CBUS Personal Accident & Sickness Insurance
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CBUS Personal Accident &
Sickness Insurance
PRODUCT DISCLOSURE STATEMENT (PDS)
Preparation Date: 1 November 2014
The purpose of this PDS Cooling-off Period
This PDS has been prepared to help You decide: You are entitled to end this insurance cover prior
to the expiration of 14 days from the earlier of:
Whether this product will meet Your needs; the date You received confirmation of the
and
insurance transaction; or
Compare this product with any other the date the policy was issued to you
products You may be considering.
unless You have made a claim under this policy.
The unexpired portion of the premium less any
It sets out the significant features of the
non-refundable government taxes and duties will
insurance policy including its benefits, the risks
and information on how the insurance premium is then be repaid to you. You can also cancel the
calculated. You must still read the policy wording policy at other times in accordance with the terms
to ensure it meets Your needs. An index is shown in the policy.
provided to help You.
Your Duty of Disclosure
This statement and policy wording is only being
provided for comparison purposes. We have not You must tell Us anything that You know, or
considered Your personal needs or financial should know, that could affect Our decision to
situation in providing this statement and policy insure You and or the terms on which We insure
wording and/or quotation. If necessary You You. Full details are provided in the application
should seek separate professional advice. form and policy.
The Insurer The Purpose of the Cover
The insurer of this product is WFI Insurance This policy provides personal accident and illness
Limited ABN 24 000 036 279 AFS Licence No. cover for groups of individuals who are between
241461, trading as Lumley Insurance. You can the ages of 16 and 65 at the time of application.
contact Us by: Based on individual circumstances, these age
Telephone: (03) 86274333 limits may be varied by the company. It is an
Fax: (03) 86274312 annual renewable cover. The policy is not
In Writing: GPO Box 2764 Melbourne, Vic 3001. guaranteed renewable.
Freecall: 1300 651 654
Website: www.lumley.com.au How to Apply for Insurance
General Insurance Code of Practice Complete the application form and forward it to
Your Broker, representative or Us. If Your
We subscribe to the General Insurance Code of application is accepted, We will send You a
Practice that sets the standards of practice and schedule that sets out details of the insurance
service for the insurance industry. It is Our aim You have taken out. Please keep this policy
to provide a quality service to You, Our customer. wording and attach the Schedule to it.
In the event We do not achieve Our aim and
How to Make a Claim
cannot resolve the matter with You, We have a
dispute resolution process that You can access.
If You wish to make a claim, please contact Your
Full details appear in the policy under Code of
Practice. Broker, representative or Us. Details about
making a claim are shown in the policy wording.
ACHPDS50301114 1Taxation
The Total Cost
All government charges and taxes are shown
separately on the insurance schedule. Details Your premiums are calculated taking into account
about the Goods and Services Tax are shown in the many and varied risk factors. They are
the policy. payable annually or by instalments if so indicated
on the application form.
Excess Period
Your total premium includes all government
In the event of a claim, You may not receive any charges which are shown separately on the
payment until an Excess Period has expired. The schedule.
Excess Periods are described in the policy and
shown on Your Schedule. Premium rates may be changed but only on
renewal of the policy. You will be given at least
Significant Features and Benefits 14 days notice of the annual expiration of the
policy and of the renewal terms.
The policy provides for:
Weekly payments if you are temporarily
totally disabled through sickness or injury;
Weekly payments if you are temporarily
partially disabled through injury;
A capital sum payment if you lose your
hearing, an eye or limb.
An optional extra benefit of repayment of
certain business expenses.
The main benefits are:
You chose the amount of cover you
need;
The cover is world-wide;
There is cover for exposure to the elements
as a result of injury;
Death benefits are payable if your body is
not found following the sinking or wreckage
of the vehicle you are travelling in.
What is Not Covered
This policy will not provide cover in some
circumstances nor for some illnesses or injuries.
You should read the policy Exclusions for full
details. Some of the main exclusions are
sickness or injury caused by or resulting from:
Self-infliction
War and terrorism
Aerial activities
Professional sports
Pregnancy or childbirth
Criminal acts
Pre-existing conditions
Significant Risks
Your duty of disclosure is very important. If You
have not disclosed something We may be
entitled to refuse to pay a claim and it can have
consequences on Your future cover.
