Appendix for Business 360 Trauma Cover Stand Alone

Transcription

1 Trauma Cover Stand Alone Appendix for Business 360 Trauma Cover Stand Alone A. Introduction 1 This Appendix only applies if you have chosen Trauma Cover Stand Alone, and we show that cover with this Document code on the policy schedule. (You will find the Document code in the bottom right hand corner of the back page.) 2 You must read this Appendix, the Business 360 Base Policy and the policy schedule together as one document. 3 We define the words that appear in bold in this Appendix in Section O. The definitions in Section E of the Business 360 Base Policy also apply to this Appendix. B. Who is covered 1 Trauma Cover Stand Alone insures the life insured shown in the policy schedule above this cover. C. Trauma Cover Stand Alone 1 If the life insured suffers one of the Trauma Conditions in section C 3 below for the first time on or after the start date and before or on the end date, we will pay you the sum insured that applies at that time (except for Coronary Artery Angioplasty see Section D below and Recoverable Stroke see Section E below). 2 If any of the underlined Trauma Conditions in section C 3 below occur, or symptoms leading to any of those Trauma Conditions occur, within: the first 90 days after: the start date, or BUSINESS 360 TRAUMA COVER STAND ALONE 1

2 the date the cover is reinstated, we will not pay the sum insured, or the first 90 days after you increased the sum insured at any time (except for an Inflation Protection Option increase), we will not pay the amount by which the sum insured increased. If any of these apply, and the life insured suffers the same Trauma Condition again during this cover, we will also not pay anything in relation to that same Trauma Condition. 3 The Trauma Conditions are the medical conditions defined in Section N below. The life insured s medical condition must come exactly within any one of those definitions. The Trauma Conditions are summarised as follows: 3.1 Heart and circulation 3.2 Cancer Aortic Surgery Coronary Artery Angioplasty (limits apply, see Section D below) Coronary Artery Bypass Grafting Surgery Primary Pulmonary Hypertension Major Heart Attack (Myocardial Infarction) Heart Valve Surgery Cancer Life Threatening 3.3 Blood disorder Aplastic Anaemia 3.4 Functional loss/neurological Advanced Dementia (including Alzheimer s Disease) Benign Brain Tumour Coma Encephalitis Loss of Independent Existence Major Head Trauma Motor Neurone Disease Muscular Dystrophy 2 BUSINESS 360 TRAUMA COVER STAND ALONE

3 Multiple Sclerosis Paralysis (including): Hemiplegia Diplegia Paraplegia Quadriplegia Tetraplegia Parkinson s Disease Recoverable Stroke (limits apply, see Section E below) Stroke Resulting in Functional Loss 3.5 Loss of use 3.6 Organs Deafness Loss of Limbs and/or Sight Total and Permanent Blindness Loss of Speech Chronic Liver Failure Chronic Lung Failure Chronic Renal Failure Major Organ Transplant Pneumonectomy 3.7 Other conditions Intensive Care Severe Burns Medically Acquired HIV Occupationally Acquired HIV 4 If the Trauma Condition is a surgical procedure, then that surgical procedure must be the usual treatment in respect of the Trauma Condition. 5 We only pay one sum insured under this cover for each life insured. BUSINESS 360 TRAUMA COVER STAND ALONE 3

4 D. Coronary Artery Angioplasty Benefit 1 If a life insured undergoes a Coronary Artery Angioplasty we will pay you 10% of the sum insured. However, we will not pay: less than $10,000, unless the sum insured is less than $10,000 in which case we will pay just the sum insured, and more than $25, We will reduce the sum insured for the life insured by the amount we pay under this Coronary Artery Angioplasty Benefit. 3 We only pay one claim under this Coronary Artery Angioplasty Benefit for each life insured. E. Recoverable Stroke Benefit 1 If a life insured suffers a Recoverable Stroke, we will pay you the lesser of: 10% of the sum insured, and $50,000 2 We will reduce the sums insured for the life insured for this cover, and for all Life Covers on this policy insuring the life insured and owned by the same owners by the amount we pay under this Recoverable Stroke Benefit 3 We only pay one claim under this Recoverable Stroke Benefit for each life insured. F. Paralysis Assistance Benefit 1 If the life insured suffers from Paralysis insured under this cover, we will pay you an additional amount equal to the amount of the sum insured. 2 The maximum payment for Paralysis under: section C Trauma Cover, and section F Paralysis Assistance Benefit in relation to: this cover, and 4 BUSINESS 360 TRAUMA COVER STAND ALONE

