ACE VOLUNTARY WORKERS INSURANCE
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- Vanessa Dickerson
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1 ACE VOLUNTARY WORKERS INSURANCE SUMMARY OF KEY CHANGES Please note: This document provides a brief summary of the key changes made to the ACE Voluntary Workers Insurance Wording and Product Disclosure Statement (PDS). This is not an exhaustive list of the changes made and does not form part of the PDS. For a full description of the terms, conditions and exclusions of the cover please refer to the PDS and any other supporting documents that we issue you. Description of Key Changes Change Wording Reference Description New definition for "Benefit Period New definition for "Claimant New definition for "Non-Scheduled Flights" Amended definition of "Permanent Amended definition of "Permanent Total Disablement New definition for "Pre-Existing Medical Condition Amended definition of "Professional Sport" Means: the maximum period of time for which a benefit is payable under Events 25 and 26, as shown in the Schedule. Means: the holder, a Covered Person or any other person entitled to claim under the. Means: travel in an aircraft whose flights are not conducted in accordance with fixed flying schedules, over specific air routes, to and from fixed terminals. Means: having lasted twelve (12) consecutive months from the date of the Bodily Injury and at the expiry of that period, being beyond hope of improvement. Means: the disability having lasted twelve (12) consecutive months from the date of the Bodily Injury and at the expiry of that period, being beyond hope of improvement. Previously pre-existing medical conditions were excluded. The exclusion remains, but a definition of Pre- Existing Medical Conditions is now included. Means: a) any physical defect or condition for which treatment, education or advice (including advice for treatment) has been received or prescribed by a Doctor or Dentist in the three (3) years immediately prior to becoming a Covered Person under the ; or b) condition of which a reasonable person in the circumstances would be expected to be aware of three (3) months prior to becoming a Covered Person under the. Professional Sport is defined by reference to the proportion of a Covered Person's income derived from their participation in the sport. Means: any sport for which a Cover Person receives a fee, allowance, sponsorship or monetary reward as a result of their participation, which in totality accounts for more than 15% of their annual income from all sources.
2 Change Wording Reference Description New definition for "Renewal Period" New definition for "Renewal " New definition for "Seek Employment New definition for "Specially Designated List" Means: the period of insurance applicable to the Renewal Means: the voluntary workers insurance policy underwritten by Us which takes effect immediately at the end of the Period of Insurance Means: the Covered Person being registered with the government agency or department in their Country of Residence which is responsible for providing unemployment services, (such as Centrelink in Australia) and/or a recruitment company and then providing Us with proof of a minimum of two (2) new job applications per week Means: names of a person, entities, groups, or corporate specified on a list who are subject to trade or economic sanctions or other such similar laws or regulations of the United States of America, Australia, United Nations, European Union or United Kingdom. This definition facilitates the new "Sanctions Clause, contained within the. Amended definition of "Temporary Partial Disablement" Amended definition of "Temporary Total Disablement" General Definitions: Temporary Partial Disablement General Definitions: Temporary Total Disablement Means: where in the opinion of a Doctor, the Covered Person is temporarily unable to engage in a substantial part of their usual occupation or business duties resulting in their earnings post Bodily Injury of at least 25% less than their Salary. If the Covered Person ceases to be employed by the holder after the Event(s) occurs, then Temporary Partial Disablement means disablement which prevents the Covered Person from engaging in any occupation for which they may be suited by way of their education, training or experience which reduces their capacity to undertake an occupation by at least 25%. In both instances the Covered Person must be under the regular care of and acting in accordance with the instructions or advice of a Doctor. Means: where in the opinion of a Doctor, the Covered Person is temporarily unable to engage in any aspect of their usual occupation or any of their business duties. If the Covered Person ceases to be employed by the holder after the Event(s) occurs, then Temporary Total Disablement means disablement which prevents the Covered Person from engaging in any occupation for which they may be suited by way of their education, training or experience. In both instances the Covered Person must be under the regular care of, and acting in accordance with the instructions or advice of a Doctor. Amendment to the Insuring Clause Extent of Cover Bodily Injury The requirement that the Event occurs within twelve months of the date of the Bodily Injury is maintained. The definition is amended such that, with respect to Events 25 and/or 26 (weekly benefits), the Event must also occur during the Period of Insurance or any Renewal Period. Therefore, if the Event (i.e. the Covered Person temporarily ceasing work due to a Bodily Injury) first occurs outside a current policy period, then there is no cover. Amendment to Events 2, 3 and 19 Permanent Total Disablement Paraplegia or Quadriplegia Permanent partial disablement not otherwise provided for under Events 2 to 18 inclusive Any amount payable under Events 2,3 or 19 will be reduced by any benefits payable under Events 25 or 26 [weekly benefits] for any period greater than fifty-two weeks