ACHPDS50301114 2INDEX PAGE 1. When You ask for cover, You must tell Us all
that You know about the risk that You want
Product Disclosure Statement .. .. .. 1 covered that may affect Our decision:
(a) To offer You cover, and
Introduction .. .. .. .. .. 3 (b) The terms and the cost of such cover.
Important Notices .. .. .. 3 2. If You ask for the cover to be renewed,
altered or reinstated You must tell Us:
Code of Practice .. .. .. 3 (a) If there have been any changes in what
Privacy .. .. .. . .. 4 is covered, and
(b) Of all things that may increase the
Definitions .. .. .. .. 5 chances of a claim.
Agreement to Cover .. .. .. 7
NON DISCLOSURE
Additional Benefits .. .. .. 7 If You don’t tell Us something that You know that
Optional Extras “ 7 may affect Our decision to offer You cover or the
terms of that cover We may be allowed to:
Conditions .. .. .. .. 8 1. Reduce the amount that We have to pay for a
Exclusions .. .. .. .. 9 claim. This may mean that We would pay
You nothing.
Making a Claim .. .. .. .. 9 2. Cancel this policy. We may even be allowed
Table of Benefits .. .. .. 10 to cancel this policy from the date that the
cover started if You lie to Us or deliberately
keep information from Us or mislead Us.
INTRODUCTION
WHAT YOU DON’T HAVE TO TELL US
This Policy and the attaching Schedule are You do not have to tell Us of anything:
important documents and provide proof of the 1. That reduces the chances of a claim;
contract between You and Us, WFI Insurance 2. That is common knowledge;
Limited ABN 24 000 036 279. Please keep them 3. That We should know as a normal part of Our
in a safe place. business;
4. If We waive Your Duty of Disclosure.
Please read the Policy and Schedule carefully and
together to ensure that You fully understand them IF YOU REDUCE OUR RIGHTS
and that they provide You with the protection that We will not pay that part of a claim where You or
You need and that the interests and amounts an Insured Person have agreed to limit or exclude
insured are those that You selected. A copy of this their rights to recover their loss from another
policy document and the attaching Schedule must party.
be made available to all those employees covered
under it. PROVING YOUR LOSS
If You make a claim We will ask You or the
If it is not completely in accordance with Your Insured Person to justify the amount claimed. We
intentions or You are in doubt as to the meaning suggest that records be kept to make this task
or effect of the wording, please contact Your easy.
Broker, Agent or representative immediately for
clarification. GOODS AND SERVICE TAX (GST)
This policy is subject to a Goods and Services
The Policy Schedule that accompanies this Tax by You in relation to premium.
document shows those Sections of the Policy
which are in force, the people or organizations CODE OF PRACTICE
covered, the amounts of cover You have, any
excess applicable and any special terms that may We subscribe to the General Insurance Code of
change the cover provided under the standard Practice that sets the standards of practice and
Policy. service for the insurance industry.
IMPORTANT NOTICES It is Our aim to provide a quality service to You,
Our customer. However We recognize that
YOUR DUTY OF DISCLOSURE occasionally there may be some aspect of Our
This policy is subject to The Insurance Contracts service or a decision We have made that You
Act 1984. Under that Act You have a Duty of wish to query or draw to Our attention.
Disclosure.
This means:
ACHPDS50301114 3If after talking to Us, You wish to take the matter At the time of collection or as soon as practicable
further, We have a complaints and dispute thereafter We will notify You or make sure You
resolution procedure that undertakes to provide are aware of Our identity, contact details, the
an answer to Your matter within 15 working days. purposes for which We collect the information,
If Your dispute is about a claim and You are not the consequences of not providing the
happy with Our answer or We have taken more information, how You can access and correct the
than 15 days to respond, You may refer the information, that We will disclose the information
matter to the Insurance Ombudsman Services overseas and the countries We will so disclose to.
(IOS) which is an external disputes resolution
body that is free to consumers.
