For example:
5. When will Sovereign pay an Optional Partial Disablement Benefit?
If the monthly benefit as calculated in Section 3 is $10,000, the working hours at application time are 50 hours and the post-disability working hours are 20 hours, the amount paid will be $6,000 per month.
The Optional Partial Disablement Benefit only applies if shown in the schedule .
If the life assured has been totally disabled or partially disabled and then immediately thereafter works in or carries on the business at a reduced work capacity than was the case immediately before becoming totally disabled or partially disabled, an Optional Partial Disablement Benefit may apply. The following conditions must be satisfied:
$10,000 x (50 hours less 20 hours)
$6,000 per month
=
50 hours
What is the Partial Disablement Bridging Benefit and when will Sovereign pay it?
7.
the reduction in work capacity results from the continuation of the disability , and
Where the Optional Partial Disablement Benefit applies as shown in the schedule , Sovereign will pay you a Partial Disablement Bridging Benefit if:
because of the reduction in work capacity, the life assured is working and is only able to work less than 75% of their working hours at application time ; and
> you have been receiving a Total Disablement Benefit under this appendix ; and
the waiting period is over; and
the life assured is no longer totally disabled ; and
> the life assured is no longer totally disabled ; and
> based on the information provided to, and requested by Sovereign, we reasonably expect that an Optional Partial Disablement Benefit (as set out in Section 5) will be payable for that life assured for the first month after the life assured ceased to be totally disabled . The Partial Disablement Bridging Benefit is a lump-sum payment equivalent to 1/3 rd (33.3%) of the final monthly Total Disablement Benefit paid before the life assured ceased to be totally disabled . The Partial Disablement Bridging Benefit is paid at the end of the final month in respect of which a Total Disablement Benefit was paid for the life assured. Payment of the Partial Disablement Bridging Benefit does not affect the amount of the Optional Partial Disablement Benefit (as set out in Section 6). The Partial Disablement Bridging Benefit is payable once for all claims resulting from the same or a related injury or illness. The Partial Disablement Bridging Benefit is not payable where a lump sum payment has been made in lieu of monthly benefit payments, as set out in Section 2.
if applicable, the period in respect of which a Total Disablement Benefit has been paid in advance has expired; and where a lump sum payment has been made in lieu of monthly benefit payments as set out in Section 2, the benefit period to which the lump sum corresponds has expired. The Optional Partial Disablement Benefit will be paid monthly in arrears until, in Sovereign’s opinion, after considering the advice of a registered medical practitioner and other relevant information, the disability is no longer preventing the life assured from working at least 75% of their working hours at application time , or until the occurrence of any one or more of the events set out in Sections 13, 14 or 15. A Partial Disablement Bridging Benefit (as set out in Section 7) will also be paid if you have been receiving a Total Disablement Benefit under this appendix before you commence receiving an Optional Partial Disablement Benefit. Any claim for a subsequent Partial Disablement Benefit must be immediately preceded by a 14 day period of total disability . Refer to Section 8 for “What is the Recurrent Disablement Benefit?”. 6. What is the amount of the Optional Partial Disablement Benefit? The amount that Sovereign will pay monthly is calculated in the following way:
8. What is the Recurrent Disablement Benefit?
The waiting period will be waived if in Sovereign’s opinion, after considering the advice of a registered medical practitioner and other relevant information, the life assured becomes totally disabled again and this is caused by the same or a related illness or injury as the original period of total disability , not later than 12 months after benefit payments related to the original claim ceased. The provisions of Sections 2, 3, 4, 5 and 6 of this appendix will apply to any benefit claimed. All claims resulting from the same or a related illness or injury will be considered to be the same claim in respect of the benefit payment period .
monthly benefit as calculated in Section 3
( working hours at application time less post-disability working hours )
X
working hours at application time
863 TCB-BC version 3 Effective 21 May 2019
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