INCOME PROTECTION POLICY CONDITIONS GUARANTEED PREMIUMS Documet referece: MIMIIP12G This is a imptat documet Please keep it i a safe place.
Icome Protectio Guarateed Premiums Policy Coditios Welcome to LV=, ad thak you f choosig our Icome Protectio policy. Welcome to LV= ad thak you f choosig our Icome Protectio policy, which is oe of a umber of differet types of life ad health isurace policies available i our Flexible Protectio Pla. These coditios, your Policy Schedules, applicatio, ay declaratios you have made ad ay documets we sed you cofirmig chages to your policy ad the amout of your cover, fm a cotract betwee you ad us uder your Pla. These are imptat documets, so please keep them i a safe place. This cotract is siged o our behalf ad starts o the date show i your Policy Schedule. Mike Rogers Chief Executive LV=, Pyes Hill House, Rydo Lae, Exeter EX2 5SP If we ca help you, by providig these documets i Braille, i large prit o audio, please let us kow. Icome Protectio Policy Coditios Guarateed Premiums 2
Cotets Defiitios 4 Why choose LV= Icome Protectio? 5 Sectio A What you re covered f A1 Ow Occupatio cover 6 A2 Homemaker cover 9 Sectio B Claims ad paymets B1 Whe you eed to tell us about your accidet sickess 11 B2 The evidece we eed to suppt your claim 11 B3 How we pay you 12 B4 How much we will pay out 13 B5 How we wk out how much we will pay you 14 B6 1,500 Beefit guaratee 16 B7 What happes if you become sick agai (liked claims) 17 B8 B9 What happes if you go back to wk part time i your occupatio (rehabilitatio beefit) Ow Occupatio cover oly. 17 What happes if you recover, but ot eough to go back to your occupatio (proptioate beefit) Ow Occupatio cover oly 20 B10 What happes if you re isurig some else 22 Sectio C Other coditios C1 Iflatio-liked cover 23 C2 Guarateed Icrease Optios 24 C3 Chagig your policy 27 C4 What to do if you stop wkig 27 C5 Back to wk suppt 28 C6 Payig your premiums 28 C7 Stoppig your premiums 28 C8 Restartig your premiums 29 C9 Ca you chage the amout of my premium? 29 C10 Proof of age ad ame 30 C11 Whe you ca cacel your policy 30 C12 Whe we ca cacel your policy 30 C13 Whe your policy eds 31 C14 Trasferrig your policy to someoe else 31 C15 The law that applies to your policy 31 Appedix A - Special Coditios f Docts ad Surgeos 32 Icome Protectio Policy Coditios Guarateed Premiums 3
Defiitios We explai these terms because this is a legal documet. I some cases the wds may have other meaigs i every day use. We have highlighted these wds i bold (other tha persoal terms such as you ad we ) so you kow whe they apply. You meas the perso who applied f this policy, the perso who is isured ad the perso legally etitled to the paymet from this policy. Where we use your it has the same meaig. We, us, our meas Liverpool Victia Friedly Society Limited. Amout of your cover ad amout of cover meas the amout you are isured f. This is show o your Policy Schedule. Ed date meas the date whe your policy eds. This date is show i your Policy Schedule. Homemaker We d cosider you a homemaker if you have chose to stay at home ad look after your family, ad you re ot doig other paid upaid wk. By family we mea your parter ad/ your childre. We d also cosider you a homemaker if you re a carer. If you are claimig Jobseekers Allowace at applicatio stage we will cosider you uemployed ad ot be able to offer you cover. Icome meas your taxable eared icome befe ay icome tax is paid, mius ay expeses which are allowable agaist icome tax. You ll fid this figure o your P60 if you are employed your tax retur if registered self employed with HM Reveue ad Customs. If you ow a limited compay the your icome ca also iclude divided icome from your busiess as log as: The divided icome is clearly related to your wk activities The frequecy of divided paymets must be of a established patter, rather tha irregular oe-off paymets. Icome Protectio Policy Coditios Guarateed Premiums 4 The divideds are paid from aual profits et of tax. If the divideds are higher tha the profit figure, we will use the et profit figure istead. Your icome ca also iclude divideds paid to your spouse civil parter as log as they are also a shareholder, ad they do t take over the ruig of the busiess. Ay divideds paid to your spouse civil parter must be appropriate f their level of shareholdig, ad must have bee declared f tax purposes. However if your spouse civil parter has used the same divided icome f their ow icome protectio cover, it ca t also be icluded i your icome. Icome befe the claim meas the icome you received from your occupatio i the 12 moths befe the date you became uable to wk. If you re ot wkig whe you claim ad you ve bee out of wk f less tha 12 moths we will wk out your earigs based o what you eared i the last 12 moths you were actually wkig. F self employed people we will average earigs over three years. Where there are less tha three years recds it will be based o the recds available. Iflatio meas the risig cost of goods ad services such as your weekly shoppig, gas ad electricity. We will measure this usig the Retail Prices Idex, uless this stops beig published, i which case we would use aother similar published idex. Occupatio meas your occupatio at the time you became sick had the accidet that meat you were uable to wk.
