Lifestyle Protection Options Terms and
Conditions
Throughout the plan there are
words and phrases that have special meanings and are shown in
italics.
A: Life Benefit
This section applies to you if Life
Benefit is shown on your Schedule.
A1: When we pay
We will pay this benefit if, within
the cover period, the life insured:
dies, or
is diagnosed with a
terminal illness more than one year before the expiry
date.
We will only pay out for one claim
under this benefit.
A2: How much we
pay
Depending on the option you have
chosen, payment will be made either as a lump sum or annual
income.
Lump Sum- We will
pay by single lump sum the amount of Life Benefit shown on
your schedule.
Annual income- We
will pay by monthly instalments the annual amount of Life Benefit
provided under your plan on the due date of
payment, including any increases in benefit up to that date.
The first monthly payment will be due on the
premium due date immediately following the life insured’s
death. For terminal illness the first monthly payment will be due
on the premium due date immediately following the date we
receive written notice of your claim.
Payments will continue monthly up to and
including the expiry date of your
plan.
A3: When we will not pay a
claim
We will not pay a claim under this
benefit:
if the life
insured dies after the expiry date or is diagnosed as
terminally ill in the 12 months immediately before the expiry
date,
for terminal
illness if the life insured does not meet
our plan definition of terminal illness,
or
for terminal
illness if any medical evidence or other evidence is not
supplied when we ask for it.
Other sections that apply to Life Benefit:
F,G,H and I. Also E if Waiver Of Premium applies to your
plan.
B: Critical Illness
Benefit
This section applies to you if
Critical Illness Benefit is shown on your
schedule.
B1: When we pay this
benefit
We will pay this benefit if, within
your cover period for this benefit, the life
insured is:
diagnosed with a total
permanent disability that meets our plan
definition and survives for at least 6 months, or
diagnosed with any of the
critical illnesses that meet our plan
definition and survives for at least 30 days. We only
cover the critical illnesses we define in this
plan document and no others.
We will only pay out for one claim
under this benefit.
B2: How much we
pay
Depending on the option you have
chosen, payment will be made either as a lump sum or annual
income.
Lump Sum - We will
pay by single lump sum the amount of Critical Illness Benefit shown
on your schedule.
Annual income - We
will pay by monthly instalments the annual amount of Critical
Illness Benefit provided under your plan on the
due date of payment, including any increases in benefit up to that
date.
The first monthly payment will be due on the
premium due date following the life insured’s survival for
the specified period after the date of diagnosis. Payments will
continue monthly up to and including the expiry date for
this benefit.
B3: When will we not pay a
claim
We will not pay a claim under this
benefit if:
the life insured
dies within 30 days of diagnosis of the critical illness or within
6 months of the diagnosis of total permanent
disability,
the cover period ceases
within 30 days of diagnosis of the critical illness or within 6
months of the diagnosis of total permanent disability,
the life insured
does not meet our plan definition either for
total permanent disability, or for one of the critical
illnesses on our list,
any medical or other
evidence is not supplied when we ask for it, or
the claim is a result of
any of the following excluded causes:
alcohol or drug abuse,
HIV/AIDS (except where specifically included under the
critical illnesses definition),
self-inflicted injury, or
war and civil commotion.
Other sections that apply to Critical Illness
Benefit: F,G,H and I. Also E if Waiver Of Premium applies to
your plan.
C:
Combined Life and Critical Illness Benefit
This section applies to you if
Combined Life and Critical Illness Benefit is shown on
your schedule.
C1: When we pay this
benefit
We will pay this benefit if, within
your cover period for this benefit, the life
insured:
dies, or
is diagnosed with a
terminal illness more than one year before the expiry
date, or
is diagnosed with a
total permanent disability that meets our
plan definition and survives for at least 6 months, or
is diagnosed with any of
the critical illnesses that meet our
plan definition and survives for at least 30 days.
We only cover the critical illnesses we
define in this plan document and no others.
We will only pay out for one claim
under this benefit.
C2: How much we
pay
Depending on the option you have
chosen, payment will be made either as a lump sum or annual
income.
Lump Sum - We
will pay by single lump sum in the event of any of the above, the
amount of Combined Life and Critical Illness Benefit shown on
your schedule.
