862 TCB-TPD version 9 Effective 12 May 2026
TOTALCAREMAX BUSINESS
OPTIONAL BENEFIT APPENDIX
Total Permanent Disablement
This appendix only applies if cover under the schedule includes the Total Permanent Disablement Benefit. This appendix forms part of and is incorporated into your TotalCare Max policy, the terms of which apply to this appendix .
This Total Permanent Disablement Benefit may be standalone or accelerated. Details of the benefit and the names of the people insured for the benefit (called the life or lives assured) are shown in the schedule .
1.
What effect does payment of an accelerated Total Permanent Disablement Benefit have?
If a life assured suffers an ‘any occupation total permanent disablement’ after reaching their 65 th birthday, they will be assessed under Section 3 b) or c) of this appendix . If Sovereign could not reasonably be expected to make an assessment of the life assured prior to their 65 th birthday they will be assessed under Section 3 b) or c) of this appendix .
When Sovereign pays an accelerated Total Permanent Disablement Benefit, the Life Cover Benefit for the life assured will decrease by the same amount. Any accelerated benefits relating to that Life Cover will be reduced, if necessary, so that those accelerated benefits do not exceed the decreased Life Cover Benefit. If the Life Cover Benefit is reduced to nil, all accelerated benefits relating to that Life Cover Benefit will be removed. The maximum combined amount payable for the Life Cover Benefit, Terminal Illness Benefit, Specified Terminal Conditions Benefit, accelerated Total Permanent Disablement Benefit and, if applicable, the accelerated Living Assurance Benefit and the accelerated Progressive Care Benefit is the amount of the Life Cover Benefit for that life assured.
3.
What does ‘any occupation Total Permanent Disablement’ mean?
A life assured has suffered an ‘any occupation Total Permanent Disablement’ if in Sovereign’s opinion he or she:
a) Becomes totally incapacitated by illness or accident and, as a result of that incapacity:
Is completely unable to engage in the occupation, or carry on the business, he or she was involved in immediately before becoming incapacitated; and For three consecutive months after that incapacity began, has not worked in any occupation or carried on any business or engaged in any other gainful employment ; and Following the three consecutive months is in the opinion of Sovereign, after consideration of the medical and any other evidence satisfactory to Sovereign, so incapacitated that it is unlikely he or she will ever be able to work in any occupation or engage in any other gainful employment for which he or she may be reasonably suited by education, training or experience, which would pay remuneration at a rate greater than 25% of the life assured’s earnings during his or her last 12 consecutive months of work ; or
2.
If you have selected an ‘any occupation Total Permanent Disablement Benefit’
Sovereign will pay you an ‘any occupation Total Permanent Disablement Benefit’ if at any time after the risk commencement date : A life assured suffers in Sovereign’s opinion an ‘any occupation total permanent disablement’ as defined in Section 3 below before reaching the policy expiry age as shown in the schedule ; and
The life assured survives for three months after becoming incapacitated.
Sovereign will pay only one ‘any occupation Total Permanent Disablement Benefit’ for each life assured.
The benefit is a lump-sum payment of the amount specified in the schedule .
b) Suffers by illness or accident the total and permanent loss of meaningful use of:
If you have selected an expiry age of age 70 as shown in the schedule :
Both feet (entire feet); or both hands (entire hands); or The sight in both eyes (to the extent that visual acuity is reduced to 6/36 or less in the better eye and/or the field of vision is reduced to 10 degrees or less of arc in the better eye); or
If a life assured suffers an ‘any occupation Total Permanent Disablement’ before reaching their 65 th birthday, they will be assessed under Section 3 a), b) or c) of this appendix .
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5.
What does ‘own occupation Total Permanent Disablement’ mean?
Any combination of two of: a hand, a foot or sight in an eye (to the extent that visual acuity is reduced to 6/36 or less and/or the field of vision is reduced to 10 degrees or less of arc); or
A life assured has suffered an ‘own occupation Total Permanent Disablement’ if he or she:
c) Becomes totally and irreversibly unable by illness or accident to:
a) In Sovereign’s opinion becomes totally incapacitated by illness or accident and, as a result of that incapacity: Is completely unable to engage in the occupation, or carry on the business, he or she was involved in immediately before becoming incapacitated; and
Perform at least two of the activities of daily living without the physical assistance of someone else (if the life assured can perform an activity on his or her own by using special equipment Sovereign will treat the life assured as being able to perform that activity); or Perform one of the activities of daily living and has permanent and irrecoverable cognitive impairment as evidenced by formal neuropsychological testing performed by a registered psychologist or psychiatrist, or assessment by an appropriate specialist . Any condition that Sovereign has reasonable grounds to expect can be reversed or improved by surgery or other treatment will not be considered to be a disablement covered by the ‘any occupation Total Permanent Disablement’ definition.
