Benefit that arises as a direct or indirect consequence of:
a pre-existing condition ; or
any congenital condition , except where expressly covered under the Children’s Congenital Conditions Benefit
These exclusions also apply to any subsequent sum assured increase you make.
20. How to make a claim
To make a claim, refer to the section in your Sovereign TotalCare Max policy entitled ‘How to make a claim’.
In addition, for a Progressive Care Benefit claim, Sovereign will require information acceptable to us, including medical evidence and reports, showing proof of the condition giving rise to the claim. Sovereign may require the life assured to have an examination by a registered medical practitioner or specialist appointed by Sovereign before accepting liability for a claim. Where the Optional Total Permanent Disablement condition is the condition giving rise to the claim, Sovereign will also require: A Sovereign claims form completed by the life assured and a registered medical practitioner (at your expense). Other information which Sovereign may reasonably request to help assess the claim, which may include evidence of earnings, taxable income, business accounts, Accident Compensation Corporation details or similar. 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 practitioner or a registered medical practitioner approved by Sovereign considers necessary.
Any other information that Sovereign may deem relevant to the assessment of the claim.
For advice about submitting a claim you can phone Sovereign on 0800 500 108 or your Adviser. Find claim information online at sovereign.co.nz
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866 TCB-PC version 12 Effective 12 May 2026
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