Satisfying the definitions

Income Protection

Asteron treats all claims on a case by case basis, taking into consideration relevant policy statements or practise guidelines.

We then evaluate the impact of the infection against the definition of disablement applying to the insured.

In the case of Surgeons, GPs or Dentists covered by Asteron’s Income Protector and Income Advantage policies the disablement definitions can be one of the following:

» 10 Hours – if the inability to perform exposure-prone procedures results in the insured being unable to perform the important income producing duties of his/her usual occupation for more than 10 hours per week, then that aspect of the definition is satisfied.

» 1 Duty – if the exposure-prone procedures are an important income producing duty of the insured’s regular occupation then, if the insured is unable to perform those procedures, that aspect of the definition is satisfied.

 

Policies in action

» Income Advantage policy with a 1 Duty definition Kevin, a heart surgeon, has an Asteron Income Advantage policy with a 1 Duty definition of severe disability. When performing a routine operation Kevin contracts the Hepatitis B virus – a blood borne disease. The relevant medical board's policy statement indicates that Kevin is to cease practising surgery immediately. This is also the view of the treating doctor. Surgery is an important income producing duty of Kevin’s occupation, and he is not capable of continuing to practise as a surgeon and is not otherwise engaged in any gainful occupation. From this, Asteron is satisfied that Kevin has met the occupational aspects of the definition. If Kevin were able to continue to work, he may be entitled to the partial disability benefit under his Asteron Income Advantage policy.

» Income Protector policy with a 10-Hours definition Ben, a dental surgeon, has an Asteron Income Protector policy with a 10-Hours definition of severe disability. Ben suffers a needlestick injury while treating a patient and contracts the Hepatitis C virus – a blood borne disease. As a result, the Australian Dental Association recommends that Ben no longer perform extractions or fillings. This means Ben can only perform 9 hours per week of his former 40-hour weekly schedule. As Ben is unable to perform the duties of his occupation for more than 10 hours per week and is not working in any gainful occupation for more than the 10 hour per week limit, Asteron is satisfied that Ben has met the definition of severe disablement.

Total and Permanent Disability

When discussing TPD, it is important to remember that when you are disabled you are assessed against the occupation you were performing immediately before the occurrence of your sickness or injury.Therefore, two important factors will come into play being:

1. Whether your definition is ‘own’ or ‘any’,
2. The occupation the insured is engaged in at the time of the incident.

Karen, an orthopaedic surgeon suffers a needlestick injury while performing emergency surgery. Karen has an Asteron Life cover policy with the Total and Permanent Disablement Option with an ‘own’ occupation TPD definition. When assessing Karen’s claim Asteron will use all appropriate evidence such as the relevant medical board’s policy statement and the policy definition to determine if the she is unlikely ever to be able to work again in the occupation of ‘orthopaedic surgeon’. In Karen’s case the advice of the medical board and the relevant reports indicated that it was unlikely that Karen would be able to work again in her occupation and Asteron is satisfied that she meets the definition.

Needlestick Option available for medical professionals

The Needlestick Option for healthcare professionals recognises the risk of certain medical professionals contracting a blood borne disease as a result of performing their regular duties.

The Needlestick Option can be attached to:

» Life Cover (non-superannuation)

» TPD Stand Alone (non-superannuation)

» Income Protector and Income Advantage (non-superannuation).

» The Needlestick Option for medical professionals covers the client if they are infected with HIV, Hepatitis B, or Hepatitis C, during the course of performing their duties, ie through a:

» needlestick injury

» scalpel blade injury – blood contact with a cut or abrasion of the skin » splash of blood to the eye, providing a lump sum payment, this is in addition to any Income Protection they may receive.

Cover is available in lots of $50,000 with maximum $500,000 cover. Price is $10 per month per $100,000 cover.The sum insured is paid once the infection is confirmed, an assessment as to the impact on the medical professionals ability to work is not required.

About Asteron

Asteron is one of Australia’s largest financial service providers, with key business activities in life insurance, superannuation, retirement incomes and financial planning.

Asteron is part of the Suncorp Group - an entity with over $600 million of Life Risk premiums in force and over $26 billion funds under management.

Want to know more?

If you require any further information about this matter please contact your BDM.

The information above is designed to provide some insight into likely outcomes, however, due to the individual nature of each claim situation it is not possible to provide a definitive answer on all hypothetical cases. Of course, the policy terms and conditions will be applied to the circumstances arising in each claim. We will not pay a benefit, if Hepatitis B or C – occupationally acquired or HIV – occupationally acquired was caused directly or indirectly by an intentional self-inflicted act.

Cover for the Needlestick Option will not apply to: » Hepatitis B or C – occupationally acquired where a cure for Hepatitis B or C has become available prior to the accident or malicious act giving rise to the claim; and » HIV – occupationally acquired where a cure for HIV or Acquired Immune Deficiency Syndrome (AIDS) has become available prior to the accident or malicious act giving rise to the claim.