1.
When will AIA pay a Total Disability Income Benefit?
the other provider(s) to determine the amount to be offset. AIA will not seek to apply offsets under this sub-clause in respect of income replacement or mortgage protection benefits held with other providers which were accurately disclosed in your application, provided that there has been no change in the circumstances for you or the life assured .
AIA will pay a Total Disability Income Benefit if, in AIA’s opinion, at any time during the benefit term , the life assured : > has been totally disabled or partially disabled during the waiting period ; and
Benefits payable under an AIA Key Person Disability Income policy will not be offset.
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> is totally disabled at the end of the waiting period .
We will pay you the monthly benefit less offsets monthly in advance from the end of the waiting period until the earliest of:
− If the life assured is entitled to receive a benefit from ACC but is not receiving that benefit because the life assured has either not applied for the benefit, or has not provided all of the requirements necessary to assess the benefit, or the benefit has been stopped due to any non-compliance with ACC requirements, AIA will offset the full ACC entitlement regardless of whether the life assured is receiving a payment or not. − Where the life assured receives or is entitled to receive a benefit from ACC, AIA will offset the gross entitlement amount. > Any income before income tax, as a result of the life assured being actively involved in or actively carrying on business, other than passive income such as investment income, rental income or income earned by the business which cannot be attributed to the active involvement of the life assured . > The life assured’s sick leave payments, subject to a maximum of 10 days’ sick leave payments for all claims resulting from the same or a related disability. If you have chosen the Premier Cover Option then the life assured’s sick leave payments are not included in offsets.
> the life assured is no longer totally disabled; or
> the benefit term ends; or
> the cover ends.
Any payment for a period of less than one month is calculated on a pro-rata basis.
Where the life assured has a waiting period of 8 weeks or less, is totally disabled due to injury and the nature of the injury is such that the life assured is expected to recover within a set period of time, AIA may choose to make a lump sum payment of up to 3 monthly benefit payments (after the waiting period and any offsets have been taken into account) and close the claim. This payment may be made during the waiting period . If the life assured is still totally disabled or partially disabled at the end of the expected recovery period corresponding with the lump sum payment, then AIA will reopen the claim and pay either the Total Disability Income Benefit or a Partial Disability Income Benefit in accordance with this appendix .
2.
What amount will AIA pay for a Total Disability Income Benefit?
3.
What does totally disabled mean?
The amount that AIA will pay monthly is:
The definition of totally disabled that applies for a life assured depends on the life assured’s occupation class. The occupation class for each life assured is shown in the schedule . However, if a life assured has been on leave without pay for more than 12 months or was unemployed for three months or more immediately before becoming totally disabled , that life assured is automatically classed as occupation class five. For each occupation class, the degree of incapacity which constitutes total disablement is as follows:
The greater of calculation (i) or (ii) below, up to a maximum of 1/12 th of the benefit amount shown in the schedule : (i) (1/12 th of the benefit amount shown in the schedule ) less offsets shown below; or
(ii) ( pre-disability income less offsets shown below) x 75%.
If the life assured has been on parental leave for 12 months or less or on a work sabbatical when the life assured becomes totally disabled , then pre-disability income is based on the life assured’s income immediately before the life assured went on leave, as set out in Section 31 “Key Terms”.
For occupation classes other than occupation class five:
In AIA’s opinion, the life assured is totally disabled , if as a direct result of sickness or injury, he or she is: > under the regular and personal care of a registered medical practitioner ; and
Offsets
> Any other income replacement or mortgage protection benefits that any person receives or is entitled to receive from any sources in relation to the life assured and the same or a related disability (for example payments from ACC , or another insurer), other than Work and Income New Zealand (WINZ) payments, with the following provisions:
> unable to:
- perform at least one important income producing duty of the role they were involved in immediately before the disablement date and is not working in that role; or - engage in the occupation they were involved in immediately before the disablement date for more
Where the life assured is covered by income replacement or mortgage protection benefits held with more than one provider, AIA will negotiate with
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1109 AL-LOE version 5 Effective 12 May 2026
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