5 the equivalent entitlements in all other trauma insurance with us, and other insurers, insuring the life insured can never be more than $1,000,000. However, if the sum insured is more than $1,000,000 we always pay just the sum insured. 3 We only pay one claim under this Paralysis Assistance Benefit for each life insured. G. Chronic Diagnosis Benefit 1 We will make an advance payment to you if: the life insured is definitively diagnosed by an appropriately specialised medical practitioner as having one of the following Chronic Trauma Conditions: Motor Neurone Disease, or Multiple Sclerosis, or Muscular Dystrophy, or Parkinson s Disease, or Primary Pulmonary Hypertension The medical diagnosis of the above Chronic Trauma Conditions is sufficient for this Chronic Diagnosis Benefit, and the levels of diagnoses in Section N of this Appendix do not apply, or the life insured needs a Major Organ Transplant and is placed on a hospital waiting list for a Major Organ Transplant, as confirmed by an appropriately specialised medical practitioner. 2 The amount of the advance payment is the lesser of: $25,000, and 25% of the sum insured (subject to a minimum payment of $10,000, unless the sum insured is less than $10,000, in which case we pay just the sum insured). 3 If any of the Chronic Trauma Conditions covered by this Chronic Diagnosis Benefit occur, or symptoms leading to any of those Chronic Trauma Conditions occur, within: The first 90 days after: the start date, or the date cover is reinstated, we will not make this advance payment to you, or BUSINESS 360 TRAUMA COVER STAND ALONE 5

6 the first 90 days after you increased the sum insured at any time (except for an Inflation Protection Option increase), we will not pay the amount by which this advance payment to you increased. If any of these apply, and the life insured suffers the same Chronic Trauma Condition again during this cover, we will not pay anything in relation to that same Chronic Trauma Condition. 4 We will reduce the sum insured for the life insured by the amount we pay under this Chronic Diagnosis Benefit. 5 We only pay one claim under this Chronic Diagnosis Benefit for each life insured. H. Business Events Increase Option 1 This option applies if we show it in the policy schedule. 2 If the life insured s: ownership interests in the business increase through: his or her proportion of ownership increasing, or his or her loan guarantee to the business increasing, or the value of the business increasing, or value to the business increases (other than through ownership) you may request in writing for us to increase the sum insured for that life insured. We do this by adding a separate Trauma Cover Stand Alone for that increased amount. Subject to 5 below, that separate Trauma Cover Stand Alone is on the same terms (including any special terms or premium loadings) as this cover. 3 You must satisfy us of the value of the life insured s financial interest in the business. You must supply us with satisfactory financial information that we request. This may include (but is not limited to) the following: appropriate confirmation of the increase in the life insured s financial interest in the business a valuation of the business (as provided by an independent qualified accountant or business valuer) supported by business financial accounts in the case of cover effected for loan guarantees, evidence of increased indebtedness relating to the business in the case of cover effected for an increase in the value to the business, evidence of increased profitability or replacement costs (as provided by an independent qualified accountant or business valuer) supported by business financial accounts. 6 BUSINESS 360 TRAUMA COVER STAND ALONE

7 4 The method chosen to value the business or the life insured must be in accordance with established business valuation practice for the industry. The independent qualified accountant or business valuer cannot be a family member, business partner, employee or employer of you, the life insured or the key contact. The method of valuation and valuer must be satisfactory to us. 5 You do not need to produce any medical evidence regarding the life insured when you request this increase, subject to the following conditions: you must make the request within 90 days of one of the above business events. the Business Events Increase Option cannot be exercised within six months of the start date. for the first six months of each business events increase, the amount of the increase insures the life insured for injury only. you can only make two business events increases in any 12-month period. once a Business Events Increase is exercised, no business events increase is available on the increased amount of the sum insured. the total amount of all business events increases under this cover is limited to a maximum of twice the sum insured that applied at the start date. the total of: the sum insured, and the combined sums insured under all other insurance of this type with us, and other insurers, insuring the life insured (including all increases for any reason) is limited to $2,000, No increase is allowed after the earlier of: the tenth policy anniversary date after the start date, or the policy anniversary date on or immediately after the life insured s 65 th birthday. 7 No increase is allowed when you make, or are entitled to make, a claim under any insurance policy relating to injury or illness. 8 Any option to increase the sum insured not exercised, cannot be carried forward to a future time. 9 If this option is exercised, we will increase the premium based on our rates at the time. BUSINESS 360 TRAUMA COVER STAND ALONE 7

