Making a Claim

In order to make a claim for benefit in respect of an employee who is incapacitated and unable to work, the following procedure will apply:

Step 1 - Notification

You must notify us as soon as you become aware that an employee suffers an incapacity that may result in a claim. This can be done by telephone, post or electronically. Irrespective of the Waiting Period applying to your plan, you must let us have the notification within 4 weeks of the commencement of the employee’s incapacity, or, if later, the date on which he or she is no longer Actively at Work as a consequence. We do not normally accept claims for employees who have returned to work before the notification is received.

Step 2 – Claim questionnaire

When you notify us of a claim, your employee will be contacted by a qualified nurse who will complete a claim questionnaire with the employee over the telephone.

Your employee will be provided with a copy of the completed questionnaire by post and will be asked to check if it is accurate and to notify us immediately of any errors or omissions. We may also send the employee a consent form for us to obtain further medical information from the employee’s doctor if we consider it necessary.

Unless we agree otherwise, we will also require copies of any medical certificate(s) you have received. If you are unable to provide these we may request them directly from your employee.

At this point we will also ask you to certify your employee’s average gross income for the period immediately before the incapacity and your claim.

Step 3 - Acceptance

We will check the information provided to make sure the claim is valid, within the agreed income and benefit limits, and there are no special terms that might affect payment.

Step 4 - Payment

Once we have validated and accepted your claim, payment of benefit will commence at the beginning of the week after the end of your plan’s Waiting Period and will continue until the criteria for cessation of claims are met, as outlined below.