> vocational retraining must take place within New Zealand; and
form from time to time approved by Sovereign for the purposes of determining ongoing entitlement to payment of a Business Income Support 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 Income Support Benefit.
> the life assured is receiving the Total
Disablement Benefit when the programme begins.
Any benefit which Sovereign may agree to pay is to be reduced by any programme costs you or the life assured recover, or are entitled to recover, from any other source.
> Proof of any remunerated or non-remunerated work completed during the claim period.
10. What is the Home Modification or
Equipment Expenses Benefit and when will Sovereign pay it? Sovereign may agree to pay you an additional lump sum payment of up to 6 times the monthly benefit amount calculated in Section 3. This payment is to cover the costs of buying specialised equipment or completing home alterations that, because of the life assured’s total disability , have become necessary, in Sovereign’s opinion after considering the recommendation of an occupational therapist or an appropriate specialist approved by Sovereign. You must apply in writing to Sovereign before incurring these costs. Any benefit that Sovereign may agree to pay for the specialised equipment or home alterations will be reduced by any costs of buying specialised equipment or completing home alterations you or the life assured recover, or are entitled to recover from any other source.
> Any other information that Sovereign may deem relevant to the ongoing assessment of the claim.
13. When will Sovereign cease paying a benefit?
Sovereign will cease paying a benefit if:
(a) The life assured fails to undergo and complete:
–
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.
(b) The life assured fails to undertake any medical examinations that Sovereign requires the life assured to have, at our expense. (c) The life assured fails to comply with the requirements of Section 12 above. (d) Sovereign determines that the life assured is no longer totally disabled or partially 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 ceases to be actively involved in farming on the farm , unless the reason for this is related to the claim.
11. How to make a claim
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 Income Support 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
>
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; and
(h) The life assured is in prison for any reason.
(i) 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:
>
any other information that Sovereign may deem relevant to the assessment of the claim.
> 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.
12. Ongoing claim requirements
For ongoing claims Sovereign will require:
> The waiting period will be waived for the new claim.
>
Completion of a monthly medical certificate by a Registered Medical Practitioner (at your expense) in a
>
No monthly benefit payments will be payable retrospectively for any period of time before the date
855 TCB-BI version 5 Effective 21 May 2019
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