Group Personal Accident and Sickness Policy - Intrust …intrustsuper.com.au/wp-content/uploads/Intrust-Super-PayGuard... · Group Personal Accident and Sickness Policy For ... The

Group Personal Accident and Sickness Policy

For

Intrust Super Fund

Windsor Income Protection Pty Ltd

ACN: 147 905 888 AFS Licence No: 400598

Page | 2

Windsor Income Protection Pty Ltd, ACN: 147 905 888, AFS Licence No: 400598

Contents

Important Notices ........................................................................................................ 3

Your Duty of Disclosure .............................................................................................. 3

Non Disclosure ............................................................................................................. 3

A. The Policy Wording .................................................................................................................... 4

(i) Scope of Cover ................................................................................................. 4

(ii) Commencement of Cover ............................................................................... 4

(iii) Cessation of Cover .......................................................................................... 5

(iv) Takeover Terms .............................................................................................. 5

(v) Additional Benefits ......................................................................................... 6

(vi) Definitions ....................................................................................................... 7

(vii) Special Provisions ......................................................................................... 11

Conditions .................................................................................................................. 15

(viii) Making a Claim .............................................................................................. 18

(ix) Exclusions ...................................................................................................... 19

B. The Schedule ............................................................................................................................. 20

Page | 3


Important Notices All cover under this Policy is subject to: 1. The Payment of premium; 2. The terms and conditions contained in this Policy, including The Schedule; 3. The limits of liability referred to in the Policy. Subject to the terms, conditions, exclusions and limitations contained in this Policy, this Policy provides cover for Disablement caused by Accidental Injury and Sickness and Benefits are payable in the circumstances set out in the Policy, subject to the aggregate limit of liability. The particular cover which applies to you and which YOU selected when YOU applied for this insurance is referred to in The Schedule which forms part of this Policy. If for any reason you are not completely satisfied, this Policy may be returned to US within fourteen (14) days of its receipt and, subject to no claim being made, WE will refund in full any premium paid.

Your Duty of Disclosure Prior to entering into a contract of insurance with an insurer, you have a duty, under the Insurance Contracts Act 1984, to disclose to the insurer every matter that you know, or could reasonably be expected to know, is relevant to the insurer’s decision whether to accept the risk of the insurance and if so on what terms. You have the same duty to disclose those matters to the insurer before you renew, extend, vary or reinstate a contract of insurance. Your duty however, does not require disclosure of matters:

1. That diminishes the risk to be undertaken by the insurer. 2. That is of common knowledge. 3. That your insurer knows or, in the ordinary course of business, ought to know. 4. As to which compliance of your duty is waived by the insurer.

Non Disclosure If you fail to comply with your duty of disclosure and the insurer would not have entered into the contract on any terms if the failure had not occurred, the insurer may void the contract within 3 years of entering into it. If your non-disclosure is fraudulent, the insurer may void the contract at any time. An Insurer who is entitled to avoid a contract of insurance may, within 3 years of entering into it, elect not to avoid it but to reduce the sum that you have been insured for in accordance with a formula that takes into account the premium that would have been payable if you had disclosed all relevant matters to the Insurer

Page | 4


A. The Policy Wording

(i) Scope of Cover

Insurance has been affected between US and THE POLICY OWNER and this document is evidence of that insurance. We have agreed to insure YOU subject to the terms, conditions and exceptions contained in or endorsed upon this Document during the Period of Insurance for which the premium has been paid or agreed to be paid. WE agree to pay in accordance with The Schedule of Benefits if during the Period of Insurance an INSURED MEMBER sustains INJURY or SICKNESS as defined herein, subject always to the terms, conditions, provisions, limitations and exclusions hereof.

