5.
What is the amount of the Partial Disability Income Benefit?
more than ten hours per week; and
not working or engaged in any other occupation business.
The amount that Sovereign will pay monthly is worked out in the following way:
For Occupation class five:
Take the lower of:
In Sovereign’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 an adult; and not working in any gainful occupation or engaged in voluntary work.
a) 1/12 th of the benefit amount shown in the schedule ; or b) 75% x ( pre-disability income less the monthly amount the life assured is earning or is capable of earning from eligible sources while disabled). For the purposes of this calculation, income from eligible sources excludes passive income such as investment income or rental income.
Subtract from this amount each of the following:
Any other income replacement or mortgage protection benefits that any person receives or is entitled to receive from any sources in relation to the life assured and in respect of the same or a related disability (for example payments from ACC or another insurer), with the following provisions:
4.
When will Sovereign pay a Partial Disability Income Benefit?
If the life assured has been totally disabled or partially disabled and then immediately thereafter engages in work or carries on business at a reduced level than was the case before becoming totally disabled or partially disabled, then a Partial Disability Income Benefit may apply.
Where the life assured is covered by income replacement or mortgage protection benefits held with more than one provider, Sovereign will negotiate with the other provider(s) to determine the amount to be subtracted.
The following conditions must be satisfied:
the reduction in work capacity results from the continuation of the disability; and
If the life assured is entitled to receive a benefit from ACC but is not receiving that benefit because the life assured has either not applied for the benefit, or has not provided all of the requirements necessary to assess the benefit, or the benefit has been stopped due to any non-compliance with ACC requirements, Sovereign will subtract the full ACC entitlement regardless of whether the life assured is receiving a payment or not. The life assured’s sick leave payments, subject to a maximum of 10 days’ sick leave payments for all claims resulting from the same or a related disability.
because of the reduction in work capacity, the life assured earns less than 75% of the life assured’s pre- disability income ; and
the waiting period is over; and
the life assured is in an Occupation class other than Occupation class five at the time of becoming totally disabled ; and
the life assured is no longer totally disabled ; and
if applicable, the period in respect of which a Total Disability Income Benefit has been paid in advance has expired. The Partial Disability Income Benefit will be paid monthly in arrears until, in Sovereign’s opinion, after considering the advice of a registered medical practitioner and other relevant information, the disability is no longer preventing the life assured from earning at least 75% of their pre-disability income , or until the end of the benefit payment period , whichever is the earlier. A Partial Disability Bridging Benefit (as set out in Section 6) will also be paid if you have been receiving a Total Disability Income Benefit under this appendix before you commence receiving a Partial Disability Income Benefit. Any claim for a subsequent Partial Disability Income Benefit must be immediately preceded by a 14 day period of total disability . Please refer to Section 7 for “What is the Recurrent Disablement Benefit?”
For example:
Pre-disability income
$5,000 per month
Monthly amount the life assured is earning or is capable of earning from eligible sources while disabled
$3,000 per month
Benefit amount shown in the schedule
$45,000 per annum ($3,750 per month)
ACC entitlements for the same disability
$500 per month
809 TCP-EDI version 6 Effective 21 May 2019
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