8 I. Advance Payment for Cancer Option 1 This option only applies if it appears in the policy schedule for this cover. 2 We will make an advance payment to you if the life insured is diagnosed by an appropriately specialised medical practitioner as having one of the following conditions: Carcinoma in situ of the following sites: Cervix uteri: the tumour must be classified as TisN0M0 according to the TNM staging method or FIGO stage 0. Cervical Intraepithelial Neoplasia classifications (CIN) including CIN-1, CIN-2 and CIN-3 are not covered Fallopian Tube: the tumour must be limited to the tubal mucosa and classified as TisN0M0 according to the TNM staging method or FIGO stage 0 Vagina: the tumour must be classified as vaginal carcinoma in situ TisN0M0 according to the TNM staging method or FIGO stage 0 Vulva: the tumour must be classified as vulval carcinoma in situ TisN0M0 according to the TNM staging method or FIGO stage 0 Breast: the tumour must be classified as ductal carcinoma in situ (DCIS) TisN0M0 according to the TNM staging method or FIGO stage 0 Prostate: the tumour is confined within the prostate and histologically described as T1NOMO according to the TNM staging method or a Gleason score of either 2, 3, 4, or 5 Note: FIGO refers to the staging method of the Federation Internationale de Gynecologie Chronic Lymphocytic Leukaemia (Rai stage 0) Melanoma (up to 1.5mm maximum thickness as determined by histological examination using the Breslow method). 3 The amount of the advance payment is the lesser of: $25,000, and 10% of the sum insured. 4 If any symptoms leading to any of the above conditions occur, or the above conditions occur within: the first 90 days after: the start date, or the date cover is reinstated, 8 BUSINESS 360 TRAUMA COVER STAND ALONE

9 we will not make this advance payment to you, or the first 90 days after you have increased the sum insured at any time (except for an Inflation Protection Option increase), we will not pay the amount by which this advance payment to you increased. If this clause I 4 applies, and the life insured suffers the same condition again during this cover, we will not pay anything in relation to that same condition. 5 We will pay only once for each condition in I 2 above for each life insured. 6 The maximum we pay for each life insured under this option is $100, Payments made under this option are not eligible for reinstatement under the Trauma Buy Back Option. 8 This option ends on the policy anniversary date on or immediately after the life insured s 65 th birthday. J. Inflation Protection Option 1 If this option appears in the policy schedule, we offer the key contact the opportunity to increase the sum insured before each policy anniversary date, without providing us with further health information about the life insured. 2 The sum insured will be increased at the policy anniversary date, by the lesser of the annual rate of increase in the latest published consumer price index available at the date of the offer. 3 The premium will be recalculated for the increased sum insured at the policy anniversary date. 4 This option ends on the earlier of: the policy anniversary date on/or immediately after the life insured s 65 th birthday, or the combined sums insured for all insurance of this type with us insuring the life insured reach $2,000,000 for any reason. K. Trauma Cover Buy Back Option 1 This option only applies if we show it in the policy schedule for this cover. 2 After we pay a claim under this cover, you may request us in writing to reinstate the Trauma Cover sum insured by the amount paid, without providing us with further health information about the life insured. This is subject to the following: the life insured is still alive and a period of 12 months has elapsed since we paid the Trauma Cover, and BUSINESS 360 TRAUMA COVER STAND ALONE 9

