With the support of her adviser, Sally chose a:
- Benefit period of up to age 65 – this means that should something happen to her, benefits will be paid on her insured income up to the age of 65 while she is disabled.
- Waiting period of 30 days – this means that any benefits will be paid to her from 30 days after an incident – so in most cases the injury would have to put her out of work for more than 30 days for her to make a claim.
What Sally didn’t pay much attention to were the extra benefits that came with her policy, including the Specific Injury Benefit. This benefit pays a guaranteed amount if specific injuries happen to you, such as loss of sight in one eye or fractures to the leg or arm – regardless of the waiting period selected on a policy.
A couple of years after taking out her policy, Sally was cycling to her job as a school teacher. She hit a bump in the road, wobbled, came off her bike and put her arm out to break her fall. Feeling a sharp pain, she called an ambulance and went to hospital for an X-ray.
Sally had suffered a radial head fracture to her right arm, which is at the top of the bone that connects the wrist and elbow. She needed 5 days off work to recover initially, and was then back to work in a sling for the next 5 weeks. Knowing that her waiting period was 30 days, Sally didn't notify OneCare or her adviser about her injury, which only put her out of work for 5 days.
During her regular policy review with her adviser, Sally mentioned her injury in passing. Sally’s adviser explained that OneCare’s Income Secure covers begin the regular benefit payments after the waiting period, but certain conditions covered by the Specific Injury Benefit will pay automatically. In Sally’s case the Specific Injury Benefit covered “fractures of the upper arm including the elbow and shoulder bone” for a guaranteed payment period of 2 months.
20 months after the injury occurred and now back at full strength, Sally, with the support of her adviser, lodged a claim for the Specific Injury Benefit.