1104 AL-TPD version 3 Effective 23 July 2021
AIA LIVING – PERSONAL OPTIONAL BENEFIT APPENDIX
Total Permanent Disablement Benefit
This appendix only applies if cover under the schedule for your policy includes the Total Permanent Disablement Benefit. This appendix forms part of and is incorporated into your AIA Living policy, the terms of which apply to this appendix .
This Total Permanent Disablement Benefit may be standalone or accelerated. Details of the benefit and the life / lives assured are shown in the schedule .
1. What effect does payment of an accelerated Total Permanent Disablement Benefit have?
or c) of this appendix .
If a life assured suffers an ‘any occupation Total Permanent Disablement’ after reaching their 65th birthday, they will be assessed under Section 3 b) or c) of this appendix . If AIA could not reasonably be expected to make an assessment of the life assured prior to their 65th birthday they will be assessed under Section 3 b) or c) of this appendix .
When AIA pays an accelerated Total Permanent Disablement Benefit, the Life Cover Benefit for the life assured will decrease by the same amount. Any accelerated benefits relating to that Life Cover Benefit will be reduced, if necessary, so that those accelerated benefits do not exceed the decreased Life Cover Benefit. If the Life Cover Benefit is reduced to nil, all accelerated benefits relating to that Life Cover Benefit will be removed. The maximum combined amount payable for the Life Cover Benefit, Terminal Illness Benefit, Specified Terminal Conditions Benefit, Bereavement Support Benefit, Repatriation Benefit, accelerated Total Permanent Disablement Benefit and, if applicable, the accelerated Critical Conditions Benefit (including any similar benefits) and the accelerated Progressive Care Benefit is the amount of the Life Cover Benefit for that life assured .
3. What does ‘any occupation Total Permanent Disablement’ mean?
A life assured has suffered an ‘any occupation Total Permanent Disablement’ if in AIA’s opinion he or she:
a) Becomes totally and permanently incapacitated by illness or accident and, as a result of that incapacity: Is completely unable to engage in the occupation, or carry on the business, he or she was involved in immediately before becoming incapacitated; and For three consecutive months after that incapacity began, has not worked in any occupation or carried on any business or engaged in any other gainful employment ; and Following the three consecutive months is in the opinion of AIA , after consideration of the medical and any other evidence satisfactory to AIA , so incapacitated that it is unlikely he or she will ever be able to work in any occupation or engage in any other gainful employment for which he or she may be reasonably suited by education, training or experience, which would pay remuneration at a rate
2. If you have selected an ‘any occupation Total Permanent Disablement Benefit’
AIA will pay you an ‘any occupation Total Permanent Disablement Benefit’ if at any time after the risk commencement date :
A life assured suffers in AIA’s opinion an ‘any
occupation Total Permanent Disablement’ as defined in Section 3 below before reaching the policy expiry age as shown in the schedule ; and
The life assured survives for three months after becoming totally and permanently incapacitated.
AIA will pay only one ‘any occupation Total Permanent Disablement Benefit’ for each life assured .
greater than 25% of the life assured’s earnings during his or her last 12 consecutive months of work ; or
The benefit is a lump-sum payment of the amount specified in the schedule .
b) Suffers by illness or accident the total and permanent loss of meaningful use of:
If you have selected an expiry age of age 70 as shown in the schedule :
Both feet (entire feet); or both hands (entire hands); or
If a life assured suffers an ‘any occupation Total Permanent Disablement’ before reaching their 65th birthday, they will be assessed under Section 3 a), b)
The sight in both eyes (to the extent that visual
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acuity is reduced to 6/36 or less in the better eye and/or the field of vision is reduced to 10 degrees or less of arc in the better eye); or Any combination of two of: a hand, a foot or sight in an eye (to the extent that visual acuity is reduced to 6/36 or less and/or the field of vision is reduced to 10 degrees or less of arc); or
assessment of the life assured prior to their 65th birthday they will be assessed under Section 5 b) or c) of this appendix .
