Total and Permanent Disablement insurance cover

For Life and TPD Cover ‘at work’ is known as Active Employment in the insurance policy and is defined as:  a person who is employed by the employer and is capable of performing their identifiable duties without restriction by any Illness or Injury for at least 30 hours per week, whether or not they are actually working those hours. For Life and TPD cover, whether you are ‘at work’ impacts when New Events Cover becomes Full Cover.

For Income Protection Cover ‘at work’ is known as Actively At Work in the insurance policy and is defined as: a person who is considered, in the Insurer’s opinion, to be capable of performing all the duties of their usual occupation and capable of working their usual hours without restriction. For IP cover, whether you are ‘at work’ impacts when your cover starts, and when New Events Cover becomes Full Cover.

For Life and TPD Cover: means bodily injury which is caused solely and directly by external, violent and accidental means and is independent of any other cause.

For Income Protection Cover: A physical Injury which occurs fortuitously whilst Continuous Cover is in force and which results in disablement within 12 calendar months from the date of its occurrence and which continues for a period of not less than the waiting period, but does not include any condition which is also a Sickness.

For Life and TPD Cover Total and Permanent Disablement (TPD) means:

(a) When a Covered Person is under age 65 and is Employed, on average, at least 15 Hours per week (the minimum hours) within the 12 months immediately prior to the Date of Disablement, or has been on Employer Approved Leave for no more than 24 consecutive months, if one of the following (i) and (iv), or (ii) and (iv), or (iii) and (iv), or (iv) applies:

(i) the Covered Person suffering the permanent loss of use of 2 limbs or the sight of both eyes or the loss of use of one limb and the sight of one eye (where limb is defined as the whole hand or the whole foot).

(ii) the Covered Person through Illness or Injury and having provided proof to the satisfaction of the insurer is permanently unable to perform 2 of the following 6 basic activities of everyday living.

• Dressing – to dress or undress;
• Toileting – to use the toilet including getting on and off;
• Feeding – to eat and drink;
• Mobility – to get out of a bed or a chair or a wheelchair;
• Bathing – to shower or bathe;
• Continence – to control bladder or bowel function.

If the Covered Person can perform the activity by using special equipment, they will be considered able to undertake that activity.

(iii) the Covered Person through Illness or Injury is suffering from the permanent deterioration or loss of intellectual capacity and has provided proof to the insurer’s satisfaction that the Covered Person is required to be under continuous care and supervision by another adult person for 6 consecutive months and this care is likely to be on a permanent daily basis and on-going.

(iv) the Covered Person having been absent from their Occupation with the Employer through Injury or Illness for 3 consecutive months and having provided proof to our satisfaction that the Covered Person has become incapacitated to such an extent as to render the Covered Person unlikely ever to engage in or work for reward in any occupation or work for which he or she is reasonably qualified by reason of education, training or experience.

The Waiting Period is a period of 30 days. The Waiting Period starts from the date that the Injury or Sickness that your accepted claim results from occurs and/or is confirmed by your Medical Practitioner. Where a member is deemed to be entitled to a payment under the income protection policy, benefits are payable as soon as the 30-day Waiting Period has expired. No benefit will be paid for the waiting period. A member is not obliged to use any accrued sick leave, annual leave, long-service leave or other entitlements prior to being eligible for payment of a benefit.

To be clear, the waiting period commences from the date that a member is first confirmed unable to work as a result of Injury/ Sickness by their Medical Practitioner. A member should not delay seeing a Medical Practitioner but if they do, their waiting period will commence from when that Medical Practitioner confirms they are unable to work. The insurer cannot accept back-dated certificates from a Medical Practitioner. If the member returns to work during the waiting period, the waiting period starts again unless they return to work once and for a period of no more than 5 consecutive days, as certified by a medical practitioner.