unable to: −
> 1/12 th of the sum assured shown in the schedule less offsets as described below; or > 75% of the life assured’s pre-disability income less offsets as described below.
>
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 than 10 hours per week; and > not working or engaged in any other occupation or business. 6. 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 disablement . The provisions in Sections 3, 4 and 5 will apply to any benefit claimed. All claims resulting from the same or a related disability will be considered to be the same claim in respect of the benefit payment period . 7. 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. 8. What happens when you have had your policy for three years? On the third anniversary of your risk commencement date , AIA will require you to provide financial accounts for your business (if you have not already done so) in order for the agreed value basis of your cover to continue. If you provide financial accounts, the provisions of your policy (including section 4) will continue to apply but AIA may change your sum assured based on your financial information. If you do not provide financial accounts, the provisions of your policy will continue to apply except that section 4 will be replaced by: The amount that AIA will pay monthly is the lesser of:
Offsets: >
Any other income replacement, rural income protection, business income protection, key person 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 payments from ACC , Work and Income New Zealand (WINZ) or another insurer). − Where the life assured is covered by income replacement, rural income protection, business income protection, key person or mortgage protection benefits held with more than one provider, AIA will negotiate with the other provider(s) to determine the amount to be offset. − 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. > 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 . In addition, AIA will also pay any premiums due under this policy while a benefit is being paid. 9. Policy transfer options From one year after your risk commencement date you may apply to transfer to a relevant AIA Personal or Business income protection policy. Please Note : If you are able to transfer to an income protection policy and you have previously been on claim under your AIA Start-Up Income Protection policy, the condition(s) that you claimed for may be excluded under the new policy. This means you will be unable to make any further claims for that/those condition(s). If you have any exclusions or loadings on your existing AIA Start-Up Income Protection policy, these will also apply to your new AIA Personal or Business income protection policy, regardless of the benefit payment period you choose for that new income protection policy.
1180 A-SU IP version 3 Effective 23 July 2021
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