3. How to make a claim for the Waiver of Premium Benefit For any claims enquiries, advice about submitting a claim or before incurring any costs in respect to a claim, please phone the Sovereign Claims Team on 0800 500 108 or contact your adviser for assistance. We will tell you about any other information that may be required once notice of the claim has been received. You must give Sovereign written notice of a claim as soon as practicable but at least within 12 months of the event giving rise to the claim. We are under no obligation to consider a claim unless all of the information requested is provided. Furthermore, we are under no obligation to assess or pay a claim prior to receiving notification. We may also ask the waiver of premium life assured to undergo further medical examinations throughout the life of the claim. Any requests made by us for further medical information will be at our expense. In order to assess your claim, we will require: > the waiver of premium life assured to be examined by an acceptable registered medical practitioner , before accepting liability for a claim; and > a Sovereign claims form completed by the waiver of premium life assured and an acceptable registered medical practitioner (at your expense); and > other information which we may reasonably request to help assess the claim; and > the waiver of premium life assured to undergo medical and/or surgical treatment (including any operation or
> Any other information that we may deem relevant to the ongoing assessment of the claim.
5. When will we cease waiving the regular premiums payable under this policy? We will cease waiving the regular premiums payable under this policy if: a. The waiver of premium 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 us considers reasonably necessary. b. The waiver of premium life assured fails to undertake any medical examinations that we require the waiver of premium life assured to have, at our expense. c. The waiver of premium life assured fails to comply with the requirements of Section 4 above. d. We determine that the waiver of premium life assured is no longer totally disabled or a partial disability benefit is no longer payable in respect of the waiver of premium life assured under a Sovereign policy . e. The waiver of premium term expires in relation to the waiver of premium life assured . f. The waiver of premium life assured or anyone acting on behalf of the waiver of premium life assured makes a false or fraudulent statement in respect of a claim or supports any claim with false evidence. g. The waiver of premium life assured is in prison for any reason. h. The waiver of premium life assured attains age 65. i. The waiver of premium life assured dies. If we cease waiving the regular premiums payable under this policy in accordance with paragraphs (a), (b) or (c) and the waiver of premium life assured subsequently complies with the relevant requirement(s), then: > The date that the waiver of premium 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 under this Waiver of Premium benefit. > The waiting period will be waived for the new claim. > We will not waive the regular premiums payable under this policy retrospectively for any period of time before the date that the waiver of premium life assured complies with the relevant requirement(s).
vocational, medical and/or social rehabilitation programme) at your expense which the waiver of
premium life assured’s registered medical practitioner or an acceptable registered medical practitioner approved by us considers necessary; and > any other information that we may deem relevant to the assessment of the claim. 4. Ongoing Claim Requirements For ongoing claims we will require: > Completion of a monthly medical certificate by an acceptable registered medical practitioner (at your expense) in a form from time to time approved by us for the purposes of determining ongoing entitlement to a Waiver of Premium Benefit. > Completion of a monthly individual declaration by the waiver of premium life assured in a form from time to time approved by us, which may include completion of daily activity logs detailing the waiver of premium life assured’s functional activities for the purposes of determining ongoing entitlement to a Waiver of Premium Benefit. > Proof of any remunerated or non-remunerated work completed during the claim period.
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714 PH-WOP version 1 Effective 19 October 2015
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