19. How to make a claim
increase if the life assured ’s condition occurs as a direct and sole result of an accident .
To make a claim, refer to the section in your TotalCare Max policy entitled ‘How to make a claim’.
You cannot apply for an increase under this Facility at any time when you have made, or are entitled to make, a claim under your Life Cover Benefit or Comprehensive Living Assurance Benefit.
In addition, for a Comprehensive Living Assurance 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 or his or her child (if applicable) to have an examination by a registered medical practitioner 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:
Each Optional Business Safeguard Facility increase will require an increase in premium . This increase will be
calculated on the rates applicable at the time the Optional Business Safeguard Facility is used.
18. Exclusions – when Sovereign won’t pay a benefit
Sovereign will not pay any benefit described in this appendix where any of the following (and in each case either directly or indirectly) causes or contributes to the claim: The life assured (or the child in the case of a Built-in Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit) deliberately injures himself or herself or attempts to do so. The life assured (or the child in the case of a Built-in Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit) engages in or is part of any conduct that is criminal. Any condition or any symptom or signs leading to the condition (whether or not a registered medical practitioner has been consulted) that existed before the risk commencement date , unless Sovereign is satisfied that you or the life assured could not have known of the existence of the condition or symptom or signs leading to the condition , or the condition or symptom or signs leading to the condition were declared on your application and accepted by Sovereign. Sovereign will not pay any benefit described in this appendix where any of the following occurs before a life assured (or any child in the case of a Built-in Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit) reaches age 21, and (in each case either directly or indirectly) causes or contributes to a claim for that life assured (or child ):
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
any intentional act by you or by any parent or guardian of the life assured , or child.
any intentional act by someone who lives with or supervises the life assured, or child.
Sovereign will not pay a children’s benefit under the Children’s Trauma Benefit or the Optional Children’s and Maternity 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 apply to any subsequent benefit increase you make.
852 TCB-LAC version 19 Effective 12 May 2026
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