For the three consecutive months after that incapacity began, has not worked in that occupation or carried on that business; and
Is, in the opinion of Sovereign, after consideration of the medical and any other evidence satisfactory to Sovereign, so incapacitated that it is unlikely he or she will ever be able to resume work in that occupation or carry on in that business; or
b) Suffers by illness or accident the total and permanent loss of meaningful use of:
4.
If you have selected an ‘own occupation Total Permanent Disablement Benefit’
Both feet (entire feet); or both hands (entire hands); or
Sovereign will pay you an ‘own occupation Total Permanent Disablement Benefit’ if at any time after the risk commencement date : A life assured suffers in Sovereign’s opinion an ‘own occupation Total Permanent Disablement’ as defined in Section 5 below before reaching the policy expiry age as shown in the schedule ; and
The sight in both eyes (to the extent that visual acuity is reduced to 6/36 or less in the better eye and/or the field of vision is reduced to 10 degrees or less of arc in the better eye); or Any combination of two of: a hand, a foot or sight in an eye (to the extent that visual acuity is reduced to 6/36 or less and/or the field of vision is reduced to 10 degrees or less of arc); or
The life assured survives for three months after becoming incapacitated.
c) Becomes totally and irreversibly unable by illness or accident to:
Sovereign will pay only one ‘own occupation Total Permanent Disablement Benefit’ for each life assured.
Perform at least two of the activities of daily living without the physical assistance of someone else (if the life assured can perform an activity on his or her own by using special equipment Sovereign will treat the life assured as being able to perform that activity); or Perform one of the activities of daily living and has permanent and irrecoverable cognitive impairment as evidenced by formal neuropsychological testing performed by a registered psychologist or psychiatrist, or assessment by an appropriate specialist . Any condition that Sovereign has reasonable grounds to expect can be reversed or improved by surgery or other treatment will not be considered to be a disablement covered by the ‘any occupation Total Permanent Disablement’ definition.
The benefit is a lump-sum payment of the amount specified in the schedule .
If you have selected an expiry age of age 70 as shown in the schedule :
If a life assured suffers an ‘own occupation Total Permanent Disablement’ before reaching their 65 th birthday, they will be assessed under Section 5 a), b) or c) of this appendix . If a life assured suffers an ‘own occupation Total Permanent Disablement’ after reaching their 65 th birthday, they will be assessed under Section 5 b) or c) of this appendix . If Sovereign could not reasonably be expected to make an assessment of the life assured prior to their 65 th birthday they will be assessed under Section 5 b) or c) of this appendix .
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6.
When does an ‘own occupation Total Permanent Disablement Benefit’ cease?
9. Premium Conversion Facility
You may at any time prior to the life assured reaching age 65:
Cover under the ‘own occupation Total Permanent Disablement Benefit’ will cease and cover under the ‘any occupation Total Permanent Disablement Benefit’ will apply should the life assured of the benefit commence full-time domestic duties.
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 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.
7.
When will Sovereign pay a Partial Permanent Disablement Benefit?
Where the life assured has suffered:
Permanent loss of the entire use of one limb (entire hand or entire foot) as a result of illness or accident ; or
Irrecoverable loss of sight in one eye as a result of illness or accident to the extent that visual acuity is reduced to 6/60 or less in that eye and/or the field of vision is reduced to 20 degrees or less of arc. Sovereign will pay 25% of the Total Permanent Disablement Benefit sum assured up to a maximum of $100,000 across all Sovereign policies . Only one claim can be made for the Partial Permanent Disablement Benefit per life assured. 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.
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.
8.
Financial and Legal Advice Benefit
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.
Sovereign shall be entitled to arrange for an 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
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:
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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
requested increase to the amount of cover. You must include: − a valuation of the business or valuation of the life assured to the business (as provided by an independent qualified accountant or business valuer); and/or − evidence of the loan guarantee, and any other contractual or financial evidence we may request.
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.
Any increase is subject to approval by Sovereign.
12. Optional Business Safeguard Facility
The method chosen to value the business or life assured must be in accordance with established business valuation practice for the industry. The independent qualified accountant or business valuer cannot be a family member, business partner, employee or employer of you or the life assured. The method of valuation and valuer must be satisfactory to Sovereign. In the first six months following an increase, the life assured will only be covered for the amount of the increase if the life assured’s death occurs as a direct and sole result of an accident . You cannot apply for an increase under this Facility if at any time the life assured has made, or was entitled to make, a claim under your Life Cover Benefit or Total Permanent Disablement Benefit.