(ii) Commencement of Cover

Cover shall commence for all members of THE POLICY OWNER who are ACTIVELY AT WORK on the Policy’s commencement date provided premiums shown in The Schedule have been paid by YOU to US. For those members not ACTIVELY AT WORK on the Policy’s commencement date, cover shall commence when they recommence employment and are ACTIVELY AT WORK, provided an employer superannuation contribution payment is made by an ADMITTED EMPLOYER after they recommence employment by the quarterly deadlines outlined in the SUPERANNUATION GUARANTEE LEGISLATION. Cover for new members of THE POLICY OWNER will commence from the first date that the first employer superannuation contribution payment made by an ADMITTED EMPLOYER represents, provided that this payment is made by the quarterly deadlines outlined in the SUPERANNUATION GUARANTEE LEGISLATION and the member is ACTIVELY AT WORK and has not nominated in writing to not receive this cover. For those members of THE POLICY OWNER who are eligible for cover but have not accepted cover, cover may re-commence from when their written request to take up this cover is received, provided an employer superannuation contribution payment is made by an ADMITTED EMPLOYER after this request by the quarterly deadlines outlined in the SUPERANNUATION GUARANTEE LEGISLATION. For those members of THE POLICY OWNER where cover has ceased due to the INSURED MEMBER no longer being employed by an ADMITTED EMPLOYER and the INSURED MEMBER later re-commences employment with an ADMITTED EMPLOYER, cover will recommence from the first date that the first employer superannuation payment made by the most recent ADMITTED EMPLOYER represents provided that this payment is made by the quarterly deadlines outlined in the SUPERANNUATION GUARANTEE LEGISLATION and the member is ACTIVELY AT WORK on their first day of employment.

Page | 5


(iii) Cessation of Cover Cover for an INSURED MEMBER under this policy ceases;

a) when the INSURED MEMBER elects in writing to no longer have this cover; or

b) when the INSURED MEMBER reaches the Maximum Age Limit as stated in The Schedule, or

c) when the INSURED MEMBER is no longer employed by an ADMITTED EMPLOYER – refer (v) Additional Benefit No. 3; or

d) when the INSURED MEMBER ceases to be a member of THE POLICY OWNER; or

e) when all cover for every INSURED MEMBER under this Policy ceases, subject to Financial Services Council Guidance Note No. 11 – Group Insurance Takeover Terms

(iv) Takeover Terms WE accept the Financial Services Council Guidance Note No. 11 – Group Insurance Takeover Terms in relation to both the takeover of cover and the cessation of this policy, subject to OUR definition of ACTIVELY AT WORK, to determine liability between insurers on claims.

Page | 6


(v) Additional Benefits

1. Rehabilitation Assistance In the event of the payment of a claim under this Policy WE, at OUR absolute discretion, may elect to assist the INSURED MEMBER in arranging for training or advice from a licensed vocational school, provided such training or advice is undertaken with the agreement of the INSURED MEMBER’S attending physician. Assistance may also include family counselling to help the INSURED MEMBER and his or her family cope with the INSURED MEMBER’S disability and to enable the INSURED MEMBER to live an independent life. The maximum amount payable by US in respect of rehabilitation assistance is AUD25,000.

2. Return to Work Assistance

In the event of the payment of a claim under this Policy WE, at OUR absolute discretion, may elect to assist the INSURED MEMBER in arranging for professional assistance to improve their physical and/or emotional condition. Assistance includes special equipment for and/or modifications to the INSURED MEMBER’S normal home or workplace. The maximum amount payable by US in respect of return to work assistance is AUD25,000.

3. Extended Cover Coverage under this Policy continues for a period of no more than thirty (30) days from the date the INSURED MEMBER ceases his or her current employment with an ADMITTED EMPLOYER provided that the INSURED MEMBER has accepted a position with another ADMITTED EMPLOYER prior to ceasing his or her employment. If the INSURED MEMBER does not have a position to go to with another ADMITTED EMPLOYER, then cover will cease under this Policy on the date he or she leaves their employment.

4. Superannuation i. In the event of an INJURY or SICKNESS claim under this Policy, WE will also pay to YOU a

Superannuation Benefit for the INSURED MEMBER equal to the amount specified in The Schedule.

ii. If the INSURED MEMBER is receiving a PARTIAL DISABLEMENT Benefit, the Superannuation Benefit is reduced proportionately.

iii. The benefit above is payable monthly in arrears on a pro rata basis and to the FUND.

