Personal Accident and Sickness Insurance

About This Policy

This policy pays fixed benefits if you suffer an injury, or (if the schedule shows sickness cover) a sickness, during the policy period. It pays a lump sum for death and for the permanent disablements listed in the Capital Benefits clause, and a weekly benefit while you are temporarily disabled and cannot work.

It is a benefit policy, not an indemnity policy. The capital benefits are fixed amounts that do not depend on your financial loss. The weekly benefits replace part of your income and are measured against it, as the How Much We Pay Each Week provision sets out.

It is not workers compensation, life insurance or private health insurance, and it does not replace any of them. It cannot pay any medical expense for which a Medicare benefit is payable (see the What the Law Does Not Allow Us to Pay provision).

This policy, together with your schedule, your proposal and any endorsements shown in the schedule, forms your contract of insurance with us. Please read them together and tell us if anything is incorrect. Where the schedule and this wording differ, the schedule applies. Words with special meanings are listed in the Definitions section.

Version and Document History

This document is version-controlled. The version and date shown on the cover page and in the footer of each page govern this text. The version stated in your schedule as current at the start of the policy period applies for the whole policy period, unless your schedule or an endorsement states otherwise.

Important Information

Who issues this policy. The insurer, its Australian Financial Services Licence and its contact details are shown in the schedule. Where the insurer subscribes to the General Insurance Code of Practice, the schedule says so.

Who this policy is for. This wording is designed for retail clients. An issuer using it must give a Product Disclosure Statement and make a Target Market Determination available, as the Corporations Act 2001 (Cth) requires. This wording is not itself a Product Disclosure Statement.

Note for issuers. Before this wording is used, the issuer must wrap it in a Product Disclosure Statement that contains the information the Corporations Act 2001 (Cth) requires, and must prepare and keep current a Target Market Determination for the product.

Your duty when you apply. What you must tell us depends on the kind of contract this is.

• If you take out this policy wholly or mainly for personal, domestic or household purposes, it is a consumer insurance contract. You have a duty under the Insurance Contracts Act 1984 (Cth) to take reasonable care not to make a misrepresentation to us before the policy is entered into, renewed, extended, varied or reinstated. Answer every question in the proposal honestly and completely. If you do not take reasonable care, we may reduce or refuse a claim, or cancel the policy, as that Act allows.
• Otherwise, you have the duty of disclosure in s.21 of that Act. Before the policy is entered into, renewed, extended, varied or reinstated, you must tell us every matter you know, or that a reasonable person in your circumstances could be expected to know, that is relevant to our decision whether to insure you and on what terms. You do not need to tell us anything that reduces the risk, that is common knowledge, that we know or should know as an insurer, or that we waive. If you do not comply, we may reduce or refuse a claim, or cancel the policy, as that Act allows.

[WP REVIEW: confirm presenting both the s20B and s21 regimes in one wording, with classification by purpose, is acceptable where the purchaser's purpose is mixed.]

