You can choose which Cover you’d like for your Income Protection from:
- Accident Cover;
- Illness Cover; and
- Sports Cover
|Income Protection||What you’re Covered for|
|Accident Cover||You will be Covered in the event of Total Disability or Partial Disability as a result of Accidental Injury, subject to any Special Conditions outlined in your Policy Schedule. For example Cover would be provided for Accidental Injury such as a broken leg sustained in a household accident which leaves you Totally Disabled or Partially Disabled.|
|Illness Cover|| You will be Covered in the event of Total Disability or Partial Disability as a result of Illness, subject to any Special Conditions outlined in your Policy Schedule. For example, Cover would be provided for Illness such as a Heart Attack which leaves you Totally Disabled or Partially Disabled.
Any claim as a result of Mental Health Related Illness will be limited to a maximum Benefit Period of 2 years only.
|Sports Cover|| In order to hold this Cover, you must also take out Accident Cover.
You will be Covered in the event of Total Disability or Partial Disability as a result of a Sports Injury, subject to any Special Conditions outlined in your Policy Schedule. For example, Cover would be provided for an Injury such as a torn hamstring sustained while playing tennis, or a broken leg sustained while playing football, which leaves you Totally Disabled or Partially Disabled.
|Income Protection||What you’re not Covered for|
|Accident Cover||If you select Accident Cover only, then no Cover is provided if you become Totally Disabled or Partially Disabled due to an Illness or due to a Sports Injury. For example, no Cover would be provided if you were Totally Disabled or Partially Disabled directly or indirectly as a result of an Injury sustained while playing football or as a result of a heart attack.|
|Illness Cover||If you select Illness Cover only, then no Cover is provided if you become Totally Disabled or Partially Disabled due to an Accidental Injury or due to a Sports Injury. Additionally, no Cover is provided if you become Totally Disabled or Partially Disabled due to a Mental Health Related Illness as a result of Accidental Injury or Sports Injury. For example, no Cover would be provided if you were Totally Disabled or Partially Disabled directly or indirectly as a result of injuries sustained in a motor vehicle accident, a broken leg sustained while playing football, or depression resulting from a an accidental injury such as a broken shoulder.|
|Sports Cover||If you hold Accident Cover and Sports Cover but not Illness Cover, you will not be Covered for Total Disability or Partial Disability arising from any Illness. For example, no Cover would be provided for a Heart Attack or infection which leaves you Totally Disabled or Partially Disabled|
Total Disability Benefit
Income Protection pays you a Benefit in the event that you are Totally Disabled as a result of something you are Covered for.
You must be Totally Disabled for the entire Waiting Period and solely because of the Illness or Injury you are Covered for you:
- are not working in any Gainful Occupation;
- are following the advice of a Medical Practitioner; and
- are unable to attend or engage in one or more of the important income-producing duties of your Own Occupation.
Partial Disability Benefit
Income Protection pays you a Benefit if you are Partially Disabled as a result of a Covered event. You must be:
- working or capable of working in a Gainful Occupation; and
- under the ongoing care of, and following the advice of a Medical Practitioner; and
- have suffered a reduction of 20% or more in your ability to generate Monthly Income.
You must have been Totally Disabled for the entire Waiting Period.
The Benefit Amount takes into consideration your average income in the 12 months prior to your Disability and the Monthly Income you received in the claimed period.
If a Total Disability or Partial Disability reoccurs from the same or a related cause within 12 months of a claim ending, we treat it as a continuation of the original claim which means no Waiting Period applies before payments recommence. Please note all claim periods will be added together to calculate the maximum Benefit Period for the Total Disability or Partial Disability.
Where you become Totally or Partially Disabled as a result of two separate and distinct unplanned Illnesses or Injuries, only one Benefit is payable under Income Protection. The Benefit paid will be the amount that provides the highest payment.
You can also choose whether you want your Cover to increase each year in line with the cost of living – this will mean that your premium will increase each year as the Cover is increased through a process called indexation. If you have a Stepped Premium Policy, it will mean that there are two reasons your Policy will increase each year.
The default setting for all TAL Lifetime Protection Policies is for those Policies to have indexation applied to them but can be turned off on request. If you are Bundling TPD or Recovery Insurance with your Life Insurance, you will need to have Inflation Protection switched on or off for all insurances.
