10. How to make a claim To make a claim, the relevant procedures in the section of your TotalCare Max policy entitled ‘How to make a claim’ must be followed. In addition, for a Rural Continuity Benefit claim, Sovereign will require: > the life assured to be examined by a registered medical practitioner acceptable to Sovereign before accepting liability for a claim; and > a Sovereign claims form completed by the life assured and a registered medical practitioner (at your expense); and > other information which Sovereign may reasonably request to help assess the claim; and > the life assured to undergo medical and/or surgical 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 > any other information that Sovereign may deem relevant to the assessment of the claim. 11. Ongoing claim requirements For ongoing claims Sovereign 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 Sovereign for the purposes of determining ongoing entitlement to payment of a Rural Continuity 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 Rural Continuity Benefit. > Proof of any remunerated or non-remunerated work completed during the claim period. > Any other information that Sovereign may deem relevant to the ongoing assessment of the claim. 12. When will Sovereign cease paying a benefit? Sovereign will cease paying a benefit if: 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 11 above. d) Sovereign determines that the life assured is no longer totally disabled or partially 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 farming , unless the reason for this is related to the claim. 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. > 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 . > 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). 13. When will this appendix terminate for a life assured? This appendix will terminate and eligibility for the Rural Continuity Benefit will cease for a life assured: > At the expiry of the benefit term for that life assured as shown in the schedule . > When the life assured dies. > If the life assured is no longer actively involved in the farm for more than 60 consecutive days for reasons other than total disability , unless Sovereign has been notified in writing and its written consent has been given for the continuation of the appendix . > If the farming business is wound-up or liquidated or the farm is sold or its lease ends, unless Sovereign has been notified in writing and its written consent has been given for the continuation of the appendix . However, if the life assured is on claim and the reason for the farming business being wound-up or liquidated is due to the total disability or partial disability of the life assured, the benefit will remain in force until the end of the benefit payment period . > When the benefit is cancelled by the policy owner.
864 TCB-RC version 4 Effective 21 May 2019
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