Making a Claim

The information below is taken from our Lifestyle Cover policy wording and explains the process that your clients need to follow should they need to make a claim.

How to make a claim for an accident or sickness

Employed or Contract Worker	Self-Employed
Step 1: Check your policy booklet and schedule and see if your circumstances are covered. Ask your doctor to assess your disability. To register a claim, or for further help with this process, please call us on: 0800 072 8315 (lines are open Mon‑nri 9am‑mpm).	Step 1: Check your policy booklet and schedule and see if your circumstances are covered. Ask your doctor to assess your disability. To register a claim, or for further help with this process, please call us on: 0800 072 8315 (lines are open Mon‑nri 9am‑mpm).
Step 2: Send us your completed claim form, which must include confirmation of your condition from your doctor and your absence from work from your employer. You will also need to provide us with at least your last three payslips, which confirm your gross monthly income, and bank statements showing that this income has been paid to you. Please remember that, for certain conditions, your disability must be confirmed by a consultant. See page 12 of the policy booklet for more information.	Step 2: Send us your completed claim form, which must include confirmation of your condition from your doctor. You will also need to provide proof of your gross monthly income for the last 12 months. For example, details of your income declared to HMRC, bank statements showing that these payments have been made to you from your business and/or confirmation from your accountant. Please remember that, for certain conditions, your disability must be confirmed by a consultant. See page 12 of the policy booklet for more information.
Step 3: We will contact you to tell you of our decision about your claim. If we have accepted your claim, we will tell you when your first benefit payment to your bank/building society account will be made.	Step 3: We will contact you to tell you of our decision about your claim. If we have accepted your claim, we will tell you when your first benefit payment to your bank/building society account will be made.
Step 4: If your claim continues we will need to receive your doctor’s or consultant’s certificate confirming your ongoing condition and inability to work, before we make any further benefit payments. You may also need to provide any other additional information that we ask for.	Step 4: If your claim continues we will need to receive your doctor’s or consultant’s certificate confirming your ongoing condition and inability to work, before we make any further benefit payments. You may also need to provide any other additional information that we ask for.

How to make a claim for unemployment

Employed or Contract Worker	Self-Employed
Step1: Check your policy booklet and schedule and see if your circumstances are covered. Contact your local Jobcentre to arrange an appointment to register for a Claimant Commitment. To register a claim, or for further help with this process, please call us on: 0800 072 8316 (lines are open Mon‑nri 9am‑mpm).	Step 1: Check your policy booklet and schedule and see if your circumstances are covered. Contact your local Jobcentre to arrange an appointment to register for a Claimant Commitment. Notify HMRC that your business has ceased to trade. To register a claim, or for further help with this process, please call us on: 0800 072 8316 (lines are open Mon‑nri 9am‑mpm).
Step 2: Send us your completed claim form and the following documents: • at least your last three payslips, which confirm your gross monthly income, and bank statements showing that this income has been paid to you; • the letter sent by your employer, confirming the date your employment ended or the end of your contract; and • the benefit award letter issued to you by the Jobcentre.	Step 2: Send us your completed claim form and the following documents: • proof of your gross monthly income for the last 12 months. For example, details of your income declared to HMRC, bank statements showing that these payments have been made to you from your business, and/or confirmation from your accountant; • proof that your business has ceased to trade; and • the benefit award letter issued to you by the Jobcentre
Step 3: We will contact you to tell you of our decision about your claim. If we have accepted your claim, we will tell you when your first benefit payment to your bank/building society account will be made.	Step 3: We will contact you to tell you of our decision about your claim. If we have accepted your claim, we will tell you when your first benefit payment to your bank/building society account will be made.
Step 4: If your claim continues we will need to receive a completed continuing claim form when requested and evidence of your job seeking. You will also need to provide recent bank statements and any other additional information that we ask for.	Step 4: If your claim continues we will need to receive a completed continuing claim form when requested and evidence of your job seeking. You will also need to provide recent bank statements and any other additional information that we ask for.

Your obligations when making a claim

You must:

• Tell us about your claim as soon as reasonably possible, but within 180 days of the date you were last in work 
• Take all reasonable steps to keep your claim period as short as possible
• Complete a claim form when you make a claim and send us a continuation claim form when requested
• Provide us with evidence when requested of your continuing unemployment or disability. We may ask for original documents
• Tell us as soon as you know the date when you are going to return to work

General conditions that apply to a claim

• When you make a claim we will check your eligibility for cover. You will find more information in Section 2 – ‘Eligibility for cover’
• The maximum monthly benefit we will pay is 65% of your gross monthly income. We will check the amount of monthly benefit you are entitled to based on your circumstances at the time you make a claim. We will pay 65% of your gross monthly income or the benefit shown in your schedule, whichever is less
• You can’t change the terms of your cover during a claim
• We won’t pay any benefit for periods where you can’t provide us with proof of your continuing unemployment or disability, when requested by us
• We will only pay a claim for the type of cover you have chosen
• You can’t make a claim for disability and unemployment at the same time, unless you are joint policyholders making simultaneous claims;
• You must attend an independent medical examination (which we will pay for) by a doctor or consultant of our choice if we believe it’s necessary, to continue your claim. If you don’t attend the examination or provide other proof we ask for, your claim will end and we won’t pay any benefit
• We may contact your employer, bank, tax office, HMRC, accountant or your company’s accountant for proof that you are not working
• If you are self-employed we may need to see:
  • original accounts,
  • tax returns and
  • bank statements.
• We may contact your employer for details of your gross monthly income
• We may arrange for an agent representing us to visit you. They’ll gather information about your claim so we can make an accurate assessment. You must make yourself available for any such visit. If you don’t, we may suspend any further benefit
• Claim payments will be made directly to your bank/building society account.

When will benefit payments stop?

We will keep paying benefit while you are still eligible for cover and for each day you are continuously unemployed or disabled. We will stop making payments when one of the following happens:

• Your unemployment or disability ends.
• Your short time working hours end.
• Your employer tells you, either verbally or in writing, that you may resume your normal contractual working hours, that you worked before your short time working hours began, but you choose not to do this.
• You have received the maximum benefit due under this policy.
• You stop paying the monthly premiums due in the period of insurance in which the claim commenced.
• You permanently retire from work or you die.