Terms that differ from standard cover. The Insurance Contracts Act 1984 (Cth) sets standard cover for sickness and accident contracts. This policy differs from standard cover. In particular: - it does not cover a pre-existing condition (see the Pre-existing Conditions exclusion); - it does not pay weekly sickness benefits for a sickness that first shows itself in the first 30 days after weekly sickness benefits first start (this does not apply on renewal, or to a sickness that results from an injury) (see the First 30 Days of Sickness Cover exclusion); - it does not pay weekly sickness benefits for disablement caused by pregnancy, childbirth or miscarriage, except for a complication that is not a normal part of pregnancy or childbirth, which it covers only from the 26th week of pregnancy (see the Pregnancy exclusion); - it does not cover disablement caused by cosmetic or elective treatment (see the Elective Treatment exclusion); - it does not cover an injury that happens while you are taking part in a hazardous pursuit, in professional sport, in flying other than as a passenger, or in military service, or an injury to the extent caused by your alcohol or drug use, criminal act or malicious act (see the Hazardous Pursuits exclusion, the Professional Sport exclusion, the Flying exclusion, the Military Service exclusion, the Alcohol and Drugs exclusion and the Criminal and Malicious Acts exclusion); - it does not cover intentional self-injury, war or nuclear risks (see the Intentional Self-Injury exclusion, the War exclusion and the Nuclear exclusion); - weekly benefits start only after the waiting period, stop at the end of the benefit period, are limited to a percentage of your income, and stop at age 65 unless the schedule shows otherwise; - weekly sickness benefits for a mental illness are limited to 26 weeks for any one sickness (see the Mental Illness provision); - weekly benefits are reduced by workers compensation, other statutory payments and employer pay for the same disablement (see the Other Payments for the Same Disablement provision); - weekly benefits already paid for an injury are deducted from most capital benefits for the same injury (see the Weekly Benefits Before a Capital Benefit provision); - capital benefits are reduced where the total of capital benefits across our policies for the same life is above the accumulation limit (see the Accumulation Limit provision); - capital benefits are reduced from age 70, and no benefit is payable for an injury after age 75 (see the Age Limits provision); - cover outside Australia is limited to 90 consecutive days on any one trip (see the Living and Travelling Overseas provision).

[WP REVIEW: confirm this summary, given before the policy is entered into, is enough to clearly inform the insured under s35(2) of the Insurance Contracts Act 1984 (Cth) and Insurance Contracts Regulations 2017 regs 24 to 26, and whether it must also appear in a separate notice.]

Cooling-off period. You may cancel this policy within 21 days of the date it starts, and within 21 days of each renewal, by telling us in writing. If you have not made a claim, we will refund the full premium paid for that period, less any non-refundable government charges we cannot recover. After that, you may still cancel under the Cancellation condition.

Financial Claims Scheme. If the schedule shows the insurer is an APRA-authorised general insurer, you may be entitled to a payment under the Financial Claims Scheme if the insurer becomes insolvent. Information is available at www.fcs.gov.au.

Schedule

(Completed separately for each policy. It contains your specific details.)

The schedule shows:

• The insured person's name and date of birth, and their occupation and occupation class
• The policy period, with its start and end dates
• The scope of cover: 24 hours a day, occupational only, or non-occupational only
• The capital sum
• Whether weekly benefits apply, and if so the weekly benefit, the percentage of income it is limited to (default 85%), the waiting period and the benefit period
• Whether weekly sickness benefits apply
• The limits of the additional benefits, where they differ from the defaults in the Additional Benefits section
• The accumulation limit, if different from the default in the Accumulation Limit provision
• Any pre-existing condition we have accepted, and any condition excluded by endorsement
• Any hazardous pursuit we have agreed to cover
• Any corporate travel policy that this policy is excess of, for weekly and additional benefits (see the Other Insurance provision)
• The premium, including stamp duty and GST
• The insurer and its licence, and the state or territory whose law governs this policy (see the Governing Law condition)
• The endorsements that apply, by code, with their variables

Definitions

In this policy, the words below have these meanings wherever they appear, whatever their capitalisation. The singular includes the plural.

What Is Covered

Capital Benefits

If you suffer an injury during the policy period and within the scope of cover, and within 12 months of the accident the injury results in one of the events in this table, we will pay the percentage of the capital sum shown against that event. An event that must be permanent only needs to have started within those 12 months. We assess whether it is permanent once 12 months have passed since the accident, and may do so after the 12 months have ended.

In this table, loss of use of a limb includes loss of the hand or foot, and loss of a limb, hand, finger or toe includes its physical separation.

[WP REVIEW: confirm the Fifth Edition of the American Medical Association Guides to the Evaluation of Permanent Impairment is the right default edition, and that Event 18 may rely on it by reference.]

Weekly Benefits for Injury

If the schedule shows weekly benefits, and you suffer an injury during the policy period and within the scope of cover that results in temporary total disablement starting within 12 months of the accident, we will pay you the weekly benefit after the waiting period, for as long as the temporary total disablement continues, up to the benefit period.