Pla meas your LV= Flexible Protectio Pla, your Pla Schedule, ad ay policies (icludig this policy) which are icluded i it. Pla aiversary meas each 12 moth aiversary from the date your pla igially started. This will be the same as the 12 moth aiversary of your policy uless you have added a ew policy to a existig pla. You ca check this o your Pla Schedule. Policy meas these coditios, your Policy Schedule, ay Special Provisios listed i that Policy Schedule ad ay documets we sed you to cofirm chages to your policy the amout of your cover. We will apply a Special Provisio whe we are ot able to offer you a policy based o the terms detailed i these coditios. This may be because of your occupatio, your health your leisure activities. We will let you kow if this applies to you befe we start askig you f ay moey. Premium ad premiums mea the mothly amout you pay f the amout of your cover. Related claim meas you are uable to wk either directly idirectly due to the same accidet sickess that we have igially agreed to pay a claim f. Start date meas the date whe your policy started. This date is show i your Policy Schedule. Uable to wk, iability to wk, able to wk, ability to wk The way we measure these uder this policy depeds o whether you have Ow Occupatio cover Homemaker cover. We explai this i detail i Sectio A1 f Ow Occupatio Cover ad Sectio A2 f Homemaker Cover. Waitig period meas the umber of moths you have chose to wait after you are uable to wk, befe we will start payig you, whe we approve a claim. You choose the waitig period whe you apply f your policy. This will be show i your Policy Schedule. Why choose LV= Icome Protectio? This policy is desiged to help you cope if you lose your icome as a result of sickess a accidet. The cover we ca offer depeds o your occupatio whe you take out the policy. Whe you ask f a quote we ca tell you what type of cover is available. We will cofirm this whe you apply. If you re claimig job seekers allowace at the time you apply we will treat you as uemployed. If you re uemployed you wo t be able to take out the policy. Ow Occupatio cover This pays out if, because of a accidet sickess, you are uable to do your usual occupatio. You would ot be expected to go back to wk i a differet occupatio f as log as you are uable to do your usual occupatio, the policy will cotiue to pay out. This is explaied i detail i Sectio A1 If you re a Homemaker This pays out if, because of a accidet sickess, you are uable to prepare a meal do basic housewk. We promise we ll be reasoable i reviewig your claim, our aim is to make sure we ca pay out whe someoe is geuiely uable to be a homemaker. This is explaied i detail i sectio A2. Icome Protectio Policy Coditios Guarateed Premiums 5
Sectio A: What you re covered f This sectio tells you about: What you re covered f The types of cover available This policy is desiged to pay you a regular icome if you are uable to wk due to sickess accidet. There are two ways we ca measure whether you are uable to wk; we call these Ow Occupatio ad Homemaker cover. We tell you which cover we ca offer befe your policy starts. F referece you will fid this o your Policy Schedule. (If you have t applied yet you may have this ifmatio o your quote. Make sure you look at your cover whe your acceptace terms are set to you i case it has chaged from your quote). O the followig pages we explai the differet types of cover i me detail, ad explai what you re covered f, ad what you re ot covered f. You oly eed to read the sectio that applies to the type of cover show o your Policy Schedule. So, if your Policy Schedule shows that you have Ow Occupatio cover, you oly eed to read Sectio A1 ad if it shows you have Homemaker cover, read Sectio A2. A1 Ow Occupatio cover Icome Protectio Policy Coditios Guarateed Premiums What s covered Uable to wk due to sickess accidet I this sectio, the wds uable to wk ad iability to wk mea that we will pay a claim if, followig your waitig period, because of sickess accidet, you are uable to carry out the mai tasks of your occupatio ad are t doig ay other paid upaid wk. The wds able to wk ad ability to wk mea that you ca wk. By mai tasks we mea the thigs which ca t reasoably be left out of your role, chaged by you your employer. We ll also use this measure to determie whether you re uable to wk if you claim withi the first 12 moths from - becomig uemployed - becomig a homemaker, - takig a career break If you have bee out of wk f loger tha 12 moths whe you claim your we ll use the measures uder homemaker cover (which we explai i Sectio A2) to wk out whether to pay your claim. You recover but oly go back to your occupatio part-time If you have bee claimig o your policy, but recover eough to go back to your occupatio part-time, we may pay you some of the amout of your cover. 6
We explai this i me detail i Sectio B8. You recover but go back to wk i a differet occupatio We realise that you might recover, but are ot well eough to go back to your occupatio. We wat to help with your recovery ad help you get back to paid wk. So, if you are still ot well eough to go back to your occupatio but wat to start wk i a ew paid job f less moey, the we may be able to pay you a proptio of the amout of your cover to help with this. We explai this i me detail i Sectio B9. All types of sickess accidet There are o restrictios o the type of sickess accidet, uless we have told you about ay restrictios befe your policy starts. We will list ay exclusios o your Policy Schedule uder the headig of Special Provisios. Sickess medical coditios that you had befe you applied As we ask you f all your medical histy befe we offer you the policy, we will cover all illesses uless we have told you that we wo t, befe your policy starts. We will list ay exclusios o your Policy Schedule uder the headig Special Provisios. We will tell you about ay exclusios befe we ask you f the first premium. Chagig your occupatio You re covered if you chage your occupatio. You are ot required to tell us, however you may wish to check with us whether your ew occupatio would give you a lower premium. If it would t, you ca still keep your existig cover so there is othig to lose by askig. Me ifmatio o how you ca chage your policy if you chage your occupatio ca be foud i Sectio C3. Travellig Abroad We will pay you after your waitig period, if you have a valid claim ad you are i ay of the followig coutries: Australia, Austria, Belgium, Bulgaria, Caada, Chael Islads, Cyprus, Czech Republic, Demark, Estoia, Filad, Frace, Germay, Gibraltar, Greece, Hugary, Icelad, Irelad, Isle of Ma, Italy, Latvia, Lithuaia, Luxembourg, Malta, Netherlads, New Zealad, Nway, Polad, Ptugal, Romaia, Slovakia, Sloveia, Spai, Swede, Switzerlad, UK USA. If you are aywhere else i the wld we would pay you f a maximum of 26 weeks. If, at the ed of the 26 weeks, you have retured to oe of the coutries above we will cotiue to pay you if you still have a valid claim. Please ote we will stop payig a claim if you travel from oe of the coutries listed above to stay i oe that is ot listed f me tha two weeks, eve if this is just f a holiday. Icome Protectio Policy Coditios Guarateed Premiums 7