Annual income
-We will pay by monthly instalments the annual amount of
Combined Life and Critical Illness Benefit provided under
your plan on the due date of payment, including
any increases in benefit up to that date. The first monthly payment
will be due on the premium due date following the earlier of:
the life
insured’s death,
the life
insured’s survival for the specified period after date of
diagnosis of critical illness or total permanent
disability.
Payments will continue monthly up to and
including the expiry date for this benefit.
C3: When we will not pay a
claim
We will not pay a claim for this
benefit:
if the life
insured dies after the expiry date or is diagnosed as
terminally ill within the 12 months immediately before the
expiry date,
for terminal
illness if the life insured does not meet
our plan definition of terminal
illness,
for critical illness if
the life insured does not meet our plan
definition either for total permanent disability, or for
one of the critical illnesses on our list,
for critical illness if
the cover period ceases within 30 days of diagnosis of the critical
illness or within 6 months of the diagnosis of total permanent
disability,
if any medical or other
evidence is not supplied when we ask for it, or
for critical illness if it
is a result of any of the following excluded causes:
alcohol or drug abuse,
HIV/AIDS (except where specifically included under the
critical illnesses definition),
self-inflicted injury, or
war and civil commotion.
Other sections that apply to Combined Life and
Critical Illness Benefit: F,G,H and I. Also E if Waiver Of Premium
applies to your plan.
D: Income Protection
Benefit
This section applies to you if Income
Protection Benefit is shown on your schedule.
D1: When we start paying this
benefit
We will start paying this monthly
benefit if, within your cover period for this benefit:
the life insured
is diagnosed as being incapacitated for a continuous
period longer than the deferred period shown in the
schedule, and,
the deferred
period ends before the date on which cover for this benefit
expires.
Benefit is payable in monthly instalments,
starting from the premium due date after the deferred
period has ended.
You should provide written
notification of incapacity within 8 weeks of the
diagnosis. Otherwise, commencement of the benefit may be
delayed.
D2: How much we
pay
If the life insured is employed or
self-employed at the start of incapacity we will
pay by monthly instalments the lower of:
the amount of the Income
Protection Benefit provided under your plan on
the due date of payment, including any increases in benefit up to
that time;
two-thirds of the life
insured’s pre-incapacity earnings, less the total
monthly equivalent of:
other income protection insurances payable to the
life insured as a result of this incapacity,
state benefits received by the life
insured, and
earnings from any employment or self-employment
received by the life insured, while they are
incapacitated. This would include pension payments, unless
the life insured was entitled to them whilst still
working.
If the life insured is not employed
or self-employed at the start of incapacity we
will pay by monthly instalments the lower of:
the amount of the Income
Protection Benefit provided under your Plan on
the due date of payment, including any increases in benefit up to
that time;
£1,000, or a higher amount
if we decide, less the total monthly equivalent of:
other income protection insurances payable to the
life insured as a result of this incapacity,
state benefits received by the life
insured, and
earnings from any employment or self-employment
received by the life insured, while they are
incapacitated. This would include pension payments,
unless the life insured was entitled to them whilst still
working.
You must notify us of any
changes to other income protection insurances, state
benefits, or earnings from any employment or self-employment
received by the life insured whilst they are
incapacitated. We reserve the right to change the
level of Income Protection Benefit accordingly.
D3: When payments cease
Monthly payments will continue up to the
earlier of:
the date on which the
life insured ceases to be incapacitated,
the date that cover for
this benefit ends,
the life
insured’s death.
D4: When we will not pay a
claim
We will not pay a claim if:
the life insured
does not meet our plan definition of
incapacitated,
if any medical evidence or
other evidence is not supplied when we ask for it, or
it is the result of any of
the excluded causes.
D5: Rehabilitation
Benefit
Rehabilitation Benefit may be payable where
the life insured has been in receipt of Income Protection
Benefit and returns to their occupation but is unable to
fully resume their duties. We will pay Rehabilitation
Benefit provided the life insured:
can demonstrate a
reduction in earnings compared to their pre-incapacity
earnings,
is medically unable to
fully resume the duties of their occupation, and
supplies us with
any medical or other evidence we ask for.
Rehabilitation Benefit will be based on the
reduction in earnings compared to pre-incapacity earnings,
and the loss of any state benefits, following the life
insured’s return to work on a reduced capacity.
We will continue to pay
Rehabilitation Benefit until:
the life insured
is able to fully resume their occupation,
the life
insured’s earnings revert to the level of their
pre-incapacity earnings,
the date that cover for
Income Protection Benefit ends, or
the life
insured’s death.
