Accident means an event where Injury or death is caused directly and solely by accidental, violent, external and visible means.
Accidental Injury means a new physical Injury caused by an Accident, as confirmed by a Medical Practitioner, while Cover is in force. It does not include Injury arising from:
- attempted intentional self-injury or suicide;
- sickness, medical or surgical treatment;
- the taking of intoxicating liquor or drugs other than those prescribed to you and taken in the correct dosage.
It also excludes Accidents which occur through undertaking Sports unless Sports Cover has been selected by you.
Accidental Death means a death caused solely and directly by an Accident while Cover is in force. It does not include death arising from:
- actual or attempted intentional self-injury or suicide;
- sickness, medical or surgical treatment;
- the taking of intoxicating liquor or drugs other than those prescribed for you and taken in the correct dosage.
It does not include death as a result of participating in an Adventure Sport, unless Adventure Sports Cover has been selected by you.
Activities of Daily Living (ADL) are:
- Bathing - the ability to shower and bathe;
- Dressing - the ability to put on and take off clothing;
- Toileting - the ability to get on and off and use the toilet;
- Mobility - the ability to get in and out of bed and a chair; and
- Feeding - the ability to get food from a plate into the mouth.
Adventure Sports means sports, pastimes or activities which carry an inherently higher risk of death or Injury to the participant and include but are not limited to recreational aviation, hang-gliding, scuba diving, rock fishing, rock climbing, surfing, skydiving, jet skiing, and motor racing.
Average Monthly Income
Average Monthly Income means the average of your Monthly Income calculated on the 12 months immediately prior to the Accidental Injury, Illness or Sports Injury that led to the claimable event.
Benefit or Benefit Amount
Benefit or Benefit Amount means the monthly amount or lump sum amount, as shown on your Policy Schedule, that we will pay you upon receipt of and acceptance by us of a valid claim for the respective Cover type on your Policy.
Benefit Period means the maximum time period for which an Income Protection Benefit is payable, as shown in your Policy Schedule.
Blindness means the permanent Loss of Sight of both eyes.
Bundled, Bundle or Bundling
Bundled, Bundle or Bundling means where under one Policy:
- TPD Insurance is added to Life Insurance; or
- Recovery Insurance is added to Life Insurance.
A payment under one will effect a corresponding reduction in the Benefit Amount payable under the other (Bundled) Covers and a reduction in the total premium payable.
Commencement Date means the date your Policy started or Cover was added to your Policy.
Cover or Covered
Cover or Covered refers to the circumstances in which a Benefit Amount is payable in accordance with your Policy. The Cover your Policy provides is shown in your Policy Schedule.
Critical Illness means the diagnosis or undergoing of the following specified medical condition events, or the underlying Illness becoming apparent after the Commencement Date or, in the case of an increase to a Benefit, after the commencement of the increase:
- heart conditions including Angioplasty, Aortic Surgery, Cardiomyopathy, Coronary Artery Bypass Surgery, Heart Attack, Heart Valve Surgery, Open Heart Surgery, Primary Pulmonary Hypertension, or Triple Vessel Angioplasty; or
- neurological conditions including Alzheimer’s Disease, Coma, Dementia, Encephalitis and Meningitis; or
- Meningococcal Disease, Motor Neurone Disease, Multiple Sclerosis,
- Muscular Dystrophy, Paralysis, Parkinson’s Disease or Stroke; or
- permanent conditions of Blindness, Loss of Hearing, Loss of Independent Existence, Loss of a Single Limb or Loss of Speech; or
- organ disorders including Chronic Kidney Failure, Chronic Liver Failure, Chronic Lung Failure, Major Organ Transplant, Pneumonectomy or Severe Diabetes; or
- Aplastic Anaemia or Intensive Care.
Critical Injury means a specified Accidental Injury suffered by you after the Commencement Date or, in the case of an increase to a Benefit, after the commencement of the increase which results in:
- Severe Burns;
- Major Head Trauma;
- Intensive Care; or
- the permanent conditions of Blindness, Loss of Hearing, Loss of Independent Existence, Loss of a Single Limb and Loss of Speech.