5. What does ‘own occupation Total Permanent Disablement’ mean?
A life assured has suffered an ‘own occupation Total Permanent Disablement’ if in AIA’s opinion he or she:
c) Becomes totally and irreversibly unable by illness or accident to:
a) Becomes totally and permanently incapacitated by illness or accident and, as a result of that incapacity: Is completely unable to engage in the occupation, or carry on the business, he or she was involved in immediately before becoming incapacitated; and For the three consecutive months after that incapacity began, has not worked in that occupation or carried on that business; and Is, in the opinion of AIA , after consideration of the medical and any other evidence satisfactory to AIA , so incapacitated that it is unlikely he or she will ever be able to resume work in that occupation or carry on in that business; or
Perform at least two of the activities of daily living without the physical assistance of someone else (if the life assured can perform an activity on his or her own by using special equipment AIA will treat the life assured as being able to perform that activity); or Perform one of the activities of daily living and has permanent and irrecoverable cognitive impairment as evidenced by formal neuropsychological testing
performed by a registered psychologist or psychiatrist, or assessment by an appropriate specialist .
Any condition that AIA has reasonable grounds to expect can be reversed or improved by surgery or other treatment will not be considered to be a disablement covered by the ‘any occupation Total Permanent Disablement’ definition.
b) Suffers by illness or accident the total and permanent loss of meaningful use of:
Both feet (entire feet); or both hands (entire hands); or
4. If you have selected an ‘own occupation Total Permanent Disablement Benefit’
The sight in both eyes (to the extent that visual acuity is reduced to 6/36 or less in the better eye and/or the field of vision is reduced to 10 degrees or less of arc in the better eye); or Any combination of two of: a hand, a foot or sight in an eye (to the extent that visual acuity is reduced to 6/36 or less and/or the field of vision is reduced to 10 degrees or less of arc); or
AIA will pay you an ‘own occupation Total Permanent Disablement Benefit’ if at any time after the risk commencement date :
A life assured suffers in AIA’s opinion an ‘own
occupation Total Permanent Disablement’ as defined in Section 5 below before reaching the policy expiry age as shown in the schedule ; and
The life assured survives for three months after becoming totally and permanently incapacitated.
c) Becomes totally and irreversibly unable by illness or accident to:
AIA will pay only one ‘own occupation Total Permanent Disablement Benefit’ for each life assured .
Perform at least two of the activities of daily living without the physical assistance of someone else (if the life assured can perform an activity on his or her own by using special equipment AIA will treat the life assured as being able to perform that activity); or Perform one of the activities of daily living and has permanent and irrecoverable cognitive impairment as evidenced by formal neuropsychological testing performed by a registered psychologist or psychiatrist, or assessment by an appropriate specialist . Any condition that AIA has reasonable grounds to expect can be reversed or improved by surgery or other treatment will not be considered to be a disablement covered by the ‘own occupation Total Permanent Disablement Benefit’ definition.
The benefit is a lump-sum payment of the amount specified in the schedule .
If you have selected an expiry age of age 70 as shown in the schedule :
If a life assured suffers an ‘own occupation Total Permanent Disablement’ before reaching their 65th birthday, they will be assessed under Section 5 a), b) or c) of this appendix . If a life assured suffers an ‘own occupation Total Permanent Disablement’ after reaching their 65th birthday, they will be assessed under Section 5 b) or c) of this appendix .
If AIA could not reasonably be expected to make an
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6. When does an ‘own occupation Total Permanent Disablement Benefit’ cease?
Level premium structure, of which term duration may be the same or less than current Level premium structure.
Cover under the ‘own occupation Total Permanent Disablement Benefit’ will cease and cover under the ‘any occupation Total Permanent Disablement Benefit’ will apply should the life assured of the benefit commence full- time domestic duties.
AIA will not require you or the life assured to produce further medical evidence at the time of conversion.