Indexation can be declined on any number of occasions or switched off permanently at any time, otherwise indexation continues on Life Insurance, and on TPD or Recovery Insurance Bundled with Life Insurance until Policy expiry. For TPD which is Standalone, indexation ends at the Policy Anniversary prior to your 65th birthday. For Recovery Insurance which is Standalone, indexation ends at the Policy Anniversary prior to your 70th birthday.
Indexation applies to both Stepped and Level Premiums. For Level Premiums, the additional premium for the increased Cover is based on your age at the time of the increase – not at the time the Policy started. Indexation does not apply to Cover due to Life Insurance Buy Back Options, and Future Life Event increases.
The indexation rate is the CPI or 5%, whichever is the greater for Life Insurance, TPD and Recovery Insurance. For Income Protection, the indexation rate is 3% or CPI, whichever is the greater. The CPI rate is published each October and applies from the beginning of the following calendar year. Indexation applies to the Anniversary Statement issued for the next Policy Anniversary (i.e. after 1 January.) Indexation will cease on the anniversary prior to the Policy Expiry Date. Indexation continues through the maximum Cover allowable at the time of taking out the Policy.
While you have an active Income Protection claim, and you are receiving payments from TAL, the Benefits are not indexed unless the Policy has the “increasing claims” optional extra. Indexation of these Benefit Amounts is the lower of CPI and 3%.
Indexation increases can be reversed on request. In this case only the most recently increased portion of the Cover is cancelled. The rest of the Cover (pre indexation) remains the same, and the premium relating to this Cover is the premium based on the recently calculated anniversary.
Inflation Protection will not apply if Premiums are being waived under the Premium Relief Option.
Waiver of Premium Benefit
We will waive or reimburse your Income Protection premiums while you are receiving a Benefit payment for Total or Partial Disability.
- Applies when Total or Partial Disability payments have accrued (including payments under Scheduled Injury Benefit).
- Waiver of Premium starts to accrue from the first day of the Waiting Period.
- Waiver of Premium applies immediately after the Waiting Period for any premiums paid during the Waiting Period and monthly in arrears for subsequent premiums.
- Waiver of premium will stop on the earlier of:
- You no longer being Totally Disabled or Partially Disabled;
- The end of the Benefit Period.
Rehabilitation Expense Benefit
If you are Totally Disabled or Partially Disabled we may reimburse the expense of your rehabilitation through an occupational or vocational Rehabilitation Program pre-approved by us (less amounts reimbursed from elsewhere). Reimbursement is subject to:
- our prior written approval of the rehabilitation expense; and
- a maximum allowable reimbursement of six times the monthly Benefit Amount.
The cost of medical consultations and medical therapy consultations will not be reimbursed.
Scheduled Injury Benefit
Available for Accident Cover and Sports Cover only.
The Scheduled Injury Benefit is paid for a specific period for the Injury events shown below.
Note: Your selected Waiting Period for Income Protection does not apply to this benefit.
Fracture^ of the:
|Payment period (months)|
|Thigh or pelvis||3|
|Leg (between the knee and foot), knee cap, upper arm, shoulder bone or jaw||2|
|Forearm (above the wrist), collarbone or heel||1|
|Skull (excluding bones of the nose and face)||2|
^ Fracture means a bone fracture requiring the application of a plaster cast or a similar immobilising device by a Medical Practitioner, or Totally Disabled for 28 days.
The Benefits will be paid monthly in advance.
The Scheduled Injury Benefit will stop on the earlier of:
- The expiry of the payment period as set out in the table above; or
- The date Cover ends.
At the expiry of the payment period, you may be eligible for other Benefits if you meet the stated conditions.
The Scheduled Injury Benefit is not available on Cover through a SMSF (Self-Managed Super Fund).
At TAL we understand that not everything always goes as planned, that’s why we allow you to request to pause your Cover for up to three months in the event of financial hardship. During Cover Pause you will not have to pay premiums.
You need to be aware that no Cover will be provided under any TAL Lifetime Protection Insurance Cover while the Cover Pause is in effect.
At the end of the Cover Pause period, you can re-start Cover without needing to go through health and lifestyle assessment again.