A1 Ow Occupatio cover (cotiued) Icome Protectio Policy Coditios Guarateed Premiums What s ot covered Uemploymet This policy will oly pay out if you are uable to do your occupatio (paid upaid), because of sickess accidet. This meas we wo t pay a claim if you are ot wkig f a differet reaso, f example if you have chose ot to wk, whether paid upaid you have bee made redudat. This would also apply if you are employed by your ow limited compay but have o actual cotracts wk. Of course, if you are already uemployed at the time you have a accidet sickess that prevets you from the takig paid upaid wk, the you are still covered. This is explaied uder the What s covered sectio. However it s imptat to uderstad that we ca stop payig a claim if you become fit f wk eve if there is ot a vacacy that you ca apply f. Sickess accidet ad still wkig You caot geerally claim uder this policy if you are sick have had a accidet ad are still able to wk i your occupatio are doig other paid wk. The oly exceptio is where you recover but we re already payig a valid claim. Me detail o this is explaied i Sectios B8 ad B9. Do please check with us if you wk i me tha oe job. You may ot be covered if you are able to do oe job but ot the other. Gettig home if you have a sickess accidet abroad This policy does ot cover you f the costs of returig home if you are abroad, f example if you eed special medical assistace special seatig arragemets o a plae. Please remember: It s a good idea to have appropriate travel isurace whe travellig abroad. Death This policy does ot pay out i the evet of your death. I that evet, this policy will ed ad, if we were payig you, the paymets would stop. Fraud ad Deliberate o-disclosure Please uderstad that whilst we kow that the vast majity of our customers are hoest, we do have to protect ourselves (ad our customers) agaist the effect of fraud. F this reaso we will cacel the policy ad ot pay a claim if we fid someoe has deliberately withheld ifmatio from us has itetioally provided us with false ifmatio lied to us, whe they applied, whe they claim, whe they apply to re-start their premiums (see Sectio C8). Me detailed ifmatio o whe we ca cacel the policy ca be foud i Sectio C12. 8
A2 Homemaker cover What s covered Uable to wk due to sickess accidet I this sectio, the wds uable to wk ad iability to wk mea that we will pay a claim if, followig your waitig period, because of sickess accidet, you are uable to prepare a meal do basic housewk ad are ot doig ay other paid upaid wk. We promise we ll be reasoable i reviewig your claim, our aim is to make sure we ca pay out whe someoe is geuiely uable to carry out these tasks. All types of sickess accidet There are o restrictios o the type of sickess accidet, uless we have told you about ay restrictios befe your policy starts. We will list ay exclusios o your Policy Schedule uder the headig of Special Provisios. Sickess medical coditio that you had befe you applied As we ask you f all your medical histy befe we offer you the policy, we will cover all illesses uless we have told you that we wo t, befe your policy starts. We will list ay exclusios o your Policy Schedule uder the headig of Special Provisios. We will tell you about ay exclusios befe we ask you f the first premium. Chagig your occupatio You re covered if you chage your occupatio. You are ot required to tell us, however you may wish to check with us whether your ew occupatio would give you a lower premium whether we could offer you Ow Occupatio cover. If it would t, you ca still keep your existig cover so there is othig to lose by askig. Me ifmatio o how you ca chage your policy if you chage your occupatio ca be foud i Sectio C3. Travellig Abroad We will pay you after your waitig period, if you have a valid claim ad you are i ay of the followig coutries: Australia, Austria, Belgium, Bulgaria, Caada, Chael Islads, Cyprus, Czech Republic, Demark, Estoia, Filad, Frace, Germay, Gibraltar, Greece, Hugary, Icelad, Irelad, Isle of Ma, Italy, Latvia, Lithuaia, Luxembourg, Malta, Netherlads, New Zealad, Nway, Polad, Ptugal, Romaia, Slovakia, Sloveia, Spai, Swede, Switzerlad, UK USA. If you are aywhere else i the wld we would pay you f a maximum of 26 weeks. If, at the ed of the 26 weeks, you have retured to oe of the coutries above we will cotiue to pay you if you still have a valid claim. Please ote we will stop payig a claim if you travel from oe of the coutries listed above to stay i oe that is ot listed f me tha two weeks, eve if this is just f a holiday. Icome Protectio Policy Coditios Guarateed Premiums 9
Icome Protectio Policy Coditios Guarateed Premiums What s ot covered Uemploymet This policy will oly pay out if you are uable to prepare a meal do basic housewk because of sickess accidet. This meas we wo t pay a claim if you are ot wkig f a differet reaso, f example if you have chose ot to wk, you have bee made redudat. Sickess accidet ad still wkig You caot claim uder this policy if you are sick have had a accidet ad are still able to prepare a meal do basic housewk are doig paid upaid wk. You recover ad go back to wk If you recover ad are able to prepare a meal do basic housewk, go back to a differet occupatio, the your claim will stop. This meas Sectios B8 & B9 do ot apply to Homemaker cover. Gettig home if you have a sickess accidet abroad This policy does ot cover you f the costs of returig home if you are abroad, f example if you eed special medical assistace special seatig arragemets o a plae. Please remember: It s a good idea to have appropriate travel isurace whe travellig abroad. Death This policy does ot pay out a lump sum i the evet of your death. I that evet, this policy will ed ad, if we were payig you, the paymets would stop. Fraud ad Deliberate o-disclosure Please uderstad that whilst we kow that the vast majity of our customers are hoest, we do have to protect ourselves (ad our customers) agaist the effect of fraud. F this reaso we will cacel the policy ad ot pay a claim if we fid someoe has deliberately withheld ifmatio from us has itetioally provided us with false ifmatio lied to us, whe they applied, whe they claim, whe they apply to re-start their premiums (see Sectio C8). Me detailed ifmatio o whe we ca cacel the policy ca be foud i Sectio C12. 10