You will be issued a new policy for the sum assured amount of Total Permanent Disablement Benefit being converted, in which case: The Total Permanent Disablement Benefit under this policy will be reduced by the sum assured amount converted;
7. When will AIA pay a Partial Permanent Disablement Benefit?
Where the life assured has suffered:
The new policy will be issued based on the information provided at the time of conversion, together with the information provided in the original proposal; The terms and conditions of the new policy will be those which are then offered by us to the general public;
Permanent loss of the entire use of one limb (entire hand or entire foot) as a result of illness or accident; or Irrecoverable loss of sight in one eye as a result of illness or accident to the extent that visual acuity is reduced to 6/60 or less in that eye and/or the field of vision is reduced to 20 degrees or less of arc. AIA will pay 25% of the Total Permanent Disablement Benefit sum assured up to a maximum of $100,000 across all AIA policies . Only one claim can be made for the Partial Permanent Disablement Benefit per life assured . After you have made a claim under this Partial Permanent Disablement Benefit, the Total Permanent Disablement Benefit sum assured will be reduced by the claim amount, and premiums will be adjusted accordingly. If you have chosen the accelerated Total Permanent Disablement Benefit then Section 1 of this appendix also applies.
Premiums will be calculated on the current age of the life assured ; and
Any special terms, exclusions or premium loadings that applied to your existing Total Permanent Disablement Benefit under this policy will apply to your new Total Permanent Disablement Benefit under the new policy.
10. Assistance Benefit
If AIA pays a claim under this Total Permanent Disablement Benefit, then subject to the following conditions, AIA will reimburse you for costs up to $15,000 including GST (in total) that you pay for purchasing specialist equipment, completing home alterations or modifications to the life assured’s vehicle which are necessary as a result of the illness or accident which led to the life assured’s claim: You must incur the costs after the life assured suffers the Total Permanent Disablement and, no later than six months following the date AIA pays the Total Permanent Disablement Benefit claim. You must provide AIA with receipts and/or other evidence satisfactory to AIA for the costs you are claiming. AIA shall be entitled to arrange for an appropriately qualified health professional to assess any recommendation for specialist equipment or home alteration. AIA will only pay one Assistance Benefit per life assured across all AIA policies .
8. Financial and Legal Advice Benefit
If AIA pays a claim under this Total Permanent Disablement Benefit, then AIA will reimburse you for fees incurred up to $2,500 including GST (in total) that you pay for financial planning you receive from an accredited Adviser or legal advice received from a legal professional approved by AIA , subject to the following conditions: You must pay for the financial planning or legal advice within the 12 months following AIA paying the Total Permanent Disablement Benefit claim. AIA will only pay one Financial and Legal Advice Benefit per life assured across all AIA policies . This benefit is in addition to the sum assured.
9. Premium Conversion Facility
This benefit is in addition to the sum assured.
You may at any time prior to the life assured reaching age 65:
11. Counselling Benefit
Convert all or part of your Total Permanent Disablement Benefit from the premium type shown in the schedule to a Level premium structure; or
The Counselling Benefit covers the cost of a Psychiatrist or Psychologist consultation and/or counselling for the life assured and/or a close relative of the life assured where
Convert a Level premium structure to an alternate
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the support treatments and/or consultations directly relate to a claim under the Total Permanent Disablement Benefit. After referral by a registered medical practitioner we will reimburse up to $2,500 including GST (in total) per life assured , subject to the following conditions: The consultation and/or counselling must be paid for within 12 months following AIA paying the Total Permanent Disablement Benefit claim; and
Cover for the life assured will be reinstated from the date set out in AIA’s written acknowledgement.
The premium payable for the reinstated benefit will be based on AIA’s premium rates at the time of the reinstatement.
13. Special Events Increase Facility
What is the special events increase facility?
AIA must be provided with a receipt for the consultation and/or counselling being claimed.
