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
862 TCB-TPD version 9 Effective 12 May 2026
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