Dangerous Pastimes are those pastimes, sports and activities that involve an inherent degree of danger and increased risk, including but not limited to:
- engaging in or training for sporting activities or stunts that are undertaken professionally;
- engaging in or training for sporting activities involving animals or the use of weapons; boxing, competitive fighting, martial arts or combative sports of any kind;
- solo hang gliding, skydiving or parachuting;
- flying in an aircraft, except as a fare-paying passenger on a commercial airline;
- being at depths below 30 metres underground or underwater;
- speed racing or contests of any kind involving any type of motor vehicle, motor cycle, or power boat;
- the riding of trail, dirt, pit or motocross bikes; quad bike riding; or riding any other type of power-assisted off-road buggy, kart or other vehicle; and
- rock fishing, back-country skiing or snowboarding, extreme white-water canoeing or kayaking, mountain climbing, BASE (buildings, antennas, spans and earth) jumping.
Date of Disablement
Date of Disablement means the later of:
(a) the date the Insured Person ceases work due to Illness or Injury; or
(b) the date a Medical Practitioner examines the Insured Person and certifies in writing that he or she suffers from the Illness or Injury that is the principal cause of their inability to work.
Day One Accident Benefit
Day One Accident Benefit has the meaning given to that term here
Disability or Disablement
Disability or Disablement means either Total Disability or Partial Disability.
Disability Benefit means either Total Disability Benefit or Partial Disability Benefit.
Duty of Disclosure
Duty of Disclosure means your duty as set out here
Exclusion of Exclusions
Exclusion or Exclusions means an event or circumstances leading to a claim which are not Covered under your Policy. Exclusions can be found under the heading ‘What isn’t Covered’ for Life Insurance, Total Permanent Disability Insurance, Recovery Insurance, Income Protection Insurance, and on your Policy Schedule.
Future Life Event or Future Life Events
Future Life Event or Future Life Events refers to a specified event or circumstances that may allow you to increase your Life Insurance Benefit without the need for evidence of health or pastimes. Refer to Future Life Events section for more information.
Gainful Occupation means an occupation in which you are working and as a result your physical exertion generates Monthly Income.
Illness under Income Protection and TPD means sickness or diseases such as cancer, trauma such as heart attack, degenerative conditions and infections that have not resulted from Accidental Injury, Sports Injury or any additional Exclusions as shown on your Policy Schedule.
Illness under Life Insurance means sickness or diseases such as cancer, trauma such as heart attack, degenerative conditions and infections that have not resulted from Accidental Injury, Accidental Death or death occurring due to your participation in Adventure Sports, or any additional Exclusions as shown on your Policy Schedule.
Immediate Family Member
Immediate Family Member means a spouse, de facto, partner (same or opposite sex), child, grandchild, parent, grandparent, sibling, aunt, uncle, cousin, niece or nephew.
Income Protection means TAL Lifetime Protection income protection insurance, the terms and conditions of which are detailed here.
Increasing Claims has the meaning given to that term here .
Indexation Factor is the percentage change in the Consumer Price Index (Weighted Average All Capital Cities) as last published by the Australian Bureau of Statistics in respect of the 12 month period finishing on 30 September of each year. This factor will be determined at 30 November each year and applied, where indicated, for the following year. If it is not published by 30 November, the Indexation Factor will be calculated based upon a retail price index we consider replaces it. If the percentage change in the Consumer Price Index, or any substitute for it, is negative, the Indexation Factor will be taken as zero.
Injury means an Accidental bodily Injury suffered by you after the Commencement Date or in the case of an increase to a Benefit, after the commencement of the increase. The Injury must be caused directly and solely by an Accident.
Level Premiums means the amount you pay will be based on your age at the Policy Commencement Date and the premium rate will remain the same until the Policy Anniversary immediately preceding your 65th birthday, at which point Level premiums revert to Stepped Premiums. If your Benefit Amount increases for any reason, including increases arising from Inflation Protection, then, while Level premiums apply, the part of the amount you pay in relation to each increase will be based on your age when each respective increase occurred.
If you select Level premiums, the amount you pay will be based on your age at the Cover start date. This generally means your premium will only increase if:
- you include a new Cover or option in your Policy;
- your Benefit Amount increases, including through Inflation Protection;
- Level Premiums revert to Stepped Premiums due to your age;
- the Policy fee increases;
- the rates in the premium rate table increase;
- Policy discounts no longer apply; or
- Government duties or charges increase.
Where you choose to increase your Cover, the rates used to calculate premiums for the alteration will be based on your age at that time.