D6: Linked claims
A linked claim happens if the life
insured suffers a re-occurrence of their incapacity
within 3 months of an income protection or waiver of premium claim
having ended. We will treat the further period of
incapacity as a linked claim and re-start the payments one
month after we have received written notification,
provided that the life insured:
is incapacitated
from the same cause as the original claim,
is still working in the
same occupation at the time the further period of
incapacity starts, and
supplies us with
any medical or other evidence we ask for.
Benefits in payment under a linked claim are
subject to the same conditions as benefits in payment under the
original claim.
Other sections that apply to Income Protection
Benefit E,F,G,H and I.
E: Waiver Of Premium
This section applies if Waiver Of Premium is
shown on your Schedule.
E1: When we waive
your premiums
We will waive your monthly
premiums during a period of incapacity provided that the
life insured becomes incapacitated for a
continuous period longer than 6 months.
Premiums will be waived from the premium due
date after the 6 month deferred period has ended.
You should provide written
notification of incapacity within 8 weeks of the
diagnosis. Otherwise, commencement of the benefit may be
delayed.
E2 When we stop waiving
your premiums
We will stop waiving monthly premiums
on the earliest of:
the date on which the
life insured ceases to be incapacitated,
the life
insured’s 65th birthday,
the expiry date
of your plan,
the life
insured’s death.
E3 When we will not waive
your monthly premiums
We will not waive your
monthly premium if:
the life insured
does not meet our plan definition of
incapacitated,
any medical or other
evidence is not supplied when we ask for it, or
the incapacity is
a result of any of the excluded causes.
E4: Linked claims
A linked claim happens if the life
insured suffers a re-occurrence of their incapacity
within 3 months of a waiver of premium claim having ended.
We will treat the further period of incapacity as
a linked claim and re-start the payments one month after
we have received written notification, provided that the
life insured:
is incapacitated
from the same cause as the original claim,
is still working in the
same occupation at the time the further period of
incapacity starts, and
supplies us with
any medical or other evidence we ask for.
Benefits in payment under a linked claim are
subject to the same conditions as benefits in payment under the
original claim.
Other sections that apply to Waiver Of
Premium: F,G,H and I.
F: About claiming your
benefits and notifying us of changes
F1: How to make a claim
1. Request a claim form by contacting
us. See contact details on page 2.
2. Complete the claim form we send to
you and return to us.
3. Supply any medical or other evidence
we request from you.
In order to prevent any unnecessary delay in
payment of benefit, please notify us as soon as
you believe that you may wish to claim.
Please note that claims for income protection
and waiver of premium cannot be backdated before the date
you notified us.
F2: Evidence we require
before we can pay the benefit
Before we can pay any claim
we will require:
this Plan
Document and schedule together with any endorsements
issued in connection with the plan. However, we
will not request this for waiver of premium claims,
evidence of the life
insured’s age and sex.
In addition we will require the
following:
for death claims - evidence
of death (for example, original UK death certificate)
for critical illness and terminal
illness claims - satisfactory medical evidence to support
the claim. We will decide whether satisfactory evidence
has been received after consultation with our Chief or
Consulting Medical Officer. As a minimum we will require
confirmation of the diagnosis from our Chief or Consulting
Medical Officer or from a specialist consultant holding such an
appointment at a major hospital within Australia, Canada, the
European Union, New Zealand, Switzerland or the United States of
America. We may also require the life insured to
be examined by a medical examiner appointed by us or to
undergo medical tests at our expense.
for income protection and waiver of
premium claims - evidence:
of the date that the
incapacity started, (for example a letter from the
life insured’s employer or doctor),
of the life
insured’s employment situation immediately before the
incapacity started, (for example pay slips, form P60
and/or audited accounts to confirm pre-incapacity
earnings), and
that the life
insured remains incapacitated (for example a
disability claim assessment form completed by the life
insured’s doctor)
While Income Protection or Waiver Of Premium
Benefit is being paid we may ask from time to time for
evidence that the life insured remains
incapacitated. This may include a medical examination at
our expense. You will be responsible for the cost
of producing any other evidence which we request.
We reserve the right to stop paying a
claim, or not to pay it, if you do not provide any
evidence we ask for, or if at any time you
provide information which is inaccurate or incomplete.
F3: Who we pay the benefit
to
We will pay the benefit to the person
legally entitled to receive it. Payment will be made only after
we have received satisfactory evidence of legal
entitlement to the benefit.