Use and disclosure
We may disclose Your personal information to
We are bound by their decision but You are not
and if You disagree, can still pursue the matter companies in the Insurance Australia Group (IAG),
further through other channels. Please telephone Our agents, overseas service providers, other
Us or the Insurance Council of Australia for the insurers, mailing houses and document service
IOS’s contact number. providers, financial institutions, insurance and
claim reference agencies, credit agencies, loss
PRIVACY assessor and adjusters, financial or investigative
service providers, internal dispute resolution
We are committed to meeting Our privacy officers and dispute resolution providers such as
obligations to You under the Privacy Act 1988 the Financial Ombudsman Service.
(Cth) (‘the Act’). The Act provides for information
to be collected, used, disclosed and held in We use and disclose Your personal information for
accordance with the Australian Privacy Principles the purposes of providing insurance,
(APPs). administration of Your policy, claims handling and
dispute resolution.
You agree that We may collect, use, disclose and
hold Your personal information as set out below. We may also use or disclose Your personal
information for a secondary purpose and You
Collection agree that We may so use it.
We collect information which is reasonably
necessary to provide Our services for underwriting Indirect collection
and administering Your insurance, claims When You provide information about other
handling, market and customer satisfaction individuals You must make them aware of the
research and to develop and identify products and disclosure and the use to which their personal
services that may interest You. Collection will only information will be put.
take place by lawful and fair means.
We will only collect personal information about an
We collect information regarding You, other individual from that individual, unless it is
people, any risk to be insured, previous claims or unreasonable or impractical to do so.
losses, details of previous insurances and insurers,
credit status and any matters relevant to the Overseas recipients
insurance to be provided. If Your personal information is collected by or
We collect personal information directly or supplied to an organisation outside of Australia
indirectly by telephone, email, facsimile, online, We will ensure it will be held, used or disclosed
post, external agencies and in person from You or only in accordance with the Act. We collect and
another person or persons. provide Your personal information to a call centre
in South Africa, information technology centres in
If We collect information pursuant to a law, India and a customer survey service in New
regulation, or court order then We will advise You Zealand. The countries to which information may
of the law or the court order applicable. be disclosed may vary from time to time. We
provide You with notification of these changes by
If You fail to provide Us with personal information means of Our online privacy policy which You can
then this insurance may not meet Your needs. If access at www.lumley.com.au.
You fail to provide information further to Your
duty of disclosure to Us, then there may be no Marketing
cover or a reduced cover for any claim made and We also collect Your information so that We and
in some cases the policy may also be avoided. Our related companies and business alliance
partners can offer You services and products that
ACHPDS50301114 4We believe may be of interest to You. You agree any kind to Your complaint within 30 days, then
that We may so use Your personal information. You have the right to take the matter to the
However, You can opt out of receiving such OAIC.
communications by contacting Us.
The OAIC is the statutory body given the
Access and correction responsibility of complaint handling under the Act.
You can seek access to Your personal information The OAIC is independent and will be impartial
by contacting Us. You can require Us to correct when dealing with Your complaint. The OAIC will
the personal information if it is inaccurate, investigate Your complaint, and where necessary,
incomplete or out of date. We will respond to any make a determination about Your complaint,
such request within a reasonable time. We will provided Your complaint is covered by the Act.
provide You with access within a reasonable time You have 12 months from the date You became
in the manner requested, unless We are entitled aware of Your privacy issue to lodge Your
to refuse to provide access. If We decline to complaint with the OAIC. The contact details of
provide You with access We will provide You with the OAIC are:
the reasons for Our refusal and how You may
access Our internal dispute resolution (IDR) Office of the Australian Information Commissioner
process. GPO Box 2999
Canberra
If We correct information We will inform You. If ACT 2601
We refuse to amend information We will provide Telephone: 1300 363 992
You with Our reasons for the refusal and details of Website: www.oaic.gov.au
how to access Our IDR process. Email: enquiries@oaic.gov.au
Data quality and security You also have a right in limited circumstances to
We will take such steps as are reasonable in the have Your privacy complaint determined by the
circumstances to ensure the personal information Financial Ombudsman Service (FOS). The FOS can
We collect is accurate, up to date, complete and determine a complaint about privacy where the
protected from unauthorised access, misuse, complaint forms part of a wider dispute between
modification, interference or loss. You and Us or when the privacy complaint relates
to or arises from the collection of a debt. The FOS
Privacy policy is an independent dispute resolution body
If You would like more details about Our privacy approved by the Australian Securities and
policy, would like to seek access to or correct Investments Commission. We are bound by FOS’
Your personal information, or opt out of receiving determinations, provided the dispute falls within
materials We send, please contact Us. You can the FOS’ Terms of Reference, but You are not so
also view a copy of Our privacy policy on Our bound. You have two years from the date of Our
website at www.lumley.com.au. letter of decision to make an application to the
FOS for a determination. You can access the FOS
Complaints dispute resolution service by contacting them at:
If You have a complaint regarding Our
management of Your privacy You may access Our The Financial Ombudsman Service,
internal dispute resolution (IDR) process by GPO Box 3,
contacting Us. In the first instance You should Melbourne,
contact Us requesting a resolution. The person Victoria 3001.