Where Level Premium to age 65 is shown in Your Policy Schedule, they will revert to Stepped Premiums on the Policy Anniversary preceding your 65th birthday.
Life Buy Back Option
Life Buy Back Option means the option to buy back your Life Insurance Cover that has been drawn down as a result of the payment of a claim on a Bundled Cover.
Life Insurance means TAL Lifetime Protection life insurance, the terms and conditions of which are detailed here.
Life Insured means you, the insured person under your Policy.
Limb means an arm, leg, hand or foot. In respect of this definition, the hand or foot starts from the wrist or ankle joint, respectively.
Loss of Independent Existence
Loss of Independent Existence means Significant Cognitive Impairment or the total and irrecoverable loss of ability, due to Illness or Injury, to perform at least two of the Activities of Daily Living without the physical assistance of another person.
Loss of a Single Limb
Loss of a Single Limb means the total and irrecoverable loss of use of one Limb.
Loss of Limbs
Loss of Limbs means the total and irrecoverable loss of use of two or more Limbs.
Loss of Sight
Loss of Sight means the total and irrecoverable loss of sight (whether aided or unaided) in an eye, as a result of Illness or Injury to the extent that visual acuity in the eye, on a Snellen Scale after correction by a suitable lens is less than 6/60, or to the extent that the visual field is reduced to 10 degrees or less of arc.
Medical Practitioner means a person who is registered in Australia as a Medical Practitioner by the Medical Board of Australia, other than:
- your business partner; or
- your Immediate Family Members.
If practicing other than in Australia, the Medical Practitioner must be approved by us and have qualifications equivalent to Australian standards.
Note – a chiropractor, physiotherapist and/or alternative therapy provider is not a Medical Practitioner unless registered as a Medical Practitioner by the Medical Board of Australia.
Mental Health Related Illness
Mental Health Related Illnesses means any clinically recognised mental illness, Injury or disorder, the symptoms or any physical complications thereof, as confirmed by a Medical Practitioner.
Monthly Income or Monthly Earnings
Monthly Income or Monthly Earnings when you do not directly or indirectly own any part of the business in which you work (ignoring shares in publically listed companies) is the monthly value of the remuneration paid by the employer in respect of the work performed by you and includes salary, superannuation guarantee contributions, bonuses, commission, fees, fringe benefits and overtime payments. This will be determined by calculating the amount you would have to receive if total remuneration was received as a salary or wage (before income tax is deducted).
When you directly or indirectly own all or part of the business in which you work (ignoring shares in publicly listed companies), Monthly Income is:
- the monthly value of remuneration paid by the business to you as a result of your personal exertion; and
- your share of the profits of the business, generated as a result of your personal exertion, after the deduction of business expenses, both of which are determined in line with the usual manner that the profits and losses of the business are divided between you and any co-owners of the business.
Nominated Benefit Recipient
Nominated Benefit Recipient means the person or persons nominated by you to receive all or part of the Death Benefit. Any nomination is binding on us. However, you may revoke or change a nomination at any time. Any nomination, revocation or change in the details of a Nominated Benefit Recipient has no effect unless it is in writing and we have issued a written confirmation to you.
Own Occupation under Income Protection is the occupation in which you were working immediately prior to the Illness or Injury causing Disability, unless you:
- were working in that occupation for less than ten hours a week; or
- were unemployed or on sabbatical, long service, maternity or paternity leave for more than 12 months,
in which case ‘Own Occupation’ will be any occupation for which you are reasonably suited by training, education or experience.
If you have been working in more than one occupation that meets these criteria, ‘Own Occupation’ will include all of those occupations.
Partial Disability or Partially Disabled
Partial Disability and Partially Disabled under Income Protection mean that, solely because of a Covered event, you are:
- 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.
To be eligible for a Partial Disability Benefit, you must be Totally Disabled for the entire Waiting Period.
The Benefit Amount to be paid will be:
A – B x the Benefit Amount
subject to any adjustments, where:
A = your Average Monthly Income in the 12 months prior to the claim event; and
B = your Monthly Income in respect of the month to be paid.
If you are not working solely because of Illness or Injury, but are able to perform an important income producing duty of your Own Occupation to earn income, ‘B’ will be calculated on the monthly income for which it would be reasonable for you to earn if working. We will take into account all medical and other appropriate evidence.