If temporary total disablement is followed by temporary partial disablement, we will pay you the weekly benefit less what you earn in each week of the temporary partial disablement, for the rest of the benefit period. If a medical practitioner certifies you can return to work in a reduced capacity, and you choose not to, we will pay 25% of the weekly benefit for up to 4 weeks.

How much we pay each week is set by the How Much We Pay Each Week provision.

Weekly Benefits for Sickness

This clause applies only if the schedule shows weekly sickness benefits.

If you suffer a sickness during the policy period that results in temporary total disablement, we will pay you the weekly benefit after the waiting period, for as long as the temporary total disablement continues, up to the benefit period.

Temporary partial disablement from a sickness is paid on the same terms as in the Weekly Benefits for Injury clause.

The scope of cover does not limit this clause: a sickness is covered whenever it first shows itself during the policy period.

Additional Benefits

These benefits are paid in addition to the capital sum and the weekly benefit, unless a clause says otherwise. Their limits apply to the insured person, and are shown in each clause unless the schedule shows a different amount.

Exposure and Disappearance

If you suffer an event in the Capital Benefits table because you were exposed to the elements after an accident, we will treat it as caused by injury.

If you disappear after the conveyance you were travelling in is wrecked, sinks or disappears, and you are not found within 12 months, we will pay the Event 1 benefit. Before we pay, your legal personal representative must give us a signed undertaking to repay it if you are later found alive.

Funeral Expenses

If we pay the Event 1 benefit, we will also pay the reasonable funeral, cremation or burial expenses incurred, and the cost of returning your remains to your home in Australia. Unless the schedule shows otherwise, the limit is $15,000 for any one injury.

Dependent Children

If we pay the Event 1 benefit, we will also pay a benefit for each child under 18 years of age, or under 25 years of age and studying full time, who was wholly or mainly dependent on you. Unless the schedule shows otherwise, the benefit is $10,000 for each child, and no more than $50,000 in total.

Spouse or Partner Retraining

If we pay the Event 1 or Event 2 benefit, we will also reimburse the cost of a course of training your spouse or partner takes within 2 years to gain or improve qualifications for paid work. Unless the schedule shows otherwise, the limit is $15,000.

Coma

If an injury causes you to be in a coma for more than 7 consecutive days, we will pay a daily benefit from the first day of the coma. Unless the schedule shows otherwise, the benefit is $100 a day for up to 90 days. This benefit is paid in addition to any other benefit for the same injury.

Broken Bones

If an injury causes you to fracture a bone, and a medical practitioner confirms the fracture by X-ray or other imaging, we will pay the percentage below of the broken bones limit. Unless the schedule shows otherwise, the broken bones limit is $7,500.

We pay for the highest-percentage bone only for any one injury. We do not pay this benefit if we pay a capital benefit for the same injury.

Rehabilitation

If you are receiving weekly benefits, we will pay the cost of a rehabilitation or return-to-work program that we agree beforehand is likely to help you return to work sooner. Unless the schedule shows otherwise, the limit is $10,000 for any one injury or sickness. Taking part does not reduce your weekly benefit.

Home and Vehicle Modification

If we pay the Event 2, Event 3 or Event 6 benefit, we will also reimburse the reasonable cost of modifying your home or vehicle that a medical practitioner certifies is necessary because of the injury. Unless the schedule shows otherwise, the limit is $30,000.

Transport to Work

If, because of an injury, a medical practitioner certifies that you cannot drive yourself or use public transport, but you are able to work, we will reimburse the reasonable cost of transport between your home and your place of work. Unless the schedule shows otherwise, the limit is $2,500 for any one injury.

Escalation of Weekly Benefits

If we have paid weekly benefits for the same period of disablement continuously for 12 months, we will increase the weekly benefit by 5% on each anniversary of the first day it was paid, for the rest of the benefit period.

How We Pay Benefits

How Much We Pay Each Week

Each week we pay the lower of:

• the weekly benefit; and
• the percentage of your income shown in the schedule. Unless the schedule shows otherwise, it is 85%.

If Endorsement E01 applies, the second limit does not apply, but the Other Payments for the Same Disablement provision still does.

