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.
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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
1160 ALB-BI version 3 Effective 23 July 2021
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