Policy means the legal contract between the Policy Owner and us. This document, the application (whether in writing, verbally or online), the Policy Schedule and any Special Conditions or endorsements make up the Policy.
Policy Anniversary means each anniversary of the Policy Commencement Date.
Policy Owner means the person shown in the Policy Schedule as the person to who the Policy has been issued. If your Policy is structured through a SMSF, the Trustee of the fund is the Policy Owner.
Policy Schedule means the document which will be provided to you by us, containing details of your Cover under a Policy. Your Policy Schedule will be updated by us as a result of:
- any changes you make to your Policy and agreed to by us; and/or
- any changes made by us in accordance with the conditions contained in this document.
Pre-Disability Earnings means your highest average Monthly Earnings for the consecutive 12 month period immediately prior to the start of the Waiting Period. When you are disabled, Pre-Disability Earnings will be increased by the Indexation Factor after every 12 consecutive payments under Total Disability or Partial Disability, following the date Disability started.
Recovery Insurance means TAL Lifetime Protection recovery insurance, the terms and conditions of which are detailed here.
Rehabilitation Program means a program or plan:
- designed to assist you in returning to work in your Own Occupation; and
- developed by an appropriately qualified vocational or occupational rehabilitation specialist.
General medical consultations and medical therapy consultations, including but not limited to, physiotherapy, psychotherapy and hydrotherapy, are excluded.
Scheduled Injury Benefit means those Benefits and Benefit Periods set out here.
Significant Cognitive Impairment
Significant Cognitive Impairment means a deterioration or loss of intellectual capacity that results in a requirement for a full-time permanent caregiver.
Special Conditions means events or circumstances leading to a claim which need to be satisfied for a Benefit to be payable under your Policy. Special Conditions are specific to your Policy and can be found on your Policy Schedule.
Sport means a regular activity involving physical exertion and skill which an individual or team participates in, or competes against another or others for entertainment, enjoyment or fitness. It includes but is not limited to football, cricket, running, cycling, tennis, golf, basketball, surfing, wind-surfing, recreational aviation, rock climbing, martial arts, horse riding and yoga.
Sports Injury means an Injury that you suffer during the participation in, or training for, any Sport.
Standalone means either Life Insurance, TPD, Recovery Insurance or Income Protection which is not Bundled with any other insurance.
Stepped Premiums means the amount you pay will generally increase at each Policy Anniversary.
Terminal Illness means an Illness where, after having regard to the current treatment or such treatment as you may reasonably be expected to receive, you will not survive more than 12 months (or 24 months for policies under superannuation including SMSFs).
Two Medical Practitioners, at least one who is a specialist Medical Practitioner who specialises in your Illness, or an area related to your Illness, must certify in writing (either jointly or separately), that despite reasonable medical treatment, you are suffering a Terminal Illness which will lead to your death within 12 months (or 24 months when under superannuation including SMSFs) of the date of the certification.
The Terminal Illness and certification must occur while you have Cover under your Policy.
A Benefit payable in respect of Terminal Illness applies only to Illness Cover for Life Insurance. The Life Insurance Benefit Amount will be paid in full where this definition is met, if Illness Cover is shown on your Policy Schedule.
Total Permanent Disability
Total Permanent Disability has the meaning given to that term here
Total Permanent Disability Insurance or TPD
Total Permanent Disability Insurance or TPD means TAL Lifetime Protection total permanent disability insurance, the terms and conditions of which are detailed here.
Total Disability and Totally Disabled
Total Disability and Totally Disabled under Income Protection mean that, solely because of a Covered event, you are:
- not working in any Gainful Occupation; and
- following the advice of a Medical Practitioner; and
- unable to perform one or more of the important income-producing duties in your Own Occupation.
To be eligible for a Total Disability Benefit, you must meet this definition for the entire Waiting Period.
Waiting Period means the period of time between you suffering Total Disability or Partial Disability and Benefits starting to accrue. The Waiting Period commences on the Date of Disablement.
Whole Person Function
Whole Person Function means where a payment depends on you meeting criteria based on the Whole Person Function, the calculation is to be based on the current edition of the American Medical Association publication entitled Guides to the Evaluation of Permanent Impairment until an equivalent Australian guide, sanctioned by the Australian Medical Association, has been produced, at which time the calculation in the relevant Australian guide will apply.