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Disability Insurance Claims

If your doctor expects you to be unable to ever work again in your occupation or business due to an illness or an injury, then notify us as soon as practicable.

In order to qualify for a total and permanent disability benefit under your policy, you must be totally incapacitated by illness or injury, and as a result of that incapacity:

  1. You are completely unable to engage in the occupation or business you were involved in immediately prior to your illness or injury; and
  2. You have not worked in any occupation or business for three consecutive months following the date on which your illness commenced or your injury occurred; and
  3. You are so incapacitated that it is considered unlikely that you will ever again be able to resume work in your own occupation or business.

Your policy also provides a partial and permanent disability benefit which is payable in the event that you permanently lose the use of a limb or the sight of an eye due to an illness or an injury. The benefit amount is the lesser of $25,000 and 25% of your cover for total and permanent disability. Check your policy for details.

Claim Requirements

After Sovereign has been notified of your intention to make a claim, a case manager will be assigned to your claim, and in the first instance will phone you for a discussion about your condition. If the nature and extent of your condition might be covered by the policy then the case manager will send a letter to you which details the information needed to assess your claim. The information required includes the following:

  1. A completed Lump Sum Claim Form  PDF.
  2. An original or certified copy of either your birth certificate or your passport.
  3. The original policy document, or a completed Lost or Destroyed Policy Document form  PDF.
  4. A functional job description which details the day to day tasks of the occupation or business you were involved in immediately prior to your illness or injury.

It would also assist if you provided copies of any relevant documents or reports from your doctor or specialist.

Following receipt and assessment of the above information, further medical information will be requested by the case manager for the claim to proceed. This will include an assessment by an occupational medicine specialist who will consider your job description and the medical information supplied, and provide an opinion on your ability or otherwise to resume your occupation or business.

Following receipt of all required information, the claim is then assessed. On acceptance of the claim, a Claim Discharge Form is prepared and sent to you. The claim is paid after receipt of the signed Discharge Form, with the amount being direct-credited to the bank account you nominate on the form.

Claims Process

The entire claims process can be illustrated as follows:

Claims Process