3 Change Wording Reference Description Amendment to Event 9 (b) Loss of hearing in one ear Amendment to Event 10 Permanent Loss of use of four Fingers and Thumb of either Hand Amendment to Event 11 Permanent Loss of the lens in: (a) two eyes (b) one eye Amendment to Event 13 Permanent Loss of use of four Fingers and of either Hand Amendment to Event 19 Permanent partial disablement not otherwise provided for under Events 2 to 18 inclusive Amendment to Event 21 Amputation of Limb Amendment to the Age Limitation Extension Amendment to Condition 4 Part B Bodily Injury Resulting In Surgery Benefits Previously: Additional Cover Under the Condition 4 from 20% to 30%. from 75% to 80%. Loss of lens in two eyes is a new benefit at 100% of the sum insured. from 40% to 50%. The benefit is no longer payable at ACE s absolute discretion. Rather we will seek the medical opinion of three Doctors as to the percentage reduction in whole bodily function, one of whom will be the Covered Person s treating Doctor and the remaining two appointed by ACE. The maximum payable under this benefit remains at 75% of the sum insured. As per above, any amount payable under Event 19 will be reduced by any benefits payable under Events 25 or 26 (weekly benefits) for any period greater than fifty-two weeks. from 50% to 100%. The Age Limitation provisions now appear under. The provisions with respect to the age limits have changed. The age exclusion has been removed. Amended to specify that the holder must provide documentation in the case of a workers compensation top-up claim and other amounts that will be offset against weekly benefit amounts claimed. The amount of any benefit payable for Temporary Total Disablement and Temporary Partial Disablement will be reduced by the amount of any: a) periodic compensation benefits payable under any workers compensation or accident compensation scheme. Where We are making payments for a topup amount above the workers compensation weekly amount up to the benefit amount payable under the as stated in the Schedule, the holder must provide copies of all documentation in respect of the related workers compensation claim; and b) common law entitlement or other income protection insurance; and c) sick pay received, or at the discretion of the holder sick leave entitlement, monies paid or payable for the notice period in the event of a redundancy, or any disability entitlement;
4 Change Wording Reference Description Amendment to Condition 9 Amendment to Condition 10 New Condition 11 Deletion of General Exclusion Deletion of General Exclusion Condition 9 Condition 10 Condition 11 Previously Exclusion 4 Previously Exclusion 5 Amended to allow for offset of the benefit payable under Events 2, 3 and 19 where weekly benefits have been paid for longer than a 52 week period. If as a result of Bodily Injury, the Covered Person is entitled to a benefit under Events 25 and/or 26 and subsequently becomes entitled to a benefit under Events 2, 3 or 19, all benefits payable under Events 25 and 26 shall cease from the date of such entitlement. In addition, any weekly benefit amounts paid under Events 25 or 26 for any period greater than fifty two (52) weeks shall be offset against the benefit amount payable under Events 2, 3 or 19. An example of the offset calculation is in the PDS. Amended to stipulate the maximum benefit payable in the case of a non-salary earning employee With respect to, where the Lump Sum Benefit is Salary linked and the Employee is not in receipt of a Salary, the benefit amount shall be limited to fifty percent (50%) of the Lump Sum Benefit shown in the Schedule against their respective category of Covered Person to a maximum of $250,000. Included to stipulate that benefits shall only be payable under one ACE policy. Should a benefit be payable under this section of the policy that is also payable under any other insurance policy with ACE, then only one (1) policy can be claimed against (i.e. the policy with the greatest benefit). The HIV / AIDS exclusion has been deleted. The following exclusion has been deleted: results from the use, existence or escape of nuclear weapons material or ionising radiation from or contamination by radioactivity from any nuclear fuel or nuclear waste or from the combustion of nuclear fuel. Deletion of General Exclusion New General Exclusion Amendment to Pre-Existing Medical Conditions exclusion Previously Exclusion 8 Exclusion 4 Exclusion 5 The age exclusion has been deleted. It was previously 85 years. Note: the Age Limitations clause has been amended as per (see below) The policy now specifically excludes any loss, damage, liability, Event or Bodily Injury which is covered by: Medicare; any workers compensation legislation; any transport accident legislation; any common law entitlement; any government sponsored fund, plan or medical benefit scheme; any other insurance policy required to effected under law. The General Exclusion for losses arising from Pre- Existing Medical Conditions now specifies that this does not apply where an illness or disease results directly from medical or surgical treatment rendered necessary by any Bodily Injury. Refer also to the new definition of Pre-Existing Medical Condition.
