2.3. Marco Legal
2.3.3. LEY DE REGIMEN TRIBUTARIO INTERNO
1. General conditions
No benefit is payable if:
•
the policy applied for is to replace existing insurance cover or another application on your life, or•
the event giving rise to the claim is as a result of suicide, attempted suicide or other intentional self- inflicted Injury, or•
either you or the proposer has failed to comply with the Duty of Disclosure as set out on the application form; or•
the application is one we would not normally accept under our standard underwriting rules; or•
the event giving rise to the claim is as a result of the life to be insured's participation in criminal activity, or incarceration, or•
the event giving rise to the claim is as a result of any condition that the life to be insured and/or policyowner knew about before the start of the Interim Cover, or•
the event giving rise to the claim is as a result of war or an act of war, whether declared or not, or•
the event giving rise to the claim is as a result of any Pre-Existing Condition, or•
a claim is made under the Interim Cover Certificate, and MLC is not in receipt of an SOA containing the Protectionfirst recommendation, made by the financial adviser for the proposed life to be insured, or•
any event giving rise to a claim (including death) for a Child Critical Condition Benefit in respect of an insured child is caused directly or indirectly by:– a congenital condition, or
– the intentional act by yourself, parent or person who will otherwise be entitled to the benefit payable.
We will pay only one Interim Benefit and the benefit will be reduced by any Interim Benefits or similar payable under any other insurance proposals to other companies. If the client has proposals for both Income and Business Expenses cover, only one Interim Benefit is payable.
'Interim Benefit' means, relevantly, payment for Interim Death, Interim Critical Injury or Interim Total Disability, Interim Substantial Disability or Interim Child Critical Conditions Benefit.
2. Conditions specific to
Interim Death
'Death' means an event which results in your death during the term of the Interim Cover.
The benefit payable is the lowest of $1,000,000, the proposed death Sum Insured, or the death insurance amount recommended within the SOA.
3. Conditions specific to
Interim Critical Injury
'Critical Injury' means an event which results in you suffering one of the following critical injuries, for the first time, within 90 days of the event: Blindness, Coma, Deafness, Major Burns, Major Head Trauma or Paralysis, as defined on pages 71 to 81, or you suffer from the total and irrecoverable loss of the use of two limbs. The benefit payable is the lowest of $600,000, the proposed disability Sum Insured or critical illness Sum Insured, as appropriate, or the disability amount or critical illness amount recommended within the SOA. The Buy Back Options do not apply to Interim Critical Injury.
4. Conditions specific to Interim
Total Disability or Interim
Substantial Disability
'Interim Total Disability' means an event which results in your Total Disability for Income Gold, Income Excell or Income Business Expense policies or Substantial Disability for Income Daily Living Benefits policies during the term of the Interim Cover.
'Total Disability' has the same meaning as defined on page 70 of this PDS. Substantial Disability has the same meaning as defined on page 70 of this PDS.
The benefit payable is the lowest of $5,000 per month, the proposed disability Sum Insured, or the monthly disability amount recommended within the SOA.
The benefit is payable each month that you remain continuously Totally Disabled or Substantially Disabled after the end of the applied for Waiting Period, up to a maximum of six months. The total monthly benefit will not exceed:
a. i. for Income Gold or Income Excell, 75% of Pre-Disability Earnings, or ii. for Income Daily Living Benefit,
the greater of $3,000 or 75% of the Pre-Disability Earnings, and
b. for Income Business Expenses, the life insured's actual Allowable Business Expenses, less all other disability benefits payable.
5. Conditions specific to
Interim Child Critical
Conditions Benefit
If you applied for the Child Critical Conditions Benefit, we will pay a benefit if the child life to be insured dies or suffers one of the following medical conditions: Blindness, Major Burns, Major Head Trauma or Paralysis as defined on pages 71 to 81.
If we pay a benefit for death, we will not pay a benefit for any of the medical conditions and if we pay a benefit for one of the medical conditions, we will not pay the benefit for death or any other medical condition.
The benefit payable is the lowest of: $100,000, the amount of the Child Critical Conditions Cover you applied for or the amount of Child Critical Illness Sum Insured recommended within the SOA.