contacted has one business day to resolve Your Telephone: 1300 780 808
complaint and if he or she cannot do so must Website: www.fos.org.au
refer the complaint to a manager. The manager Email: info@fos.org.au
has a further five business days to resolve the
matter. If the manager cannot resolve the matter
You may ask him or her to refer it to the Lumley DEFINITIONS
IDR Committee which then has 15 business days
to make a decision. When We make Our decision We, Us, Our means WFI Insurance Limited
We will also inform You of Your right to take this ABN 24 000 036 279 AFS Licence No. 241461,
matter to the Office of the Australian Information trading as Lumley Insurance.
Commissioner (OAIC) together with contact
details and the time limit for applying to the OAIC.
In addition if You have not received a response of
ACHPDS50301114 5You, Your means the person or organization Earnings means:
shown in the Schedule as the Insured.
If the Insured Person is self-employed:
Insured Person means such persons that are The Insured Person’s gross weekly income
shown in the Schedule as the Insured Person. derived from personal exertion after deducting
any expenses necessarily incurred in deriving
Schedule means the Schedule We have that income, averaged over the period of twelve
issued. The Schedule is part of the policy and months prior to the date of disablement
will show the cover You have chosen plus any commenced or over such shorter period that the
Excess or special terms that We may have Insured Person has been continuously self-
imposed. employed.
Injury shall mean bodily Injury resulting from an If the Insured Person is an employee:
accident occurring during the Period of The Insured Person’s gross weekly rate of pay
Insurance and caused by violent, external and inclusive of overtime payments, bonuses,
visible means, but does not include any commissions and allowances averaged over the
condition that is also a Sickness. period of twelve months prior to the date of
disablement commenced or over such shorter
Sickness means illness or disease first period that the Insured Person has been
manifesting itself during the Period of Insurance continuously employed.
and which must continue for a period of not less
than seven days from the date the Insured Business Expenses means the fixed expenses
Person first sought treatment from a legally that You reasonably incur in running Your
qualified medical practitioner in respect of that business being:
Sickness.
1. employees wages and on-costs (for example;
Permanent Total Disablement means superannuation, premiums for accident or
disablement resulting from an Injury and which workers’ compensation, pay-roll tax, amounts
has lasted for at least twelve calendar months payable under awards and regulations)
from the date of such Injury and which 2. rent, property rates
thereafter is beyond hope of improvement and 3. electricity, water, gas or telephone charges
which entirely prevents the Insured Person from 4. laundry and cleaning expenses
engaging in their usual occupation, profession 5. leasing payments on equipment or motor
or business, or any other for which the Insured vehicles
Person is qualified by education, training or 6. other expenses that are usual for the Insured
experience. Person’s type of business and that would be
considered business expenses for income
Temporary Total Disablement means tax purposes.
disablement that either entirely prevents the
Insured Person from engaging in their usual Business Expenses does not mean:
occupation, profession or business or prevents
the Insured Person from performing at least one 1. Payment of Your personal accounts or
of the duties of their occupation that they must withdrawals from Your accounts for
be able to perform to earn their income, while personal use
under the regular care of and acting in 2. Your wages, salary or fees
accordance with the advice of any legally 3. Wages, salary or fees for any person as Your
qualified medical practitioner. replacement.
