TCM Business Overheads Agreed Value Policy Wording

injury will be considered to be the same claim in respect of the benefit payment period .

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any medical rehabilitation programme; and/or

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any social rehabilitation programme; and/or

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any vocational rehabilitation programme,

5. How to make a claim

which a registered medical practitioner approved by Sovereign considers reasonably necessary. (b) The life assured fails to undertake any medical examinations that Sovereign requires the life assured to have, at our expense.

To make a claim, the relevant procedures in the section of your TotalCare Max policy entitled “How to make a claim” must be followed.

In addition, for a Business Overheads Benefit claim, Sovereign will require:

 the life assured to be examined by a registered medical practitioner acceptable to Sovereign before accepting liability for a claim; and  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

(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.

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.

practitioner or a registered medical practitioner approved by Sovereign considers necessary; and

 any other information that Sovereign may deem relevant to the assessment of the claim.

> 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).

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.

 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.

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:

 At the expiry of the benefit term for that life assured as shown in the schedule .

 Proof of any remunerated or non-remunerated work completed by the life assured during the claim period.

When the life assured dies.



 When the life assured ceases to have an ownership interest in the business .

 Any other information that Sovereign may deem relevant to the ongoing assessment of the claim.

When the business ceases to trade.



7. When will Sovereign cease paying a benefit?

 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:

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any surgical operation; and/or

857 TCB-BCBOV version 4 Effective 21 May 2019

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