Generali Worldwide
Group Long Term Disability
Standard Terms and Conditions
generali-worldwide.com
2 of 9 | Generali Worldwide Insurance Company Limited - Group Long Term Disability Standard Terms and Conditions
Contents
INTRODUCTION ................................................................................... 3
GENERAL ............................................................................................. 3
COMMENCEMENT OF ASSURANCE AT POLICY INCEPTION .......... 4
TERMINATION OF ASSURANCE ......................................................... 5
NO-WORSE TERMS ............................................................................. 5
DISABILITY ........................................................................................... 6
DISABILITY BENEFIT ........................................................................... 7
EXCLUSIONS........................................................................................ 8
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GLOSSARY ........................................................................................... 8
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INTRODUCTION
This document sets out the Standard Terms and Conditions governing the Generali Worldwide Insurance Company
Group Long Term Disability product. This product provides cover for income protection benefits when an employee is
unable to work due to long term sickness or injury. Employers may choose one of the following three benefit types:
Income Protection to Normal Retirement Age
Fixed Duration Income Protection
Fixed Duration Income Protection with capital payment: “LTD Capital Solution”
The Standard Terms and Conditions, together with the corresponding quotation, form part of the contract and
prospective clients are advised to read these carefully.
Any special terms detailed in the Client Quotation will replace the corresponding standard wording written in this
document. In the event of a conflict in the wording between these documents, the wording of the issued Policy
Document will prevail.
GENERAL
We will not assume risk for any Policy until all outstanding information requested in the corresponding quotation has
been received and we deem the information to be acceptable.
Our quotations are valid for 3 calendar months from date of issue shown, provided the following conditions are
met:
a)
all information required on the quote front has been provided to us and accepted by us as valid.
b)
there has been no change in the Group’s risk profile since the quote was issued
c)
any variation in membership or sums assured since the quote was issued does not exceed 20%
d)
For single-premium-costed quotes, please note the final premium may vary slightly subject to birthdays.
No return of premium will be made if the Policy is cancelled in the first year of cover.
All our quotations include active employees, but exclude those employees in receipt of income from any sickness
or incapacity insurances or those who have previously received a lump-sum payment under the LTD Capital
Solution.
A full list of the eligible members must be provided to us within one calendar month of the Policy inception date.
Provided we have received satisfactory confirmation of the Policy‘s eligibility and take-up rate, employees with
benefits below the free cover limit will not require medical underwriting.
Employees who decline to join the Policy at the first opportunity or who do not satisfy the eligibility conditions in
any other way will not benefit from any free cover limit.
If the premium is governed by a unit rate, that rate is guaranteed for two years provided that:
i)
the number of lives, and/or
ii)
the total sum assured
At the expiry of the guarantee period, the Policy shall be reviewed.
An employee’s benefit entitlement will be assumed to be calculated based on their annual basic salary. Where
cover is to be based on other definitions, details of the employee(s) must be explicitly advised to us at quotation
stage. Where an employee’s remuneration comprises fluctuating emoluments, any ensuing claim will be
calculated based on earnings averaged over the three-year period immediately prior to the employee’s first date
of absence from work.
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do not change by more than 20% compared to those at the commencement date. In these circumstances, where
such changes have occurred, we reserve the right to change the premium rate with effect from the date on which
the changes first occurred.
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We will not provide cover for short-term or fixed-term contract employees unless explicitly agreed by us.
The Policy will be terminated immediately and without notice if the invoiced premium is not paid within 30 days of
the invoice date.
We will not insure benefits for an individual beyond contracted retirement age.
The definition of Disability used in determining the validity of a claim will depend on the benefit option chosen:
a)
For Income Protection to Normal Retirement Age and Fixed Duration Income Protection: A Member
being so disabled by bodily injury or disease that:
iii)
iv)
b)
during the first 24 months of any period of such disability after the Deferred Period has ended,
he/she is unable to perform any part of the duties of his/her own occupation, and
thereafter, during the continuance of such disability, he/she remains totally incapacitated by reason
of illness or injury from performing any occupation for which he/she is reasonably suited by reason
of education, experience or training other than as provided for under proportional benefit or
rehabilitation.
For LTD Capital Solution:
A Member being totally incapacitated by reason of injury or illness such that the said Member is prevented
from performing the Material and Substantial Duties of his/her own occupation and is not following any
other occupation other than provided for under proportional benefit or rehabilitation.
We do not offer Continuation Options.
