23. How to make a claim
a related condition ):
The life assured (or a child in the case of a Built-in Children’s Trauma Benefit or the Optional Children’s and Maternity Benefit) deliberately injures himself or herself or attempts to do so. The life assured (or a child in the case of a Built-in Children’s Trauma Benefit, the Built-In Parents Grieving Benefit or the Optional Children’s and Maternity Benefit) engages in or is part of any conduct that is criminal. Sovereign will not pay any benefit under this appendix where any of the following occurs before a life assured (or any child in the case of a Built-in Children’s Trauma Benefit, Built-in Parents Grieving Benefit or the Optional Children’s and Maternity Benefit) reaches age 21, and (in each case either directly or indirectly) causes or contributes to a claim for that life assured (or child ):
To make a claim, refer to the section in your Sovereign TotalCareMax policy entitled ‘How to make a claim’.
In addition, for a Progressive Care Benefit claim, Sovereign will require information acceptable to us, including medical evidence and reports, showing proof of the condition giving rise to the claim. Sovereign may require the life assured to have an examination by a registered medical practitioner or specialist appointed by Sovereign before accepting liability for a claim. Where the Optional Total Permanent Disablement condition is the condition giving rise to the claim, Sovereign will also require: A Sovereign claims form completed by the life assured and a registered medical practitioner (at your expense). 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
any intentional act by you or by any parent or guardian of the life assured, or child .
any intentional act by someone who lives with or supervises the life assured, or child .
Sovereign will not pay any benefit under this appendix for:
Any condition ; or
Any symptom or sign that leads to a condition
that existed before the risk commencement date (whether or not a registered medical practitioner has been consulted), unless Sovereign is satisfied that: You and the life assured could not have known of the existence of the condition or the symptom or sign that led to the condition ; or The condition or symptom or sign that led to the condition was declared on your application and accepted by Sovereign. Sovereign will not pay a benefit under the Built-in Children’s Trauma Benefit or the Children’s Critical Conditions Benefit in the Optional Children’s and Maternity Benefit that arises as a direct or indirect consequence of:
medical practitioner or a registered medical practitioner approved by Sovereign considers necessary.
Any other information that Sovereign may deem relevant to the assessment of the claim.
For advice about submitting a claim you can phone Sovereign on 0800 500 108 or your Adviser. Find claim information online at sovereign.co.nz
a pre-existing condition ; or
any congenital condition , except where expressly covered under the Children’s Congenital Conditions Benefit.
These exclusions also apply to any subsequent sum assured increase you make.
818 TCP-PC version 12 Effective 12 May 2026
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