4. The cost of stock or merchandise
Temporary Partial Disablement shall mean
disablement that entirely prevents the Insured Period of Insurance means the period the
Person from carrying out a substantial part of insurance policy is in force for which a premium
the duties normally undertaken in connection has been paid as shown in the Schedule. This
with their usual occupation, profession or period may be restricted to certain times of the
business. day or week as shown under Scope of Cover.
Loss of Use means loss of, by physical Endorsement Period means the period
severance or permanent loss of the full effective between the date of a requested change in the
use of the part of the body referred to in the policy cover and the expiry date of the policy as
Table of Benefits. shown in the Schedule.
ACHPDS50301114 6Excess Period means the period stated in the such condition will be treated as though it were
Schedule during which no benefits are payable an Injury for the purpose of this policy.
for Temporary, Total or Partial Disablement.
2. Disappearance
Benefit Period means the maximum time for If, during the Period of Insurance, a conveyance
which benefits are payable for Temporary, Total on which the Insured Person is travelling, sinks
or Partial Disablement. or is wrecked and the Insured Person’s body
has not been found within one year of the date of
Act of Terrorism means an act, including but the disappearance, sinking or wrecking, We will
not limited to the use of force or violence and or presume that the Insured Person has died as a
threat thereof, of any person or group of result of Injury at that time and the benefits will be
persons, whether acting alone or on behalf of or payable accordingly.
in connection with any organization or
government which from its nature or context is 3. Rehabilitation Expenses
done for, or in connection with, political, If We have paid for a claim under a condition
religious, ideological, ethnic or similar purposes listed under the Weekly Benefits section in the
or reasons, including the intention to influence Table of Benefits, We will also pay expenses
any government and or to put the public, or any incurred for tuition or advice from a licensed
section of the public, in fear. vocational school, provided such tuition or advice
is undertaken with Our prior written agreement
Scope of Cover means a period of time within and the agreement of the Insured Person’s
a Period of Insurance that the cover under this attending physician.
policy is restricted to as shown in the Schedule.
Payments under this provision will be limited to
Aggregate Limit of Liability means the the actual costs incurred not exceeding $500 per
maximum amount shown in the Schedule that month and will be payable for a maximum of six
We will pay for any one event giving rise to months.
claims involving more than one Insured Person
in any one Period of Insurance. 4. Home Renovations
If an Insured Person is entitled to claim
AGREEMENT TO COVER compensation under The Table of Benefits,
Capital Sum Benefits Conditions 5 to 9, and is
Provided You have paid Us the premium, if, as also as a direct result of such Injury required to
a result solely and directly of: renovate their residence (including but not limited
1. Sickness, an Insured Person suffers from to the installation of ramps for external or internal
Temporary Total Disablement; wheel chair access, internal guide rails,
2. Injury, an Insured Person suffers from emergency alert system and similar disability aids)
Temporary Total Disablement or any of the in order to perform daily lifestyle activities such as
other conditions set out in the Table of washing, cooking, bathing, dressing and
Benefits movement around their existing residence, We will
occurring anywhere in the world, We will pay pay 80% of the cost incurred for such renovations
the benefits set out in the Table of Benefits to to a maximum of $10,000.
You or to the Insured Person shown in the
Schedule if so directed by You. This additional benefit is only payable:
a) where such renovations are undertaken with
The Sickness or Injury must occur within the Our prior written agreement and the
Scope of Cover shown in the Schedule. agreement of the Insured Person’s attending
physician; and
All conditions in the Table of Benefits must b) in respect of one residence only.
occur within twelve months of the Sickness or
Injury as the case may be.
OPTIONAL EXTRAS – Business Expenses
ADDITIONAL BENEFITS
If:
1. Exposure 1. Your Schedule shows that You are covered
If by reason of an Injury occurring during the for this Optional Extra and
Period of Insurance the Insured Person is 2. We have agreed to pay You a weekly benefit
exposed to the elements and as a result of such for total disablement,
exposure suffers a condition for which benefits We will also pay You the lessor of:
are payable as set out in the Table of Conditions, 1. Your Weekly Business expenses that You
actually incur each week, or
ACHPDS50301114 72. Your Weekly Business Expenses that You benefit entitlement. If the Insured Person
incur periodically for that week. For example is receiving a weekly benefit at the time the
if You have to pay a Business Expense every Insured Person becomes entitled to a
four weeks, then We will pay You one quarter capital sum benefit for the same Injury and
of that amount for each week You are totally the capital benefit is the higher, then the
disabled. weekly benefit will cease and any weekly
benefit payments already made will not be
We will pay Your weekly Business Expenses for deducted from the capital sum benefit.
