AIA LIVING - BUSINESS OPTIONAL BENEFIT APPENDIX
Specified Accidental Injury Cover This appendix only applies if cover under the schedule for your policy includes the Specified Accidental Injury Cover. This appendix
forms part of and is incorporated into your AIA Living policy, the terms of which apply to this appendix . This is an Agreed Value Benefit. Details of the benefit and the life / lives assured are shown in the schedule .
1. When will AIA pay Specified Accidental Injury Cover? AIA will pay Specified Accidental Injury Cover if a life assured suffers a specified injury after the risk commencement date of this benefit and survives for at least 14 days thereafter. A Specified Accidental Injury Cover claim must be supported by medical evidence confirming the specified injury giving rise to the claim. No waiting period applies, and the Specified Accidental Injury Cover sum assured will be paid once an eligible claim is accepted by AIA . 2. What amount will AIA pay for Specified Accidental Injury Cover? If a life assured suffers a specified injury, the Specified Accidental Injury Cover will be paid as a lump sum payment equal to the monthly benefit amount set out in the schedule multiplied by the applicable number set out in the table in Section 6 below, subject to a maximum amount of $60,000 per life assured , per policy year across all Specified Accidental Injury Cover claims. If you have selected Inflation Cover (specified in the schedule as CPI Linked), your monthly benefit amount will increase in line with the provisions set out in your AIA Living policy to a maximum of $5,000 per month, across all Specified Accidental Injury Cover benefits for the life assured . The Specified Accidental Injury Cover is not subject to any offsets. Multiple Injuries Only one Specified Accidental Injury Cover claim will be paid for the same event. If the life assured suffers more than one specified injury from the same event, AIA will pay the specified injury that provides the highest benefit. If more than one specified injury occurs within a 24-hour period, AIA will only pay one (the highest) Specified Accidental Injury claim amount. However, if AIA pays a specified injury that provides a lower benefit and subsequently the same specified injury would qualify for a higher benefit, then AIA will pay the difference between the higher benefit and any lower benefit already paid for the same specified injury. Once AIA has paid a claim for a specified injury under this benefit, we will provide cover for the same type of specified injury again, provided that:
> The new specified injury was caused by a new accident, and > The new specified injury is not related to any previous specified injury AIA has paid a claim for and that the life assured hasn’t fully recovered from. 3. How to make a claim To make a claim, the relevant procedures in the section of your AIA Living policy entitled ‘How to make a claim’ must be followed. AIA will not pay a claim under this Specified Accidental Injury Cover until AIA has received medical evidence of the specified injury (at your expense). 4. When will this appendix terminate for a life assured ? This appendix will terminate and eligibility for the Specified Accidental Injury Cover will cease for a life assured at the earliest of when: > The life assured dies. > On the 20 th day of the first month after the life assured reaches age 70. > The benefit is cancelled. > All of the life assured’s qualifying AIA Living benefits with AIA are cancelled or reduced below the minimum qualifying sum assured requirements. 5. Exclusions – When AIA won’t pay a benefit AIA will not pay Specified Accidental Injury Cover if a specified injury arises directly or indirectly from any of the following: > Any illness, disease or degenerative illness , > Any avulsion fracture, including flake fractures, > Any hairline or stress fractures , > Any act or omission by the life assured intended to cause harm to him or herself, > The life assured being under the influence of alcohol or drugs, except where the drugs were prescribed by and were being used in accordance with the directions of a registered medical practitioner , or > The life assured’s participation in any criminal activity.
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6. What specified injuries will AIA cover under this benefit? This table lists the specified injuries covered under this benefit and how much AIA will pay for each. Some of these specified injuries have definitions, which you can find under ‘Key Terms’. Specified Accidental Injury Cover will only pay a benefit if the life assured suffers one of the specified injuries set out in the below table. All other types of accidental injury are not covered by this benefit.
Specified Injury Categories Category A Fracture of jaw, skull, collarbone
What AIA will pay (Lump Sum)
Fracture of forearm, wrist Fracture of hand (excluding fingers) Fracture of thumb Fracture of ankle, heel, fracture of leg below the knee (tibia or fibula) Fracture of foot (excluding toes) Fracture of big toe Fracture of 3 or more ribs Amputation of any finger (including thumb) or big toe Category B Fracture of upper arm, elbow, shoulder Fracture of vertebrae Fracture of kneecap Injury that results in a tear of the shoulder or knee that results in surgery under general anaesthesia Category C Fracture of leg above the knee (femur)
One times the monthly benefit amount
Two times the monthly benefit amount
Fracture of the pelvis Fracture of the hip Fracture to multiple limbs Category D Amputation of the thumb and index finger of the same hand
Three times the monthly benefit amount
Full thickness burns (excluding hands) to 20% or more of the body surface Full thickness burns to 25% of the face or 50% of the surface of both hands Permanent total blindness in one eye Category E Amputation or Permanent total loss of function of a foot or hand Amputation or Permanent total loss of function of one or more limbs Permanent total paralysis Permanent total blindness Permanent total loss of hearing
Six times the monthly benefit amount
Twelve times the monthly benefit amount
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Irrecoverable loss of the sight of both eyes (whether aided or unaided). This is evidenced by: > visual acuity of 6/36 or less in both eyes; or > field of vision reduced to 10 degrees or less of arc in the better eye; or > a combination of visual defects resulting in the same degree of visual impairment as either of the points above. The life assured loses all hearing in both ears (aided or unaided). The loss must be total and permanent as assessed three months after the accidental injury . Total and permanent loss of function caused by: > Monoplegia (loss of function in one arm or leg); > Hemiplegia (loss of function of one side of the body); > Diplegia (loss of function of both arms or both legs); or
7. Key terms
permanent total blindness
Bodily injury caused solely, suddenly and directly by violent, accidental, external and visible means. Means irrecoverable: > loss or removal of finger or toe below the proximal inter phalangeal joint, or > loss or removal of a limb(s) . A failure of bone in which a bone fragment is pulled away from its main body by soft tissue that is attached to it. A disorder characterised by the progressive loss of function and/or structure of the affected tissues. The disruption in continuity of bone, with or without displacement, as confirmed by radiological imaging and certified by a registered medical practitioner . The induction of a state of unconsciousness with the absence of pain sensation over the entire body, through the administration of anaesthetic drugs. An arm, leg, hand or foot. In respect of this definition: > the arm starts from the shoulder joint and ends at the wrist joint; > the hand starts from the wrist joint; > the leg starts from the hip joint and ends at the ankle joint; and
accidental injury
amputation
permanent total loss of hearing
avulsion fracture
degenerative illness
permanent total paralysis
fracture
general anaesthesia
> Quadriplegia or
Tetraplegia (loss of function of both arms and legs).
An accidental injury which falls within one of the Specified Injury Categories set out in the table in Section 6. An overuse injury characterised by small, possibly microscopic cracks in a bone caused by repetitive force.
specified injury/ injuries
limb(s)
stress fracture
the foot starts from the ankle joint.
>
Evidence of the specified injury as deemed appropriate by AIA , or as required by this policy,
medical evidence
from a registered medical practitioner and which is acceptable to AIA.
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