We pay weekly benefits fortnightly in arrears, for each day of disablement at one-seventh of the weekly amount. We pay no weekly benefit for the waiting period.

Recurring Disablement

If you return to work and, within 6 months, you are again disabled from the same or a related injury or sickness, we treat it as a continuation of the earlier disablement. No new waiting period applies, and the benefit period already used counts towards the benefit period.

If you have worked full time in your usual occupation for 6 consecutive months, a further disablement is a new claim.

One Capital Benefit for Each Injury

For any one injury, we pay only one of Events 1 to 18 in the Capital Benefits table, the one with the highest percentage. We do not add the percentages of two or more events together.

Once we have paid 100% of the capital sum for one or more injuries, your cover under the Capital Benefits clause ends. The rest of this policy continues, and we will refund the part of the premium that relates to capital benefits for the unexpired policy period.

Weekly Benefits Before a Capital Benefit

If we pay a capital benefit for an injury, we deduct from it the weekly benefits we have already paid for the same injury, except where the capital benefit is for Event 1 or for Events 8 to 18. We then stop paying weekly benefits for that injury.

If you die from a cause unrelated to the injury before a capital benefit for Events 2 to 18 is assessed, we will pay the amount we reasonably consider would have been payable.

Other Payments for the Same Disablement

We reduce the weekly benefit by any weekly payment you receive, or are entitled to receive, for the same period of disablement from:

• a workers compensation or transport accident scheme, or any other statutory compensation scheme; and
• sick leave or other pay from your employer or your business that continues while you are disabled,

so that the total of all those payments and our weekly benefit is no more than your income, or no more than the weekly benefit if Endorsement E01 applies.

We do not reduce the weekly benefit because of any other personal accident, sickness, income protection or disability income insurance. The Other Insurance provision explains how this policy fits with other insurance.

We do not reduce capital benefits, or the benefits in the Additional Benefits section, for any other payment.

Other Insurance

If a loss covered by this policy is also covered by another insurance policy, we will not refuse or reduce our payment because of that other insurance. We may seek contribution from the other insurer as the law allows. This does not apply where the schedule or an endorsement states that this policy is excess of a specified underlying policy, in which case this policy pays only after the limit of that specified policy is exhausted.

Corporate travel policies. If the schedule names a corporate travel policy as a specified underlying policy for an injury or sickness on a trip that policy covers, this policy pays its weekly benefits and additional benefits only for the amount that the corporate travel policy does not pay for the same benefit, and both policies pay their capital benefits in full.

Mental Illness

For temporary total disablement or temporary partial disablement from a mental illness, we pay weekly sickness benefits for no more than 26 weeks for any one sickness, even if the benefit period is longer. This limit does not apply to a mental illness that results from an injury.

[WP REVIEW: confirm the 26-week limit is supportable under the Disability Discrimination Act 1992 (Cth) s46 on actuarial or statistical data, and is not an unfair term for a consumer or small business contract.]

Age Limits

We do not pay weekly benefits for any period after your 65th birthday, unless Endorsement E09 applies.

If you are 70 or older on the date of the accident, the capital sum for that injury is 50% of the amount shown in the schedule, and the most we pay for Event 2 is $250,000 unless the schedule shows otherwise.

We do not pay any benefit for an injury or sickness that happens after your 75th birthday.

Living and Travelling Overseas

You are covered while you are outside Australia, for up to 90 consecutive days on any one trip, unless Endorsement E10 allows a longer period.

If you leave Australia while you are receiving weekly benefits, tell us before you go. We will continue to pay weekly benefits for up to 90 days while you are outside Australia, and for longer if we agree in writing. We may ask you to return to Australia for a medical examination at our expense.

Accumulation Limit

The most we will pay in capital benefits for any one injury, under this policy and every other personal accident policy we have issued that covers you, is the accumulation limit. Unless the schedule shows otherwise, the accumulation limit is $2,000,000. If the total would be more, we reduce the benefit under each policy in proportion.