Once your Cover is restarted by paying your premium, a qualifying period of three months will apply, so you’ll be eligible to claim three months after you re-start your Cover. You will not be eligible to claim should your death, or Illness or Injury leading to your death occur or become apparent during the qualifying period.
Stepped vs. Level Premiums
TAL Lifetime Protection offers the choice of Stepped or Level Premiums for all Cover types.
Stepped Premiums means that the amount you pay in premiums increases each year as you get older.
Stepped Premiums are re-calculated based on your age at each Policy Anniversary. This generally means your premium rate will start lower than the Level Premium structure, but will increase each year corresponding with increasing risks.
Level Premiums means that the base cost of your Cover stays the same year on year, however as your Cover increases with Inflation Protection , the cost of that new Cover will be added to your premium.
Level Premiums can give you more certainty on cost when planning ahead for the future and if you’re planning to keep your Cover for many years. If keeping your costs stable is important to you, you also have the option of removing Inflation Protection.
When you select our Level Premium option, you should note that Level Premiums end at age 65 and will revert to the corresponding Stepped Premium for your age after age 65 until your Policy expiry.
The options you can add
Day One Accident Option
Available for Accident Cover and Sports Cover only. This needs to be set up over the phone with one of our Insurance Specialists.
You can choose to add the Day One Accident Option for an additional premium. If Covered under this option, we will backdate your Monthly Benefit payments to the Date of Disablement in the event of an Accidental Injury resulting in Total Disability for the duration of the Waiting Period. Payments will be made monthly in arrears.
This option is only available when 2 and 4 week Waiting Periods have been selected and will not be available for selected occupations which require individual consideration, for example: construction worker, and road traffic controller.
Increasing Claims Option
This needs to be set up over the phone with one of our Insurance Specialists.
You can choose to add the Increasing Claims option for an additional premium if you have selected Inflation Protection. Increasing Claims ensures your Benefit keep up with inflation while you are receiving payments. We will increase Benefit payments in line with the Indexation Factor on the anniversary of the commencement of continuous Benefit payments. This annual increase is capped at 3%.
Increasing Claims will not apply if you have not selected Inflation Protection.
How claims work
How to make a claim
If you wish to make a claim under the Policy, you must contact us at the earliest possible opportunity. Once a claim has been lodged, we will begin the assessment process and identify any opportunities where further assistance can be provided.
The event for which you are claiming must occur at a time while your Cover is current. Benefit payments will commence once we are satisfied you have met the terms and conditions of your Policy.
To ensure we are able to assist you in an efficient manner, you must notify us in writing or by telephone, of any event that gives rise to a claim. This should be done as soon as reasonably possible otherwise claim payments may be reduced to the extent the ability to assess the claim has been prejudiced by the delay in being able to adequately assess the claim.
Claim requirements at your expense
You must provide us with any requirements we reasonably consider necessary to assess your claim. Upon notification, TAL will provide specific details of these claim requirements.
Our obligation to pay a Benefit under the Policy is subject to the following information being provided to us:
- notice of any claim or potential claim being provided to us as soon as reasonably possible;
- the initial Medical Practitioner’s report;
- a certified copy of your identification and proof of age;
- the Policy Schedule;
- all standard claim forms and other documentation or reports required by us to continue the initial and ongoing assessment, including but not limited to progress medical reports, records of your income and other personal financial documentation; and
- such other information relating to the claim that we may reasonably request.
For Income Protection insurance you will be advised if you are required to provide:
- verification of your Pre-Disability Earnings, stated in the application;
- verification of your Monthly Earnings, before and after the event giving rise to your claim; and/or
- an audit of your business and personal financial circumstances as often as is required. This may include auditing documents that constitute a legal requirement such as business and personal taxation returns and profit and loss statements.
We will not reimburse any costs incurred by you in obtaining documents to verify your Pre-Disability Earnings, Monthly Earnings or any auditing of your business or personal financial circumstance as required by us. This includes any translation costs or other associated costs incurred by you in providing documents that we can reasonably rely upon.
Claim requirements at TAL’s expense
If we arrange for you to be medically examined in connection with your claim:
- the person who examines you will be an appropriate registered Medical Practitioner or other health practitioner chosen by us at our discretion;
- you must use your best endeavours to attend the examination; and
- we will pay the Medical Practitioner’s fees.
