Some case studies:
Life cover customer
A customer holding life cover is diagnosed with terminal cancer during the suspension period. Once cover is reinstated, a terminal illness claim is not payable but a death claim would be payable, i.e. the terminal illness claim event arose during the suspension period but the death claim event arose after reinstatement.
Income protection customer
A customer holding income protection cover is diagnosed with cancer during the suspension period. If the customer met the criteria for an IP claim during the suspension period and was not working ordinary (i.e. pre-disability) hours when the cover was reinstated, there is no claim. However, if a customer was working ordinary hours when cover was reinstated and subsequently suffers a recurrence of the cancer, we will consider the IP claim. In this case, the claim event is Total Disability or Partial Disability.
Trauma insurance customer
If a customer holding trauma cover is diagnosed with a carcinoma in situ during the suspension period, there is no claim under the Carcinoma-in-Situ or Early Cancer Upgrade Benefit. If the cancer subsequently metastasises after cover is reinstated, a claim could be payable under the Malignant Tumours benefit if the customer first meets this definition after reinstatement.
A customer holding trauma cover has a biopsy during the suspension period. After cover is reinstated the customer receives a histology report confirming a diagnosis of Carcinoma-in-Situ. A claim could be payable under the Carcinoma-in-Situ benefit if the customer is meeting this definition for the first time.