Page | 7


(vi) Definitions

a) ACTIVELY AT WORK means when an INSURED MEMBER is considered to be genuinely performing all the duties of their usual occupation and capable of working their usual hours without restriction, for their usual ADMITTED EMPLOYER(S). An INSURED MEMBER who is on paid annual leave, paid sick leave or long service leave shall also be considered to be ACTIVELY AT WORK provided that leave is not in connection to the INJURY or a SICKNESS that leads to the TOTAL DISABLEMENT.

b) ADMITTED EMPLOYER means an employer who makes employer superannuation

contributions to THE POLICY OWNER on behalf of an INSURED MEMBER. c) ANY ONE EVENT means all insured losses which arise directly from the same cause and which

occur during the same period of time and in the same area. Such cause is understood to be the peril which directly occasions the losses or where there are several perils which, in an unbroken chain of causation, have occasioned the losses, the peril which triggered the chain of causation. For example, as long as they are covered by this Policy, losses occasioned by the perils set out below at letters (a) to (g) shall constitute single events: (a) storm due to an atmospheric disturbance usually so designated by a meteorological

institute; (b) hail and/or thunderstorms and/or tornadoes due to an atmospheric disturbance; (c) earthquake, tsunami, volcanic eruption; (d) flood by one and the same instance of high water which may have more than one peak and

which may occur in one or more bodies of water; (e) conflagration; (f) strike, riot, civil commotion or violent demonstration occurring within the boundaries of

one city, town or village; (g) any communicable disease arising from a single source or pathogen

The following hours clause is then applied. An event shall thus encompass a continuous period of time starting with the occurrence of THE POLICY OWNER’s first individual loss and lasting; 72 hours for perils mentioned under (a), (b), (e) and (f); 168 hours for perils mentioned under (c) and (d) as well as those perils not referred to

above but covered by this Policy; 504 hours for perils mentioned under (g) In the case of differing perils which are not connected to each other by an unbroken chain of causation, the applicable number of hours corresponds to those of the peril which has caused the largest amount of damages. In the case of more than one event, if it is impossible to allocate any losses, THE POLICY OWNER shall allocate them to the event whose cause is most likely to have occasioned them. In case of uncertainty over scientific issues, the parties agree to seek expert advice from a neutral and recognised organization.

Page | 8


d) COMMENCEMENT DATE means the date of commencement of cover under this Policy as set out in The Schedule.

e) CONTINUOUS COVER means an unbroken period of time that an INSURED MEMBER has been covered under an Income Protection policy provided to YOU by US. If an INSURED MEMBER ceases cover, their continuous cover period ends on that date. If an INSURED MEMBER recommences cover under an Income Protection policy provided to YOU by US, their new continuous cover period commences on the date their cover recommences.

f) INCOME Employee: means the average weekly income before personal deductions and income tax, and including all overtime and all allowances actually paid to the INSURED MEMBER which was earned from personal exertion from his or her usual employment, from which they are a member of THE INSURED, for the number of weeks so engaged during the twelve (12) month period immediately preceding INJURY or SICKNESS resulting in payment of the Benefits covered by this Policy. Self Employed: For the purpose of this policy, income shall mean the lesser of this year’s SG payments made multiplied by 11 or the gross income earned less all business expenses incurred in earning that income. (INSURED MEMBER‘s will be required to supply their last year’s tax assessment.)

g) INJURY means a physical injury caused by a violent, external and visible means which occurs fortuitously whilst this insurance is in force and which results in payment of any of the Benefits specified in the Policy, within 12 calendar months from the date of its occurrence, but does not include any condition which is also a SICKNESS.

h) INSURED MEMBER means a member of the POLICY OWNER who has not opted-out, is

ACTIVELY AT WORK and for whom the premiums shown in The Schedule have been paid by YOU to US.

i) MEDICAL PRACTITIONER means a medical practitioner legally qualified and registered to

practice in Australia who is a person other than the INSURED MEMBER, their relatives; business partners, shareholders or employees. Where the INSURED MEMBER is outside Australia the medical practitioner must have qualifications which are recognised by the Australian Medical Association as equivalent with those required of a medical practitioner registered to practice in Australia.

j) MEMBERSHIP STATUS means:

BRONZE MEMBER – an INSURED MEMBER who has had less than two years of continuous cover under an Income Protection policy provided to YOU by US and has not had a claim accepted by US or any previous Insurer.

SILVER MEMBER – an INSURED MEMBER who has had greater than two years but less than four years of continuous cover under an Income Protection policy provided to YOU by US and has not had a claim accepted by US or any previous Insurer.

Page | 9


GOLD MEMBER – an INSURED MEMBER who has had greater than four years but less than six years of continuous cover under an Income Protection policy provided to YOU by US and has not had a claim accepted by US or any previous Insurer.

