We’ll start paying this cover if, during the cover term, the life assured is diagnosed as being totally or partially disabled for a continuous period longer than the waiting period.
We’ll pay a Total Disability Benefit while the life assured is:
unable to work in their usual occupation for more than 10 hours per week; or
unable to perform at least 75% of the key tasks and responsibilities of their usual occupation; and
is under the ongoing care of a medical doctor or specialist; and
is complying with the recommended treatment; and
is not undertaking any other paid work other than up to ten (10) hours per week in their usual occupation; and
they are not incarcerated in a penal institution at the commencement of incapacity.
We’ll pay a Partial Disability Benefi t while the life assured is:
working in their usual occupation for less than seventy-fi ve percent (75%) of the average weekly hours worked in the twelve (12) months immediately before becoming disabled; and
is under the ongoing care of a medical doctor or specialist; and
is complying with the recommended treatment.
We’ll continue paying the applicable benefit until the earliest of the following events happening:
the life assured is no longer totally or partially disabled;
the employment of the life assured by the business comes to an end (other than as a result of their illness or injury);
the payment term ends;
the cover term expires;
the life assured is incarcerated in a penal institution.
A connected claim happens if we start paying a claim and:
the life assured goes back to work but has to stop work again within 6 months
the reason for the further period of total or partial disablement is the same illness or injury
the recurrent disability lasts for 30 continuous days
We’ll treat the further period of incapacity as a connected claim and, because this is a continuation of the previous claim, we won’t apply another wait period. We’ll calculate the remainder of the claim payment terms as the payment term less the number of months for which your claim was previously paid.
The life assured must have been actively employed by the business and have worked for an average of 25 or more hours per week in the 4 consecutive weeks immediately prior to the incapacity, otherwise they will be considered to be a part-time employee and will not be covered.
If the life assured is on employer approved leave without pay when they become incapacitated and they have been on leave for less than 2 months, we will treat the life assured as if they were actively employed.
If you want the life assured to be regarded as actively employed in circumstances where they may be on employer approved leave without pay for more than 2 months you can select the Leave Without Pay Option. The Leave Without Pay Option allows the life assured to be on employer approved leave without pay and still be regarded as actively employed, for up to 12 months.
Because a person can suffer a serious illness that would trigger certain financial business conditions but may not meet the claims triggers on traditional Trauma, Severe Trauma or Total & Permanent Disability Covers, we have introduced the new, unique concept of ‘total long term disablement’.
The concept of ‘total long term disablement’ is that we will consider a claim if the covered person has been suffering an illness or injury which leaves them totally unable to do their own job for 3 months, and is likely to prevent them from being able to go back to that job for at least a further 6 months* into the foreseeable future.
We believe, on balance, that this trigger is more closely aligned to the likely timing for the following key business decisions, and therefore gives the business owners more certainty about outcomes:
the buy-sell agreement being enforced;
the business debt requiring repayment;
the business having to fund the replacement of a key person or sole trader;
As well as the covers described above, you can also add the following traditional covers.
Total and Permanent Disability Cover
Severe Trauma Cover
These standard Partners Life covers can also be used to fund buysell agreement commitments, debt repayment commitments and key person replacement costs in the event of the death, terminal illness, total and permanent disability or trauma of a sole trader or key employee or an owner or debt guarantor (whether employed within the business or not).
They can also be used to fund business debt re-payment in the event of the death of any individual. Finally, they can also provide capital to the business to fund replacement costs and loss of revenue in the event of the death of a key employee of the business.
We all want our business to be successful and to grow. As it grows, you might need to take out more cover. Whether your business grows because of a key person becoming more important, a shareholder’s interest becoming more valuable, or an increase in the business debt, by selecting Business Future Insurability Option – you can increase your cover, without having to give us any medical information about the covered person.
You can also choose whether you have all the covers on one policy or split over multiple policies to facilitate differing ownership requirements and it won’t cost you any extra to have the cover split over multiple policies.
Claims time is when it counts. Our intention is to manage claims fairly and ethically, irrespective of what the law might allow us to do as a life insurer, and this is a legally binding promise. We have included our commitment to our claims philosophy into our policy wordings – so we are contractually obliged to behave this way.
If the covered life ceases to be a shareholder, sole trader, key employee or debt guarantor of the business, or if your business goes into receivership, and as a result the covers under the policy are cancelled, Partners Life will allow these covers to be converted to personal Life, Trauma, Severe Trauma or Total and Permanent Disability covers under the Partners Protection Plan, without further health assessment, within 3 months following the cancellation date (some limits and exclusions apply).
Your Life Cover, TPD Cover, Trauma Cover and Severe Trauma Cover is valid wherever you may be in the world. However, for the following, Cover is worldwide as long as the life assured remains an owner, a key person, actively involved in the business operations or liable for business debt:
This overview is a marketing document that highlights a number of the key features of Specific Condition Cover. The full terms and conditions that apply to those features and to the overall Partners Protection Plan are detailed in the Specific Condition Cover Protection Benefit Sheet and Partners Protection Plan Policy Document available from your adviser