What the Law Does Not Allow Us to Pay

The Health Insurance Act 1973 (Cth), the National Health Act 1953 (Cth) and the Private Health Insurance Act 2007 (Cth) do not allow us to pay:

• any medical expense for which a Medicare benefit is payable, or any gap between the Medicare benefit and the fee charged; or
• any amount that would make this policy health insurance business under those Acts.

We will not pay any benefit, or part of a benefit, to the extent that paying it would breach those Acts.

[WP REVIEW: the Non-Medicare Medical Expenses benefit was removed because it paid for general treatment (physiotherapy, chiropractic, dental and ambulance services) while excluding general treatment within the meaning of the Private Health Insurance Act 2007 (Cth), and it overlapped with health insurance business. Confirm the removal, and whether a fixed-sum benefit that does not reimburse a cost could be offered instead.]

Who We Pay

We pay every benefit to you, except that the Event 1 benefit and the benefits that follow it are paid to your legal personal representative. If you are unable to manage your affairs, we may pay a person legally entitled to act for you. Payment to that person discharges our liability for the amount paid.

What Is Not Covered

The exclusions below apply to every benefit under this policy, unless an exclusion says otherwise.

Intentional Self-Injury

We do not pay any benefit for your intentional self-injury, suicide or attempted suicide.

War

We do not pay any benefit for an injury or sickness caused by war, invasion, act of a foreign enemy, hostilities (whether war is declared or not), civil war, rebellion, revolution or insurrection.

This exclusion does not apply to an act of terrorism, unless you took part in it.

Nuclear

We do not pay any benefit for an injury or sickness caused by ionising radiation, or contamination by radioactivity, from any nuclear fuel, nuclear waste or nuclear weapon.

Alcohol and Drugs

We do not pay any benefit for an injury to the extent that it was caused or contributed to by: - you driving or being in charge of a motor vehicle with a blood alcohol concentration above the legal limit where you are driving; - at any other time, your blood alcohol concentration being above 0.10 grams per 100 millilitres; or - you being under the influence of a drug that a medical practitioner did not prescribe for you, or that you did not take as prescribed.

It is for us to show that the alcohol or drug caused or contributed to the injury.

We do not pay any benefit for a sickness that results from your addiction to alcohol or a drug.

Criminal and Malicious Acts

We do not pay any benefit for an injury to the extent that it was caused or contributed to by you committing, or attempting to commit, a criminal offence punishable by imprisonment, or by you acting maliciously.

Acting maliciously means acting with the intention of harming another person or damaging another person's property.

Professional Sport

We do not pay any benefit for an injury that happens while you are taking part in, training for, coaching or officiating in any sport for which you receive, or are entitled to receive, a fee, sponsorship or prize money that is more than your reasonable expenses.

Flying

We do not pay any benefit for an injury that happens while you are in or on an aircraft, other than as a passenger in an aircraft that is licensed to carry passengers and is operated by a person licensed to fly it.

This exclusion does not apply to flying shown in the schedule under Endorsement E05.

Hazardous Pursuits

We do not pay any benefit for an injury that happens while you are taking part in:

• parachuting, skydiving, hang-gliding, paragliding, BASE jumping or ballooning;
• a race, rally or speed trial in or on any motor vehicle or motorcycle, other than a road vehicle event that tests regularity and is not timed for speed;
• scuba diving below 30 metres, or scuba diving without a qualification from a recognised training body unless under the supervision of a qualified instructor;
• mountaineering above 4,000 metres; or
• rodeo, bull riding, or horse racing (including harness racing and steeplechase).

This exclusion does not apply to a pursuit shown in the schedule under Endorsement E05.

Military Service

We do not pay any benefit for an injury that happens while you are serving full time, or on operational deployment as a reservist, in the armed forces of any country or of an international organisation.

Pre-existing Conditions

We do not pay weekly sickness benefits for disablement caused by a pre-existing condition. We do not pay any benefit for an injury to the extent that a pre-existing condition caused or contributed to the disablement or event.

This exclusion stops applying to a pre-existing condition once you have been insured with us continuously under this policy, and the policies it renews, for 24 months.