each week that You are totally disabled by the
Sickness or Injury up to the Benefit Period shown 4. Not more than one capital sum benefit shall
in the Schedule for each claim You make under be payable for any condition resulting from
this Optional Extra in each Period Of Insurance. the one Injury. In the event that more than
one benefit is payable, We shall pay the
The weekly amount We will pay is shown in the highest benefit.
Schedule less any amount for the Excess Period.
5. Weekly benefits shall not be payable for
All General Conditions, Exclusions and Definitions more than one condition during the same
apply to Business Expenses. period.
6. No benefits are payable unless as soon as
CONDITIONS possible after the happening of any Injury
or Sickness the Insured Person procures
1. The cover under this policy for an Insured and follows medical advice from a qualified
Person shall become effective on the latest of medical practitioner.
the following dates:
a) the commencing date of the first Period of 7. If an Insured Person suffers an Injury
Insurance set out in The Schedule; resulting in any one of the conditions under
b) the date such Insured Person becomes the Table of Benefits, Capital Sum Benefits
eligible for cover under this policy. Section 5 to 9, We will not be liable under
c) where a proposal is required by Us, on this policy for any subsequent Injury to that
the date of Our acceptance of Your Insured Person.
written proposal
8. If an Insured Person received compensation
Provided always that, if as a result of under the Weekly Benefits section of the
medical advice, an Insured Person is not Table of Benefits and while this policy is in
regularly performing all the usual duties of force suffers a recurrence of Temporary Total
their occupation on the date of their or Temporary Partial Disablement from the
inclusion under this policy, then this same or related causes within 6 consecutive
Insurance shall only take effect on the date months of their return to their occupation on a
of return to the regular performance of all full time basis, We will consider such
their usual duties after being medically Disablement to be continuation of the prior
certified fit to do so. claim period.
2. The weekly benefit payable for Temporary The period of recurring Disablement will be
Total Disablement shall be reduced by: aggregated with the prior claim period.
(a) the amount of any worker's
compensation entitlement or any other 9. You must give Us immediate written notice if
form of statutory compensation You take out any other insurance with
(b) income earned from any other another insurer providing for weekly benefits
occupation of a similar kind which together with this
(c) weekly benefits from any other accident insurance, will exceed the Insured
and or sickness policy of insurance Person’s Earnings.
in order to limit the total payments to the
Insured Person under this policy and items 10. You must give Us written notice containing
(a), (b) and (c) above, to their weekly income full particulars of any Injury or Sickness in
or the limit stated in the policy Schedule, respect of which a claim is to be made as
whichever is the lesser. soon as possible and the Insured Person
must, at their own expense, furnish Us with
3. If the Insured Person becomes entitled to all such documentation and evidence as
a weekly benefit and a capital benefit for the We may require.
same Injury We will pay You the highest
ACHPDS50301114 811. In the event of a claim, the Insured condition for which a duly qualified medical
Person must submit to any medical or practitioner was consulted or for which
other examination or examinations as We medication or treatment was prescribed
may, at Our expense, require. within six months immediately prior to
becoming insured under this policy. This time
12. In the case of the Insured Person’s death, frame includes a condition, the symptoms of
We shall be entitled to conduct a post which would have caused a reasonable
mortem examination. person to seek medical advice or treatment.
13. All Weekly benefits will be paid fortnightly 4. In respect of any Injury or Sickness directly
in arrears. The underwriter will pay one- or indirectly caused by or contributed to by
seventh (1/7th) of the Weekly Benefit for an Act of Terrorism
each day of Disablement.
5. For any Injury or Sickness that results from
14. This policy may be cancelled at any time at the illegal or criminal acts of the Insured
Your request. We may cancel the Policy only Person.
in accordance with the provisions contained
in the Insurance Contracts Act 1984.