If we arrange for you to be medically examined and you fail to attend the examination and we incur a non-attendance fee, this fee must be paid by you.
We may also require you to:
- attend interviews with a member of our staff or someone appointed by us as often as is reasonably required to fully consider your claim; and
- attend and engage with occupational rehabilitation services by an appropriately qualified person selected by us.
If you are outside Australia and become Disabled, the entitlement to your claim may be suspended where we are unable to appraise the medical opinion or data relied upon by you. Consequently, you may have to return to Australia for the claim to be assessed, at no expense to us, before we are able to determine our liability for the claim.
We may cancel a Policy for a fraudulent claim
If you make a fraudulent claim under your Policy or another policy you have with us, we may cancel your Policy.
Your obligation regarding Disability duration and severity
In providing you with this Policy, TAL insures you on the basis of the agreed Cover. While TAL has accepted the risks associated with any potential loss, you must not knowingly contribute to the severity or longevity of your Disablement. For Income Protection claims, TAL will continually assess your claim and will make a decision to cease paying your Benefit if we determine that you no longer meet the terms and conditions for the payment of the Benefit.
Both the eligibility and extent of any claim payments relating to your Illness, Injury or Disablement will be based solely on the medical factors contributing to the Illness, Injury or Disablement. Under the terms of this Policy, we will exclude any claims made on the basis of additional impact due to economic, seasonal or any other non-medical factors.
If Cover is provided under Income Protection and a claim is made for a period of Disability of less than one month, it will be paid on a pro-rata basis. The payment will be made at a rate of 1/30 of the Benefit Amount for each day you are Disabled, excepting any Adjustments or Offsets.
Payment of claim
If you are judged not to be legally competent, we will pay any Benefits to whomever we are legally permitted to make payments.
We will not be liable to you for any loss you suffer (including consequential or special loss) caused by the fact that we are required by law to delay, block, freeze or refuse to process a transaction, where applicable.
Claims contact details
GPO Box 5380 Sydney NSW 2001
Customer Service 1800 101 016
The cost of your Policy depends on a range of factors, including your age and gender, the type and amount of Cover, the number of Cover types you hold, the length of time you’ve held Cover with us and whether or not you smoke.
We also take your occupation, health, income and personal pastimes into account. Once we know a little bit about you and the Cover you require, we can then determine the basic costs involved.
When you take out a Policy you will receive welcome documentation and a Policy Schedule, you should read it carefully. The welcome documentation will show you the first premium payable and due date. The premium amount will also include any extra amounts charged to you when we accepted your application or re-issued you a Policy.
Australian citizens, permanent Australian residents, or New Zealand citizens residing permanently in Australia aged 18 to 59 are eligible to apply. You must be working in paid employment for a minimum of 25 hours a week, and can be either employed or self-employed.
For some occupations, generally those with a focus on manual work, eligibility will be limited to age 54.
Examples of manual occupations include: truck and courier drivers, farmers, labourers, gardeners, handymen, carers, enrolled nurses, chefs, waiters, security guards, machine operators and toolmakers.
Cover Start and End Dates
Once your application is accepted by us, your Cover continues until the Policy Anniversary prior to your 65th birthday as long as you have complied with the Duty of Disclosure and paid the premiums when due.
Your Cover will end when Cover is removed from your Policy, Cover lapses through non-payment of premiums (where premiums are payable) or when Cover expires at age 64. There may be other reasons Cover may end.
Minimum and Maximum Cover
The minimum Benefit Amount you can apply for is $1,000 per month.
The maximum Benefit Amount we will pay is limited to the lesser of either $10,000 per month or 75% of your Monthly Income, less any Adjustments and Offsets.
TAL Lifetime Protection’s Income Protection is on an indemnity basis – this means you will be insured for up to 75% of the income you earn at the time you apply, but you’ll need to verify your income at the time of claim. If prior to your claim, 75% of your income is lower than your Cover amount, your claim may be paid on the reduced amount. More detail about how we assess your income at claim can be found here
Benefit Periods and Waiting Periods
A choice of Waiting Periods applies from the Date of Disablement before Benefits commence:
- 2 weeks;
- 4 weeks;
- 13 weeks; and
- 2 years (104 weeks).