This exclusion is subject to s.47 of the Insurance Contracts Act 1984 (Cth): we will not rely on it for a condition that you were not aware of, and that a reasonable person in your circumstances could not have been expected to be aware of, when you were first insured.

First 30 Days of Sickness Cover

We do not pay weekly sickness benefits for a sickness that first shows itself in the first 30 days after weekly sickness benefits first start under this policy. This exclusion does not apply on renewal, or to a sickness that results from an injury.

Pregnancy

We do not pay weekly sickness benefits for disablement caused by pregnancy, childbirth or miscarriage, except a complication that a medical practitioner certifies is not a normal part of pregnancy or childbirth. We pay weekly sickness benefits for such a complication as a sickness, from the first day of the 26th week of pregnancy at the earliest.

[WP REVIEW: confirm the 26th-week start is supportable under the Sex Discrimination Act 1984 (Cth) s41, or remove it.]

Elective Treatment

We do not pay any benefit for disablement caused by cosmetic or elective surgery or treatment, unless it is needed because of an injury or sickness covered by this policy.

Your Obligations

Each obligation is subject to the Insurance Contracts Act 1984 (Cth) condition.

Tell Us About Claims

Tell us as soon as reasonably practicable after an accident, injury or sickness that may lead to a claim. For weekly benefits, give us a medical certificate covering the start of the disablement, and further certificates when we reasonably ask for them.

Give us the information and documents we reasonably need to assess the claim, including evidence of your income and of other payments under the Other Payments for the Same Disablement provision, at your own cost.

Medical Care and Examination

Get treatment from a medical practitioner as soon as reasonably practicable after an injury or the start of a sickness, and follow their reasonable advice.

You must attend an examination by a medical practitioner or other health professional we choose, as often as we reasonably require while a claim is open. We pay for it. If you die, we may ask for a post-mortem examination at our expense, where the law allows it.

Tell Us About Changes

Tell us during the policy period, as soon as reasonably practicable, if:

• you change your occupation, or your duties change so that a higher occupation class would apply; or
• you start taking part regularly in a hazardous pursuit, or in any activity listed in the proposal that you did not tell us about.

We will tell you whether the change affects your cover or premium.

General Conditions

Insurance Contracts Act 1984 (Cth)

Nothing in this policy excludes, restricts or modifies the operation of the Insurance Contracts Act 1984 (Cth). Where this policy is inconsistent with the Act, the Act prevails.

If this policy would otherwise let us refuse to pay a claim, in whole or in part, because of something you did or did not do after this policy was entered into, section 54 of the Act applies. We may not refuse to pay the claim only because of that act or omission. Our liability is reduced by the amount that fairly represents the extent to which our interests were prejudiced. Where the act or omission could reasonably be regarded as capable of causing or contributing to the loss, we may refuse to pay only the part of the claim that the act or omission caused or contributed to. We may not refuse any part that you prove the act or omission did not cause. This applies to every condition, exclusion, limit and obligation in this policy, not only to the claims conditions.

Cancellation

You may cancel this policy at any time by telling us. We refund the premium for the unexpired period of insurance on a pro-rata basis, less any non-refundable government charges. If you cancel within the cooling-off period, the refund is as the Important Information section states.

We may cancel this policy only as the Insurance Contracts Act 1984 (Cth) allows, by giving you written notice as that Act requires. We refund the premium for the unexpired period on a pro-rata basis.

Cancellation does not affect a claim for an injury that happened, or a sickness that first showed itself, before cancellation.

Renewal

Each renewal is a new contract. Before this policy ends, we will tell you whether we offer to renew it and on what terms, as s.58 of the Insurance Contracts Act 1984 (Cth) requires. We are not obliged to offer renewal.

Fraudulent Claims

If a claim is made fraudulently, we may refuse to pay it, as s.56 of the Insurance Contracts Act 1984 (Cth) allows.

Sanctions

We do not provide cover, pay any claim or provide any benefit under this policy to the extent that doing so would expose us to any sanction, prohibition or restriction under: - the Autonomous Sanctions Act 2011 (Cth), the Charter of the United Nations Act 1945 (Cth), or regulations made under either Act; or - the trade or economic sanctions laws of the United Kingdom, the United States of America or the European Union, to the extent they apply to us.