Sectio B: Claims ad Paymets This sectio tells you about: Whe we will pay the amout of cover How much we will pay B1 Whe you eed to tell us about your accidet sickess If you are uable to wk because of your accidet sickess, it is imptat that you tell us withi the times give below, so we ca maage your claim as quickly as possible, ad start makig paymets to you as soo as we ca. You ca tell us i writig, by phoe by fax. (a) If the waitig period you ve chose is two moths less You eed to tell us withi two weeks after your accidet occurs, sickess starts. If we do t hear from you util after two weeks, we will still pay your claim if it s valid, but we will cout your waitig period as if you became uable to wk two weeks befe you told us. (b) If the waitig period you ve chose is three moths me You eed to tell us withi eight weeks after your accidet occurs, sickess starts. If we do t hear from you util after eight weeks, we will still pay your claim if it s valid, but we will cout your waitig period as if you became uable to wk eight weeks befe you told us. If you are ot i paid upaid wk whe you make a claim we will cout your waitig period from the date o which your accidet sickess meat you were uable to do your last occupatio were uable to either prepare a meal do basic housewk. We explai i me detail what happes if you re ot wkig whe you make a claim, i Sectio C4. B2 The evidece we eed to suppt your claim To make a claim: Ask us f a claim fm. Fill i the claim fm tellig us about your accidet sickess, your occupatio ad your icome. Retur the fm to us as soo as possible, mally withi 14 days. So that we ca assess your claim, we will eed evidece of your icome, ad we may eed to get medical repts from your doct. If we do, we will eed you to complete a coset fm. The fm will fully explai your rights uder the Access to Medical Repts Act 1988. Please uderstad that whilst the vast majity of our customers are hoest, we do have to protect ourselves (ad our customers) agaist the effect of fraudulet claims. Therefe, if you are asked f additioal ifmatio, please do ot take this as a reflectio of our opiio of you. We do t kow what evidece we will eed util you make a claim, as all claims are looked at idividually. We wo t ask f uecessary evidece ad we will explai why we eed aythig we ask f. Icome Protectio Policy Coditios Guarateed Premiums 11
Whilst we are payig you, we may ask you to complete extra declaratios about your iability to wk as a routie review. As part of this review, we may eed routie medical repts from your doct(s), other specialists your employer. Whe this happes we will tell you what we eed ad supply the fms f you ad your doct(s) to fill i. If your doct charges f this, you will have to pay f it, as we do ot cover this cost. However, we will pay f all other o-routie medical repts evidece we ask f. We may eed you to be examied by a doct of our choice. We may also ask f other evidece to cosider your claim to cofirm that you are still uable to wk. Some examples of the evidece we may eed are: a rept from ay doct ( ay alterative medical practitioer) who has treated examied you. a rept from a member of our staff a perso actig o our behalf who has visited you i your ow home to discuss the claim. You are ot covered if ay of the ifmatio we ask f is ot provided, uless there is a good reaso. I the wst case, this could mea that we would refuse stop payig your claim. B3 How we pay you Oce we approve a claim, we will pay you a moth i arrears. This meas that the first paymet will be paid at the ed of the moth after your waitig period eds. (Your waitig period is the umber of moths you have chose to wait befe we will start payig you.) F example f a waitig period of two moths, if you were uable to wk i Jauary, we would make the first paymet at the ed of March. Paymets will be made directly ito your bak buildig society accout. You eed to be cotiuously uable to wk throughout this period f us to start payig a claim. Icome Protectio Policy Coditios Guarateed Premiums If you were uable to wk f less tha a whole caledar moth, we would wk out how much to pay you by dividig the umber of days you could t wk by the umber of days i the moth. The example o the ext page shows you how we wk out what to pay whe this happes. The figures used i the example do t relate to your ow policy. If you are a Doct Surgeo directly employed by the NHS you may be able to claim uder our NHS Docts ad Surgeos sick pay guaratee. This meas we would pay your claim early if you ve chose a waitig period of 12 moths. F me ifmatio please read Appedix A - Coditio 3. 12
Example Rosie makes a claim. Her policy has a 2 moth waitig period. The waitig period eds o 15th March. Rosie s first paymet would be calculated as follows: (31-15) = 16 (as there are 31 days i March ad the first 15 are ot eligible f paymet) (16 / 31) x 100 = 52% This meas Rosie will receive 52% of the full mothly amout payable at the ed of March. We will cotiue to pay you util oe of the followig happes: You are ow able to wk (as defied uder the type of cover you have) your policy reaches its ed date your death. We explai how we wk out how much we will pay you i Sectios B4 & B5. B4 How much we will pay out Oce we have approved your claim, we will wk out the total mothly paymet as follows: (a) If you are wkig i your occupatio have bee out of wk f less tha 12 moths whe you become uable to wk we will pay the lower of: the amout of your cover at the time, the maximum mothly amout we could pay you. We explai this i Sectio B5 (b) If you are a homemaker have bee out of wk f me tha 12 moths whe you become uable to wk we will pay the lower of: the amout of your cover at the time, 1,500 a moth mius ay other mothly paymets f ay accidet sickess policies that you are receivig paymets from (f example: this could be a mtgage paymet protectio policy a credit card paymet pla). This limit of 1,500 ca be icreased by us i the future. If we decide to icrease this limit, we will let you kow. Uftuately, we wo t be able to refud ay premiums if we do t pay the amout of your cover i full. So, it is wth checkig this if your circumstaces chage, f example if you chage your job. Icome Protectio Policy Coditios Guarateed Premiums 13