Normally we will pay the benefit to
you. If payment is made to legal personal representatives,
we will need to be sent an original Grant of
Representation or Confirmation (which we will return)
before we can make payment.
If the plan has been assigned
we will need to see the original Deed of Assignment before
we can make payment to the assignee. However, if Income
Protection Benefit is provided under the Plan, the
Plan may be assigned only after we have given
our written consent.
If the plan is under trust
we will need to see the original Trust Deed (and any deeds
altering the Trust) before we can make payment to the
Trustee(s).
F4: Notifying us of
changes
Please remember to tell us of changes
to:
occupation
name
address
bank account details
ownership of the
plan (the plan being assigned or put under
trust)
the life
insured’s residence or living abroad.
G: About premium payments to your plan
G1: When premiums are due
The first
premiumis due on the Start date of your plan, as shown
in your Schedule, and monthly thereafter. We will
collect premiums by direct debit.
The last premium is due on the premium due
date immediately before the earlier of:
the expiry date
of your cover,
the life
insured’s death,
the date the plan
is cancelled.
G2: What happens if premiums are not
paid
If you do not make your
first payment, your plan will not start and the
life insured will not be covered.
If a subsequent premium remains unpaid for
more than 2 months from the date it is due, your
plan will be cancelled and your cover will
cease.
We will write to inform you
if your plan is cancelled.
G3: Restarting your
plan
If your plan is cancelled,
you may ask us to restart it at any time up to 12
months after the first unpaid premium was due, on terms that
we decide. These will include the repayment of all missed
premiums.
You may need to provide us
with evidence of occupation, state of health, smoking
habits and pastimes before we decide whether to restart
the Plan. We will write to inform you of
the evidence we require.
G4: Changes to your premium
payments
Your premium may increase or decrease
as a result of any changes to the cover provided by your
plan.
Your premium may increase or decrease
as a result of a premium review. We may undertake a review
in any of the following circumstances:
For income protection or waiver of
premium cover –change of occupation by the
life insured or living abroad.
For critical illness or combined life
and critical illness cover – if we need to
reassess the assumptions we have made in calculating
your current premium. These assumptions include claims
levels, our expenses, inflation, taxes and the amounts
we need to hold as financial reserves. We reserve
the right to change premiums by an amount we believe is
reasonably necessary if our actual or expected experience
for these benefits is different to the assumptions we have
made.
We will write to inform you
at least 30 days before we increase or decrease
your premium.
H: About increasing and reducing
your cover
H1: Increasing your
cover
You may request any of the following
increases in cover at any time during the plan term:
increase an existing
benefit,
add a new benefit.
Increases are subject to upper age limits and
a minimum remaining term of 5 years.
We will normally require medical
and/or other evidence before we can consider your
request. However, there are special situations (see below) where
you can add or increase benefits without any medical
evidence being required. These special situations do not apply to
Income Protection Benefit.
We reserve the right to decline
your request or to apply special conditions, restrictions
or premiums.
We will recalculate your
premium to take into account the increase in cover and inform
you in writing. However, there is no charge for automatic
annual increases to annual benefits.
H2: Automatic increases to
your annual benefit
This section applies to Income Protection
Benefit and to the annual income options on Life, Critical Illness,
and Combined Life and Critical Illness Benefits.
The amount of your annual benefit
will automatically increase each year by the lesser of:
- 10%
- the percentage change in the Retail Prices
Index (RPI) over the year (subject to a minimum of 0%). The
percentage change is calculated from the month, six months before
the month of your plan’s anniversary, compared to
the Index for the same month one year earlier. We will
select another index if the RPI is replaced or discontinued.
The increased annual benefit will be rounded
as we decide.
This increase will take place on the day after
each anniversary of the start date of your
plan. There will be no corresponding increase in
your premium.
H3: Optional increases in
benefits without medical evidence
You may ask us to
increase or add benefits to your plan on the
occurrence of certain special events such as childbirth or
marriage. Subject to the following conditions and limits,
these increases can be made without any further medical evidence
being required. The benefit increase or addition will take place
from the premium due date following your
request.
We will recalculate your
monthly premium, on our standard terms, to take account of
the change in benefits. This calculation will also apply to
any waiver of premium cover on your plan.