[WP REVIEW: confirm that naming the UK, US and EU regimes is appropriate for Australian capacity; this is a deliberate library-wide scope choice.]

GST

The premium includes GST where it applies, under A New Tax System (Goods and Services Tax) Act 1999 (Cth). The benefits under this policy are fixed amounts and are not adjusted for GST or input tax credits.

Privacy

We collect, use and disclose your personal information, including health information, to assess your proposal, administer this policy and manage claims, in accordance with the Privacy Act 1988 (Cth) and our privacy policy. Our privacy policy explains how you can access and correct your information and how to complain about a privacy matter.

Complaints and Disputes

If you are unhappy with our service or a decision, contact us at the details in the schedule. We will acknowledge your complaint within one business day and give you our decision within 30 calendar days.

If you are not satisfied with our response, or we have not responded within 30 calendar days, you may take your complaint to the Australian Financial Complaints Authority (AFCA), a free and independent dispute resolution service: www.afca.org.au, 1800 931 678, info@afca.org.au.

Governing Law

This policy is governed by the law of the Australian state or territory shown in the schedule. If the schedule does not show one, it is governed by the law of the state or territory where you lived on the date this policy started.

Jurisdiction

You and we submit to the jurisdiction of the courts of the state or territory whose law governs this policy, and of any court that may hear appeals from them.

Headings and References

Headings are for convenience only. A reference to legislation includes any legislation that amends or replaces it. A reference to a clause by its heading is a reference to that clause as it appears in this wording.

How to Make a Claim

1. Contact your broker, or contact us directly at the details shown in the schedule.
2. Tell us what happened and when, and the name of the medical practitioner treating you (see the Tell Us About Claims obligation).
3. For weekly benefits, send us a medical certificate and evidence of your income for the last 12 months.
4. Tell us about any workers compensation, transport accident, sick leave or other insurance payments you receive or have claimed.
5. We will acknowledge your claim, send you a claim form within 7 days and keep you informed.

Endorsement Library

An endorsement applies only if its code is shown in the schedule. Each endorsement changes this policy only as it states, and is read together with the variables shown for it in the schedule. Where an endorsement and the rest of this policy conflict, the endorsement applies to the extent of the conflict. If a variable an endorsement needs is not shown in the schedule, the default stated in the endorsement applies; if it has no default, the endorsement does not apply until we show the variable in the schedule.

E01 Agreed Value Weekly Benefit

The second limit in the How Much We Pay Each Week provision, the percentage of your income, does not apply. We pay the weekly benefit as an agreed amount, subject to the Other Payments for the Same Disablement provision.

You confirm that the weekly benefit was no more than the percentage of income shown in the schedule for this endorsement when this policy started or was last renewed, and you must give us evidence of your income for the 12 months before then if we ask.

Schedule variables: agreed weekly benefit; percentage of income at inception (default 85%).

E02 Business Expenses

If you are self-employed or a working director of your own company, and you are receiving weekly benefits for temporary total disablement, we will also reimburse the fixed expenses of your business that you continue to pay, up to the weekly business expenses amount shown in the schedule, for up to 26 weeks of any one disablement.

Fixed expenses are rent, electricity, gas, telephone and internet, equipment lease and loan repayments, insurance premiums, accounting fees, and the wages of employees who are not employed to generate income in your place. They do not include your own remuneration, the cost of stock, or the cost of a person employed to replace you.

Schedule variables: weekly business expenses amount; benefit period for this endorsement (default 26 weeks).

E03 Occupational Cover Only

The scope of cover is occupational only, as defined in the definition of Scope of Cover. The Weekly Benefits for Sickness clause is not affected.

Schedule variables: none.

E04 Non-Occupational Cover Only

The scope of cover is non-occupational only, as defined in the definition of Scope of Cover. The Weekly Benefits for Sickness clause is not affected.

Schedule variables: none.

