to ensure that DAN-SA members have appropriate coverage for managing and treating injuries and accidents associated with diving-related travel and activities for which they need emergency medical services and transportation as recommended, authorised and/or mobilised by the DAN-SA Hotline. The terms and conditions have been adapted over the years to offer the best value for coverage relevant to recreational divers.

With all this in mind, it is very important that DAN-SA members understand how the group policy works. They need to realise what DAN-SA can and cannot authorise on their behalf, by virtue of the DAN-SA Group Policy, when they require or request emergency medical services based on the benefits of the group policy.
Key Concepts 

We would like to highlight the following key concepts relating to membership claims and medical expenses:
  • DAN-SA is not a medical aid and membership is not an alternative to a medical aid.
  • DAN-SA does not sell insurance and membership is not insurance.
  • DAN-SA is not an insurer; it is the insured party. DAN-SA extends the benefits of its own DAN Group Policy cover to its members.
  • Unless DAN-SA submits a claim to the insurers, there is no coverage.
  • DAN-SA members are responsible for ensuring that their membership is valid.
  • DAN-SA membership cannot be renewed retrospectively to cover a claim during the period in which a membership had lapsed.
  • It is essential for members to alert DAN-SA immediately in the case of a diving emergency or injury.
  • The DAN-SA Hotline supports five core functions:
    • Notification of an overseas or remote trip (via the website) in case of an emergency or (under exceptional, life-threatening circumstances) for delayed notification of an incident for which a claim will be forthcoming
    • Validation of current active DAN-SA membership to qualify for DAN-SA Group Policy benefits
    • Authorisation of emergency medical and evacuation services
    • Mobilisation of appropriate emergency medical services, recompression facilities, and evacuation modalities as required
  • Guarantee of payment (GOP) to service providers
  • Notify DAN-SA of any remote or overseas travel (using the online registration forms) as this saves time when contacting the DAN-SA Hotline in case of a subsequent emergency.
  • Involving the DAN-SA Hotline is essential to ensure that members receive the appropriate emergency medical services and treatment, and to ensure coverage for the services and treatment. Many medical facilities are unfamiliar with diving-related injuries, particularly DCI. Calling the DAN-SA Hotline is critical to ensure that diving specific aspects are considered in the care of injured divers.
  • It is in the best interests of DAN-SA members to allow DAN-SA to request emergency medical services and treatment directly, on their behalf, and for DAN-SA to offer any necessary GOPs upfront.
  • Unless this is justified by life-threatening situations, services arranged by (or on behalf of) a DAN-SA member without the direct involvement of the DAN-SA Hotline are not covered and may be rejected by the insurers. In the past, the DAN-SA Hotline has been required to indicate the usual and customary actions and costs of services it would have recommended if it had been involved. Although this has been avoided in the past, the member may become liable for any unusual or excessive costs. Claiming back is also more cumbersome and is subject to a longer administrative process.
  • DAN-SA cover is secondary cover. This means that the benefits under the DAN-SA Group Policy should be considered as a “gap” cover. In the case of an individual having no medical aid benefits for the emergency medical treatments needed, no alternative travel insurance or any other primary form of insurance, DAN-SA will authorise and claim for any usual and customary expenses incurred in providing emergency medical care, within the terms and conditions of the group policy. This is the only way in which membership (including these coverage benefits) can remain affordable.
  • Whenever DAN-SA members are asked to submit supporting documentation to facilitate the submission of a claim, it should be understood as being a collaborative process. In other words, members are assisting us in submitting a claim on its own (DAN-SA’s) behalf so that the benefits of the claim can then be made available to the member. Should members be on a medical aid or have travel insurance, all accounts will first be processed by their medical aid or travel insurance.
Step-By-Step Process

Step 1: Call DAN-SA

The DAN-SA Hotline will make all the necessary arrangements for your treatment and issue GOPs to the service providers, hospitals or healthcare professionals.
From inside South Africa, call us toll free on 0800 020 111. From outside of South Africa, call us on + 27 828 10 60 10. Remember to save these number on your cell phone, especially before travelling abroad.