10 you exercise the option within 30 days after the end of that 12-month period, and the maximum Trauma Cover sum insured we will reinstate is the lesser of: 100% of this payment, or $2,000, The total amount of Trauma Cover with us, including the reinstated amount and cover with all other insurers, cannot exceed $2,000, A premium is payable if you exercise this option. We will calculate the premium based on the rates applicable for both the age of the life insured and the sum insured reinstated, at the time you exercise the option. 5 If this option is exercised any special terms and premium loadings which applied to this cover will also apply to the Trauma Cover sum insured reinstated. 6 If the life insured is subsequently diagnosed with a Trauma Condition, we will only pay the reinstated amount if the Trauma Condition: occurred or was diagnosed, or the symptoms leading to diagnosis became apparent after the Trauma Cover sum insured was reinstated. 7 We will not pay the reinstated amount if the Trauma Condition: is the same as the original Trauma Condition, or is directly or indirectly caused by or related to the original Trauma Condition, or symptoms or conditions which caused the occurrence of the original Trauma Condition, or is a Loss of Independent Existence, or is a Heart and Circulation Condition (defined below) and the original Trauma Condition was also a Heart and Circulation Condition, or is a Recoverable Stroke, Stroke resulting in Functional Loss or Paralysis (directly or indirectly resulting from a stroke) and the original Trauma Condition was a Heart and Circulation Condition. A 'Heart and Circulation Condition' means any of the following: Aortic Surgery Coronary Artery Angioplasty Coronary Artery Bypass Grafting Surgery Primary Pulmonary Hypertension 10 BUSINESS 360 TRAUMA COVER STAND ALONE

11 Major Heart Attack (Myocardial Infarction) Heart Valve Surgery 8 This option cannot be exercised where payment is made for Coronary Artery Angioplasty Benefit, Recoverable Stroke Benefit, Chronic Diagnosis Benefit, Paralysis Assistance Benefit or Advance Payment for Cancer Option. 9 The reinstated amount will not be eligible for increases under the Inflation Protection Option or the Business Events Increase Benefit. 10 This option ends: on the policy anniversary date on or immediately after the life insured s 65 th birthday, or immediately after the option is exercised, whichever happens first. 11 If this option is exercised the premium will be reduced accordingly. L. When we will not pay 1 We will not pay anything under this cover if what happens to the life insured is in connection with: intentional self inflicted injury (whether sane or insane) by the life insured, or the life insured engaging in conduct which gives rise to any criminal offence for which the life insured is convicted, or the life insured not following the advice and treatment recommended by a medical practitioner. 2 We will not pay anything under this cover, if the life insured dies within the 14-day period immediately following the date of diagnosis of the Trauma Condition. M. How to make a claim 1 You must follow the requirements of Section B 5 Claims in the Business 360 Base Policy. 2 In addition, if you wish to claim under this cover you must: advise us as soon as possible, but no later than 30 days after the life insured suffers the Trauma Condition give to us an original or certified copy of the life insured s birth certificate, driver s licence or passport and the complete policy document BUSINESS 360 TRAUMA COVER STAND ALONE 11

12 complete and return our claim form. You can call us on to request a claim form at your own expense: supply medical certificates and any other information that we may require from time to time obtain a definite diagnosis of the Trauma Condition as soon as possible after the life insured first becomes aware that he or she might be suffering from a Trauma Condition. The diagnosis must be by an appropriately specialised medical practitioner (or other medical practitioner approved by us) and the investigations must be based on (but not limited to): clinical, and radiological, and histological, and laboratory evidence acceptable to us. obtain, as soon as possible after the life insured first becomes aware that he or she might be suffering from a Trauma Condition, advice and medical treatment from an appropriately specialised medical practitioner (or other medical practitioner approved by us) and to follow that advice and medical treatment. 3 If requested by us, the life insured must undergo medical examinations and other tests by a medical practitioner of our choice to enable us to confirm that the life insured is suffering from one of the Trauma Conditions. This will be at our expense. 4 If the life insured suffers Medically Acquired HIV, we will not pay anything until the life insured meets the definition in Section N. 5 Before we pay any amount, you and the life insured must comply with your obligations under this policy. 12 BUSINESS 360 TRAUMA COVER STAND ALONE