B5 How we wk out how much we will pay you The example below illustrates how we wk out how much we will pay you. Example Joh ears 30,000 a year, which gives him a mothly take home pay of 1,900. He ca take out a Icome Protectio policy f a maximum of 55% of his aual icome of 30,000. (Which divided by 12 meas he could take out a Icome Protectio Policy f a maximum of 1,375 a moth. Joh chooses 1,375 a moth cover. His employer will pay him f 6 moths if he ca t wk due to a accidet sickess, so he chooses a waitig period of 6 moths. A year after takig out his Icome Protectio policy, he applies f a small persoal loa, ad takes out paymet protectio isurace o that loa. 5 years after takig out his Icome Protectio policy, Joh becomes sick ad is uable to wk as a result. His paymet protectio isurace f his loa starts payig 300 a moth. By this time his salary has also icreased to 36,000. To wk out the maximum mothly amout we will pay uder Joh s policy: First of all we wk out 55% of Joh s icome befe the claim 36,000 x 55% = 19,800 The we divide this by 12 to wk out the mothly equivalet Icome Protectio Policy Coditios Guarateed Premiums 19,800 12 = 1,650 The we take off the paymets from his paymet protectio isurace 1,650-300 = 1,350 The maximum mothly amout we could pay based o his icome is 1,350 a moth. As the amout of his cover is me tha the maximum mothly amout, we could oly pay Joh 1,350 a moth, ad ot the 1,375 he is covered f. But because we ige ay over-isurace of up to 10%, we agree to pay the full amout he is covered f of 1,375.This is because the differece betwee his amout of cover ad the maximum we could pay is less tha 10%. After the 6 moth waitig period he starts to receive tax free paymets from LV= of 1,375 a moth. 14
We wk out the maximum mothly amout, as follows: First we take 55% of your icome befe the claim ad divide this by 12. If this wks out to be less tha 1,500 a moth we ll use 1,500 a moth istead if you qualify f the 1,500 beefit guaratee. We explai the requiremets f the guaratee i Sectio B6. If you are a Doct a Surgeo, the we may use a figure of 3,000 istead. We explai these special requiremets f the guaratee f Docts ad Surgeos i Appedix A - Coditio 1. The we take off ay of the followig mothly paymets, befe tax, that you are etitled to: paymets from ay other sickess accidet isurace o your life (f example, ay mtgage paymet protectio credit card protectio you are claimig o) 60% of sickess beefit retiremet paymets you receive from ay source 60% of ay cotiuig icome pesio paymets that you are still receivig whilst you are claimig, (we do t take ito accout ay icome eared befe you became uable to wk f example a bous that is paid at the ed of the year) We take these paymets off so that you do t mally receive paymets totallig me tha your icome ad lose the icetive to go back to wk. Do t fget that the paymets we make to you are free of icome tax ad therefe closer to your previous taxed icome. Fially we check the result agaist the amout of your cover. We will pay the lower of the maximum mothly amout ad the amout of your cover as show o your Policy Schedule. We wo t reduce the amout we pay you by the amout of ay state sickess beefits - you ca cotiue to receive these i additio to the paymets you receive from this policy. However ay paymets from this policy could affect the amout of state beefit you ca claim. So you will eed to make sure that you metio the paymets from this policy at the time you claim ay state beefits. However if the maximum mothly amout is less tha your amout of cover, we will still pay your amout of cover as log as the differece is t me tha 10% of your amout of cover. F example: if your amout of cover is 2,000, as log as your maximum mothly amout is 1,800 me, the we ll still pay your amout of cover, eve though you are over-isured. Remember that your icome befe the claim geerally meas the icome you received from your occupatio i the 12 moths befe you became uable to wk. We ca use our discretio to base your icome befe the claim o your average icome over a loger period, if this me accurately reflects the icome you were aimig to replace ad where it meas your icome befe the claim is higher. F example we might do this if you have suffered a progressive sickess which has meat that your icome has reduced although you have still bee wkig. If you have iflatio-liked cover we will icrease the amout of your icome befe the claim each year, i lie with iflatio while we are payig you. Icome Protectio Policy Coditios Guarateed Premiums 15
We may chage the way i which we wk out the maximum mothly amout we will pay you, if ay of the followig chage: the way paymets from icome protectio policies are taxed the way ay of the paymets we take ito accout i wkig out the maximum mothly amout we will pay you are taxed. If we decide to do this, we will tell you about the chages we have made at least 30 days befe they become effective. Naturally, we will make sure ay chages we make are reasoable ad proptioate to the chages that have prompted the review. I fact, we will oly do this to make sure that o oe was etitled to receive me i total paymets tha they would uder this policy pri to the chages beig made ad i so doig lose the icetive to retur to wk. B6 1,500 Beefit Guaratee At LV= we uderstad that your icome ca go up ad dow, ad that whe you come to claim it is possible that your icome might have dropped. If your icome drops but your amout of cover stays the same, it s possible that your amout of cover might ow be me tha the 55% of icome allowed. If this happeed we would usually reduce the amout we pay you to the maximum mothly amout (as explaied i Sectio B5). Whe you make a claim we will ask f ifmatio o your fiacial situatio to help us uderstad how we ca best help you with your claim. But if whe we do this, we fid your icome o loger suppts the amout of cover you chose, uder this guaratee we will pay you at least 1,500 a moth ( the amout of cover you chose if it was less tha 1,500) less the followig mothly paymets befe tax: Icome Protectio Policy Coditios Guarateed Premiums 16 paymets from ay other sickess accidet isurace o your life (f example, ay mtgage paymet protectio credit card proptio that you are claimig o) 60% of sickess beefits retiremet paymets you receive from ay source (except NHS sick pay if you re claimig uder the NHS Docts Surgeos Sick Pay Guaratee explaied i Appedix A - Coditio 3) 60% of ay cotiuig icome pesio paymets that you are still receivig whilst you re claimig (we do t take ito accout ay icome eared befe you became uable to wk - f example a bous that is paid at the ed of the year) To qualify f this guaratee you must have bee wkig f at least 16 hours a week if you re self employed, 25 hours a week if you re employed at the time you became uable to wk. You ca still receive state beefits (f example, Employmet ad Suppt Allowace) o top of the guaratee. The aim of the beefit guaratee is to protect you agaist a geuie drop i your icome after you take out your policy. If you were t earig eough whe whe your policy started to suppt the amout of cover you chose, the we reserve the right ot to apply the beefit guaratee. If you are a Doct Surgeo, the we may be able to offer you a 3,000 beefit guaratee istead. Please see Appedix A - Coditio 1 f me ifmatio.