PLATINUM MEMBER – an INSURED MEMBER who has had greater than six years of continuous cover under an Income Protection policy provided to YOU by US and has not had a claim accepted by US or any previous Insurer.

k) PARTIAL DISABLEMENT means that as a result of an INJURY or SICKNESS an INSURED

MEMBER is prevented from engaging in a substantial part of his or her usual occupation with their ADMITTED EMPLOYER in Australia. The INSURED MEMBER must be ACTIVELY AT WORK at the time the said INJURY or SICKNESS occurs and must be under the regular care of and acting in accordance with the instructions or professional advice of a MEDICAL PRACTITIONER other than the INSURED MEMBER.

If during such DISABLEMENT the INSURED MEMBER is able to return to work in a reduced capacity then the compensation payable shall be calculated as the difference between their earnings from reduced work capacity and their pre-disability INCOME, multiplied by the Benefit for TOTAL DISABLEMENT. If the INSURED MEMBER is able to return to work in a reduced capacity, and that work is available but the INSURED MEMBER declines to do so, or has resigned and would otherwise have been fit for light duties, then the compensation payable will be reduced to 25% of the compensation for TOTAL DISABLEMENT per week.

l) POLICY OWNER means the entity that pays the premium to US.

m) POLICY PERIOD means the period specified in The Schedule, or any prior or subsequent periods

in respect of which YOU pay and WE accept the premium required for the continuation of this Policy.

n) PRE-EXISTING SICKNESS means any sickness that an INSURED MEMBER is having or has had treatment for or advice for treatment for in the six (6) calendar months prior to the date of commencement, recommencement or increase of his or her cover under the Policy. However such condition will be covered provided:

a. an INSURED MEMBER has, with the agreement of a MEDICAL PRACTITIONER, ceased all treatment or advice for at least six (6) months during the POLICY PERIOD;

OR

b. An INSURED MEMBER has had one year of CONTINUOUS COVER under this policy prior to the time of their TOTAL DISABLEMENT and had been ACTIVELY AT WORK prior to the TOTAL DISABLEMENT which leads to the claim.

o) PREMIUM DUE DATE means 15th day of each month, payable monthly in arrears.

p) PROFESSIONAL SPORTING ACTIVITIES means participating in any sporting activity, including

training for that activity, where the INSURED MEMBER earns more than 50% (including any sponsorship they receive) of their annual gross income from that activity

Page | 10


q) SICKNESS means a state of being ill which is first contracted or which the INSURED MEMBER

first becomes aware of while this insurance is in force and which continues for a period of not less than the WAITING PERIOD and excludes any PRE-EXISTING SICKNESS and any INJURY.

r) STATUTORY BENEFIT means a weekly benefit payment to an INSURED MEMBER from a

relevant Workers’ compensation insurer or authority or as a result of a transport accident.

s) SUPERANNUATION GUARANTEE LEGISLATION means the Superannuation Guarantee (Administration) Act 1992 and associated Regulations.

t) TOTAL DISABLEMENT means that as a result of INJURY or SICKNESS the INSURED MEMBER is

prevented from engaging in his or her usual occupation with their ADMITTED EMPLOYER in Australia for which they are a member of THE POLICY OWNER. The INSURED MEMBER must be ACTIVELY AT WORK at the time the said INJURY or SICKNESS occurs, and must be under the regular care of and acting in accordance with the instructions or professional advice of a MEDICAL PRACTITIONER other than the INSURED MEMBER.

u) WAITING PERIOD means the continuous period stated in The Schedule before a Benefit is

payable, commencing with the first day of TOTAL or PARTIAL DISABLEMENT, as certified by a MEDICAL PRACTITIONER, other than the INSURED MEMBER. If the INSURED MEMBER returns to work during the waiting period, the waiting period starts again unless they return to work once and for a period of no more than 5 consecutive days, as certified by a MEDICAL PRACTITIONER.

v) YOU/YOUR means THE INSURED.

w) WE/OUR/US means the Insurers listed as the Underwriters in The Schedule.

Page | 11


(vii) Special Provisions

1. Aggregate Limit of Liability. Our total liability for all claims arising under this Policy from ANY ONE EVENT during any Policy Period shall not exceed AUD25,000,000 In the event that claims made under this Policy exceed the Aggregate Limit of Liability, then the amount by which the claims exceed it will be proportionally reduced.

2. Compensation shall not be payable: a) For the Waiting Period b) In excess of the Maximum Benefit Period, as specified in The Schedule, in respect of any

one INJURY or SICKNESS c) Beyond four weeks from the date of the INSURED MEMBER’S death d) Under more than one of the Benefits in respect of the same period of time e) Once the INSURED MEMBER is deemed fit to return to work by a MEDICAL

PRACTITIONER 3. Compensation for a period of less than one week will be paid at the rate of one-seventh

(1/7th) of the Weekly Benefit for each day during which INJURY or a SICKNESS continues.