13 N. Definitions of the Trauma Conditions Advanced Dementia (including Alzheimer s Disease) Alzheimer s disease or other Dementia resulting in permanent irreversible failure of brain function and significant cognitive impairment for which no other recognisable cause can be identified. Significant cognitive impairment means a deterioration or loss of intellectual capacity that results in a requirement for a permanent caregiver. Aortic Surgery The undergoing of medically necessary surgery to: repair or correct an aortic aneurysm, or an obstruction of the aorta, or a coarctation of the aorta, or a traumatic rupture of the aorta. For the purpose of this definition aorta shall mean the thoracic and abdominal aorta but not its branches. Aplastic Anaemia Total bone marrow failure resulting in anaemia, neutropenia and thrombocytopenia requiring treatment with at least one of the following: blood product transfusion marrow stimulating agents immunosuppressive agents bone marrow transplantation. Benign Brain Tumour A life-threatening, non-cancerous tumour in the brain, giving rise to characteristic symptoms of increased intracranial pressure such as papilloedema, mental symptoms, seizures and sensory impairment. The tumour must result in neurological deficit causing either: at least 25% impairment of whole person function, that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. This does not include cysts, granulomas, cholesteatomas, malformations in or of the arteries or veins of the brain, haematomas, and tumours in the pituitary gland or spine. BUSINESS 360 TRAUMA COVER STAND ALONE 13

14 Cancer Life Threatening The presence of one or more malignant tumours including leukaemia, lymphomas and Hodgkins disease. The malignant tumour is to be characterised by the uncontrollable growth and spread of malignant cells and the invasion and destruction of normal tissue. The following are not included: tumours showing the malignant changes of carcinomas in situ* (including cervical dysplasia CIN-1, CIN-2 and CIN-3) or which are histologically described as pre-malignant. all skin cancers, including hyperkeratoses, basal cell carcinomas and squamous cell carcinomas, unless there is evidence of metastases**. non-life-threatening cancers, such as: prostatic cancers which are histologically described as TNM Classification T1 or are of another equivalent or lesser classification Papillary Micro-Carcinoma of the Thyroid or Bladder. Chronic Lymphocytic Leukaemia less than Rai Stage 1. * Carcinoma in situ of the breast is covered if it results directly in the removal of the entire breast. The procedure used must be performed specifically to arrest the spread of malignancy and be considered to be the usual and necessary treatment. ** Malignant melanoma of greater than 1.5mm maximum thickness as determined by histological examination using the Breslow Method are covered. Chronic Liver Failure End stage liver failure with permanent jaundice, ascites or encephalopathy. This does not include liver disease related to alcohol use or drug abuse. Chronic Lung Failure End stage respiratory failure requiring extensive, continuous and permanent oxygen therapy as well as FEV 1 test results of consistently less than one litre. Chronic Renal Failure End stage renal failure presenting as chronic irreversible failure of both kidneys to function as a result of which regular renal dialysis is instituted or renal transplantation performed. Coma resulting in Functional Loss A state of unconsciousness with no reaction to external stimuli or internal needs, persisting continuously for at least 96 hours requiring the use of life support systems and resulting in neurological deficit causing either: at least 25% impairment of whole person function, that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. This does not include coma as a result of alcohol use or drug abuse. Coronary Artery Angioplasty The actual undergoing for the first time of Coronary Artery Angioplasty that is considered medically necessary to correct or treat coronary artery disease. 14 BUSINESS 360 TRAUMA COVER STAND ALONE

