> a Sovereign claims form completed by the life assured and a registered medical practitioner (at your expense); and > other information which Sovereign may reasonably request to help assess the claim and any claim payments, which may include business accounts, any business expenses/overheads payments received from other sources, confirmation of the business continuing to trade, etc; and > the life assured to undergo medical and/or surgical treatment (including any operation or vocational, medical and/or social rehabilitation programme) at your expense which the life assured’s registered medical
(c) You or the life assured fails to comply with the requirements of Section 6 above.
(d) Sovereign determines that the life assured is no longer totally 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 is in prison for any reason.
(h) The life assured dies.
practitioner or a registered medical practitioner approved by Sovereign considers necessary; and
If Sovereign 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.
> any other information that Sovereign may deem relevant to the assessment of the claim.
6. Ongoing claim requirements
For ongoing claims Sovereign 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 Sovereign for the purposes of determining ongoing entitlement to payment of a Business Overheads Benefit. > Proof of the eligible business overheads incurred in relation to the business and the completion of a business expenses claim form. > Completion of a monthly individual declaration by the life assured in a form from time to time approved by Sovereign, 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 Overheads Benefit.
> The waiting period will be waived for the new claim.
> The original claim and the new claim will be considered to be the same claim in respect of the benefit payment period . > 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). 8. When will this appendix terminate for a life assured? This appendix will terminate and eligibility for the Business Overheads Benefit will cease for a life assured:
> Proof of any remunerated or non-remunerated work completed by the life assured during the claim period.
> At the expiry of the benefit term for that life assured as shown in the schedule .
> Any other information that Sovereign may deem relevant to the ongoing assessment of the claim.
> When the life assured dies.
> When the life assured ceases to have an ownership interest in the business .
7. When will Sovereign cease paying a benefit?
> When the business ceases to trade.
> When the benefit is cancelled by the policy owner.
Sovereign will cease paying a benefit if:
(a) The life assured fails to undergo and complete:
9. Exclusions – When Sovereign won’t pay a benefit Sovereign will not pay a benefit under this appendix for any period before being notified of a claim for this benefit. Sovereign will not pay a benefit under this appendix where any of the following directly or indirectly cause or contribute to the life assured being totally disabled :
–
any surgical operation; and/or
– any medical rehabilitation programme; and/or
– any social rehabilitation programme; and/or
– any vocational rehabilitation programme,
which a registered medical practitioner approved by Sovereign considers reasonably necessary.
> The life assured deliberately injures himself or herself or attempts to do so.
(b) The life assured fails to undertake any medical examinations that Sovereign requires the life assured to have, at our expense.
> The life assured engages in or is part of any conduct that is criminal.
858 TCB-BCBOI version 4 Effective 21 May 2019
Page 2 of 3
Powered by FlippingBook