14. When will AIA cease paying a benefit?
11. Rehabilitation and Support
AIA will cease paying a benefit if:
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 .
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 13 above.
12.
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 Rural Continuity Benefit claim, AIA will require:
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 , unless the reason for this is related to the claim.
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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
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h) The life assured is in prison or sentenced to home detention for any reason.
> 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
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:
which the life assured ’s registered medical practitioner or a registered medical practitioner approved by AIA considers necessary; and
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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.
> any other information that AIA may deem relevant to the assessment of the claim.
13. Ongoing claim requirements
> The waiting period will be waived for the new claim.
For ongoing claims AIA will require:
> The original claim and the new claim will be considered to be the same claim in respect of the benefit payment period .
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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 Rural Continuity Benefit.
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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).
> Completion of a monthly individual declaration by the life assured in a form from time to time approved by 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 Rural Continuity Benefit.
15. When will this appendix terminate for a life assured ? This appendix will terminate and eligibility for the Rural Continuity Benefit will cease for a life assured : > At the expiry of the benefit term for that life assured as shown in the schedule .
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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.
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> When the life assured dies.
> If the life assured is no longer actively involved in the farm for more than 60 consecutive days for reasons
1159 ALB-RC version 4 Effective 08 April 2022
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