15 Coronary Artery Bypass Grafting Surgery The undergoing of medically necessary Coronary Artery Bypass Grafting Surgery to correct, or treat coronary artery disease. Deafness The complete and irrecoverable loss of hearing of both ears, (whether aided or unaided) as a result of illness or injury. Encephalitis resulting in Functional Loss The severe inflammatory disease of the brain resulting in neurological deficit causing either: at least 25% impairment of whole person function, that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living, without the physical assistance of another person. Heart Valve Surgery The undergoing of surgery to replace, or repair cardiac valves as a consequence of heart valve defects or abnormalities. Repair via valvotomy, catheter surgery, minimally invasive, keyhole or similar techniques are specifically excluded. Intensive Care Means that an injury or illness has resulted in the life insured requiring continuous mechanical ventilation by means of tracheal intubation for 10 consecutive days (24 hours per day) in an authorised intensive care unit of an acute care hospital and causing either: at least 25% impairment of whole person function that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. Loss of Independent Existence A condition as a result of illness or injury whereby the life insured is totally and permanently unable to perform (whether aided or unaided) at least two of the five activities of daily living, or suffers cognitive impairment that results in the life insured requiring permanent and constant supervision. Loss of Limbs and/or Sight The total and irrecoverable: loss of two or more limbs, or loss of sight of both eyes, or loss of one limb and the sight of one eye. The loss of sight of an eye means the complete and irrecoverable loss of sight (whether aided or unaided). The loss of a limb means complete loss of the use of an entire hand or entire foot. Loss of Speech The complete and irrecoverable loss of speech (whether aided or unaided) as a result of illness or injury. BUSINESS 360 TRAUMA COVER STAND ALONE 15

16 Major Head Trauma resulting in Functional Loss Accidental cerebral injury resulting in permanent neurological deficit causing either: at least 25% impairment of whole person function, that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. Major Heart Attack (Myocardial Infarction) Means the life insured has had a myocardial infarction (other than as a direct result of cardiac or coronary intervention) with the following criteria being satisfied: a diagnostic rise and fall in either Troponin I in excess of 2.0ug/L, Troponin T in excess of 0.6ug/L or cardiac enzyme CK-MB, and development on an ECG of either new pathological Q waves or new changes indicative of ischaemia. If the above criteria are not met then we will pay a claim based on satisfactory evidence that the life insured has suffered a Myocardial Infarction which has resulted in a permanent reduction in the Left Ventricular Ejection Fraction to less than 50%. Major Organ Transplant The medically necessary human to human transplant from a donor to the life insured of one or more of the following complete organs: kidney, liver, heart, lung, pancreas, small bowel or the transplantation of bone marrow. Medically Acquired HIV Infection with the Human Immunodeficiency Virus (HIV) which, must have occurred to the life insured in New Zealand or Australia from a health professional who is registered with the appropriate statutory body, where in our opinion the infection arose from one of the following medically necessary events: transfusion with blood products organ transplant to the life insured assisted reproductive techniques a medical procedure or operation performed by a doctor or dentist. Notification and proof of the incident will be required via a statement from the appropriate statutory health authority that the infection is medically acquired. This benefit will not apply in the event that any medical cure is found for AIDS or the effects of the HIV virus or a medical treatment is developed that results in the prevention of the occurrence of AIDS. Infection in any other manner, including infection as a result of sexual activity or intravenous drug use is excluded. We must have open access to all blood samples and be able to obtain independent testing of such blood samples. Motor Neurone Disease resulting in Functional Loss Motor Neurone Disease with significant persistent neurological deficit resulting in either: at least 25% impairment of whole person function, that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. 16 BUSINESS 360 TRAUMA COVER STAND ALONE

17 Multiple Sclerosis resulting in Functional Loss Multiple Sclerosis with significant persistent neurological deficit resulting in either: at least 25% impairment of whole person function, that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. Muscular Dystrophy resulting in Functional Loss Muscular Dystrophy with significant persistent neurological deficit resulting in either: at least 25% impairment of whole person function, that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. Occupationally Acquired HIV Infection with the Human Immunodeficiency Virus (HIV) where HIV was acquired as a result of an accident during the course of carrying out normal occupational duties with sero-conversion to HIV infection occurring within six months of the incident. Any incident giving rise to a potential claim must be reported to us within 30 days of the incident and be supported by a negative HIV antibody test taken by the life insured, taken within seven days after the incident. This benefit will not apply in the event that any medical cure is found for AIDS, or the effects of the HIV virus or a medical treatment is developed that results in the prevention of the occurrence of AIDS. Infection in any other manner, including infection as a result of sexual activity or intravenous drug use is excluded. We must have open access to all blood samples and be able to obtain independent testing of such blood samples. Paralysis The permanent and total loss of function of two or more limbs as a result of injury to, or disease of, the spinal cord or brain as defined below. Limb is defined as the complete arm or the complete leg: Hemiplegia: the permanent and total loss of function of one side of the body as a result of injury to, or disease of, the spinal cord or brain Diplegia: the permanent and total loss of function of both sides of the body as a result of injury to, or disease of, the spinal cord or brain Paraplegia: the permanent and total loss of function of both legs as a result of injury to, or disease of, the spinal cord or brain Quadriplegia: the permanent and total loss of function of both arms and both legs as a result of injury, to or disease of, the spinal cord or brain Tetraplegia: the permanent and total loss of function of both arms and both legs and loss of head movement as a result of injury to, or disease of, the spinal cord or brain. Parkinson s Disease resulting in Functional Loss Parkinson s Disease where the condition cannot be controlled with medication and shows signs of progressive incapacity with either: at least 25% impairment of whole person function, that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. BUSINESS 360 TRAUMA COVER STAND ALONE 17

