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When a Critical Illness Cover or Life Insurance (Assurance) with Critical Illness Cover plan is arranged, this will usually include Total Permanent Disability cover also.

When the life office pays a claim for Total Permanent Disability will depend on the ‘definition of disability’ on the plan.

The life office will decide which definition applies when the plan is underwritten at outset. The definition of disability the life assured receives will depend on the applicant’s health, whether they are working and if so, their occupation.

Examples of the definitions that can apply are:

Own occupation

This means that the life office will pay out the cover if an illness or injury permanently prevents the life assured from doing the essential duties of their occupation.

Working tasks

Sometimes life offices cannot give the applicant an own occupation definition. This might be because of the type of work that they do or because they are not working. The life office may then offer a definition which will pay out depending on whether the applicant is able to carry out specific work-related tasks. If this definition applies then the life office will pay out the cover if an illness or injury permanently prevents the applicant from performing a number of tasks, for example:

Walking

The ability to walk 200 metres on a level surface with a stick or other aid without stopping or severe discomfort.

Lifting

The ability to pick up 1kg from table height and carry it for five metres.

Using a pen/pencil/keyboard

The ability to use a pen, pencil or keyboard with either hand or using any aids.

Hearing

The ability to hear well enough to understand someone speaking a common language in a normal voice in a quiet room with a hearing aid.

Speech

The ability to be understood in a common language in a quiet room.

Vision

The ability to see well enough to read 16 point print using spectacles or other aids.

Living tasks (or Activities of Daily Living)

If the life assured is over age 65 when a claim is made, the life office may apply a definition called ‘living tasks’. The life office could then meet the claim if an illness or injury permanently prevents the life assured from performing a number of tasks, for example:

Washing

The ability to wash in the bath or shower (including getting into and out of the bath and shower) such that an adequate level of personal hygiene can be maintained.

Dressing

The ability to put on, take off, secure and unfasten all necessary garments and any medically necessary braces, artificial limbs or other surgical appliances.

Transferring

The ability to move from a bed to an upright chair, or wheelchair and vice versa, and to get on or off a toilet or commode.

Mobility

The ability to move from one room to another on a level surface.

Continence

The ability to manage bowel and bladder functions such that an adequate level of personal hygiene can be maintained.

Feeding

The ability to feed oneself once food and drink have been prepared and made available. In some circumstances, the life office may not be able to offer Total Permanent Disability cover. This will be confirmed during underwriting.