On each occasion that one of the following circumstances occurs for a life assured on the Total Permanent Disablement Benefit:
The $2,500 is payable once per life assured per policy. This is in addition to the sum assured.
Having a child (by birth or legal adoption);
12. Suspension of Cover Benefit
Becoming married or entering into a civil union;
A life assured can suspend their cover under this benefit appendix for up to 12 months if they:
Becoming legally separated, divorced or the dissolution of the life assured’s civil union;
go on parental leave;
Financially supporting a dependent child through a first course of full-time tertiary education;
go on leave without pay for any reason;
become unemployed or redundant;
The commencement of secondary school for the first time by a child of the life assured ;
experience at least a 20% reduction in pay (comparing the most recent payslip against a previous payslip from the same year); or
Taking out or increasing a home loan because the life assured has purchased a new home, a new residential investment property, a vacation home, or a bare block of land zoned as residential, or is making extensions to a residential property or residential investment property owned by the life assured ;
if self-employed, experience a 30% reduction in revenue (by comparing one month’s revenue against the same month for the previous year),
provided that:
Becoming responsible for the full-time care or payment for long term care of a close relative ;
you notify AIA within three months of one of the above
listed suspension events occurring and provide evidence to AIA of the suspension event; and
Receiving an annual salary increase. This special event is not available to a life assured who is self- employed;
AIA acknowledges in writing receipt of that notification.
Experiencing the death of a spouse, civil or de facto partner,
Cover for the life assured will be suspended from the date set out in AIA ’s written acknowledgment.
you may write to AIA asking us to increase the Total Permanent Disablement Benefit for that life assured .
No premium will be payable during the period that the cover is suspended.
What is the maximum cover that can be added?
No claim under this benefit appendix will be payable for any claim event that occurs during the period that the cover is suspended. A claim may only be payable if the life assured first meets the criteria for an eligible claim under this policy after their cover is reinstated. Cover under this benefit appendix may be reinstated at the end of the suspension period in accordance with this Section without the need to provide further medical evidence, provided that the benefit has been suspended for no longer than 12 months.
The maximum increase for each special event cannot exceed the lower of:
50% of the original Total Permanent Disablement Benefit for the life assured ; or
$250,000.
The total of all increases made under this Facility cannot exceed the lower of:
100% of the original Total Permanent Disablement Benefit for the life assured ; or
$750,000.
At the end of the suspension period, the benefit will be automatically reinstated for the life assured .
In the case of taking out or increasing a home loan, the
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individual increase cannot exceed the amount of the home loan or the increase in the home loan.
a)
Increases in sum assured added to this policy
After an increase under this Facility has been made, AIA will not pay the increased benefit amount if, before the increase, or within six months of the Facility being exercised, the life assured :
In the case of an annual salary increase, the individual increase cannot exceed five times the annual salary increase. The maximum increases outlined above each apply in respect of all Total Permanent Disablement and similar benefits for that life assured across all AIA policies .
Suffers any claim event for anything other than an accident under the benefit; or
Has any symptoms or signs leading to a claim event (whether or not a registered medical practitioner has been consulted) that may result in a claim for anything other than an accident under the benefit.
The following maximum sum assured limits also apply across all AIA policies for each life assured :
$5,000,000 for Total Permanent Disablement and similar benefits, including increases under this Facility; and $5,000,000 for Critical Conditions, Progressive Care, Total Permanent Disablement and similar benefits (combined), including increases under this Facility.
b) Increases in sum assured issued as an additional new policy
Where this policy or any part of the sum assured under it, has been issued as the result of an increase under the Special Events Increase Facility or as the result of a Total Permanent Disablement Future Insurability Benefit increase, then: The Special Events Increase Facility will not be available under this policy for the proportion of the sum assured that represents the increase. AIA will not pay the increased benefit amount if, before the increase, or within six months of the increase, the life assured :
What are the other conditions applying to this facility?
