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.
appropriately qualified health professional to assess any recommendation for specialist equipment or home alteration. Sovereign will only pay one Assistance Benefit per life assured across all Sovereign policies .
This benefit is in addition to the sum assured.
11. Counselling Benefit
8. Financial and Legal Advice Benefit
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 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:
If Sovereign pays a claim under this Total Permanent Disablement Benefit, then Sovereign 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 Sovereign, subject to the following conditions: You must pay for the financial planning or legal advice within the 12 months following Sovereign paying the Total Permanent Disablement Benefit claim. Sovereign will only pay one Financial and Legal Advice Benefit per life assured across all Sovereign policies . This is in addition to the sum assured.
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The consultation and/or counselling must be paid for within 12 months following Sovereign paying the Total Permanent Disablement Benefit claim; and
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Sovereign must be provided with a receipt for the consultation and/or counselling being claimed.
The $2,500 is payable once per life assured per policy. This is in addition to the sum assured.
9. Premium Conversion Facility
You may at any time prior to the life assured reaching age 65:
12. Suspension of Premium Benefit A life assured can suspend their cover under this Total Permanent Disablement Benefit appendix for up to 12 months if they:
Convert all or part of your Total Permanent Disablement Benefit from the premium shown in the schedule to a Level premium structure. The Total Permanent Disablement Benefit under your policy will be reduced by the sum assured amount converted; or
go on parental leave;
Convert a Level premium Term to a further Level premium Term, of which duration may be the same or less than current Level premium Term. Sovereign will not require you or the life assured to produce further medical evidence at the time of conversion. The terms and conditions of the new policy will be those which are then offered by us to the general public. Premiums will be calculated on the current age of the life assured. Any special terms, exclusions or premium loading that applied to your existing Total Permanent Disablement Benefit will apply to your new Total Permanent Disablement Benefit.
go on leave without pay for any reason;
become unemployed or redundant;
experience at least a 20% reduction in pay (comparing the most recent payslip against a previous payslip from the same year); or 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:
You notify Sovereign within three months of one of the above listed suspension events occurring and provide evidence to Sovereign of the suspension event; and
10. Assistance Benefit
If Sovereign pays a claim under this Total Permanent Disablement Benefit, then subject to the following conditions, Sovereign 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 Sovereign pays the Total Permanent Disablement Benefit claim. You must provide to Sovereign with receipts and/or other evidence satisfactory to Sovereign for the costs you are claiming.
Sovereign acknowledges in writing receipt of that notification.
Cover for the life assured will be suspended from the date set out in Sovereign’s written acknowledgment.
No premium will be payable during the period that the cover is suspended.
No claim under this Total Permanent Disablement 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.
Sovereign shall be entitled to arrange for an
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