Claims Information

• The policy must be in force with all premiums paid at the time of the claim
• Premiums must continue until a decision is made
• The majority of claims will require medical evidence and in some cases specialist reports
• Reports for critical illness claims will be paid by us
• For all other Health Claims, the claimant will pay for the first report from their Doctor
• We will require a signed consent form
• On occasion, we may ask for either an independent examination or a home visit to progress the claim
• Sometimes we may need additional financial information; e.g.
  • P60s
  • Details of other benefits being received
  • Business accounts for those who are self employed
• Birth and marriage certificates must be originals and these will be returned promptly

Once a claim is in payment, regular medical and financial reviews will take place to ensure the claim is still valid. These may include:

• Home visits
• Reviews with the claimant
• Reviews with both Doctors and Specialists
• Independent medical examinations

• The policy must be in force with all premiums paid at the time of the claim
• We may need to obtain medical reports from a deceased’s Doctor before we can consider the claim
• Sometimes we will need the next of kin’s permission to obtain a Doctor’s Report, without this agreement we will not be able to consider a claim
• We will pay for the cost of this information
• We will need to see an original Registrar’s certified death certificate

When we deal with a pension claim, we need to consider Inland Revenue Guidelines and our Scheme Rules. How the proceeds will be paid is determined by a number of factors, which include:

• Type of contributions paid
• The member’s circumstances at the time of the claim and any nominated beneficiaries

A claim will not be paid without all relevant documentation being seen, to include an original Registrar’s certified death certificate where appropriate.

• The claimant will need to supply any documentation that we request before a claim can be considered. Typical requirements are:
  • Original death certificate
  • Original policy document
  • Trust documentation
  • Grant of representation (Certificate of Confirmation in Scotland)
  • Form of indemnity if policy lost (for smaller sums assured)
• When proof of death is received, the value of the claim is fixed
• For an investment bond that is either under trust, granted or assigned to another person we will only deal with the legal owners of the policy or someone appointed to act on their behalf
• We will need the Registrar’s certified death certificate

Material Non-Disclosure or misrepresentation of information

We have a responsibility to pay only valid claims, and unfortunately, there will be occasions when we will not pay a claim for either material non-disclosure or misrepresentation of information.

All items of information on an application form, or a Declaration of Health (DOH) in respect of a re-instatement of a lapsed policy, are regarded as material facts. Applicants should inform us of any changes to the information provided on the application form or Declaration of Health (DOH) before the policy goes in force. During the claims assessment if we find that any information originally provided is not correct, or an applicant failed to inform us of a change of information before the cover was provided, we will consider this material non-disclosure.

If the applicant knew about this information when they completed the documentation but did not tell us at the time, it could impact on the payment of benefits as we have the right to void the policy due to non-disclosure of material information. If that happens the policy will be cancelled from outset and all the premiums will be returned without interest.

Fraudulent non-disclosure; i.e. where has been a deliberate attempt to defraud Legal & General, will result in no return of premium.