Step 2: Fill in the claim form

In all situations where coverage is offered under the DAN-SA Group Policy, DAN-SA is required to submit a claim to the insurers on behalf of the member, even in situations where the DAN-SA Hotline authorised these services and provided a GOP directly to the service providers.
In unusual situations where a DAN-SA member needs to claim for expenses incurred for emergency medical services arranged without the direct involvement of the DAN-SA Hotline, the DAN-SA Hotline needs to be notified first to register the event. Call DAN-SA on 0860 242 242, or if calling from outside of South Africa, call us on +27 11 266 4903.
Members can contact a DAN-SA medic either on 011 266 4903 or danmedic@dansa.org for a claim form.

Step 3: Send the completed claim form to DAN-SA

Submit the completed claim form to DAN-SA, together with any relevant supporting documentation (invoices, receipts, medical reports). Ideally, these should be scanned and emailed to danmedic@dansa.org Alternatively, the completed forms and documentation can be:
Mailed to:
DAN Southern Africa Claims
Private Bag X197
Halfway House
Midrand
1685
 
Couriered to:
DAN Southern Africa Claims
Rosen Office Park, DAN-SA Building
C/O Invicta and Matuka Close Halfway Gardens
Midrand 1684

Faxed to:
0861 326 329 (from within South Africa)
+27 11 312 0054 (from outside of South Africa) +27 86 512 9091 (fax to email)
Step 4: Await settlement and final reconciliation documents from DAN-SA

DAN-SA will arrange settlement of all services and expenses for covered services, reconcile any short payments with service providers, and arrange for any reimbursements to be paid out to you. We will also send you a final reconciliation so that they can see what the total pay-out was.
Important reminders

Remember these important key concepts:
  • Please ensure that your DAN-SA membership is up to date.
  • The DAN-SA Hotline must be notified for a claim to be eligible for processing.
  • A claim form must be submitted to allow DAN-SA to claim for services rendered under the DAN-SA Group Policy cover.
  • DAN-SA will (by law) first attempt to arrange settlement via any relevant medical aid or any other travel insurance that you may have.
  • If you receive any invoices/statements directly from service providers, kindly forward these to DAN-SA.
  • Notify DAN-SA if you are travelling to remote areas, overseas or if you will be outside your country of residence for a continuous period of more than 90 days.