4. Benefits shall be payable fortnightly in arrears or such other period as may be agreed between YOU and US from time to time and case to case, commencing at the end of the first fortnight after the WAITING PERIOD.

5. If an INSURED MEMBER suffers a recurrence of TOTAL or PARTIAL DISABLEMENT from

the same or related cause or causes, the subsequent period of disablement will be deemed a continuation of the prior period and a new Waiting Period will not apply unless between such periods The INSURED MEMBER has worked on a full-time basis for a least six (6) consecutive months, in which case the subsequent period of disablement shall be deemed to have resulted from a new INJURY or SICKNESS and a new WAITING PERIOD shall apply.

6. If an INSURED MEMBER is entitled to make a claim to be paid under this Policy through

being unable to follow their usual occupation with their ADMITTED EMPLOYER and continues to earn an income from another source or employer then that income from that other employer will not affect the payment of a benefit under this Policy unless the total of the payment under this Policy and the income derived from the other employment exceeds the total INCOME as at the date of occurrence of the SICKNESS or INJURY. Should the total figure exceed the INCOME then the excess portion of that INCOME will be deducted from payments under this Policy. This provision does not apply in the case where an INSURED PERSON suffers a work related INJURY/SICKNESS as a result of their employment by another Employer who is not an ADMITTED EMPLOYER of THE POLICY OWNER. In such cases no benefit is payable under this policy.

Page | 12


7. In the case where an INSURED MEMBER, after the expiry of the WAITING PERIOD, receives sick leave payments or receives or should receive other not-at-work related payments either directly or indirectly from an ADMITTED EMPLOYER , WE will pay the difference between the sick leave payment received or the other not-at-work related payment which the INSURED MEMBER receives or should receive and the amount shown in The Schedule.

8. WE will pay the difference between the STATUTORY BENEFITS and amount per week

specified in the Schedule for as long as the INSURED MEMBER is entitled to receive the STATUTORY BENEFITS or the end of the Maximum Benefit Period, whichever occurs first. When the relevant Workers Compensation Insurer or Authority decides to cease weekly STATUTORY BENEFITS payable to the INSURED MEMBER due to the INSURED MEMBER being medically able to return to work, WE will also cease payments and no further claim will be accepted or benefit payable with respect to the INJURY/SICKNESS from which the INSURED MEMBER received the STATUTORY BENEFITS. When the STATUTORY BENEFITS payable to the INSURED MEMBER cease but the INSURED MEMBER is medically unable to return to work, WE will continue to pay a benefit, up to the Maximum Benefit Period, with respect to the INJURY/SICKNESS from which the INSURED MEMBER received the STATUTORY BENEFITS, equal to 65% of INCOME, provided the INSURED MEMBER is assessed by an Independent Medical Officer. The above is subject to Special Provision 9.

9. If the INSURED MEMBER reaches an agreement with the relevant Workers Compensation

Insurer or Authority to cease weekly STATUTORY BENEFITS and receives a Lump Sum in lieu of those benefits, WE will pay to the INSURED MEMBER a Lump Sum in lieu of future weekly benefits payable by US under Special Provision 8 above, calculated as follows:

The lesser of, the Maximum Benefit Period, less any period of payments already made by US under clause Special Provision 8, or the number of weeks used in the calculation of the Lump Sum by the Workers Compensation Insurer or Authority.

Once determined, the benefit payable by US will be that number of weeks multiplied by the last per week payment made by US under clause Special Provision 8.

10. If an INSURED MEMBER suffers a work related Injury or Sickness and is not covered by the State’s Workers Compensation Scheme, for whatever reason, WE will only pay the difference between what the INSURED MEMBER would have received if they were covered by the State’s Workers Compensation Scheme and amount per week specified in the Schedule for as long as the INSURED MEMBER would have been entitled to receive the Statutory Benefits or the end of the maximum benefit period as specified in the Schedule, whichever occurs first.

Page | 13


11. INSURED MEMBERS who were covered by an Income Protection policy of THE POLICY OWNER’s, up to the commencement date of this policy, and who transfer to this policy on the commencement date will have their continuous coverage under that previous policy recognised when considering the application of (x) Exclusions - No.4 applying to them when making a claim, provided their cover under this policy remains continuous.

