Disability - Injury Only

What does injury only actually exclude?

Illness. The injury-only coverage insures preventable injuries and nothing else, so a claim arising from a medical condition rather than an accident is not payable under it. Illness is insured only by adding the separate injury and illness coverage.

This is the single most important line on the page, and it is the reason the product is named the way it is. Someone who reads "income protection" and assumes any inability to work triggers a payment has misread it.

The injury and illness option is underwritten rather than guaranteed issue, uses a simplified set of medical questions, and cannot be bought on its own. Injury coverage has to be in place first. Its issue ages run to 64, against 69 for injury cover alone.

Who is eligible for injury-only cover?

Applicants aged 18 to 69 who work at least 20 hours a week and at least 35 weeks a year, and who do not have an injury or pre-existing condition restricting bodily movement and daily activities.

The hours-and-weeks test is what makes this a working person's product rather than a household one. It suits the self-employed, contractors and anyone whose income stops when they stop working, which is the situation an employer plan would normally cover.

Because the coverage is guaranteed issue, acceptance does not depend on answering medical questions. The pre-existing condition wording above is an eligibility condition rather than an underwriting assessment, and it is worth reading carefully by anyone with a current mobility limitation.

The injury and illness option carries its own age band. It is issued between ages 18 and 64, while injury coverage alone is issued to 69 and the injury element then continues to age 70. Someone approaching the upper band who wants illness cover has less time to arrange it than the injury-only figures suggest.

How much does it pay each month?

Monthly benefits are sold in $500 increments from $1,000 to $5,000 across the BB, B, A, AA and Executive classes. The AA and Executive classes also offer $5,500 and $6,000.

The amount actually paid is the lesser of qualifying insurable monthly earnings and the amount of coverage purchased. Buying a higher benefit than earnings support does not raise what a claim pays, which is why the earnings figure is established at application rather than at claim.

Sutherland Insurance can work through which class applies to a given occupation before an application is submitted, since the class governs which benefit amounts are available at all.

Qualifying insurable monthly earnings is the figure the contract measures a claim against, and it is established from what the applicant actually earns from working rather than from total household income. For someone self-employed whose drawings vary between years, that figure is worth settling at application, because it is the number a claim is tested against later.

When do payments start, and how long do they last?

Waiting periods are 0, 30 or 120 days from the disability. Benefit periods are two years, five years, or to age 70, chosen at application.

The waiting period is the gap between the disability beginning and the first payment, so a longer one means longer on savings before the benefit arrives. The benefit period is how long payments continue once they start.

Age affects the end of the benefit as well as the start. Someone disabled before age 68 can be paid to age 70; someone disabled between 68 and 75 is paid for 24 months. Coverage itself terminates at 75.

The two choices pull in different directions. A nil waiting period pays sooner but costs more; a 120-day wait assumes four months of savings or other income are available first. Matching the waiting period to what the household could genuinely absorb is the practical way to choose between them.

How is a soft tissue injury treated?

Soft tissue claims are limited rather than excluded. Edge Benefits states payout periods of 20, 40 or 60 days or longer per occurrence, with a lifetime maximum of 36 months for soft tissue.

Soft tissue injuries (strains, sprains and similar damage to muscle, tendon and ligament) are among the most common reasons a working person cannot work, so the limitation matters more than its position in a brochure suggests.

The per-occurrence period varies by contract, and the 36-month lifetime figure applies across the policy rather than resetting with each claim. Anyone whose work carries a high risk of this kind of injury should read that section of the wording with an advisor.

How is a policy applied for?

Through a fast-tracked underwriting process, with a policy issued in a matter of days or weeks. The injury-only coverage requires no medical underwriting; the illness option adds a simplified set of medical questions.

Applying through Sutherland Insurance does not change Edge's process or timing. It changes who reads the request, which class and waiting period get discussed before the form is submitted, and who is available afterwards if a claim raises a question.

Edge Benefits does not publish premium figures, so no rate appears on this page. A quote is produced from the age, class, benefit amount, waiting period and benefit period selected.

How does this compare with an employer plan?

An employer group plan is arranged by a company for its staff and generally ends when the employment does. This coverage is owned by the individual, so it continues through a change of employer or a move into self-employment.

Portability is the practical difference. A group plan is a benefit of the job; this is a contract in the policyholder's own name that follows them.

For employers arranging cover for a workforce rather than for themselves, Sutherland Insurance places group employee benefits separately, and the employee benefits page sets out how those plans work.

What is worth deciding before applying?

Four things: whether illness cover is wanted alongside injury, which waiting period suits the household's savings, how long benefits should run, and what monthly amount qualifying earnings support.

Those four choices interact. A shorter waiting period, a longer benefit period and a higher monthly amount each affect the quote, and the monthly amount is capped by earnings regardless of what is selected.

Nothing on this page is a recommendation about which combination applies to a particular situation. A licensed advisor at Sutherland Insurance goes through the options and the wording, and no coverage is in force until it is issued and accepted.

Sources

• Edge Benefits: Income Replacement Benefits