You can also select the length of your Benefit Period (subject to eligibility). This is the length of time we will pay you a Benefit once we have accepted your claim and Monthly Benefit payments commence:
- 1 year;
- 2 years; and
- 5 years.
You should note:
- The Benefit Period is payable once per claimed condition, including any recurrences;
- Benefit payments expire at the end of the Benefit Period; and
- A maximum Benefit Period of 2 years applies for claims arising from Mental Health
- Related Illnesses even if a longer Benefit Period has been selected.
Other things you need to know
Please note the following terms and conditions that apply to your Income Protection Cover:
- The 75% indemnity value is calculated based on your Pre-Disability Earnings for the 12 months immediately prior to the Disability leading to your claim, inclusive of any adjustments;
- Benefit payments start to accrue when your claim is admitted and your Waiting Period has expired. Payments are paid monthly in arrears; and
- Benefit payments will continue for as long as you are Totally Disabled or Partially Disabled in accordance with the terms and conditions of your Policy but will cease at the end of the Benefit Period or Cover Expiry, whichever is earlier.
Adjustments & Offsets
Other income payments
Adjustments and Offsets reduce your Income Protection Benefit, if you receive other income payments, which together with the Benefit exceed 75% of your Average Monthly Income. Other income payments include payments received from:
- any other income protection or similar policy;
- any workers’ compensation, legal judgment, or statute related payment; or
- sick leave greater than 60 days.
Your Income Protection Benefit will be reduced to allow for any other compensation for Disability that is in the form of a lump sum or is commuted to a lump sum.
If it can be shown that a portion of the lump sum represents compensation for pain and suffering, or the loss of use of a part of the body, we will not take that portion into account for the purpose of reducing your Income Protection Benefit.
Any legal judgement, workers’ compensation or statutory payment received as a lump sum where pain and suffering cannot be isolated from loss of earnings will be taken into account for the purpose of reducing your Income Protection Benefit.
For this purpose, the monthly Income Protection Benefit will be reduced by 1% of the lump sum amount. For example:
Bill is an employed 40 year old electrician earning $8,000 per month which includes contributions to his superannuation fund. On 1 June, Bill hurts his back after an accident at work where he falls off his ladder. Sadly, Bill is not able to return to work after his Injury.
Under Income Protection, Bill is entitled to claim 75% of his Average Monthly Income for up to 2 years, (his chosen Benefit Period) once he meets the Waiting Period and definition of Total Disability.
On 1 September, Bill decides to lodge a claim for an Accidental Injury with us. Once assessed, we approve his claim and he is paid $6,000 (i.e. 75% of his Average Monthly Income) per month.
In addition to his TAL Lifetime Protection claim, Bill had lodged a claim for compensation. On 1 October, his compensation claim is settled for a lump sum of $400,000. As this lump sum payment is a ‘global settlement’ figure and Bill’s loss of earnings could not be determined, we offset his entire settlement amount as set out below:
|Ongoing Monthly Offsets
(as at 1 October 2014)
|=||1% x Lump Sum Received|
|=||1% x $400,000|
After applying the offset amount against Bill’s monthly Income Protection Benefit, his ongoing monthly Benefit would be:
|Ongoing Monthly Benefit
(as at 1 October 2014)
|=||75% of Pre-disability Income
(minus) 1% x Lump Sum Received
|=||75% of $8,000 - $4,000|
|=||$6,000 - $4,000|
Bill would be entitled to receive $2,000 per month for the remaining months he is on claim with us.
The amount of the reduction will not exceed the amount of the other payments.
No Benefit will be paid when the other payments, plus your Monthly Earnings in the month to be paid, are greater than or equal to 100% of Pre-Disability Earnings.
In months where a Benefit payment is reduced, a proportionate refund of premiums paid will be made.
The refund will be A x B, where:
A = the percentage reduction in the Benefit payment; and
B = the average monthly premium over the 12 months prior to the claim starting.
The refund will be made for the lesser of 12 months or the number of months your Income Protection was in-force prior to the claim starting.
Residing outside of Australia
A maximum Benefit Period of 90 days will apply while you reside outside of Australia.
