Claims

Am I Entitled to claim?

You are entitled to claim if the following criteria have been met

• You are unfit for work – and have suffered a loss of income due to this fact
• You have reached your deferment period (the time you have to wait before we will start paying you benefit) and are still unable to work due to accident or illness
• You are not claiming for any condition that has been excluded from your contract, please check your policy conditions or contact the claims department for clarification.
• Your premiums are paid up to date
• You are outside the initial qualifying period; This is the first 12 Weeks after your policy commenced. (For Classic Plans ONLY)

Please note that along with the claim form, proof of your earnings will be required to verify the level of benefit you are entitled to as well as evidence of incapacity. A copy of the Fitness to Work Statement issued by your GP is required.

How to Claim

If you wish to make a claim for sickness benefit on your policy please contact our claims team (who have collectively over 30 years’ worth of claims handling experience) on 01452 782754, who will be happy to send you out a claim form.  Alternatively, you can download all the forms below:

• Claim Form
• A Guide to Claims
• A Guide to Claims PIP policy
• Self Employed Financial Details

The claim form and any other requested documents must be returned within the notification period relevant to your policy, please see below for details of notification periods.

How your benefit is calculated

Depending on the type of plan you have we will pay a maximum of either 50% or 60% of your personal taxable earnings or the amount of benefit your plan covers you for if it is less than the 50%/60% maximum. Please check your policy conditions to find out the maximum payable under your plan or call the Claims Team on 01452 782754

How this works:

E.G. Your taxable earnings are £24,000 per annum/£2000 per month. If your plan covers a maximum of 50% of your earnings then the maximum benefit we can pay you is £12,000 per annum/£1000 per month.

1. If the benefit on your plan is £1,500 per month, we would only be able to pay you the maximum allowed under your plan which would be £1000 per month.

2. If the benefit on your plan is £800 per month, we would pay you this amount as it does not exceed the maximum of £1000 per month.

What are your taxable earnings?

If you are employed the benefit calculation is based on your gross earnings before tax. 

If you are self employed we base the calculation for your benefit on your personal taxable income as declared on your tax return to the Inland Revenue; this is normally your share of the net profit before your personal tax is deducted.

If you are the director of a limited company we base the calculation for your benefit on your gross earned income and your share of dividends declared before tax is deducted.

For details of evidence of earnings we will require please see our ‘Claim Guidance Notes’. Note if you have a Personal Income Protection Plan please refer to the ‘PIP Claim Guide’.

When can I expect Payment?

Claims are paid twice monthly to claimants by direct credit. If you have not heard within one month of sending all required documentation please contact the Claims Team - we will be happy to help regarding the progress of your claim.

* If you are self employed or a partner/director of a limited company you will also need to submit this addendum.