5 Change Wording Reference Description New General Provision "Age Limitations" As above, the age exclusion (previously 85 years) has been replaced by this Age Limitations provision, which limits the amounts recoverable by Covered Persons over the age of 75, as follows: Covered Persons aged 75yrs - 84yrs: Events 1-19 maximum sum insured is $25,000 (or schedule amount if less) Emergency Home Help sum insured is $250 per week for a maximum benefit period of 26 weeks Covered Persons aged 85yrs or over: Events 1-19 maximum sum insured is $10,000 (or schedule amount if less) Emergency Home Help sum insured is $250 per week for a maximum benefit period of 13 weeks Amended General Provision "Currency" New General Provision "Sanctions Clause" Furthermore, there is no cover for Events, 25 and 26 (weekly benefits) for Covered Persons aged 75 years or over at the time of loss. The reference to currency being in AUD is removed. The applicable currency is to be specified on the Schedule. The international operations of the ACE Group necessitates the inclusion of this clause: This insurance does not cover or pay claims arising directly or indirectly from, caused by, a consequence of, arising in connection with or contributed to by any loss or expenses with respect to a specially designated person, entity, group or company on the Specially Designated List or to the extent that trade or economic sanctions or other laws or regulations prohibit us from providing insurance, including but not limited to, the payment of claims. All other terms and conditions of the remain unchanged. Amended General Provision "Subrogation" The following wording is added to the existing subrogation clause: We will not be liable for a loss where the Claimant is a party to an agreement that excludes or limits Our rights to recover damages from a third party in respect of that loss, whenever that agreement was made, i.e. before or after the loss occurred. The effect of this provision is that the Claimant may prejudice the Claimant s rights with regard to a claim if the Claimant makes or has made any agreement with a third party that will prevent Us from recovering the loss from that party or another party. ACE Group is an American company which necessitates the inclusion of this clause.
6 About ACE ACE Group is one of the world s largest multiline property and casualty insurers. With operations in 54 countries, ACE provides commercial and personal property and casualty insurance, personal accident and supplemental health insurance, reinsurance and life insurance to a diverse group of clients. ACE Limited, the parent company of ACE Group, is listed on the New York Stock Exchange (NYSE: ACE) and is a component of the S&P 500 index. ACE, via acquisitions by its predecessor companies, has been present in Australia for over 50 years. ACE s operation in Australia (ACE Insurance Limited) provides specialised and customised coverage s, including Marine, Property, Liability, Energy, Professional Indemnity, Directors & Officers, Financial Lines, Utilities, as well as Accident & Health insurance, to a broad client base. ACE is a major insurer of many of the country s largest companies. With five branches and 400 staff in Australia, it has a wealth of local expertise backed by its global reach and breadth of resources. More information can be found at CONTACT US Australia Head Office and New South Wales Branch The ACE Building 28 O Connell Street Sydney NSW 2000 Tel: (02) Fax: (02) Queensland Branch Level 27, 10 Eagle Street Brisbane, QLD 4000 Tel: (07) Fax: (07) South Australia Branch Level 7, 147 Pirie Street Adelaide SA 5000 Tel: (08) Fax: (08) Victoria Branch Level 16, 600 Bourke Street Melbourne VIC 3000 Tel: (03) Fax: (03) Western Australia Branch Level 26, 44 St. George s Terrace Perth WA 6000 Tel: (08) Fax: (08) The Voluntary Workers Insurance is issued by ACE Insurance Limited (ABN ; AFSL ). Any information provided is factual only. Potential purchasers should read the policy wording and Product Disclosure Statement available online at to decide if the product is right for them ACE Group. ACE, ACE logo, and ACE insured are trademarks of ACE Limited. ACE
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