AIA Living Business Rural Continuity Business Income Support Policy Wording 1160 ALB-BI version 3 Effective 23 July 2021
AIA LIVING - BUSINESS OPTIONAL BENEFIT APPENDIX
Rural Continuity Business Income Support Benefit This appendix only applies if cover under the schedule for your policy includes the Business Income Support Benefit and the Rural Continuity Benefit. This appendix forms part of and is incorporated into your AIA Living policy, the terms of which apply to this appendix . Your Rural Continuity Benefit should be read in conjunction with this benefit. This is a Business Income Support Benefit. Details of the benefit and the life/lives assured are shown in the schedule .
1. When will AIA pay a Business Income Support Benefit?
– 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. on business. This does not include 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 > Any income after income tax, as a result of the life assured being actively involved in or actively carrying maximum of 10 days’ sick leave payments for all claims resulting from the same or a related disability . 4. What does totally disabled mean? 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 > unable to: – engage in farming that they were involved in immediately before the disablement date for more than ten hours per week; or – 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; and > not in fact working or engaged outside the farm or in any other business.
To qualify for a benefit, the life assured must be actively involved in farming in New Zealand on the date of becoming totally disabled .
2. When will AIA pay a Total Disablement Benefit?
AIA will pay a Total Disablement Benefit if, in AIA’s opinion, at any time during the benefit term , the life assured : > is totally disabled at the end of the waiting period. We will pay you the benefit monthly in advance from the end of the waiting period until the earliest of: > the life assured is no longer totally disabled ; or > the benefit term ends; or > the cover ends. has been totally disabled or partially disabled during the waiting period ; and > 3. What amount will AIA pay for a Total Disablement Benefit? The amount that AIA will pay monthly is 1/12 th of the benefit amount shown in the schedule , less any offsets as described below. Any other farm protection, business income, key person, 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 in respect of the same or a related disability (for example ACC payments), with the following provisions: – Where the life assured is covered by insurance policies held with more than one provider, AIA will negotiate with the other provider(s) to determine the amount to be offset. Offsets: >
5. When will AIA pay a Partial Disablement Benefit?
AIA will pay a Partial Disability Income Benefit if, in AIA’s opinion, at any time during the benefit term , the life assured : > has been partially disabled during the waiting period, and is partially disabled at the end of the waiting period ; or
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the final month in respect of which a Total Disablement Benefit was paid for the life assured . Payment of the Partial Disablement Bridging Benefit does not affect the amount of the Partial Disablement Benefit (as set out in Section 7). The Partial Disablement Bridging Benefit is payable once for all claims resulting from the same or a related injury or illness.
> becomes partially disabled , following a period of receiving a Total Disability Income Benefit under this appendix and the life assured is no longer totally disabled , provided the period in respect of which a Total Disability Income Benefit has been paid in advance has expired. The Partial Disablement Benefit will be paid monthly in arrears until, in AIA’s opinion, after considering the advice of a registered medical practitioner and other relevant information the disability is no longer preventing the life assured from working at least 20 hours per week, or until the end of the benefit payment period , whichever is the earlier. A Partial Disablement Bridging Benefit (as set out in Section 8) will also be paid if you have been receiving a Total Disablement Benefit under this appendix before you commence receiving a Partial Disablement Benefit. 6. What does partially disabled mean? In AIA’s opinion, the life assured is partially disabled, if as a direct result of sickness or injury he or she: > has a reduction in work capacity resulting from the continuation of the disability ; and > because of the reduction in work capacity, the life assured is working less than 20 hours per week. 7. What is the amount of the Partial Disablement Benefit? The amount that AIA will pay monthly is calculated in the following way: (50% x 1/12 th of the benefit amount shown in the schedule , noted under the Business Income Support Benefit) less offsets as defined in Section 3. For example, for a benefit amount shown in the schedule of $48,000 per annum ($4,000 per month) with offsets of $1,000, the amount that AIA will pay monthly is: (50% x $4,000) - $1,000 = $1,000 8. What is the Partial Disablement Bridging Benefit and when will AIA pay it? AIA will pay you a Partial Disablement Bridging Benefit if: > you have been receiving a Total Disablement Benefit under this appendix ; and > the life assured is no longer totally disabled ; and > based on the information provided to, and requested by AIA , we reasonably expect that a Partial Disablement Benefit (as set out in Section 5) will be payable for that life assured for the first month after the life assured ceased to be totally disabled . The Partial Disablement Bridging Benefit is a lump-sum payment equivalent to 1/3 rd (33.3%) of the final monthly Total Disablement Benefit paid before the life assured ceased to be totally disabled . The Partial Disablement Bridging Benefit is paid at the end of