B7 What happes if you become sick agai (sometimes called liked claims) This sectio is imptat if you have bee claimig, retur to paid wk but the become too sick to wk agai. It is imptat as if you are uable to wk agai you might ot eed to wait befe we would start payig a claim agai. Oce we have started to pay you, you will hopefully become well eough to go back to wk. However, we realise that sometimes people are uftuate eough to fid they have to stop wk agai, because of the same sickess accidet. If this happes withi the first six moths of you goig back to wk, we will start payig you agai straight away as log as: ad ad the cause of your iability to wk is the same as it was f the igial claim. your occupatio is the same as it was whe you were first uable to wk. you tell us withi two weeks of the date that you stop wk agai. If we ca t cofirm that the reaso you are uable to wk is the same, you go back to wk i a differet occupatio we will have to treat this as a ew claim. If we do, you will eed to wait util aother waitig period eds agai befe we start to pay you agai. B8 What happes if you go back to wk part-time i your occupatio (sometimes called rehabilitatio beefit) Ow Occupatio cover oly Sectio B8 oly applies where your Policy Schedule states that you have Ow Occupatio cover. If you have Homemaker cover, Sectio B8 does t apply. This sectio explais how we wk out what we will pay you if you ca oly go back to wk part-time after your sickess accidet. We have used examples, which you might fid helpful, later i this sectio. If you re claimig o your policy, ad we have started to make paymets to you, ad you the go back to wk i your occupatio part-time, we will cotiue to pay you if: ad ad ad you have bee uable to wk cotiuously f at least three moths you go back to wk f less tha 30 hours a week you wked f me tha 30 hours a week immediately befe you became uable to wk your icome from part-time wk is less tha your icome befe the claim. Icome Protectio Policy Coditios Guarateed Premiums 17
We uderstad that if you are self-employed, it might be difficult f you to prove your weekly wkig hours whe you make a claim. We will wk with you to try ad fid evidece that will suppt your wkig hours. A example of evidece that would help could be a copy of your accouts. We wk out how much we will pay you as follows: ( ) (Icome befe the claim mius your icome from part time wk) icome befe the claim x actual cover I this fmula, your icome from part time wk is based o the yearly equivalet, befe ay tax is paid. F example if your mothly icome from part time wk, befe tax, was 500, the we would use 6,000 i this fmula, ( 500 x 12 moths = 6,000 a year). By actual cover, we mea the amout we were payig you befe you wet back to wk part-time. If we applied either our 1,500 3,000 beefit guaratee, it will still be icluded as your actual cover. We will eed evidece of your icome from part-time wk, such as your P60, payslip, writte cofirmatio from your employer, ivoices your accouts. We will eed to review the amout we pay you if ay of the followig chage: your icome from part-time wk the amout of your cover the maximum mothly amout we will pay you. We describe this i Sectio B5. We will pay you util oe of the followig happes: Icome Protectio Policy Coditios Guarateed Premiums your icome from part-time wk is the same as me tha your icome befe the claim you are able to carry out the mai duties of your occupatio f me tha 30 hours a week your policy reaches its ed date you die. The example below illustrates how we wk out what we will pay you if you go back to your occupatio o a part-time basis. 18
Example Befe her accidet, Mega eared 30,000, givig her mothly take home pay of 1,900. Mega has bee claimig o her Icome Protectio policy sice her accidet, because she has bee uable to wk. The amout of her cover is 1,250 a moth. After a year off wk, her doct tells her she ca start wk agai, but that she ca t wk me tha 20 hours a week. Her employer agrees to pay her a reduced salary of 18,000 a year, reducig Mega s take home pay to 1,200 a moth. To wk out what we will pay, we take Mega s part-time icome away from her icome befe the claim to give us the differece. 30,000-18,000 = 12,000 We the divide her reduced icome by her icome befe the claim ad multiply this by 100 to tell us the decrease i her icome as a percetage. 12,000 30,000 = 0.4 x 100 = 40% Mega s icome from part time wk is 40% less tha her icome befe the claim. So she will cotiue to receive 40% of her Icome Protectio paymets. ( 1,250 x 0.4 = 500) This equates to 500 a moth. Befe her accidet, Mega took home 1,900 a moth. Now that she is back at wk part-time, she takes home 1,700 ( 1,200 from her job, plus 500 tax free from her policy). Icome Protectio Policy Coditios Guarateed Premiums 19
B9 What happes if you recover but ot eough to go back to your occupatio (sometimes called proptioate beefit) Ow occupatio cover oly Sectio B9 oly applies where your Policy Schedule states that you have Ow Occupatio cover. If you have Homemaker cover, Sectio B9 does t apply. This sectio explais how we wk out what we will pay you if you ca oly go back to wk i a differet occupatio after your accidet sickess. We have used examples that you might fid helpful later i this sectio. Where you recover from sickess accidet but are t fit eough to go back to wkig i your occupatio we will pay you if: ad ad because of sickess accidet you are uable to carry out the mai tasks of your occupatio you start a differet occupatio your icome from your ew occupatio is lower tha your icome befe the claim. We wk out how much we will pay you as follows: Icome Protectio Policy Coditios Guarateed Premiums ( ) (Icome befe the claim mius your icome from part time wk) icome befe the claim x actual cover I this fmula, icome from your ew occupatio is based o the yearly equivalet, befe ay tax is paid. F example if your mothly icome, befe tax, from your ew occupatio was 500, the we would use 6,000 i this fmula, ( 500 x 12 moths = 6,000 a year) By actual cover, we mea the amout we were payig you befe you wet back to wk i your ew occupatio. If we applied either our 1,500 3,000 beefit guaratee, it will still be icluded as your actual cover. So that we ca cotiue to pay you, we will eed: ad ad details of your ew occupatio a descriptio of your ew job evidece of your icome. 20