12. If any provision of this Policy is held invalid or unenforceable by any court of competent

jurisdiction, the other provisions of this Policy will remain in full force and effect. Any provision of this Policy held invalid or unenforceable only in part or degree will remain in full force and effect to the extent not held invalid or unenforceable.

13. If an INSURED MEMBER suffers an INJURY or SICKNESS whilst on Paid Parental Leave WE will consider a claim on the same basis as if the INSURED MEMBER was not on leave, except that benefits shall only become payable from the date that Paid Parental Leave was due to cease.

14. In the event of a period of TOTAL or PARTIAL DISABLEMENT exceeding an INSURED MEMBER’s WAITING PERIOD: A Platinum Member’s Benefit Period commences 21 days prior to the last day of their

WAITING PERIOD A Gold Member’s Benefit Period commences 14 days prior to the last day of their WAITING

PERIOD A Silver Member’s Benefit Period commences 7 days prior to the last day of their WAITING

PERIOD A Bronze Member’s Benefit Period commences the first day after the last day of their

WAITING PERIOD All of the above is always subject to the Maximum Benefit Period stated in The Schedule

15. If an INSURED MEMBER elects to reduce their WAITING PERIOD, Exclusion 4 of this Policy will be applied to the days between the previous higher WAITING PERIOD and the new WAITING PERIOD. Exclusion 4 will be removed once the INSURED MEMBER has had one year of continuous cover from the date they elected to reduce their WAITING PERIOD.

Page | 14


16. When an INSURED MEMBER has a claim under this Policy, their membership status may be affected. The following rules will apply to this section of the Policy:

Membership Status

If a claim is paid (must be accepted and a benefit paid) before the INSURED MEMBER reaches the first/next Loyalty Bonus level and the claim is for a benefit period of 60 days or less

If a claim is paid (must be accepted and a benefit paid) before the INSURED MEMBER reaches the first/next Loyalty Bonus level and the claim is for a benefit period greater than 60 days

Bronze You retain Bronze and your ‘continuous cover with no claims’ period continues without a break.

You retain Bronze and your ‘continuous cover with no claims’ period restarts.

Silver You retain Silver and your ‘continuous cover with no claims’ period continues without a break.

You return to Bronze and your ‘continuous cover with no claims’ period restarts at 0 years.

Gold You retain Gold and your ‘continuous cover with no claims’ period continues without a break.

You return to Silver and your ‘continuous cover with no claims’ period restarts at 2 years.

Platinum You retain Platinum and your ‘continuous cover with no claims’ period continues without a break.

You return to Gold and your ‘continuous cover with no claims’ period restarts at 4 years.

Page | 15


(viii) Conditions 1. Non Payment of Premium

If at the time of making a claim under this Policy it is found that the instalment Premium has remained unpaid for a period of thirty (30) days or more past the last premium Due Date, then WE can delay payment of the claim until this premium has been received by US.

If premiums remain in arrears for a further period of thirty (30) days or more then WE may cancel this Policy by giving YOU 30 day’s written notice.

If this Policy is cancelled due to Non Payment of Premium, the amount owing will be deducted from any outstanding claim payments.

This condition applies as each and every premium installment becomes due and cannot be disregarded because WE may have previously accepted an installment after thirty (30) days.

If at any time the premium is more than 30 days in arrears we will notify THE POLICY OWNER in writing and allow THE POLICY OWNER 14 days to rectify the premium arrears prior to taking any further action.

2. Premium Increase After the guaranteed period stated in The Schedule WE may vary premium payments under this Policy. Such premium variation shall be notified to YOU in writing and will take effect from the next Premium Due Date.

3. Time of the Payment of Claim Compensation other than periodic payment will be paid immediately upon receipt of due written proof of the Claim. Periodic payment will be paid in the manner specified in (vii) Special Provisions - No 4.

4. Clerical Error Any clerical error by any of the parties to this insurance shall not invalidate this insurance, nor shall this insurance continue if it was not validly in force.

5. Fraud Any fraud, misstatement or concealment by YOU or an INSURED MEMBER in relation to any matter affecting this insurance or in connection with the making of any claim under it will give Us the rights provided for in the Insurance Contracts Act, 1984 including where appropriate the right to reduce or refuse payment of any claim or to cancel or avoid the Policy.