The Optional Business Safeguard Facility applies only if shown in the schedule and if you have selected an accelerated Total Permanent Disablement Benefit. On each occasion that the life assured’s financial interest in the business increases, or their loan guarantee increases, or their value to the business increases you may write to Sovereign asking us to increase the accelerated Total Permanent Disablement Benefit for that life assured without the need to provide medical evidence, subject to the following conditions: The Total Permanent Disablement Benefit for a life assured under this policy after the use of this Facility cannot exceed the lesser of five times the original Total Permanent Disablement Benefit or $5 million. Example 1: Original benefit = $100,000 Original benefit x 5 = $500,000 Cover available after the use of this Facility cannot exceed $500,000 Total increase under this Facility cannot exceed $400,000 Example 2: Original benefit = $1,500,000 Original benefit x 5 = $7,500,000 Cover available after the use of this Facility cannot exceed $5,000,000 Total increase under this Facility cannot exceed $3,500,000 The Total Permanent Disablement Benefit for a life assured under this policy after the use of this Facility cannot exceed the Life Cover Benefit for that life assured.
Each Optional Business Safeguard Facility increase will require an increase in premium . This increase will be
calculated on the rates applicable at the time the Optional Business Safeguard Facility is used.
13. Waiver of Total Permanent Disablement Waiting Period
Sovereign will at its discretion waive the three month waiting period when assessing a Total Permanent Disablement Benefit claim if: In Sovereign’s opinion, the life assured has met all other requirements for payment of a Total Permanent Disablement Benefit; and
Sovereign expects the life assured to survive beyond three months after the incapacity began.
In exercising this discretion, Sovereign will consider whether the medical condition of the life assured enables an assessment to be made immediately in respect of whether the life assured has met all other requirements for payment of a Total Permanent Disablement Benefit. Sovereign will not waive the three month waiting period if, in our opinion, after considering suitable medical evidence, we believe that the life assured may die within three months after the incapacity began. A decision not to waive the three month waiting period will not affect our consideration of a Total Permanent Disablement Benefit claim for the life assured if the life assured survives for three months after the incapacity began.
After the use of this Facility, the Total Permanent
Disablement Benefit for a life assured under this policy plus any other Total Permanent Disablement cover held on the life assured with any provider cannot exceed $5 million.
In any 12 month period you can make only two increases under this Facility.
You must make the request within three months of the relevant business event.
To apply for the increase in cover, you need to write to Sovereign to satisfy us that the value of the life assured’s financial interest is at least equal to the
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14. How to make a claim
17. Key terms
To make a claim, the relevant procedures in the section of your TotalCare Max policy entitled ‘How to make a claim’ must be followed.
accident
Injury caused by violent, accidental, external and visible means.
In addition, for a Total Permanent Disablement Benefit claim, Sovereign will require:
Either an Adviser with a current financial adviser agreement with Sovereign Services Limited or a member of a financial services industry body approved by Sovereign.
accredited Adviser
The life assured to be examined by a registered medical practitioner acceptable to Sovereign, before accepting liability for a claim.
A Sovereign claims form completed by the life assured and a registered medical practitioner (at your expense).
Bathing and showering.
activities of daily living
Other information which Sovereign may reasonably request to help assess the claim, which may include evidence of earnings, taxable income, business accounts, Accident Compensation Corporation details or similar. 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
Dressing and undressing.
Eating and drinking.
Using a toilet.
Moving from place to place by walking, in a wheelchair, or with a walking aid.
practitioner or a registered medical practitioner approved by Sovereign considers necessary.
Any biological child/children, adopted child/children or child/children under the legal guardianship of:
Any other information that Sovereign may deem relevant to the assessment of the claim.
child/children
15. Exclusions – when Sovereign won’t pay a benefit
a life assured; or
Sovereign will not pay any Total Permanent Disablement Benefit where any of the following (and in each case either directly or indirectly) causes or contributes to the disablement:
the spouse, civil or de facto partner of a life assured.
A relative who is the life assured’s spouse, civil or de facto partner, mother, father, step mother, step father, brother, sister, step brother, step sister, child , grandfather or grandmother Working to generate income through personal efforts by using the life assured’s time and skills. He or she can be self- employed, employed, earning fees, under contract, receiving commissions, working on contract or otherwise remunerated for his or her efforts.
close relative
The life assured deliberately injures himself or herself or attempts to do so; or
The life assured engages in or is part of any conduct that is criminal.
These exclusions apply to any subsequent benefit increase you make.
gainful employment
16. When will this appendix terminate for a life assured?
This appendix will terminate and eligibility for the Total Permanent Disablement Benefit will cease for a life assured:
When the life assured dies; or
When the benefit is cancelled by the policy owner; or
When the full sum assured has been paid.
Any policy or policies where Sovereign is the insurer.
Sovereign policies
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specialist
A registered medical practitioner who has an approved fellowship in one of the approved surgical, anaesthetic or traditional non-surgical colleges and who is registered with the New Zealand Medical Council. These include, but
are not limited to, the following disciplines: general surgery,
orthopaedic surgery, urology, neurosurgery, anaesthesiology, cardiology, endocrinology, gastroenterology, haematology, paediatrics, gynaecology, obstetrics, neurology, oncology, renal
specialists and rheumatology.
Personal effort using the life assured’s time and skills, whether or not income is generated for the life assured. Worked and working shall have similar meanings.
work
The ‘Policy Owner’ named in the schedule .
you/your
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