Disability and Death Cover Definitions
"Differing definitions of “disability” apply to the different types of disability insurance available through HESTA. It’s important to understand these before you choose the type of cover you want.
FOR INCOME PROTECTION BENEFITS
(Uses the “own occupation” definition)
“total disability” means in relation to an insured member, the following applies:
In the first 2 years – ING is of the opinion, after considering medical evidence, that the insured member is unable to perform at least one of the important duties of his or her usual occupation, due to the direct result of injury or illness. (If at the time the insured member suffered the injury or illness causing total disability he or she was not at work, usual occupation means his or her most recent gainful occupation).
An insured member would not be totally disabled if he or she is engaged in any work for wages or profit, or is not under the continuous care of and following the treatment recommended by a registered medical practitioner.
After the expiry of 2 years – ING is of the opinion, after considering medical evidence, that the insured member is disabled to such an extent that he or she is unlikely ever to be capable of engaging in his or her usual occupation. (If at the time the insured member suffered the injury or illness causing total disability he or she was not at work, usual occupation means his or her most recent gainful occupation).
An insured member would not be totally disabled if he or she is engaged in any work for wages or profit, or is not under the continuous care of and following the treatment recommended by a registered medical practitioner.
“partial disability” and “partially disabled” means in relation to an insured member, the following applies:
(a) he or she has been totally disabled:
- for a period during which a total disability benefit has been paid; or
- for at least 7 days out of 12 consecutive days during the waiting period; and either
(b) he or she then returns to work in his or her usual occupation, or becomes capable of returning to his or her usual occupation, but only in a limited capacity, and the salary the member is earning, or is capable of earning, is less than his or her predisability salary due to the injury or illness that caused the total disability or is causing the partial disability; or
(c) he or she then returns to work in another occupation and is earning an income less than his or her pre-disability salary due to the injury or illness causing the total disability or partial disability.
The partial disability benefit is payable monthly in arrears and stops at the earliest of:
- the end of the benefit period;
- total disability or partial benefits having been paid in aggregate for 24 months;
- the insured member attaining the benefit expiry age;
- the death of the insured member;
- the insured member ceasing to be partially disabled; or
- the insured member earning, or being capable of earning, monthly salary equal to or greater than his or her pre-disability salary.
“Salary” (for determining maximum IP benefits available) means the total amount of annual remuneration received by the insured member from his or her regular occupation or occupations, as the case may be, averaged over the most recent 12 month period the member was working, or the actual period of work if less. If, when the insured member was most recently at work, he or she:
(a) was employed, then “remuneration” will be determined by calculating the amount the insured member could be expected to receive if all his or her remuneration from his or her regular occupation was received as wages (before the deduction of income tax), based on the insured member’s group certificate income, and includes salary, fees, commission, bonuses, regular overtime, and fringe benefits; and / or (as applicable)
(b) directly or indirectly owned all or part of the business from which he or she earned his or her regular income, then his or her “remuneration” will be that earned by the business directly due to his or her own personal exertion or activities through his or her regular occupation, less his or her share of business expenses for that business, but before the deduction of income tax for that business (or the relevant portion for part of a financial year).
Your Tax Payment Summary will be used to identify any renumeration taken as fringe benefits. Salary sacrificed Superannuation contributions will also be included in “salary”.
FOR COVER PROVIDING A LUMP-SUM BENEFIT ON TOTAL AND PERMANENT DISABLEMENT (TPD)
The standard “any occupation” definition of “total and permanent disability” is:
1) Unlikely to return to work (Any)
The insured member suffers an injury or illness and, as a result of that injury or illness, he or she is:
- totally unable to engage in any occupation, business, profession or employment for a period of six consecutive months;
And
- determined by ING at the end of that six month period (or such later time as ING agrees with the policy owner), to be permanently incapacitated to such an extent as to render him or her unlikely ever to engage in any gainful occupation, business, profession or employment, for which he or she is reasonably suited by education, training or experience.
Or
2) Permanent impairment
The insured member suffers an injury or illness and, as a result of that injury or illness, he or she:
a) suffers a permanent impairment of at least 25% of whole person function as defined in the American Medical Association publication ‘Guides to the Evaluation of Permanent Impairment’, 4th edition, or an equivalent guide to impairment approved by ING and
b) is disabled to such an extent, as a result of this impairment, that ING determine that he or she is unlikely ever again to be able to engage in any gainful occupation, business, profession or employment for which he or she is reasonably suited by his or her education, training or experience.
Or
3) Specific loss
As a result of illness or injury, the insured member suffers the total and permanent loss of the use of:
- two limbs (where ‘limb’ is defined as the whole hand or the whole foot); or
- the sight in both eyes; or
- one limb and the sight in one eye.
Or
4) Loss of independent existence
As a result of illness or injury, the insured member suffers loss of independent existence.
‘Loss of independent existence’ means being, in ING’s opinion, totally and irreversibly unable to perform at least two of the following five ‘activities of daily living’ without the assistance of another adult person:
- bathing and/or showering
- dressing and undressing
- eating and drinking
- using a toilet
- getting in and out of bed, a chair or wheelchair, or moving from place to place by walking, wheelchair or with assistance of a walking aid.
Or
5) Cognitive loss
As a result of illness or injury, the insured member, in ING’s opinion, suffers cognitive loss.
’Cognitive loss’ means a total and permanent deterioration or loss of intellectual capacity that has required the insured member to be under continuous care and supervision by another adult person for at least six consecutive months and that, at the end of that six month period, is likely to require the insured member to be under permanent ongoing continuous care and supervision by another adult person.
Home duty spouses will be assessed based on the ‘Loss of independent existence’ TPD definition.
or you may apply to be covered under an “own occupation“ definition of “total and permanent disability” under which part 1 of the standard TPD definition is altered to:
1) Unlikely to return to work (Own)
The insured member suffers an injury or illness and, as a result of that injury or illness, he or she is:
- totally unable to engage in his or her usual occupation, business, profession or employment for a period of six consecutive months; and
- determined by ING at the end of that six month period (or such later time as ING agree with the policy owner), to be permanently incapacitated to such an extent as to render him or her unlikely ever to engage in his or her usual occupation.
Parts 2 to 5 of the definition are unaltered.
Part 1 of either TPD definition does not apply after age 65.
At Work means:
On the date of joining HESTA
- the member is employed by a HESTA employer; or
- the member directly or indirectly owns all or part of the business from which he or she earns his or her regular income
and in either case the member is capable of, and is performing without restriction due to injury or illness all of the usual identifiable duties of the occupation from which they earn their regular income:
- on a full-time basis (if the member usually works on a full-time basis); or
- on a part-time or full-time basis (if the member usually works on a part-time basis).
A member will still be considered to meet the At Work requirements of this definition if not at work on the date of joining HESTA where the absence is not due to, or caused or contributed to in any way, by illness or injury of the member or person applying to become a member of HESTA.
Where the member does not meet the At Work requirement, cover will be restricted to New Events cover only.
New Events cover is defined as follows:
The member only being covered for claims arising from a sickness which first becomes apparent or an injury which first occurs on or after the date that cover last commenced, recommenced or was reinstated in respect of the member.