MAKING A CLAIM
If You cancel the policy, We shall retain or be
entitled to the proportional premium for the If You become aware of an event that may lead to
period during which the Policy has been in a claim You must:
force plus Our cancellation charge. 1. Tell Us about it as soon as You can;
2. Within 30 days, assist Us in obtaining full
15. The insurance cover on any Insured Person details in writing including any proofs for
shall be immediately cancelled at the earliest which We may ask;
of the following times: 3. Tell the Police if the claim was due to a
(a) The date the policy is cancelled by You; crime.
(b) The date the Insured Person leaves or is
dismissed from Your employment;
(c) The date You request the Insured Person
is to be deleted from cover;
(d) The date the Insured Person reaches an
age that is outside the age limits
specified in the Schedule.
EXCLUSIONS
No benefits are payable:
1. For any condition resulting from Injury or
Sickness which:
(e) is deliberately caused by the Insured
Person or which is self –inflicted;
(f) occurs as a result of war, invasion or
civil war;
(c) results from being engaged in any aerial
activity other than as a passenger in a
licensed aircraft;
(d) results from taking part in or training for
any professional sporting activity.
2. For any condition attributable to pregnancy
or childbirth or complications of these unless
the Insured Person is continuously
confined to bed on advice from a duly
qualified medical practitioner and the term of
the pregnancy has not exceeded 26 weeks.
3. For any Injury or Sickness that is directly or
indirectly caused by any pre-existing
ACHPDS50301114 9Table of Benefits
The Conditions The Benefits
Weekly Benefits - Sickness
1. Temporary Total Disablement caused For each week of Disablement, the weekly sum insured
directly and solely by Sickness. stated in the Schedule or the percentage of the Insured
Person’s Earnings stated in the Schedule (whichever is
the lesser) payable for the period shown in the Schedule
and commencing from the first treatment by a duly
qualified medical practitioner.
Weekly Benefits - Injury
2. Temporary Total Disablement caused For each week of Disablement, the weekly sum insured
by Injury stated in the Schedule or the percentage of the Insured
Person’s Earnings stated in the Schedule (whichever is
the lesser) payable for the period shown in the Schedule
and commencing from the first treatment by a duly
qualified medical practitioner.
3. Temporary Partial Disablement caused Is calculated by reducing the Temporary Total
by Sickness or Injury Disablement benefit by the same proportion that the
Insured Person’s Earnings are reduced as a direct result
of being unable to perform their normal hours of duties.
Capital Sum Benefits (payable as a result of Injury only) The Benefits
The percentage of the capital sum insured stated in the Schedule as
shown hereunder
4. Death 100%
5. Permanent Total Disablement 100%
6. Permanent and incurable paralysis of all limbs 100%
7. Permanent total loss of one or two limbs 100%
8. Permanent total loss of sight in one or both eyes 100%
9. Permanent and incurable insanity 100%
10. Permanent total loss of hearing
10.1 In one ear 20%
10.2 In both ears 75%
11. Permanent total loss of lens of one eye 50%
12. Permanent total loss of use of fingers:
12.1 Three joints per finger 10%
12.2 Two joints per finger 8%
12.3 One joint per finger 5%
13. Permanent total loss of use of one thumb of either hand
13.1 in both joints 30%
13.2 in one joint 15%
14. Permanent total loss of use of toes in either foot
14.1 All in one foot 15%
14.2 Great both joints 5%
14.3 Great one joint 3%
14.4 Other than great each toe 1%
15. Fractured leg or patella with established non-union 10%
16. Permanent disability not otherwise An amount that We shall in Our absolute discretion
provided for under conditions 5 to 15 determine and being in Our opinion not inconsistent with
inclusive the benefits provided under Conditions 5 to 15 inclusive but
in no case more than 75% of the Capital Sum Insured
shown in the Schedule.
17. Burns or disfigurement extending to more than 50% of the entire body 50%
18. Loss of at 50% of all sound and natural teeth, including capped or 1% per tooth
crowned teeth per tooth. Maximum $10,000 per event.
19. Shortening of leg by at least 5 cm 7.5%
20. Permanent Total Loss of four fingers and thumb of either hand 70%
21. Permanent Total Loss of four fingers of either hand 40%
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