No Comments


Categories

 2020
 2019
 2018
 2016
immersion and bubble formation Accidents Acid reflux Acute ailments After anaesthesia Air Quality Air exchange centre Air hose failure Airway control Alert Diver Magazine Alternative gas mix Altitude changes Altitude sickness Aluminium Oxide Ama divers Amino acids Anaerobic Metabolism Annual renewal Apnea Apnoea Archaeology Arterial gas embolism Arthroscopic surgery Aspirin Aurel hygiene BCD BHP BLS Back adjustment Back pain Back treatment Backextensors Badages Bag valve mask Bahamas Balancing Bandaids Barbell back squat Barometric pressure Barotrauma Basic Life Support Batteries Bench press Benign prostate hyperplasia Black Blood flow Blurred vision Boat safety Bone fractures Bouyancy compensators Boyle's Law Boyle\'s Law Bradycardia Brain Breast Cancer Breath Hold Diving Breath hold Breath-hold Breathing Gas Breathing Breathold diving Broken bones Bruising Bubbleformation Buddy Exercise Buoyancy Burnshield CGASA CMAS CO2 COVID-19 COVID CPR Cabin pressure Caissons diseas Camera settings Cancer Remission Cancer treatments Cancer Cannabis and diving Cannabis Cape Town Dive Festival Cape Town Carbon dioxide Cardio health Cardiological Cardiomyopathy Chamber Safety Chamber science Charging batteries Charles' Law Charles\' Law Charles\\\' Law Charles\\\\\\\' Law Charles\\\\\\\\\\\\\\\' Law Chemotherapy Chest compressions Chiropractic Citizen Conservation Cleaning products Coastalexcursion Cold Water Cold care ColdWater Cold Commercial diving Commercial schools Compressed gas Consercation Conservation Contaminants Contaminated air Coral Conservation Coral Reefs Corals Core strength Corona virus Courtactions Crohns disease Crowns Crystal build up Crystallizing hoses Cutaneous decompression DAN Courses DAN Profile DAN Researchers DAN medics DAN members DAN report DCI DCS Decompressions sickness DCS theories DCS DEMP DM training DNA DReams Dalton's Law Dalton\'s Law Dalton\\\'s Law Dalton\\\\\\\'s Law Dalton\\\\\\\\\\\\\\\'s Law Dauin island Deco dives Decompression Illness Decompression Sickness Decompression Stress Decompression illsnes Decompression treatment Decompression Deep diving Deep water exploration Delayed Offgassing Dental Diaphragms Diseases Dive Chamber Dive Computer Dive Destinations Dive H Dive Industry Dive Instruction Dive Instructor Dive Medical Form Dive Pros Dive Research Dive Training Dive Travel Dive accidents Dive buddies Dive computers Dive excursions Dive fitness Dive gear Dive heallth Dive health Dive medicines Dive medicine Dive operators Dive planning Dive safety Dive safe Dive staff DiveLIVE Diveleader training Diveleaders Diver Health Diver Profile Diver infliencers Diver on surface Divers Alert Diving Kids Diving Trauma Diving career Diving emergencies Diving emergency management Diving fit Diving guidelines Diving injuries Diving suspended Diving Dizziness Dolphins Domestic Donation Dowels Dr Rob Schneider Drysuit diving Drysuit valves Drysuits Dyperbaric medicines EAPs EAP Ear pressure Ear wax Ears injuries Eco friendly Education Electronic Emergency action planning Emergency decompression Emergency plans Emergency underwater Oxygen Recompression Emergency Enviromental Protection Environmental factors Environmental impact Environmental managment Equalisation Equipment care Evacuations Evacuation Evaluations Even Breath Exercise Exhaustion Extended divetime Extinguisher Extreme treatments Eye injuries FAQ Failures Fatigue Faulty equipment Fillings Fire Coral Fire Safety Firefighting First Aid Equipment First Aid Kit First Aid Training First Aid kits Fish Identification Fish Fitness Training Fitness to dive Fitness Flying Fractures Francois Burman Fredive Free Student cover Free diving Free flow Freedive Training Freediver Freediving performance Freediving Gas Density Gas laws Gas mixes GasPerformance Gases Gastoeusophagus Gastric bypass Gastroenterologist Gear Servicing Gordon Hiles Great White Sharks Gutt irritations HCV HELP HIRA HMS Britanica Haemorhoid treatment Hazard Description Hazardous Marine life Hazardous marinelife Health practitioner Heart Attack Heart Health Heart Rate monitor Heart rates Heart rate Heart Heat stress Helium Hepatitis C Hepatitus B High temperatures Hip strength Hip surgery Hippocampus History Hot Humans Hydrate Hydration Hydrogen Hydroids Hydrostatic pressure Hyperbaric Chamber Hyperbaric research Hyperbarics Hypothermia Hypoxia IdentiFin Immersion Immine systems In Water Recompression Indemnity form Indian Ocean Indonesia Inert gas Infections Injections Instinct Instruction Instructors Insurance Integrated Physiology International travel International Interval training Irritation Joint pain KZN South Coast Kidneys Kids scubadiver KwaZulu Natal Labour laws Laryngospasm Lauren Arthur Learning to dive Legal advice Legislation Leukemis Liability Risks Liability releases Liability Life expectancy Lifestyle Lightroom editing Live aboard diving Liver Toxicity Liver diseas Low blood pressure Low pressure deterioration Low volume masks Lung Irritation Lung function Lung injuries Lung squeeze Lung surgery Lung