You do not need to produce any medical evidence regarding the life assured when you request this increase, but any Special Events Increase is subject to the following conditions: You must make the request within 60 days either side of the relevant special event and provide AIA with suitable evidence of the occurrence of the event. A life assured is only eligible for special events increases where the special event occurs before age 55. If, at any time before you seek to exercise the Facility, a claim for the life assured had been accepted by us or notified to us, AIA will have discretion in determining whether the Facility can be exercised. In exercising discretion, we will consider whether the life assured represents an increased risk of claim for the benefit being added under this Facility. If a Total Permanent Disablement Future Insurability Benefit increase or another Special Events Increase has occurred in the previous 12 months or (if applicable) the Special Events Total Permanent Disablement/Trauma Facility under the Life Cover Benefit and/or similar benefits has been exercised in the previous 12 months to add an accelerated Total Permanent Disablement Benefit, then no increase is available under this Facility.
− Suffers any claim event for anything other than an accident under the benefit; or
− Has any symptoms or signs leading to a claim event (whether or not a registered medical practitioner has been consulted) that may result in a claim for anything other than an accident under the benefit.
14. Total Permanent Disablement Future Insurability Benefit
At every third policy anniversary date you may write to AIA asking us to increase the Total Permanent Disablement Benefit for a life assured . You do not need to produce any medical evidence regarding the life assured when you request this increase, but any Total Permanent Disablement Future Insurability Benefit increase in sum assured is subject to the following conditions: You must request the increase by providing written advice to AIA within 60 days either side of the applicable anniversary date . Each individual increase cannot exceed 20% of the original Total Permanent Disablement Benefit sum assured or $200,000, whichever is the lesser.
AIA will increase the Total Permanent Disablement Benefit for a life assured from the date we accept your request.
Each increase will require an increase in premium . This increase will be calculated on the rates applicable at the time the Special Events Increase Facility is exercised. Any loadings, exclusions or special terms on the original Total Permanent Disablement Benefit sum assured will be applied to the increased amount.
The total of all Total Permanent Disablement Future Insurability Benefit increases for a life assured cannot
When will AIA not pay a claim under this facility?
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exceed 100% of the original Total Permanent Disablement Benefit for that life assured or $500,000, whichever is the lesser. The maximum sum assured for the Total Permanent Disablement Benefit cannot exceed $5,000,000 across all AIA policies including Total Permanent Disablement Future Insurability Benefit increases. The total sum assured for Critical Conditions, Progressive Care, Total Permanent Disablement and similar trauma benefits (combined) must not exceed $5,000,000, including Total Permanent Disablement Future Insurability Benefit increases. Where this Total Permanent Disablement Benefit is accelerated against the Life Cover Benefit, the Total Permanent Disablement Benefit, including the total of all Total Permanent Disablement Future Insurability Benefit increases, cannot exceed the sum assured of the Life Cover Benefit. See Section 1 “What effect does payment of an accelerated Total Permanent Disablement Benefit have?” for details. A life assured over the age of 55 is not eligible for Total Permanent Disablement Future Insurability Benefit increases. AIA will increase the Total Permanent Disablement Benefit for a life assured from the date we accept your request. You will not be eligible for a Total Permanent Disablement Future Insurability Benefit increase if a claim has been accepted for the life assured or you have notified us of a claim event for that life assured which is under assessment. If a Special Events Increase has occurred in the previous 12 months, or (if applicable) the Special Events Total Permanent Disablement/Trauma Facility under the Life Cover Benefit and/or similar benefits has been exercised in the previous 12 months to add an accelerated Total Permanent Disablement Benefit, then no Total Permanent Disablement Future Insurability Benefit increase is available. Each Total Permanent Disablement Future Insurability Benefit increase in the sum assured will require an increase in premium . This increase will be calculated on the rates applicable at the time the Total Permanent Disablement Future Insurability Benefit is exercised. Any loadings, exclusions or special terms on the original Total Permanent Disablement Benefit sum assured will be applied to the increased amount.