9. What is the Recurrent Disablement Benefit?
The waiting period will be waived if not later than 12 months after the benefit payments related to the original claim ceased, the life assured becomes disabled again and, in AIA’s opinion, after considering the advice of a registered medical practitioner and other relevant information, this is caused by the same or a related illness or injury as the original period of total or partial disablement . The provisions of Sections 2, 3, 4, 5, 6 and 7 of this appendix will apply to any benefit claimed. All claims resulting from the same or a related illness or injury will be considered to be the same claim in respect of the benefit payment period . 10. Rehabilitation and Support On receiving notification of a new or potential claim, we will appoint the life assured a Case Manager, who will work with the life assured to understand their personal situation and assist them with the claims process. They will work with the life assured to consider what rehabilitation or functional support could assist the life assured’s return to work or improve their capacity to work, either during or after the waiting period as appropriate in the opinion of AIA . Acceptance of any costs associated with the agreed rehabilitation and functional support by AIA does not mean that we will accept liability for any other benefit under this appendix and are accepted at the sole discretion of AIA . 11. What is Vocational Assistance and when will AIA pay it? AIA may agree to pay for vocational assistance for the life assured if, in AIA’s opinion, the life assured is unlikely to return to paid work in their pre-disability occupation without assistance. The Case Manager appointed to the life assured’s claim will work to understand their personal situation and consider what assistance could aid the life assured’s return to gainful employment at an earlier date than would otherwise be possible. In all cases: > the assistance must be approved in advance by AIA , and reviewed regularly; and > the life assured must actively participate and comply with the assistance as agreed with AIA ; and > the total amount which AIA will pay for any vocational assistance is limited to a maximum of 12 times the monthly benefit amount as calculated in Section 3; and > the life assured must be receiving a Total
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Disablement Benefit or Partial Disablement Benefit when the assistance begins.
AIA , which may include completion of daily activity logs detailing the life assured’s functional activities for the purposes of determining ongoing entitlement to payment of a Business Income Support Benefit. > Proof of any remunerated or non-remunerated work completed during the claim period. > Any other information that AIA may deem relevant to the ongoing assessment of the claim. 15. When will AIA cease paying a benefit? AIA will cease paying a benefit if: (a) The life assured fails to undergo and complete: – any surgical operation; and/or – any medical rehabilitation; and/or – any social rehabilitation; and/or – any vocational rehabilitation, which a registered medical practitioner approved by AIA considers reasonably necessary. (b) The life assured fails to undertake any medical examinations that AIA requires the life assured to have, at our expense. (c) The life assured fails to comply with the requirements of Section 14 above. (d) AIA determines that the life assured is no longer totally disabled or partially disabled . (e) The benefit payment period expires in relation to the life assured . (f) The life assured or anyone acting on behalf of the life assured makes a false or fraudulent statement in respect of a claim or supports any claim with false evidence. (g) The life assured ceases to be actively involved in farming on the farm , unless the reason for this is related to the claim. (h) The life assured is in prison or sentenced to home detention for any reason. (i) The life assured dies. If AIA ceases paying a benefit in accordance with paragraphs (a), (b) or (c) and the life assured subsequently complies with the relevant requirement(s), then: > The date that the life assured complied with the relevant requirement(s) will, subject to the provisions of this appendix, be treated as the disablement date for a new claim. > The waiting period will be waived for the new claim. > No monthly benefit payments will be payable retrospectively for any period of time before the date that the life assured subsequently complies with the relevant requirement(s).
Any benefit which AIA may agree to pay is to be reduced by any vocational assistance costs you or the life assured recover, or are entitled to recover, from any other source. 12. What is the Home Modification or Equipment Expenses Benefit and when will AIA pay it? AIA may agree to pay you an additional lump sum payment of up to 6 times the monthly benefit amount calculated in Section 3. This payment is to cover the costs of buying specialised equipment or completing home alterations that, because of the life assured’s total disability , have become necessary, in AIA’s opinion after considering the recommendation of an occupational therapist or an appropriate specialist approved by AIA . You must apply in writing to AIA before incurring these costs. Any benefit that AIA may agree to pay for the specialised equipment or home alterations will be reduced by any costs of buying specialised equipment or completing home alterations you or the life assured recover, or are entitled to recover from any other source. 13. How to make a claim To make a claim, the relevant procedures in the section of your AIA Living policy entitled ‘How to make a claim’ must be followed. In addition, for a Business Income Support Benefit claim, AIA will require: > the life assured to be examined by a registered medical practitioner acceptable to AIA before accepting liability for a claim; and > an AIA claims form completed by the life assured and a registered medical practitioner (at your expense); and > other information which AIA may reasonably request to help assess the claim; and > the life assured to undergo medical and/or surgical treatment (including any operation or vocational, medical and/or social rehabilitation) at your expense
which the life assured’s registered medical practitioner or a registered medical practitioner approved by AIA considers necessary; and any other information that AIA may deem relevant to the assessment of the claim.