COMMENCEMENT OF ASSURANCE AT POLICY INCEPTION
For any individual who is eligible to be covered by the Policy, assurance for their full benefit entitlement commences on
the corresponding commencement date with the following exceptions:
i)
Any employee who has been absent from work due to illness or injury for 10 consecutive days or more in the 12
month period immediately prior to the date at which the employee first became eligible for cover under the
Policy. We may consent to providing cover subject to receipt of written details stating the reason why the
employee was absent from work together with the corresponding dates of absence. Cover for such employees
would only commence once we have issued written confirmation.
Please refer to the wording in the Quote Front which explicitly details the period of time of such absence
for which we shall require to be notified.
ii)
Any Benefit in excess of the insured free cover limit will be subject to acceptance following appropriate medical
underwriting as per our procedures.
Any employee who is required to undergo medical underwriting will be covered for his/her full benefit entitlement
(excluding pre-existing medical conditions) for a period of 90 days to allow for completion of the underwriting
procedure. If, after this period has elapsed, the underwriting decision remains outstanding these employees will
be restricted to the insured free cover limit, or covered against illness or injury arising from accidental causes
only, in the absence of a free cover limit, and will continue to be so until the decision has been made.
If the underwriting decision remains outstanding after 90 days, an extension of full cover (excluding pre-existing
medical conditions) may be granted at our discretion.
Any employee who is not actively at work on the commencement date as a result of illness or injury will not be
covered until they have returned to work in his/her usual capacity for two consecutive months.
Actively at Work means that the employee
a)
Is working his/her contracted hours and undertaking their usual duties and
b)
Is not working contrary to medical advice received.
We will not backdate cover for the Policy as a whole, or for any individuals subsequently joining after Policy
commencement.
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iii)
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TERMINATION OF ASSURANCE
The assurance of a Member covered under the Policy will cease immediately on the earliest of the following
occurrences:
i)
The Member ceases to be eligible in any way under the Policy;
ii)
Discontinuance of payment of premiums.
NO-WORSE TERMS
For insured policies that switch to us, all medical underwriting terms applied by the previous insurer will be matched
by us on a no-worse terms basis at the date of switch of cover subject to:
i)
Such terms will only apply to the Member’s annual benefit entitlement that had been previously underwritten. Any
subsequent increase in benefit that Member is entitled to would be underwritten on our terms;
ii)
If our free cover limit is higher than that of the previous insurer, our free cover limit will not apply to any Member
whose previous cover had been subject to adverse underwriting decisions. Any further increases in benefit for
these Members will be fully underwritten on our terms;
iii)
The previous underwriting decision was made less than 12 months before the date the Policy switched to us. If
the previous underwriting decision was made prior to this 12 month period, we reserve the right not to offer noworse terms;
iv)
Such terms will only apply to previous medical ratings of up to +200% extra morbidity.
v)
No Member had been restricted to a previous free cover limit as a result of poor health. For any individual
restricted in this manner, we would underwrite the Member for his full benefit entitlement before terms would be
considered;
vi)
Similarly, any Member previously declined cover by the previous insurer would be underwritten for their full
benefit entitlement before acceptance terms would be considered.
In instances of v) or vi), any free cover limit that the Policy may have will not apply to such Members.
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Clients shall agree to provide any information requested by us to support previous underwriting terms. Failure to provide
such details will result in the offer of no-worse terms being withdrawn by us.
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DISABILITY
Claim Notification:
The Employer is required to notify us when a Member has been continuously absent from work or working on a reduced
basis due to disability for one month. This notification should include the Member’s name, date of birth, disability, date of
commencement of the disability, annual salary, benefit level and location.
A claim for benefit shall be submitted to us by the Employer on the appropriate claim forms together with the supporting
documentation no later than four weeks before the Deferred Period is due to expire. Failure to do so will result in the
Deferred Period being deemed to end four weeks after the actual date the claim form is received.
No Benefit shall be due before proof of disability is received and accepted by us.
Proof of Disability:
Medical evidence will be given to us, free of expenses, to prove the disability, (a) at the time when notice is given by
medical certificate, (b) its continuance during the Deferred Period and when a claim is made, (c) its continuance during
and at the expiry of the 30 months from the onset of the disability and, (d) thereafter as we may consider necessary.
The Member, if and when required by us, shall submit himself/herself to be examined by a medical referee appointed or
approved by us.
Medical Treatment:
Disability shall not be admitted by us unless proof is supplied that, during the Deferred Period, the Member received
medical treatment as an in-patient or out-patient for an injury or disease which forms the basis of the claim.
Linked Periods:
If, within six months of a Member having returned to work, that Member has a recurrence (lasting at least one month) of
the disability which led to the original monthly benefit payment, you may request payment of benefits to recommence
without having to serve a further Deferred Period, subject to satisfactory medical evidence being received and accepted
by us.