Page | 16


6. Disputed Claims Group

(a) WE will establish a Disputed Claims Group which will consist of four people, two people nominated by YOU and two people nominated by US. The group’s role is to meet in Sydney, or another agreed location within Australia, to review claims that have been rejected, where an INSURED MEMBER has lodged a complaint with YOU or US about the decision. A majority decision of this group will be binding on US but will not affect the INSURED MEMBER’s rights to seek further redress of the disputed claim. (see b) below)

(b) If YOUR dispute remains unresolved YOU will be referred to the Lloyd’s General Representative in Australia at Lloyd’s Australia Ltd and then if necessary the Financial Ombudsman Service or the Superannuation Complaints Tribunal. For other disputes you will be referred to other proceedings for resolution. Details are available from Lloyd’s Underwriters’ General Representative in Australia at the address below.

Lloyd’s Underwriters’ General Representative in Australia

Suite 2, Level 21 Angel Place

123 Pitt Street Sydney NSW 2000

Telephone Number: (02) 9223 1433 Facsimile Number: (02) 9223 1466

7. Subrogation/Offset

(a) If WE make weekly payments under this Policy to an INSURED MEMBER, then to the extent that the INSURED MEMBER receives payments: (other than Benefits under this Policy):

i) from an ADMITTED EMPLOYER or a former ADMITTED EMPLOYER, business partnership, or other similar source;

ii) from a Superannuation or pension plan; iii) from any other disability, injury or sickness policy; (except for lump sum

benefits received for total and permanent disablement under such an insurance policy);

iv) from any workers compensation insurer, compulsory third party motor vehicle insurer or public liability insurer;

v) from any government authority or government instrumentally in the form of a pension or allowance;

vi) by way of commission payments or remuneration relating to the period(s) from which the INSURED MEMBER is paid under this Policy

Then WE are entitled to recalculate and reduce the Benefit, to the INSURED MEMBER, under this Policy, by any amount received from any of the above.

Page | 17


b) Any difference between the Benefit paid and the recalculated Benefit shall be repaid by the INSURED MEMBER. If the INSURED MEMBER does not fully repay US we can reduce future Benefits by the amount of the unpaid difference and/or be entitled to a repayment of the recalculated Benefits.

c) If an INSURED MEMBER receives payments from any of the categories in (a) above,

after the Benefit has been paid by US, then WE are entitled to a repayment of the recalculated Benefit in full.

d) The INSURED MEMBER is obliged to disclose to US immediately details of any

payments received, in accordance with (a) above, either before, during or after receiving their Benefit under this Policy.

8. Choice of Law and Jurisdiction In the event of a dispute arising under this Policy, WE, at the request of THE POLICY OWNER

will submit to the jurisdiction of any competent Court in the Commonwealth of Australia. Such dispute shall be determined in accordance with the law and practice applicable in such court.

9. Service of Suit

WE hereon agree that: - (i) Any summons notice or process to be served upon the Underwriters may be served

upon: Lloyd’s General Representative in Australia Lloyd’s Australia Ltd Suite 2, Level 21 Angel Place 123 Pitt Street Sydney NSW 2000 who has authority to accept service and to enter an appearance on OUR behalf, and who is directed at the request of THE POLICY OWNER to give a written undertaking to THE POLICY OWNER that they will enter an appearance on OUR behalf.

(ii) If a suit is instituted against any one of the Underwriters, all Underwriters hereon will

abide by the final decision of such Court or any competent Appellate Court. 10. Surrender Value

No surrender value is acquired under this Policy. 11. Cancellation

This Policy may be terminated at any time by the POLICY OWNER. 12. Change in Law

We reserve the right to vary premiums and / or the terms under this Policy upon written notification to YOU in the event of any change in the law and as a result: a) it becomes impractical or impossible to carry out our obligations; or b) our Policy is inconsistent with the law; or c) Government charges relating to the Policy are imposed or changed.

Page | 18


(ix) Making a Claim 1. Claims Procedure:

a) Written notice must be given to: Windsor Income Protection Pty Ltd 1A Homebush Bay Drive, Rhodes NSW 2138 or such other address as WE may advise YOU in writing.

b) All certificates and evidence (subject to clause c) below) required by US shall be furnished

as required at the INSURED MEMBER’S expense as often as is reasonably required.

c) In order to assess a claim an INSURED MEMBER shall submit to a medical examination at OUR expense as often as is required.