>
14. Ongoing claim requirements For ongoing claims AIA will require: > Completion of a monthly medical certificate by a registered medical practitioner (at your expense) in a form from time to time approved by AIA for the purposes of determining ongoing entitlement to payment of a Business Income Support Benefit. > Completion of a monthly individual declaration by the life assured in a form from time to time approved by
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16. When will this appendix terminate for a life assured ? This appendix will terminate and eligibility for the Business Income Support Benefit will cease for a life assured : > At the expiry of the benefit term for that life assured as shown in the schedule . > If the life assured dies. > If the life assured is no longer actively involved in farming on the farm for more than 60 consecutive days for reasons other than total disability, unless AIA has been notified in writing and its written consent has been given for the continuation of the appendix . > If the life assured is no longer a life assured under a Rural Continuity Benefit. > If the farming business is wound-up or liquidated or the farm is sold or its lease ends, unless AIA has been notified in writing and its written consent has been given for the continuation of the appendix . However, if the life assured is on claim and the reason for the farming business being wound-up or liquidated is due to the total disability or partial disability of the life assured , the benefit will remain in force until the end of the benefit payment period . > When the benefit is cancelled by the policy owner .
17. Exclusions – When AIA won’t pay a benefit AIA will not pay a benefit where any of the following directly or indirectly cause or contribute to the total disability or partial disability : > The life assured deliberately injures himself or herself or attempts to do so. > The life assured engages in or is part of any conduct that is criminal. > Pregnancy of, or childbirth by, the life assured , unless the disability lasts for more than 90 days after the end of pregnancy, in which case the waiting period will start from the 91 st day. > The life assured does not comply with the treatment recommended by the attending treatment providers. If the life assured is imprisoned or sentenced to home detention for any reason, no monthly benefit will be payable during the term of imprisonment or home detention.
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18. Key terms
rather than employment if he or she derives income (either realised or unrealised) from a company or other legal entity, and he or she has effective control, either directly or indirectly (e.g. through a trust, partnership or other legal structure) of more than 25% of the shares or ownership in that company or other legal entity. His or her income will be assessed in accordance with the amounts referred to in both (a) and (b) above. See Section 6 of this appendix for the meaning of this key term. Partial disability has a corresponding meaning. An individual, employer, company, partnership, association, organisation or trust. The provision of services under a Sharemilking Agreement as defined by the Sharemilking Agreements Act 1937 and any of its subsequent amendments including any replacement Act and/or Regulations. See Section 4 of this appendix for the meaning of this key term. Total disability has a corresponding meaning. The period stated as such in the schedule for which no Total Disablement Benefit or Partial Disablement Benefit is payable.
Farming for more than 30 hours per week in or on the farm . The term for which the life assured is insured for the Business Income Support Benefit as stated in the schedule The maximum term for which the Business Income Support Benefit is payable as stated in the schedule. The illness or injury giving rise to the claim for total disability or partial disability. The date the life assured became totally disabled or partially disabled.
actively involved in farming
benefit term
benefit payment period
disability/disabled
partially disabled
disablement date
The area where the farming occurs.
farm
person
Owning or leasing the farm and/or animals and actively raising the animals for commercial purposes including sharemilking . Any income that the life assured receives or is entitled to receive from his or her current or former employment or business/es. This includes: a) Life assured’s share of profits of the business (and/or any associated
farming
sharemilking
income
totally disabled
entities), after the deduction of business expenses, which are determined in line with the usual manner that profits and/or losses of the business (and/or associated entities) are divided between the life assured and any co-owners, partners, shareholders or beneficiaries of the business (and/or associated entities); and whether in the form of salary or wages, superannuation, director’s fees, allowances or any other monetary or nonmonetary benefit, the life assured receives or is entitled to receive directly or indirectly from his or her employment or the business. The current year’s taxation liability excludes any tax losses which have been brought forward from previous years. For the purposes of this definition, the life assured is deemed to be in business
waiting period
b) Any other remuneration,
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