Which benefits may be increased or
added
You may request an increase in Life
Benefit, Critical Illness Benefit or Combined Life and Critical
Illness Benefit without medical evidence each time the life
insured:
marries or
re-marries,
gives birth, or becomes
the biological and legal father, to a child,
legally adopts a child,
or
purchases a property as a
principal private residence with a mortgage or other loan secured
on it. This does not include remortgages.
You may also request an increase in
Life Benefit, or (if you are covered only for Combined
Life and Critical Illness Benefit) for Life Benefit to be added,
each time the life insured:
loses existing life cover
through expiry of a fixed term life assurance contract which was in
force on the day before the start date and has run its
full course, or
joins a new employer
within 3 months of leaving the old employer, and the new employer’s
pension scheme has a lower level of lump sum death-in-service
benefits than those provided by the previous employer’s pension
scheme on date of leaving.
Maximum limits for increases or
additions without medical evidence
The maximum increase or addition you
may request each time one of these events occurs is the lesser
of:
£50,000 as a lump sum
benefit,
£5,000 as an annual
benefit,
50% of the current
benefit.
Conditions applying to increases or
additions without medical evidence
We will not allow increases or
additions to benefits without medical evidence:
if the existing benefit(s)
have not been provided on standard terms,
whilst premiums are being
waived,
if the life
insured is over age 54,
within 5 years of the
plan expiry date,
if the life
insured is living abroad, or
if the request is made
more than 3 months after the event has occurred.
We will require evidence that the
event has occurred.
You are limited to a total allowance
for increases in benefit on this plan and any other
plans you hold with Forester Life.
The total allowance is £100,000 for lump sum
benefits and £10,000 for annual benefits.
We may apply a minimum premium to
increases or additions.
H4: Reducing your
cover
You may request a reduction in, or
removal of, any of the benefits on your plan at
any time. We will recalculate the premium to take account
of the reduction in cover and inform you in writing.
We reserve the right to apply special
conditions or restrictions. This may include a minimum premium on
your plan.
I: General terms and
conditions
The plan does not acquire a surrender
value under any circumstances. At expiry the plan ceases
with no value.
No term or condition in this document can be
modified or waived (unless this document expressly provides that it
can be) except by an endorsement issued by us from
our registered office and signed by one of our
authorised officials.
This document and the Schedule
contain all the Terms and Conditions of the plan.
We will not be liable for any condition, claim, statement,
warranty or representation, whether express or implied, and whether
collateral to this agreement or not, which differs from these Terms
and Conditions.
We will satisfy ourselves that
any person to whom we delegate any of our
functions or responsibilities under these Terms and Conditions is
competent to carry out those functions and
responsibilities.
Any requests made in connection with these
Terms and Conditions must be made in writing and delivered to
us at our registered office at Foresters House,
Cromwell Avenue, Bromley BR2 9BF. We will use certain
procedures and forms when any change to your Plan
or any payment is to be made. We will only make changes or
payments when all normal procedures have been complied with.
Requests will become effective on the later of
the effective date stated in the request and the day after receipt
at our Registered Office. We will not allow
you to withdraw or vary any request you have made
or any notice you have given in accordance with these
Conditions on or after the date we have put it into
effect. If the effective day for any calculation or action under
any of the Conditions contained in this document is not a working
day the effective day will instead be the next working day.
We reserve the right to adjust
your benefits if the life insured’s date of
birth, sex, occupation or smoking status is incorrectly
stated to us at any time.
We are authorised and regulated by
the Financial Services Authority.
We will update our
literature from time to time.
We will always communicate with
you using the English language.
Disputes
We take the concerns of our
Planholders very seriously. If at anytime you have any
comments or wish to make a complaint, please write to the Customer
Relations Officer at Forester Life, Foresters House, Cromwell
Avenue, Bromley, Kent, BR2 9BF. In the unlikely event that
your complaint cannot be resolved to your
satisfaction, you can write to the Financial Ombudsman
Service (FOS), South Quay Plaza, 183 Marsh Wall, London, E14 9SR
(telephone 0845 080 1800). The existence of the FOS or this
complaints procedure does not prejudice your right to take
legal action.
Data protection
We record personal information on
computer and use it to assess applications and to administer
policies. The information may be used for fraud prevention or money
laundering prevention.
We may share your
information with organisations who are our business
partners. We, or they, may contact you by mail,
telephone, SMS, fax or e-mail to let you know about any
goods, services or promotions, which may be of interest to
you.