Benefit, or
Has any symptoms or signs leading to a claim event (whether or not a registered medical practitioner has been consulted) that may result in a claim for anything other than an accident under the Total Permanent Disablement Benefit.
Increases in sum assured issued as an additional new policy
Where this policy or any part of the sum assured under it, has been issued as the result of an increase under the Total Permanent Disablement Future Insurability Benefit or as the result of an increase under the Special Events Increase Facility, then: The Total Permanent Disablement Future Insurability Benefit under this policy will not be available for the proportion of the sum assured that represents the increase. AIA will not pay the increased amount if, before the increase, or within six months of the increase, the life assured : − Suffers any claim event for anything other than an accident under the Total Permanent Disablement Benefit; or − Has any symptoms or signs leading to a claim event (whether or not a registered medical practitioner has been consulted) that may result in a claim for anything other than an accident under the Total Permanent Disablement Benefit.
15. Waiver of Total Permanent Disablement Waiting Period
AIA will, at its discretion, waive the three month waiting period when assessing a Total Permanent Disablement Benefit claim if: In AIA’s opinion, the life assured has met all other requirements for payment of a Total Permanent Disablement Benefit; and
AIA expects the life assured to survive beyond three months after the incapacity began.
In exercising this discretion, AIA will consider whether the medical condition of the life assured enables an assessment to be made immediately in respect of whether the life assured has met all other requirements for payment of a Total Permanent Disablement Benefit. AIA will not waive the three month waiting period if, in our opinion, after considering suitable medical evidence, we believe that the life assured may die within three months after the incapacity began. A decision not to waive the three month waiting period will not affect our consideration of a Total Permanent Disablement Benefit claim for the life assured if the life assured survives for three months after the incapacity began.
Increases in sum assured added to this policy
After a Total Permanent Disablement Future Insurability Benefit increase has been made, AIA will not pay the increased benefit amount if, before the increase, or within six months of the increase, the life assured :
Suffers any claim event for anything other than an accident under the Total Permanent Disablement
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16. How to make a claim
19. Key terms
To make a claim, the relevant procedures in the section of your AIA Living policy entitled ‘How to make a claim’ must be followed.
activities of daily living
Bathing and showering.
In addition, for a Total Permanent Disablement Benefit claim, AIA will require:
Dressing and undressing.
Eating and drinking.
The life assured to be examined by a registered medical practitioner acceptable to AIA , before accepting liability for a claim.
Using a toilet.
Moving from place to place by walking, in a wheelchair, or with a walking aid.
An AIA claims form completed by the life assured and a registered medical practitioner (at your expense).
gainful employment
Other information which AIA may reasonably request to help assess the claim, which may include evidence of earnings, taxable income, business accounts, ACC details or similar.
Working to generate income through personal efforts by using the life assured’s time and skills. He or she can be self-employed, employed, earning fees, under contract, receiving commissions, working on contract or otherwise remunerated for his or her efforts.
The life assured to undergo medical and/or surgical
treatment (including any operation or vocational, medical and/or social rehabilitation) at your expense which the life assured’s registered medical practitioner or a registered medical practitioner approved by AIA considers necessary.
work
Personal effort using the life assured’s time and skills, whether or not income is generated for the life assured .
Worked and working shall have similar meanings.
Any other information that AIA may deem relevant to the assessment of the claim.
17. Exclusions – when AIA won’t pay a benefit
AIA will not pay any Total Permanent Disablement Benefit where any of the following (and in each case either directly or indirectly) causes or contributes to the disablement:
The life assured deliberately injures himself or herself or attempts to do so; or
The life assured engages in or is part of any conduct that is criminal.
These exclusions apply to any subsequent benefit increase you make.
18. When will this appendix terminate for a life assured ?
This appendix will terminate and eligibility for the Total Permanent Disablement Benefit will cease for a life assured :
When the life assured dies; or
When the benefit is cancelled by the policy owner ; or
When the full sum assured has been paid.
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