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
(g) The life assured is in prison for any reason.
(h) 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: > 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.
> any other information that Sovereign may deem relevant to the assessment of the claim.
26.
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 form from time to time approved by Sovereign for the purposes of determining ongoing entitlement to payment of a Loss of Earnings 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 Loss of Earnings Benefit.
> If the benefit payment period is one, two or five years, the original claim and the new claim will be considered to be the same claim in respect of the benefit payment period . > No monthly benefit payments will be payable retrospectively for any period of time before the date that the life assured subsequently complies with the relevant requirement(s).
28.
When will this appendix terminate for a life assured?
> Proof of any remunerated or non-remunerated work completed during the claim period.
This appendix will terminate and eligibility for the Loss of Earnings Benefit will cease for a life assured:
> Any other information that Sovereign may deem relevant to the ongoing assessment of the claim.
> At the expiry of the benefit term as shown in the schedule .
> When the life assured dies.
27.
When will Sovereign cease paying a benefit?
> When the benefit is cancelled.
29.
Exclusions – When Sovereign won’t pay a benefit
Sovereign will cease paying a benefit if:
(a) The life assured fails to undergo and complete:
Sovereign will not pay any of the benefits listed in this appendix where any of the following directly or indirectly cause or contribute to the disability:
any surgical operation; and/or
−
− any medical rehabilitation programme; and/or
any social rehabilitation programme; and/or
−
> The life assured deliberately injures himself or herself or attempts to do so.
any vocational rehabilitation programme,
−
which a registered medical practitioner approved by Sovereign considers reasonably necessary.
> The life assured engages in or is part of any conduct that is criminal.
(b) The life assured fails to undertake any medical examinations that Sovereign requires the life assured to have, at our expense.
> Pregnancy of, or childbirth by, the life assured, unless the disability lasts for more than 90 days after the end of pregnancy, in which case the waiting period will start from the 91 st day.
(c) The life assured fails to comply with the requirements of Section 26 above.
> The life assured does not comply with the treatment recommended by the attending treatment providers.
(d) Sovereign determines that the life assured is no longer totally disabled or partially disabled.
If the life assured is imprisoned for any reason, no monthly benefit will be payable during the term of imprisonment.
(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.
819 TCP-LOE version 9 Effective 12 May 2026
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