If you do not wish to receive such
information please write to our Data Protection Officer,
Forester Life, Foresters House, Cromwell Avenue, Bromley BR2
9BF.
You have a right to ask for a copy of
your information (for which we may make a small
charge) and to correct any inaccuracies. When you give
us personal information about another person we
will assume that they have appointed you to act for them
and have consented to the processing of their personal data,
including sensitive personal data.
Definitions
Throughout the plan documentation
there are words and phrases that have special meanings and are
shown in italics. Those meanings are given here.
“Activities of daily living”
means the six following tasks:
washing or bathing so as
to maintain personal hygiene;
putting on and taking off
all necessary items of clothing;
moving from one room to
another or getting in or out of bed or a chair;
getting food or drink into
the body once it has been prepared and made available;
getting on and off the
toilet and maintaining personal hygiene following use of it;
controlling bowel or
bladder function.
“Critical illnesses” means
having been diagnosed with one of the medical conditions or having
undergone one of the surgical procedures listed below:
Alzheimer’s disease before age
60 –resulting in permanent symptoms
A definite diagnosis of Alzheimer’s disease
before age 60 by a Consultant Neurologist, Psychiatrist or
Geriatrician. There must be permanent clinical loss of the
ability to do all of the following:
remember;
reason; and
perceive, understand,
express and give effect to ideas.
For the above definition, the following are
not covered:
Other types of
dementia.
Aorta graft surgery
– for disease
The undergoing of surgery for disease to the
aorta with excision and surgical replacement of a portion of the
diseased aorta with a graft. The term aorta includes the thoracic
and abdominal aorta but not its branches.
For the above definition, the following are
not covered:
Any other surgical
procedure, for example the insertion of stents or endovascular
repair,
Surgery following
traumatic injury to the aorta.
Benign brain tumour –
resulting in permanent symptoms
A non-malignant tumour or cyst in the brain,
cranial nerves or meninges within the skull, resulting in
permanent neurological deficit with persisting
clinical symptoms. For the above definition, the following are
not covered:
Tumours in the pituitary
gland,
Angiomas.
Blindness –
permanent and irreversible
Permanent and irreversible
loss of sight to the extent that even when tested with the use of
visual aids, vision is measured at 3/60 or worse in the better eye
using a Snellen eye chart.
Cancer – excluding
less advanced cases
Any malignant tumour positively diagnosed with
histological confirmation and characterised by the uncontrolled
growth of malignant cells and invasion of tissue. The term
malignant tumour includes leukaemia, lymphoma and sarcoma. For the
above definition, the following are not covered:
All cancers which are
histologically classified as any of the following:
pre-malignant;
non-invasive;
cancer in situ;
having either borderline malignancy; or
having low malignant potential.
All tumours of the
prostate unless histologically classified as having a Gleason score
greater than 6 or having progressed to at least clinical TNM
classification T2N0M0.
Chronic lymphocytic
leukaemia unless histologically classified as having progressed to
at least Binet Stage A.
Any skin cancer other than
malignant melanoma that has been histologically classified as
having caused invasion beyond the epidermis (outer layer of
skin).
Coma – resulting in
permanent symptoms
A state of unconsciousness with no reaction to
external stimuli or internal needs which:
requires the use of life
support systems for a continuous period of at least 96 hours,
and
results in
permanent neurological deficit with persisting
clinical symptoms.
For the above definition, the following is not
covered:
Coma secondary to alcohol
or drug abuse.
Coronary artery by-pass
grafts – with surgery to divide the
breastbone
The undergoing of surgery requiring median
sternotomy (surgery to divide the breastbone) on the advice of a
Consultant Cardiologist to correct narrowing or blockage of one or
more coronary arteries with by-pass grafts.
Deafness – permanent
and irreversible
Permanent and irreversible
loss of hearing to the extent that the loss is greater than 95
decibels across all frequencies in the better ear using a pure tone
audiogram.
Heart attack – of
specified severity
Death of heart muscle, due to inadequate blood
supply, that has resulted in all of the following evidence of acute
myocardial infarction:
Typical clinical symptoms
(for example, characteristic chest pain),
New characteristic
electrocardiographic changes,
The characteristic rise of
cardiac enzymes or Troponins recorded at the following levels or
higher;
Troponin T > 1.0 ng/ml
AccuTnI > 0.5 ng/ml or equivalent threshold with
other Troponin I methods.
The evidence must show a definite acute
myocardial infarction.