We will eed to review the amout we pay you if ay of the followig chage: your icome from your ew occupatio the amout of your cover the maximum mothly amout we will pay you. We describe this i Sectio B5. We will pay you util oe of the followig happes: your icome from your ew occupatio is the same as me tha your icome befe the claim (but we ca restart paymets if your icome falls agai, as explaied below) we believe you are fit eough to carry out the mai tasks of your occupatio, based o the evidece we have received your policy reaches its ed date you die. We will oly restart paymets to you where your icome from your ew occupatio falls below your icome befe the claim agai. If this happes withi 52 weeks less of us stoppig the paymets, your paymets will restart straight away. Naturally, you must have bee uable to do your occupatio throughout. Befe we restart your paymets we will eed evidece of the reduced icome ad medical evidece that cofirms that the reductio i your icome is a direct result of your iability to wk. Regrettably, if you ca t provide this evidece we wo t be able to cotiue to pay you. The example o the followig page illustrates how we wk out what we would pay if someoe wet back to wk i a lower paid wk. Icome Protectio Policy Coditios Guarateed Premiums 21
Example Roger used to be a computer aalyst, ad eared 16,800 a year givig him a mothly take home pay of 1,100. He has bee claimig o his policy sice his sickess started, because he has bee uable to wk. The amout of his cover is 700 a moth. After 6 moths, his doct tells Roger he ca start wkig agai, but that he ca t type. So Roger gets a job wkig o the equiries desk at a DIY ste. His ew job pays 12,000 a year, which gives him a take home pay of 800. To wk out what to pay, we take Roger s icome from his ew job away from his icome befe the claim to give us the differece. 16,800-12,000 = 4,800 We the divide his reductio i icome by his icome befe the claim ad multiply this by 100 to tell us the decrease i his icome as a percetage. 4,800 16,800 = 0.286 x 100 = 28.6% Rogers s icome from his ew job is 28.6% less tha his icome befe the claim. So he will cotiue to receive 28.6% of his Icome Protectio paymets. 700 x 28.6% = 200 This equates to 200 a moth. Befe his sickess Roger took home 1,100 a moth. Now that he is wkig i the DIY ste, he takes home 1,000 ( 800 from his ew job at the DIY ste, plus 200 tax free from his policy). Icome Protectio Policy Coditios Guarateed Premiums B10 What happes if you re isurig someoe else If you are isurig someoe else, we will look at their occupatio, health ad leisure activities to wk out what cover we ca offer whe you take out the policy if you wat to icrease the amout of cover uder Sectio C2, C3 C4. We will oly pay you if they are uable to wk as defied i the relevet sectios of these coditios, ad, whe we wk out the amout we will pay you, we look at their situatio ad ot yours. If you are isurig someoe else, they will eed to complete the questioaire about their occupatio, health, leisure activities ad icome. If we eed ay doct s repts, these will eed to be provided by the doct of the perso you are isurig ad they will eed to give us their coset f us to ask f these. 22
Sectio C: Other coditios This sectio tells you about other thigs you eed to kow, such as how to pay your premiums, ad how to cacel your policy. C1 Iflatio-liked cover Sectio C1 applies oly if you have chose f the amout of your cover to icrease i lie with iflatio. We refer to this as iflatio-liked cover. If you re usure whether this applies to you, you will fid whether ot this is icluded o your Policy Schedule. We will icrease the amout of your cover o each Pla aiversary. This meas every 12 moths from the start date of your Pla. This is show as the pla start date i your Pla schedule. Where we apply this icrease, the amout of your cover ad premium will both go up i lie with the icrease i iflatio. This icrease will be based o the 12 moth period edig three moths befe your Pla aiversary. If your Pla aiversary is less tha three moths after the start date of this policy, the first icrease i the amout of your cover will be made o the ext Pla aiversary If we are payig a claim whe a icrease is due, we limit the icrease to a maximum of 12% f that year. We will tell you what we will icrease the amout of your cover to ad your ew premium befe we icrease them. Ay Special Provisios that apply to your policy will also apply to ay iflatio-liked icreases. These Special Provisios will be show i your Policy Schedule. If the icreases mea that the amout of your cover becomes me tha three times the iitial amout of your cover (show i your Policy Schedule), we ca stop icreasig it. The good ews is that we wo t do this if we are payig a claim whe a icrease is due. This allows us to protect ourselves if there has bee very high iflatio, as you beefit from the fact that the icreases to your premium are based o the age you were whe you bought this policy. You ca ask us ot to icrease the amout of your cover, but you must let us kow befe the Pla aiversary whe a icrease is due. We the wo t make ay further icreases to the amout of your cover f the rest of the term of your policy. However, if we are payig a claim at the time you ask us ot to icrease the amout of your cover, we will still icrease it but your premium wo t go up. Oce we have stopped payig the claim, we will chage the amout of your cover back to the level that applied befe your claim. Please ote if you ask us ot to icrease the amout of your cover, but later o decide that you wat us to start icreasig it agai, you will eed to re-apply f iflatio-liked cover. We ca t guaratee that we will be able to offer you iflatio-liked cover agai, as it will deped o your health, occupatio ad leisure activities ad whether we are offerig the same type of isurace at that time. Icome Protectio Policy Coditios Guarateed Premiums 23