MOD Maintenance Malaria Mammalian Dive Response Mammalian effect Marine Biology Marine Scientists Marine conservation Marine parks Marinelife Master scuba diver Maximum operating depth Medical Q Medical emergencies Medical questionaire Medical statement Medication Mehgan Heaney-Grier Mesophotic Middle ear pressure Mike Bartick Military front press Mixed Gas Mono Fins Mooring lines More pressure Motion sickness Muscle pain Mycobacterium marinum Nausea Nautilus Neck pain Neurological assessments Nitrogen build up Nitrox No-decompression Non-rebreather Mask Normal Air Nosebleeds O2 providers O2 servicing OOxygen maintenance Ocean Research Ocean pollution Open water divers Orbital implants Oronasal mask Osteonecrosis Out and about Outreach Oxygen Cylinder Oxygen Units Oxygen deficit Oxygen deicit Oxygen dificiency Oxygen ears Oxygen equipment Oxygen masks Oxygen supply Oxygen therapy Oxygen P J Prinsloo PFI PJP Tech Part 3 Partner Training Philippine Islands Philippines Phillipines Photography Physioball Physiotherapy Pills Pistons Planning Plastic Pneumonia Pneumothorax Poison Pollution Pool Diving Post-dive Pre-dive Preparation Prepared diver Press Release Professional rights Provider course Pulmanologist Pulmonary Bleb Pulmonary Edema Pulse Punture wounds Purge RAID South Africa RCAP REEF Radio communications Range of motion Rashes Rebreather diving Rechargeable batteries. Recompression chamber Recompression treatment Recompression Recycle Reef Conservation Reef surveyors Regulator failure Regulators Regulator Remote areas Renewable Report incidents Rescue Procedure Rescue breathing Rescue breaths Rescue training Rescue Resume diving Risk Assessments Risk assesments Risk assessment Risk elements Risk management SABS 019 SafariLive Safety Stop Safety SaherSafe Barrier Sanitising Sara Andreotti Saturation Diving Save our seas Science Scombroid Poisoning Scuba Air Quality Scuba Injury Scuba Instructor Scuba children Scuba dive Scuba health Scubalearners Sea Horses Sealife Shark Protection Shark Research Shark conservation Shark diving Sharks Shoulder strength Sideplank Signs and Symptoms Sit-ups Skin Bends Skin outbreak Skin rash Snorkeling Snorkels Sodwana Bay Solomon Islands South Africa Spinal pain Splits Squeezes Stability exercise Standars Stay Fit Stents Step ups Stroke Submerged Sudafed Sulawesi Supplemental oxygen Surface supplied Air Surfaced Surgeries Surgery Suspension training TRavel safety Tabata protocol Tattoes Technical Diving The Bends The truth Thermal Notions Tides Tips and trick Tooth squeeze Transplants Travel smarter Travel tips Travel Tropical Coastal Management Tunnelling Tweezers Ultrsound Unconsciousness Underground work Underwater photographer Underwater photography Underwater pho University of Stellenbosch Urinary retention. Vaccines Vagus nerve Valsalva manoeuvers Vape Vaping Vasopressors Vasvagal Syncope Venting Virus infections Volatile fuels Washout treatments Wastewater Water Resistance Water Weakness Weigang Xu West Papua Wet diving bell Wetsuit fitting Wetsuits White balance Wide angles Winter Woman in diving Women In Diving SA Work of Breathing Workout Wound dressings Wreck divers Wreck dive Wreckdiving Wrecks Yoga Youth diver Zoology abrasion acoustic neuroma excision air-cushioned alert diver altitude anemia antibiotics antiseptics bandages barodontalgia bent-over barbell rows bioassays body art breathing air calories burn carbon dioxide toxicity cardiovascular cerebrospinal fluid checklist chemo port child clearances closed circuit scuba currents cuts dead lift decompression algorithms decongestants decongestion dehydration dive injuries dive medicing dive ready child dive reflex dive tribe diver in distress diver rescue diver training dive diving attraction doctors domestic travel dri-suits drowning dry mucous membranes dry suits dry e-cigarettes ear spaces elearning electrolyte imbalance electroytes emergency action plans emergency assessment equalising equalizing exposure injuries eyes fEMAL DIVERS fire rescue fitnes flexible tubing frediving freedivers gas bubble gas poisoning gastric acid gene expression health heartburn histidine hospital humidity immersion and bubble formation immersion pulmonary edema (IPE jaundice join DAN knee longevity lower stress malaise marine pathogens medical issues medical procedures medical risk assesment medications mental challenge micro-organisims minor illness mucous membranes nasal steroids nasal near drowning nematocysts neurological newdivers nitrogen bubbles off-gassed operating theatre operations orthopeadic outgas pain perforation phillippines physical challenges pinched nerves plasters polyester-TPU polyether-TPU post dive posture preserve prevention psychoactive pulmunary barotrauma rebreather mask rebreathers retinal detachment risk areas safety stops saturation scissors scuba equipment scuba single use sinus infections smoking snorkeling. spearfishing sterilising stings strength sub-aquatic swimmers ears tattoo care tecnical diver thermal protection toxicity training trimix unified standards vision impaired warmers water quality