For the above definition, the following are
not covered:
Other acute coronary
syndromes including but not limited to angina.
Heart valve replacement or
repair – with surgery to divide the breastbone
The undergoing of surgery requiring median
sternotomy (surgery to divide the breastbone) on the advice of a
Consultant Cardiologist to replace or repair one or more heart
valves.
HIV infection –
caught in the UK from a blood transfusion, a physical assault or at
work in an eligible occupation Infection by Human Immunodeficiency
Virus resulting from:
a blood transfusion given
as part of medical treatment;
a physical assault; or
an incident occurring
during the course of performing normal duties of employment after
the start of the policy and satisfying all of the following:
The incident must have been reported to appropriate
authorities and have been investigated in accordance with the
established procedures.
Where HIV infection is caught through a physical
assault or as a result of an incident occurring during the course
of performing normal duties of employment, the incident must be
supported by a negative HIV antibody test taken within 5 days of
the incident. There must be a further HIV test within 12 months
confirming the presence of HIV or antibodies to the virus. The
incident causing infection must have occurred in the UK.
The eligible occupations for HIV caught at work
are:
the emergency services – police, fire, ambulance
the medical profession – including
administrators, cleaners, dentists, doctors, nurses and porters
the armed forces
For the above definition, the following is not
covered:
HIV infection resulting
from any other means, including sexual activity or drug abuse.
Kidney failure – requiring
dialysis
Chronic and end stage failure of both kidneys
to function, as a result of which regular dialysis is
necessary.
Loss of speech –
permanent and irreversible
Total permanent and
irreversible loss of the ability to speak as a result of
physical injury or disease.
Loss of hands or feet –
permanent physical severance
Permanent physical severance of any
combination of 2 or more hands or feet at or above the wrist or
ankle joints.
Major organ transplant
The undergoing as a recipient of a transplant
of bone marrow or of a complete heart, kidney, liver, lung, or
pancreas, or inclusion on an official UK waiting list for such a
procedure.
For the above definition, the following is not
covered:
Transplant of any other
organs, parts of organs, tissues or cells.
Motor Neurone disease
resulting in permanent symptoms
A definite diagnosis of motor neurone disease
by a Consultant Neurologist. There must be permanent
clinical impairment of motor function.
Multiple Sclerosis –
with persisting symptoms
A definite diagnosis of Multiple Sclerosis by
a Consultant Neurologist. There must be current clinical impairment
of motor or sensory function, which must have persisted for a
continuous period of at least 6 months.
Paralysis of limbs –
total and irreversible
Total and irreversible loss of muscle
function to the whole of any 2 limbs.
Parkinson’s disease before age
60 – resulting in permanent symptoms
A definite diagnosis of Parkinson’s disease
before age 60 by a Consultant Neurologist. There must be
permanent clinical impairment of motor function with
associated tremor, rigidity of movement and postural
instability.
For the above definition, the following is not
covered:
Parkinson’s disease
secondary to drug abuse.
Stroke – resulting
in permanent symptoms
Death of brain tissue due to inadequate blood
supply or haemorrhage within the skull resulting in
permanent neurological deficit with persisting
clinical symptoms.
For the above definition, the following are
not covered:
Transient ischaemic
attack,
Traumatic injury to brain
tissue or blood vessels.
Third degree burns –
covering 20% of the body’s surface area
Burns that involve damage or destruction of
the skin to its full depth through to the underlying tissue and
covering at least 20% of the body’s surface area.
Traumatic head injury
– resulting in permanent symptoms
Death of brain tissue due to traumatic injury
resulting in permanent neurological deficit with
persisting clinical symptoms.
“Deferred Period” means the
period of Incapacity before any benefit becomes
payable.
“Excluded Causes” means the
following:
Alcohol or drug abuse
Inappropriate use of alcohol or drugs,
including but not limited to the following:
- consuming too much alcohol,
- taking an overdose of drugs, whether lawfully
prescribed or otherwise,
- taking Controlled Drugs (as defined by the
Misuse of Drugs Act 1971) otherwise than in accordance with a
lawful prescription.
Criminal acts
Taking part in a criminal act.
Flying on a non-commercial
basis
Taking part in any flying activity, other than
in a commercially licensed aircraft.
Hazardous sports and
pastimes
Taking part in (or practising for) boxing,
caving, climbing, horseracing, jet skiing, martial arts,
mountaineering, off-piste skiing, pot holing, power-boat racing,
under-water diving, yacht racing or any race, trial or timed motor
sport.