C2 Guarateed Icrease Optios You ca icrease your amout of cover (other tha the automatic icreases that happe if you have iflatio-liked cover, which we explai i Sectio C1) without havig to complete a full applicatio fm, if certai evets happe. The evet must happe to the perso isured. I all cases you ca oly do this withi three moths of the evet happeig. Whilst you ca use these optios me tha oce, you ca t use them at the same time. Oce you ve used a optio you must wait at least three moths befe you use aother. The Sigificat Career Progressio Icrease optio ca oly be used oce durig the life of your policy. We call these Guarateed Icrease Optios, because we guaratee that you ca icrease your amout of cover without further health questios f other types of icrease you would eed to aswer health questios. Because of this we limit whe ad by how much you ca icrease your cover. We ve explaied this i me detail below. Uftuately you wo t be able to icrease the amout of your cover by a Guarateed Icrease Optio if you are uable to wk. This will also be the case if you have already suffered a accidet sickess but you have t yet made a claim you are still i the waitig period. Your premium will go up to reflect the icrease i the amout of your cover. The additioal premium will be based o your age, whether you smoke ot ad your occupatio at the time you icrease the amout of your cover. Ay special terms that apply to your igial policy will also apply to the icreased amout of cover. The evets which are covered by our Guarateed Icrease Optios are: Icome Protectio Policy Coditios Guarateed Premiums Mtgage icrease as a result of movig house home improvemet You ca use this optio if you icrease the amout of your mtgage because you re movig home if you are plaig home improvemets. You ca icrease the amout of your cover by up to 50% of the igial amout of cover show i your Policy Schedule. The maximum icrease to your policy is limited to the icrease to your mtgage repaymets. Example Marc has moved house ad icreased his mtgage. The amout of cover uder his existig Icome Protectio policy is 500 a moth. This was eough to meet his mtgage repaymets, but as his mtgage repaymets have ow goe up to 700 a moth, he eeds to icrease his cover. Marc ears 26,000 a year befe tax. This meas that the maximum amout of cover he ca have uder his policy is 14,300 a year 1,191 a moth. As he oly wishes to icrease his cover to 700 a moth, he ca because this is still less tha the maximum cover he could have which would be 1,191. Also as the amout which he wats to icrease his cover by ( 200) is less tha 50% of his igial amout of cover ( 500), he is allowed to do this uder the Guarateed Icrease Optio. 24
Marriage Civil Partership You ca use this optio if you marry eter a civil partership (as defied by the Civil Partership Act 2004). You ca icrease the amout of your cover by up to 50% of the igial amout of cover show i your Policy Schedule. Childbirth legal adoptio of a child You ca use this optio if you have a child, you legally adopt a child (this must be legally recogised i the UK). You ca icrease the amout of your cover by up to 50% of the igial amout of cover show i your Policy Schedule. Icrease i basic salary received from a employer You ca use this optio if you are employed ad have a icrease i salary of at least 10%. Your basic salary must have icreased because of a promotio, the award of a recogised professioal qualificatio both a chage of employmet ad employer. You must be employed immediately befe ad after the icrease i your basic salary. You ca icrease the amout of your cover by up to 50% of the igial amout of cover show i your Policy Schedule. Sigificat Career Progressio Icrease You ca oly use this optio oce durig the lifetime of your policy You ca use this optio if you are employed ad have a icrease i basic salary of at least 20%. This could be as a result of a promotio, a chage of employmet employer. If you have had a icrease of 20% you ca also iclude ay other salary icreases sice the start date of your policy. You ca icrease your amout of cover by up to a maximum of 20,000 a year. This optio ca oly be used oce durig the life of your policy. This optio ca t be used if you, ( a member of your family) are the ower, direct parter i the compay you are employed by. By member of your family we mea your husbad, wife, civil parter, paret, child, brother, sister, ay other relative by blood by marriage. Geeral limits f Guarateed Icrease Optios There are some limits f how much you ca chage the amout of cover by. The total of all the Guarateed Icrease Optios you use ca t be me tha 10,000 a year 50% of the igial amout of cover show o your Policy Schedule (the oly exceptio beig the Sigificat Career Progressio icrease - see above). However, if you re ot i paid upaid wk the the overall amout of cover is limited to 18,000 a year ( 1,500 a moth). F me ifmatio see Sectio C4. I additio there is a overall limit of 35,000 a year f the Guarateed Icrease Optios you ca use over the life of your policy. Oce this limit has bee reached whilst you may still be able to icrease your cover, but you ca t use oe of the Guarateed Icrease Optios (see Sectio C3 f me details). Icome Protectio Policy Coditios Guarateed Premiums 25
The total cover after usig the Guarateed Icrease Optios must ot be me tha the maximum mothly amout. We explai how we wk out the maximum mothly amout of cover i Sectios B4 ad B5. The table below explais the limits i me detail. It also shows the maximum age at which you ca make use of these optios. I all cases you ca oly use these optios withi three moths of the evet occurrig. Whilst all of these optios ca be used me tha oce (with the exceptio of the Sigificat career progressio optio), you ca t use them at the same time. Oce you ve used a optio you must wait at least three moths befe you use aother. Icome Protectio Policy Coditios Guarateed Premiums Evet Icrease limit Maximum Icrease Maximum Age Mtgage Icrease The lower of: 10,000 a year* 54 50% of the igial amout of cover show i your Policy Schedule The icrease i your mtgage repaymets Marriage/ Civil Partership 50% of the igial amout of cover show i your Policy Schedule 10,000 a year* 54 Childbirth/ Legal adoptio Icrease i basic salary Sigificat career progressio icrease (you ca oly use this optio oce) 50% of the igial amout of cover show i your Policy Schedule 50% of the igial amout of cover show i your Policy Schedule Noe other tha maximum icrease 10,000 a year* 54 10,000 a year* 54 20,000 a year* 54 * If you re ot i paid upaid wk, the the overall amout of cover is limited to 18,000 a year ( 1,500 a moth). F me ifmatio see Sectio C4. If you wat to use oe of the Guarateed Icrease Optios, we ll ask you f evidece of the chage of your circumstaces, such as: a copy of your mtgage offer your igial marriage certificate civil partership registratio certificate, the igial birth certificate adoptio certificate, a letter from your employer. copies of your payslips 26