2. Proof of Claim

Written Proof of Claim must be furnished to US, via Windsor Income Protection Pty Ltd, within ninety (90) days after the date of the INJURY or SICKNESS. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to do so, provided that the proof is furnished as soon as is reasonably possible and in no event except in the absence of legal capacity, later than 12 calendar months from the time it would normally be required.

3. Report of Claim WE will, upon receipt of a notice of claim, furnish such forms as are usually required by US for

filing Proof of Claim.

Page | 19


(x) Exclusions

This Policy shall not apply to any INJURY/SICKNESS directly caused by or resulting from: 1. Any consequence of war, invasion or civil war 2. Intentional self-inflicted INJURY or SICKNESS, including any attempt at suicide

3. Pregnancy, childbirth or miscarriage other than;

a) A complication arising from pregnancy which requires hospitalisation for greater than 24

hours within the first thirty-three (33) weeks of pregnancy. All benefit payments will cease at the date of birth and/or termination of the pregnancy. No benefit shall be payable for any complications arising after the thirty third week of pregnancy.

Or

b) A new INJURY or SICKNESS which occurs during childbirth or miscarriage.

The waiting period will commence from the conclusion of the Government’s and/or Employer’s paid maternity leave benefit period, whichever is the greater.

No benefits shall be payable during any period of maternity leave. 4. Any PRE-EXISTING SICKNESS – refer Definition (n)

5. Any criminal act committed by an INSURED MEMBER

6. An INSURED MEMBER being a pilot or crew member of any aircraft; or engaging in any aerial activity except as a passenger in a properly licensed aircraft.

7. Any PROFESSIONAL SPORTING ACTIVITIES

Page | 20


B. The Schedule

Policy No: WK101750a Class of Business: Personal Accident and Sickness Interest: Weekly Benefits Policy Period: From: 12:01am on 1st November 2011 To: 12:01am on 1st November 2014 Commencement Date: 12:01am on 1st November 2011 The Policy Owner: The Trustee of Intrust Super Fund Fund Name: Intrust Super Fund Address: Level 3, 348 Edward Street Brisbane QLD 4000 Australia Insured Members: Employees of ADMITTED EMPLOYERS of THE

POLICY OWNER Weekly Injury & Sickness Benefits:

(i) Total Disablement: Maximum of 90% of INCOME

(ii) Partial Disablement: As per Definition k)

(iii) Superannuation Benefit: An amount equal to 10% of the Benefit Paid

Maximum Monthly Benefit: $50,000 per month, always subject to a

maximum of 90% of INCOME

Maximum Benefit Period: Sickness: 104 weeks or to the date the INSURED MEMBER turns 65 years, whichever occurs first. INSURED MEMBER’s aged 65 & above – 12 weeks or to the date they turn 70 years, whichever occurs first. If on claim when they turn 65 years, the INSURED MEMBER will receive an additional 12 weeks but only to a maximum of 104 weeks total Benefit

Page | 21


Injury: 104 weeks or to the date the INSURED MEMBER turns 65 years, whichever occurs first. INSURED MEMBER’s aged 65 & above – 52 weeks or to the date they turn 70 years, whichever occurs first. If on claim when they turn 65 years, the INSURED MEMBER will receive an additional 52 weeks but only to a maximum of 104 weeks total Benefit

Maximum Age Limit: 70 years Minimum Waiting Period: 21 consecutive days Default Waiting Period: 21 consecutive days An INSURED MEMBER can choose to alter their

waiting period as follows: 30 consecutive days 45 consecutive days 90 consecutive days

Territorial Limits: (a) Non work related: Worldwide

(b) Work related: Australia Premium Rate: As agreed

Rate Guarantee: 36 months from Commencement Date

Page | 22


Guaranteed Renewal Provided that all terms and conditions of the Policy, including the payment of premiums, have been complied with we guarantee we will offer renewal terms to the Insured at the expiry of the rate guarantee period. The rates and terms may vary from the current policy.

Superannuation Guarantee (SG) Currently legislated at 9%. Should the legislated SG amount change during the policy period, the premium rate will be adjusted accordingly to ensure an appropriate premium pool for the exposure.

Underwritten By: Certain Underwriters at Lloyd’s

Documents

Group Personal Accident and Sickness Policy - Intrust …intrustsuper.com.au/wp-content/uploads/Intrust-Super-PayGuard... · Group Personal Accident and Sickness Policy For ... The