When do benefit payments commence?
For injury and sickness cover, once we admit liability on an insured persons claim, and the waiting period has expired, benefit payments start to accrue. Benefits are paid 14 days in arrears.
When do disability benefit payments reduce?
Benefits are reduced by other income benefits received from other sources in respect of the period of disability. This includes other disability income payments such as workers compensation and other statutory benefits such as traffic accident compensation payments. The benefit amount is reduced by the benefits received from these other sources. Benefits are reduced by sick leave or other not at work related payments. This will not apply if the sick leave or other not at work related payment is repaid and re-credited to the insured person.
Where the insured person is partially disabled and returns to work in a reduced capacity, weekly benefits will be calculated as follows:
a= Pre-Disability Income
b= Return to Work Income
c= Total Disability Benefit
a-b⁄a x c
If the insured person is capable of returning to work in a reduced capacity but refuses, weekly benefits will reduce to a maximum of 25% of the total disability benefit.
What happens if an insured person has a recurring disability?
If within 6 months after the cessation of total disability or partial disability benefit payments, the insured person again becomes totally disabled or partially disabled due to the same or a related injury or sickness, we will waive the waiting period and regard the total disability or partial disability as a continuation of the previous claim. The maximum benefit period will be reduced by the period over which benefit payments were previously made.
In the event an insured person has received a disability benefit for a period of at least 6 months while insured under a period of previous cover, the benefit period under the policy will be reduced by the previous benefit period in the event the claim is for the same or related cause.
If an insured person suffers a recurrence of total disability and/or partial disability for the same or a related sickness or injury, the subsequent period of total disability and/or partial disability will be deemed to have resulted from a new injury or sickness if the insured person worked on a full time basis for a period of 6 months performing all the duties of their usual occupation between such periods of total disability and/or partial disability.
When do disability benefit payments cease?
Total or partial disablement benefits will automatically cease at the earliest date where:
- the insured person is no longer totally or partially disabled, whichever is applicable;
- the maximum benefit period expires;
- the insured person reaches the benefit ceasing age of 70 for sickness and age 70 for injury; or
- the insured person dies.
If an insured person suffers total or partial disability whilst residing or travelling outside Australia, the payment of benefits will cease 6 months after the date of commencement of total or partial disability unless the insured person has permanently returned to Australia or another country acceptable to us.