If, as a result of a recurring illness or injury, a Member is absent from work for periods lasting at least one month, we will
allow such periods of absence to be linked for purposes of calculating the end of the Deferred Period, provided that the
total time from the first day of absence to the end of the Deferred Period so calculated does not exceed 12 months.
Loss of Licence:
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The loss of a professional or occupational licence or the inability to obtain one or qualify for one due to illness or injury
will not, in itself, constitute disability.
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DISABILITY BENEFIT
When Payable:
The insured benefit shall become payable once we are satisfied that the claimant meets the insured definition of
disability and has been off work due to disability for the duration of the insured Deferred Period.
How Payable:
Benefits subject to Benefit Limitations below shall be paid monthly in arrears commencing on the first day following the
expiry of the Deferred Period.
a)
For Income Protection to Normal Retirement Age and Fixed Duration Income Protection:
Benefits are paid monthly in arrears until Benefit Termination as defined below.
b)
For LTD Capital Solution:
Benefits are paid monthly in arrears for a Fixed Period followed by a lump sum payment. Two options may
be selected at quote stage:
Option
(i)
(ii)
Fixed Period
2 years
3 years
Followed by Lump sum payment of
3 x Annual Benefit
2 x Annual Benefit
Benefit Limitations:
The income protection part for all three benefit types shall be limited to 75% of insured salary or Drawings, less any
State Invalidity Benefit, sickness or accident benefit received from any source, or continuing income from any
employment.
This is subject to the following overall maximum:
a)
For Income Protection to Normal Retirement Age and Fixed Duration Income Protection:


b)
Core Benefit: £300,000 per annum
Supplementary benefit: £50,000 per annum
For LTD Capital Solution:
The total maximum benefit is equal to £1 million. This includes both the Fixed Period and Lump Sum
payments.
or currency equivalent
Payment of any benefit will cease immediately should the Member:
i)
Return to work in his/her usual capacity;
ii)
attain the insured terminal age for benefit payment;
iii)
die;
iv)
cease to be eligible for membership of the Policy;
v)
cease to be eligible under the definition of Disability;
vi)
cease to be employed by the policyholder;
vii)
receive a Lump sum benefit under the LTD Capital Solution
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Benefit Termination:
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Reduced Benefit:
A reduced benefit may become payable if the Member returns to gainful employment with earnings that are less than
pre-disability earnings where such reduction in earnings is as a consequence of the ongoing disability. This benefit is
payable for any continuous period of ongoing disability during which the Member’s earnings continue to be at a reduced
level solely by reason of that disability.
For Capital Solution LTD, this reduced benefit payment will cease at the end of the Fixed Period. The lump sum
payment shall be reduced in the same proportion as the income protection paid.
EXCLUSIONS
Policy Exclusions
Benefit shall not be paid in respect of claims that are directly or indirectly attributable to, or consequential upon:
i)
Nuclear transmutation, or radiation, resulting from the artificial acceleration of atomic particles.
ii)
Chemical or biological substances which are not used for peaceful means.
Member-specific Exclusions
In certain instances, Members may have specific conditions applied to them resulting in exclusions of cover. Claims
arising either directly or indirectly from causes excluded in this manner will not be accepted under any circumstances.
These will be explicitly detailed if they apply to any Members.
GLOSSARY
Deferred Period
The period of time as stated in the Quote commencing on the date that a Member was first absent from work due to
Disability until the date the Member’s insured benefit, under this Policy, first becomes payable by us.
Drawings
The monies withdrawn by the owner of a sole proprietorship or the partners of a partnership firm from the business.
Core Benefit
This is the income replacement part of the Benefit.
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Supplementary Benefit
This part covers waiver of premium or pension contributions.
Registered Head Office address: Generali Worldwide Insurance Company Limited, Generali House,
Hirzel Street, St Peter Port, Guernsey, Channel Islands GY1 4PA.
Incorporated in Guernsey under Company Registration No. 27151.
generali-worldwide.com
Regulated in Guernsey as a licensed insurer by the Guernsey Financial Services Commission under the
Insurance Business (Bailiwick of Guernsey) Law, 2002 (as amended).
Generali Worldwide Insurance Company Limited is part of the Generali Group, listed in the Italian Insurance
Group Register under number 026.
Websites may make reference to products that are not authorised or regulated and/or are not available for
offering to planholders in certain jurisdictions.
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T +44 (0) 1481 715 400 F +44 (0) 1481 715 390 EBLifeCustomerService@generali-worldwide.com