29.
Schedule of Categories – loss of function category
Severity Level
Conditions
Loss of independent existence means the life assured is totally and irreversibly disabled, with the effect that he or she, as a result of sickness or injury: – Is unable to perform without the physical assistance of someone else at least two activities of daily living for himself or herself (if the life assured can perform the activity on his or her own by using special equipment we will treat the life assured as being able to perform that activity); or – Suffers significant cognitive impairment means mental deterioration and loss of intellectual ability, evidenced by deterioration in memory, orientation and reasoning, which are measurable and result from demonstrable organic cause as diagnosed by an appropriate specialist in psychogeriatrics, psychiatry, neurology or geriatrics. The degree of cognitive impairment must be sufficiently severe to require a minimum of 16 hours of daily supervision by a nursing service approved by AIA . Determination of a cognitive impairment will be made on the basis of clinical data and valid standardised measures of such impairments.
Total blindness means irrecoverable loss of sight of both eyes as a result of sickness or injury. This is evidenced by:
– visual acuity on the Snellen Scale after correction by suitable lenses is less than 6/60 in both eyes; or
– field of vision is reduced to 20 degrees or less of arc in the better eye; or
– a combination of visual defects resulting in the same degree of visual impairment as either of the points above.
Loss of sight in one eye and loss of one limb means irrecoverable loss of sight in one eye (whether aided or unaided) as a result of sickness or injury. This is evidenced by:
–
visual acuity of 6/60 or less in that eye; or
–
field of vision is reduced to 20 degrees or less of arc;
and;
1
– the life assured , as a result of sickness or injury, permanently loses the entire use of one limb .
Loss of two limbs means the life assured , as a result of sickness or injury, permanently loses the use of two or more limbs .
Total deafness means the life assured , as a result of sickness or injury, suffers severe hearing impairment in both ears, whether aided or unaided, resulting in an average hearing threshold in both ears of 91db or greater as measured at 500, 1000 and 1500 Hz. The loss of hearing must be total and permanent. Loss of speech means the life assured , as a result of sickness or injury loses the ability to produce intelligible speech, both natural and assisted. This loss must be total and permanent as assessed three months after the event. Loss of speech related to any psychological cause is excluded. Paralysis means the total and permanent loss of function of two or more limbs as a result of sickness or injury causing permanent damage to the nervous system. This includes, but is not limited to, quadriplegia, paraplegia, diplegia and hemiplegia. Intensive care means a state of unconsciousness with no reaction to stimuli or internal needs, persisting continuously for at least 96 hours, requiring assisted ventilation (including the use of endo- tracheal intubation and/or tracheostomy) in the intensive care unit of a hospital. The life assured must have also sustained a neurological deficit causing inability to perform one of the activities of daily living . Unconsciousness caused by drug and alcohol abuse is specifically excluded.
Total Permanent Disablement (Optional condition ) the life assured has suffered Total Permanent Disablement if in AIA’s opinion the life assured before attaining age 65:
A. becomes totally and permanently incapacitated by illness or accident and, as a result of that incapacity: – is completely unable to engage in the occupation, or carry on the business, he or she was involved in immediately before becoming incapacitated; and
Page 25 of 33
1106 AL-PC version 7 Effective 12 May 2026
Powered by FlippingBook