Total & Permanent Disablement
For employed or self-employed persons, an insured member is totally and permanently disabled if the insured member:
- Has suffered:
(i) The permanent loss of two or more limbs - a limb being the whole hand or foot, or
(ii) The complete and irrecoverable loss of sight in both eyes, or
(iii) The loss of one limb and the complete and irrecoverable loss of sight in one eye.
OR
- As a result of sickness or injury, has been absent from all employment for 6 consecutive months from the date of disablement, and the insurer is satisfied on the basis of medical and other evidence that the insured member is unlikely ever to be able to engage in any occupation, whether or not for reward.
Where:
'Occupation' means:
- For a professional or manager, the person's occupation based on the general area of expertise of the person
- For all other staff, an occupation that the person can perform, on a full-time or part-time basis, based on the skills and knowledge the person has acquired through previous education, training or experience.
'Professional' means a person who:
- Has a tertiary qualification or is eligible to belong to a professional body
- Earns a salary greater than $80,000 per annum, and
- Only works in an office environment and in a sedentary capacity.
'Manager' means a person who:
- Is part of the management of the employer
- Earns a salary greater than $80,000 per annum, and
- Only works in an office building and in a sedentary capacity.
OR
For persons unemployed for a continuous period of 12 months before the onset of total disability leading to the permanent incapacity:
- The insured member has, in the opinion of the insurer, after consideration of medical and/or other evidence become permanently incapacitated to such an extent as to prevent him/her from engaging in any gainful occupation, or
- The insurer is satisfied that the insured member has become so disabled by bodily injury or illness that he/she will never be able to perform at least two of the following activities of daily living:
- Dressing - the ability to put on and take off clothing without assistance
- Bathing - the ability to wash or shower without assistance
- Toileting - the ability to use the toilet, including getting on and off without assistance
- Mobility - the ability to get in and out of bed and a chair without assistance
- Feeding - the ability to get food from a plate into the mouth without assistance
Where:
'Assistance' means the assistance of another person.
OR
For persons who perform full-time unpaid domestic duties, an insured member:
- has been unable to perform their unpaid domestic duties for 6 consecutive months and in the opinion of the insurer, after consideration of medical and/or other evidence, incapacitated to such an extent that it is unlikely that he or she will again be able to engage in their unpaid domestic duties, or in any other occupation for which they are reasonably suited by education, training or experience, and
- is so incapacitated that they are unable to leave their place of residence without the assistance of another person.
Where:
'Assistance' means the assistance of another person.