E05 Named Hazardous Pursuit

The Hazardous Pursuits exclusion and the Flying exclusion do not apply to the pursuits named in the schedule for this endorsement, while you take part in them as an amateur, under the rules of the governing body for the pursuit where there is one, and holding any licence or qualification it requires.

Schedule variables: named pursuits; conditions for each pursuit (for example, maximum depth or minimum licence); any capital sum limit for injury during the pursuit.

E06 Named Pursuit Exclusion

We do not pay any benefit for an injury that happens while you are taking part in the pursuits named in the schedule for this endorsement.

Schedule variables: named pursuits.

E07 Specific Condition Exclusion

We do not pay any benefit for disablement or an event caused by, or contributed to by, the condition named in the schedule for this endorsement, or by any complication of it.

Schedule variables: named condition; any period after which this endorsement stops applying.

E08 Accepted Pre-existing Condition

The condition named in the schedule for this endorsement is not a pre-existing condition. The Pre-existing Conditions exclusion does not apply to it.

Schedule variables: named condition.

E09 Weekly Benefits to Age 70

In the Age Limits provision, 70th birthday replaces 65th birthday for weekly benefits.

Schedule variables: none.

E10 Extended Overseas Cover

In the Living and Travelling Overseas provision, the number of days shown in the schedule for this endorsement replaces 90 days, for travel to the countries named.

Schedule variables: number of days; countries named, or worldwide.

E11 Capital Benefits Only

The Weekly Benefits for Injury clause, the Weekly Benefits for Sickness clause, the Rehabilitation extension and the Escalation of Weekly Benefits extension do not apply.

Schedule variables: none.

E12 Increased Additional Benefits

The limits shown in the schedule for this endorsement replace the default limits in the Funeral Expenses extension and the Rehabilitation extension.

Schedule variables: funeral expenses limit (default $30,000); rehabilitation limit (default $25,000).

E13 Lloyd's Underwriters

This policy is underwritten by the Lloyd's underwriters named in the schedule. Each underwriter is liable only for its own share, and not for the share of any other underwriter.

The underwriters agree that any dispute about this policy may be heard by a court of competent jurisdiction in Australia, and that the Lloyd's General Representative in Australia named in the schedule may accept service of process for them. Complaints may also be made to Lloyd's Australia at the details shown in the schedule, as well as under the Complaints and Disputes condition.

Schedule variables: underwriters and their shares; Lloyd's General Representative; Lloyd's complaints contact.

E14 Confirmation of Cover for a Principal

We will give the principal named in the schedule for this endorsement a written confirmation that this policy is in force, showing the capital sum and weekly benefit. The confirmation does not change this policy, and gives the principal no right to claim under it or to receive any benefit.

We will tell the principal if this policy is cancelled before the end of the policy period, if you agree that we may do so.

Schedule variables: principal name and contract or site reference.

Licence and Trademark Notice

This wording's text is licensed under Creative Commons Attribution 4.0 International (CC BY 4.0). The licence applies to the wording text only. It does not extend to, and no licence is granted in, the "Meridian" name, the Cuttleflow Systems name, logo, bearing mark, or any other trademark, trade dress, or brand asset, all of which remain the property of their respective owners and may not be used without separate permission.

An adopting insurer's own schedule, proposal, endorsements and other materials prepared for use with this wording are not required to be released under CC BY 4.0 merely because they are used together with this wording; CC BY 4.0 requires only that you attribute the wording text you use.

This wording is provided for general use and adaptation. Adopting insurers and their advisers are responsible for obtaining their own legal, regulatory, and reinsurance advice before use, including on whether a Product Disclosure Statement and Target Market Determination are required. Use of this wording requires the approval of the relevant capacity provider. Any Wording Partner review and sign-off letter issued in respect of this wording runs to Cuttleflow Pty Ltd t/a Cuttleflow Systems only and does not constitute legal advice to any adopting insurer or insured.

Designed for the Australian market. Assumes application of the Insurance Contracts Act 1984 (Cth). Users are responsible for their own legal review, regulatory compliance, and reinsurance alignment.