18 Pneumonectomy The surgical excision of an entire lung. Primary Pulmonary Hypertension Primary pulmonary hypertension with substantial right ventricular enlargement resulting in permanent irreversible physical impairment to the degree of at least class three of the New York Heart Association Classification of Cardiac Impairment, and resulting in the life insured being unable to perform his/her usual occupation. Recoverable Stroke The suffering of a recoverable stroke as a result of a cerebrovascular event producing neurological deficit lasting more than 24 hours. This requires clear evidence on a Computerised Tomography Scan or Magnetic Resonance Imaging Scan or similar appropriate scan that a stroke has occurred and evidence of: infarction of brain tissue, or intracranial or subarachnoid haemorrhage. This does not include neurological deficit due to transient ischaemic attacks, migraine, cerebral injury resulting from trauma or hypoxia and vascular disease affecting the eye, optic nerve or vestibular functions. Severe Burns Tissue injury caused by thermal, electrical or chemical agents causing third degree or full thickness burns to at least 20% of the body surface area as measured by The Rule of Nines or the Lund & Browder Body Surface Chart (or similar means of measurement as determined by us). Stroke resulting in Functional Loss The suffering of a Stroke as a result of a cerebrovascular event producing neurological deficit and causing either: at least 25% impairment of whole person function, that is permanent, or the life insured to be constantly and permanently unable to perform at least one of the activities of daily living without the physical assistance of another person. This requires clear evidence on a Computerised Tomography Scan or Magnetic Resonance Imaging Scan or similar appropriate scan that a stroke has occurred and evidence of: infarction of brain tissue, or intracranial or subarachnoid haemorrhage. This does not include neurological deficit due to transient ischaemic attacks, reversible neurological deficit, migraine, cerebral injury resulting from trauma or hypoxia and vascular disease affecting the eye, optic nerve or vestibular functions. Total and Permanent Blindness The complete and irrecoverable loss of the sight of both eyes to the extent that: a) visual acuity is less then 6/60 vision, in both eyes after correction; or b) field vision is constricted to 10 degrees or less; or c) combined visual defects result in the same degree of visual impairment as that occurring in a) or b). 18 BUSINESS 360 TRAUMA COVER STAND ALONE

19 O. Definitions applicable to this cover 1 You must read the following definitions with the definitions in Section E of the Business 360 Base Policy. activities of daily living are: bathing and showering dressing and undressing (including grooming and fitting artificial limbs) eating and drinking using a toilet to maintain personal hygiene moving to or from place to place by walking, wheelchair or walking aid carcinoma in situ: carcinoma in situ characterised by a focal autonomous new growth of carcinomatous cells, which has not yet resulted in the invasion of normal tissues. Invasion means an infiltration and/or active destruction of normal tissue beyond the basement membrane. The diagnosis of carcinoma-in situ must be based on histological examination of tissue. A clinical or radiological diagnosis will not be sufficient. usual occupation: the occupation in which the life insured was engaged and from which he or she was deriving income at the time of diagnosis of the Trauma Condition. whole person function: a criteria based on the current edition of the American Medical Association publication entitled Guides to the Evaluation of Permanent Impairment until similar means of measurement have been established by the New Zealand or Australian medical associations that are acceptable to us. Trauma S 0604B V4 BUSINESS 360 TRAUMA COVER STAND ALONE 19

20 20 BUSINESS 360 TRAUMA COVER STAND ALONE