If you are in Australia and become disabled and subsequently travel or reside outside Australia, claim payments will only be made if, in travelling or residing outside Australia, you are following the advice of the treating Medical Practitioner, and will cease after 90 days. Your case manager must be advised in advance of your start date of travel.
If you are outside Australia and become disabled, your entitlement to claim will be suspended where we are unable to appraise the medical opinion or data relied upon by you, or after 90 days. Consequently, you will have to return to Australia for medical assistance for the claim to be assessed.
Where time has elapsed between the end of the 90 day period and your return to Australia, the onus will be on you to provide sufficient evidence for us to assess your eligibility for claim payments.
What you’re not covered for
Specific Exclusions and Special Conditions may apply to your Income Protection Cover depending on the Cover that you have selected. Refer to your Policy Schedule for details of any additional Exclusions or Special Conditions that apply to your Policy.
In addition, some Exclusions apply to your Income Protection regardless of the Cover you have selected:
No payment will be made under Income Protection if the event giving rise to the claim is caused directly or indirectly by:
- an intentional, self-inflicted act by you;
- pregnancy, giving birth, miscarrying or having a pregnancy termination unless Total Disability or Partial Disability continues for longer than 3 months after the
- pregnancy ends in which case Disability will be considered to have started at the date the pregnancy ends;
- war, terrorism, civil commotion or unrest; guerrilla or insurgent activities in countries outside Australia;
- you visiting a country for which the Australian Department of Foreign Affairs and Trade (DFAT) has issued a ‘Do Not Travel’ warning advice that is in force during the time you stay in that country;
- any Illness, Injury or Sports Injury that occurs as a result of, or during the course of, committing or attempting to commit a criminal offence; or Mental Health Related Illness or any Mental Health Related Illness as a result of an Accidental Injury, Sports Injury or Illness after a Benefit has been paid for two years.
If you have selected Accident Cover only, no claim will be payable in the event of:
- your inability to work as a result of an Illness;
- your inability to work as a result of any Mental Health Related Illness, or any Mental Health Related Illness directly or indirectly as a result of an Accidental Injury, Sports Injury or Illness; or
- your inability to work as a result of a Sports Injury or Dangerous Pastimes.
If you have selected Illness Cover only, no claim will be payable in the event of:
- your inability to work as a result of an Accidental Injury;
- your inability to work as a result of a Sports Injury or Dangerous Pastimes; or
- any claim directly or indirectly as a result of Mental Health Related Illness, after a Benefit has been paid for two years.
If you have selected Illness Cover and Accident Cover only, no claim will be payable in the event of:
- your inability to work as a result of a Sports Injury or Dangerous Pastimes; or
- any claim directly or indirectly as a result of Mental Health Related Illness, after a Benefit has been paid for two years.
If you have selected Accident and Sports Cover only, no claim will be payable in the event of:
- your inability to work directly or indirectly as a result of an Illness; or
- your inability to work directly or indirectly as a result of any Mental Health Related Illness, or any Mental Health Related Illness as a result of an Accidental Injury or Illness.
For Cover structured through a SMSF (Self-Managed Super Fund), you must also satisfy the SIS definition of Temporary Incapacity. You should also be aware that due to the definition of “gainfully employed” under superannuation law, if you are unemployed in the period immediately prior to Total Disability or Partial Disability, no Benefits will be payable.
Loadings and Exclusions
When you apply for TAL Lifetime Protection, you will be asked a number of questions. These questions relate to your Duty of Disclosure.
Your answers to the questions may mean that you have increased risk factors under the Policy. In some cases we will be unable to provide you with all or some parts of the Cover for which you have applied. In other cases, Cover may be subject to conditions such as a premium loading, or an Exclusion. A premium loading will mean that you pay a higher premium for the Cover, an Exclusion will mean that you will not be Covered if you suffer a specified excluded medical condition, or you are injured or die as a result of participating in an excluded pastime or activity.
We can change the premium rates applying to all TAL Lifetime Protection Policies. If we do change them you will be advised of the change 30 days prior to it taking effect.
No one individual Policy can be singled out for an increase in premium rates because of an adverse change in your health or circumstances, once your Cover is in place.