AIA Living Business TPD Policy Wording
AIA LIVING - BUSINESS PERSONAL OPTIONAL BENEFIT APPENDIX
Waiver of Premium Benefit
This appendix only applies if cover under the schedule for your policy includes the Waiver of Premium Benefit. This appendix forms part of and is incorporated into your AIA Living policy, the terms of which apply to this appendix .
This is a Waiver of Premium Benefit. Details of the benefit and the life / lives assured are shown in the schedule .
1.
When will AIA waive the regular premiums payable under this AIA Living policy?
before the disablement date and is not working in that role; or
engage in the occupation they were involved in immediately before the disablement date for more than ten hours per week; and not in fact working or engaged in any other occupation or business. If a life assured has been on leave without pay for 12 months or less, or was unemployed for less than three months immediately before becoming totally disabled , the references in the above to “immediately before the disablement date ” are replaced by references to “immediately before going on leave or becoming unemployed ”.
AIA will waive the regular premiums payable under this AIA Living policy if, in AIA ’s opinion, at any time during the waiver of premium term the life assured becomes totally disabled and remains so for a continuous period greater than the waiting period . If cover for a life assured under another appendix of this AIA Living policy includes a partial disability benefit, then AIA will waive the regular premiums payable under this AIA Living policy after the end of the waiting period where the partial disability benefit criteria are met for the life assured under that other appendix . While AIA is waiving the regular premiums payable under this AIA Living policy, you may not change the benefits of the policy. The waiver relates to premiums payable under this AIA Living policy which fall due for payment after the end of the waiting period . AIA will waive the regular premiums payable under this AIA Living policy until the occurrence of any one or more of the events set out in Section 5.
For occupation class five:
In AIA ’s opinion, the life assured is:
disabled to such an extent that necessitates confinement to the home under medical supervision or to a recognised medical institution and necessitates receiving regular medical care; or
as a result of sickness or injury, he or she is unable to perform at least two of the activities of daily living without the 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); and in each case, not working in any gainful occupation or engaged in voluntary work.
2.
What does totally disabled mean?
The definition of totally disabled that applies for a life assured depends on the life assured’s occupation class. The occupation class for each life assured is shown in the schedule . However, if a life assured has been on leave without pay for more than 12 months or was unemployed for three months or more immediately before becoming totally disabled , that life assured is automatically classed as occupation class five. For each occupation class, the degree of incapacity which constitutes total disablement is as follows:
3.
How to make a claim for the Waiver of Premium Benefit
To make a claim, the relevant procedures in the section of your AIA Living policy entitled ‘How to make a claim’ must be followed. In addition, for a Waiver of Premium Benefit claim, AIA will require: the life assured to be examined by a registered medical practitioner acceptable to AIA , before accepting liability for a claim; and an AIA claims form completed by the life assured and a registered medical practitioner (at your expense); and
For occupation classes other than occupation class five:
In AIA ’s opinion, the life assured is totally disabled , if as a direct result of sickness or injury, he or she is: Under the regular and personal care of a registered medical practitioner ; and
Unable to:
perform at least one important income producing duty of the role they were involved in immediately
other information which AIA may reasonably request to
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help assess the claim; and
(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. (g) The life assured is in prison or sentenced to home detention for any reason.
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; and any other information that AIA may deem relevant to the assessment of the claim.
(h) The life assured dies.
If AIA ceases waiving the regular premiums payable under this policy 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.
4.
Ongoing Claim Requirements
For ongoing claims AIA will require:
Completion of a monthly medical certificate by a registered medical practitioner (at your expense) in a form from time to time approved by AIA for the purposes of determining ongoing entitlement to a Waiver of Premium Benefit. Completion of a monthly individual declaration by the life assured in a form from time to time approved by AIA , which may include completion of daily activity logs detailing the life assured’s functional activities for the purposes of determining ongoing entitlement to a Waiver of Premium Benefit. Proof of any remunerated or non-remunerated work completed during the claim period. Any other information that AIA may deem relevant to the ongoing assessment of the claim.
> The waiting period will be waived for the new claim.
> AIA will not waive the regular premiums payable under this AIA Living policy retrospectively for any period of time before the date that the life assured complies with the relevant requirement(s).
6.
Exclusions – when AIA won’t waive the regular premiums
AIA will not waive the regular premiums payable under this AIA Living policy where any of the following directly or indirectly cause or contribute to the disability: The life assured deliberately injures himself or herself or attempts to do so. The life assured engages in or is part of any conduct that is criminal. 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. The life assured does not comply with the treatment prescribed by the attending treatment providers. If the life assured is imprisoned or sentenced to home detention for any reason, regular premiums will not be waived during the term of imprisonment.
5.
When will AIA cease waiving the regular premiums payable under this AIA Living policy?
AIA will cease waiving the regular premiums payable under this policy if:
(a) The life assured fails to undergo and complete:
> any surgical operation; and/or
> any medical rehabilitation; and/or
> any social rehabilitation; and/or
> any vocational rehabilitation,
which a registered medical practitioner approved by AIA considers reasonably necessary. (b) The life assured fails to undertake any medical examinations that AIA requires the life assured to have, at our expense. (c) The life assured fails to comply with the requirements of Section 4 above. (d) AIA determines that the life assured is no longer totally disabled, or a partial disability benefit is no longer payable in respect of the life assured under another appendix of this AIA Living policy. (e) The waiver of premium term expires in relation to the life assured .
7.
Key terms
Activities of Daily Living are:
activities of daily living
> Bathing and showering.
> Dressing and undressing.
> Eating and drinking.
> Using a toilet.
Moving from place to place by walking, in a wheelchair or with a walking aid.
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disablement date
The date the life assured became totally disabled .
totally disabled
See Section 2 of this appendix for the meaning of this key term.
Total disablement has a corresponding meaning
unemployed
A person who is not engaged in remunerated work or business activities for 10 hours or more a week. This definition does not include a person on leave without pay. The period stated in the schedule for this Waiver of Premium Benefit during which AIA will not waive the regular premiums payable under this AIA Living policy.
waiting period
waiver of premium term
The term the life assured is covered for the Waiver of Premium Benefit as stated in the schedule .
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