At Legal & General we pride ourselves on paying valid claims. We aim to do this promptly once we have received all the information and evidence to support it.
However, occasionally we may decline to pay a claim because it isn’t covered under the policy. You can appeal against our decision if you wish which is why we have a formal appeal process.
If a decision is made to decline a claim the policyholder can to dispute the decision made. The process referred to for disputing a decision is an “appeal”.
An appeal can be made in writing, by e-mail or by telephone.
If a claim is declined after we have assessed it, we will send a letter giving formal notification that it has been declined and give our reasons for the decision.
This letter will explain how to make an appeal against our decision. Any information or evidence in support of the appeal should be submitted as soon as possible following our decision to decline the claim.
When we receive the appeal, the claim will be reviewed by our Claims Appeal Committee. This is a formal group which will include Group Protection’s Managing Director, Underwriting and Benefits Director and Technical Manager. Their role is to objectively look at the claim and assess any additional evidence or information.
Our Benefits Team will tell you the outcome of the Claims Appeal Committee in writing.
If after the appeal we consider that the original decision to decline the claim was correct, we’ll let you know. We’ll write to you and state that following assessment by the Claims Appeal Committee, our decision on the claim is final.
If the matter is not resolved you may be able to refer the matter to the Financial Ombudsman Service (FOS). We’ll send you details of this with our letter.
We may record and monitor calls. Call charges will vary.
Early intervention and rehabilitation for members who are absent from work because of a long term illness or injury.