HIV/AIDS (except where
specifically included under the critical illnesses
definition)
Infection with Human Immunodeficiency Virus
(HIV) or conditions due to any Acquired Immune Deficiency Syndrome
(AIDS).
Living abroad
Living outside of Australia, Canada, the
European Union, New Zealand, Switzerland or the United States of
America for more than 13 consecutive weeks in any 12 months.
Self-inflicted injury
Intentional self-inflicted injury.
Unreasonable failure to follow medical
advice
Unreasonable failure to seek or follow medical
advice.
War and civil commotion
War, invasion, hostilities (whether war is
declared or not), civil war, rebellion, revolution or taking part
in a riot or civil commotion.
“Expiry Date” – the date that
cover on your plan ceases.
“Irreversible” means cannot
be reasonably improved upon by medical treatment and/or surgical
procedures used by the National Health Service in the UK at the
time of claim.
“Incapacitated”/”Incapacity”
means any illness or injury arising before age 65 as a result of
which the life insured is total unable either:
to follow their own
occupation and is not following any other
occupation, or
(if the life
insured is not in an occupation at the onset or
occurrence of that illness or injury), to perform any three of the
activities of daily living without the assistance of
another person or the use of special devices or equipment.
“Life insured” means the
person covered for benefits under this plan, as shown in
the Schedule.
“Living abroad” means living
outside of Australia, Canada, the European Union, New Zealand,
Switzerland and the United States of America, for more than 13
consecutive weeks in any 12 month period.
“Marriage”/ “Marries” means a
legally recognised marriage including civil
partnerships.
“Occupation” means the
life insured’s trade, profession or type of work
undertaken for profit or pay. It is not a specific job with any
particular employer and is independent of location.
“Permanent” / “Permanently”
means expected to last throughout the life of the life
insured, irrespective of when the cover ends or the life
insured retires.
“Permanent neurological deficit with
persisting clinical symptoms” means symptoms of
dysfunction in the nervous system that are present on clinical
examination and expected to last throughout the life of the
life insured. Symptoms that are covered include numbness,
hyperaesthesia (increased sensitivity), paralysis, localised
weakness, dysarthria (difficulty with speech), aphasia (inability
to speak), dysphagia (difficulty in swallowing), visual impairment,
difficulty in walking, lack of coordination, tremor, seizures,
lethargy, dementia, delirium and coma.
The following are not covered:
An abnormality seen on
brain or other scans without definite related clinical
symptoms,
Neurological signs
occurring without symptomatic abnormality, e.g. brisk reflexes
without other symptoms,
Symptoms of psychological
or psychiatric origin.
“Plan” means the Forester
Life Lifestyle Protection Options Plan that you
have applied for and which is evidenced by this document.
“Pre-incapacity earnings”
means:
If the life
insured is employed, the average of their total pre-tax
earnings for PAYE assessment purposes (excluding benefits in kind)
in the 12 months before they become incapacitated. This
may include regular bonuses and commission.
If the life
insured is self employed, the average of their total share of
pre-tax profits from their trade, profession or vocation for the
purposes of Schedule D Case 1 and 2 of the Income and
Corporation Taxes Act 1988 for the 12 months before they became
incapacitated.
Income received from savings and investments
is not included in this definition.
“Schedule” means the personal
information relating to your plan, including any
endorsements which are issued from time to time.
“Start Date” means the date
that cover starts on your plan.
“State benefits,” means
benefits payable by the Department of Work and Pensions to which
you become eligible as a result of your
incapacity.
“Terminal Illness” means any
disease process, which, in the opinion of a specialist consultant
holding such an appointment at a major hospital in Australia,
Canada, the European Union, New Zealand, Switzerland or the United
States of America, and with the agreement of our Chief or
Consulting Medical Officer, is likely to lead to death within 12
months.
“Total permanent disability”
means any illness or injury before age 65 which
permanently prevents the life insured from
performing any three of the six activities of daily living
without the assistance of another person or the use of special
devices or equipment.
“We” and
“Us” mean Forester Life Limited.
“Our” has a corresponding meaning.
“You” means the Planholder
and where the context requires the Planholder’s assignee(s) or
legal personal representative(s).
“Your” has a corresponding
meaning.
Unless the context otherwise requires, words
in the singular include the plural and vice versa.