10. Ongoing claim requirements
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).
>
For ongoing claims Sovereign will regularly require: > Completion of a monthly medical certificate by a Registered Medical Practitioner (at your expense) and in a form from time to time approved by Sovereign for the purposes of determining ongoing entitlement to payment of a 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 benefit. > Proof of any remunerated or non-remunerated work completed by the life assured during the claim period. > Any other information that Sovereign may deem relevant to the ongoing assessment of the claim.
12. Exclusions – When Sovereign won’t pay a benefit Sovereign will not pay a benefit where any of the following directly or indirectly cause or contribute to the total 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. > The life assured does not comply with the treatment recommended by the attending treatment providers. > 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.
11. When will Sovereign cease paying a benefit?
Sovereign will cease paying a benefit if:
If the life assured is imprisoned for any reason, no monthly benefit will be payable during the term of imprisonment.
(a) The life assured fails to undergo and complete: - any surgical operation; and/or - any medical rehabilitation programme; and/or - any social rehabilitation programme; and/or - any vocational rehabilitation programme, which a Registered Medical Practitioner approved by Sovereign considers reasonably necessary. (b) The life assured fails to undertake any medical examinations that Sovereign requires the life assured to have, at our expense. (c) The life assured fails to comply with the requirements of Section 10 above. (d) Sovereign determines that the life assured is no longer totally disabled . (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. (g) The life assured ceases to be actively involved in the business , unless the reason for this is related to the claim. (h) The life assured is in prison for any reason. (i) 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 policy , be treated as the disablement date for a new claim. > The waiting period will be waived for the new claim. > The original claim and the new claim will be considered to be the same claim in respect of the benefit payment period .
13. When can your policy be cancelled?
Policy termination This policy will terminate and eligibility for the Start-Up Income Protection Benefit will cease for the life assured:
> At the expiry of the policy term for the life assured as shown in the schedule .
When the life assured dies.
>
> If the life assured is no longer actively involved in the business for more than 60 days for reasons other than total disablement , unless Sovereign has been notified in writing and its written consent has been given for the continuation of the policy. > If the life assured sells his or her ownership interest in the business . However, if the life assured remains in the business as a key employee, you may apply to Sovereign in writing to continue the benefit. If the life assured is on claim and the reason for selling his or her ownership interest is due to the total disability of the life assured, the policy will remain in force until the life assured ceases to be totally disabled or the end of the benefit payment period, whichever is earlier. > If the business is wound-up or liquidated, unless Sovereign has been notified in writing and its written consent has been given for the continuation of the policy. However, if the life assured is on claim and the reason for the business being wound-up or liquidated is due to the total disability of the life assured, the policy will remain in force until the life assured ceases to be totally disabled or the end of the benefit payment period, whichever is earlier. > When the policy is cancelled by the policy owner.
420 Start-Up IP version 7 Effective 06 March 2017
Page 4 of 8
Powered by FlippingBook