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POLICY WORDING

 

 

1. Eligibility
You are covered under this insurance if, on the Start Date, You are over 18 but under 65 at the End Date (if applicable) and, You are working when You apply and, You have paid or agreed to pay the Premium(s) for cover and, you have met the underwriting criteria set out in the application and, We have accepted Your application as evidenced by the issue of this Certificate.

You must not be aware of any illness, disease, condition or injury in the 6 months before the Start Date of oyur income protection insurance policy that may cause You to make a claim for Disability benefits and You must not be aware of any impending Unemployment. We may still insure You if You are aware of any of these events. However, We will not pay benefits directly relating to that Unemployment which You were aware of in the 6 months before the Start Date nor will We pay benefits directly relating to the illness, disease, condition or injury which You were aware of in the 12 months before the Start Date.

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2. Income Protection Insurance Benefits
Disability If You are Working and become Disabled after the Start Date and before the End Date for at least 30 continuous days We will pay Your Monthly Benefit. You will continue to receive an amount equal to 1/30th of Your Monthly Benefit (payable monthly in arrears) for each further day that You remain off Work until the End Date or, You stop being Disabled or, We pay 12 Monthly Benefits for each Disability claim. Disability benefits will not start until You consult a Doctor. However, if You complete a self-certification form (from Your employer) for the first 7 days of Disability, You will be classified as Disabled for those 7 days. We will only pay You Disability benefit if a Doctor is regularly treating You for the condition causing Your Disability. If You have made a Disability claim which ends for whatever reason, You will not be able to make another Disability claim until You have been in continuous work for 30 days if the Disability is different or, 180 days if the Disability is the same.

Unemployment If You are Working and become Unemployed after the Start Date of your protection policy and before the End Date for at least 30 continuous days We will pay Your Monthly Benefit. You will continue to receive an amount equal to 1/30th of Your Monthly Benefit (payable monthly in arrears) for each further day that You remain off Work until the End Date or, You stop being Unemployed or, We pay 12 Monthly Benefits for each Unemployment claim.

If two periods of Unemployment are separated by 3 months or less We will treat this as one continuous claim but We will not pay any benefit during any time You were not Unemployed between these periods. If the two periods of Unemployment are separated by more than 3 months, You must return to Work for a total of 6 continuous months before You can make another Unemployment claim.

If You are receiving Unemployment benefit and want to start temporary Work which will continue for less than 6 months, please let Us have details in writing before You start this Work. We will not pay any benefit during the period that You are not Unemployed. However, when the temporary Work finishes, Your Unemployment claim may continue and We will treat this as one continuous income protection insurance claim. The most We will pay for this continuous claim is 12 times the Monthly Benefit in total.

If You are Self Employed and wish to make an Unemployment claim, Your business must have ceased trading and You must be registered for Job Seekers Allowance and informed the Inland Revenue that You are no longer in business.

3. Payment of Benefits
We will pay benefits into the account specified on Your claim form. Disability and Unemployment benefits are paid monthly in arrears.

We only pay You one type of Monthly Benefit (Disability or Unemployment) at a time. If You are Joint Income Protection Applicants, We will pay to each of You in the percentages shown on Your application Schedule.

The maximum combined income protection insurance benefit payable for Disability or Unemployment claims under this insurance will not be more than the sum of £1,000 per month or 50% of Your gross monthly income whichever is the less.

4. Income Protection Cover Exclusions
Disability We will not pay You any Disability benefits resulting from the following circumstances

if You did not elect to have Disability benefit on Your application form,

the recurrence of any Disability, illness symptom or related condition for which You sought medical advice in the 12 month period immediately before the Start Date

alcohol or drugs not taken under the advice or supervision of a Doctor,

medical operations or treatments which are not medically necessary such as (but not limited to) cosmetic or beauty treatment,

self inflicted injuries caused while sane or insane,

any Disability which occurs while You are Working outside of the United Kingdom unless You are Working for the British Armed Forces, or as a civil servant in a British embassy or consulate, or unless You are Working on a specific project for less than 30 days outside the United Kingdom and were actually outside the United Kingdom for less than 30 days,

backache and related conditions unless there is additional medical evidence (for example an MRI scan) of abnormality which We may require to validate Your claim,

stress or stress related conditions including depression unless and until We may validate Your claim by reference to additional specialist medical evidence which We may require

normal pregnancy conditions causing morning sickness or fatigue, actual child birth or maternity leave. Pathological conditions lasting longer than 30 days and diagnosed by a member of the Royal College of Obstetricians are not excluded and neither are any other abnormalities during normal pregnancy.

Unemployment We will not pay You any Unemployment benefits resulting from the following circumstances

if You did not elect to have Unemployment benefit on Your application form,

if You were not in continuous Work for 6 months immediately before Your employment ended. If You were not in Work for 2 weeks or less, We will not count this as a break in Your employment,

if, at the Start Date, You knew You were going to be made Unemployed or had reason to believe that it was likely to happen,

if Your employment ends or You are notified, verbally or in writing, of Your employment ending, within 120 days of the Start Date,

if Your Work is seasonal or if Unemployment is a regular feature of Your Work,

if You are Working on a specific project and this project finishes,

if You become voluntarily Unemployed (which includes ending Your Work voluntarily during a period of notice given by Your employer) or voluntary redundancy,

if You Work on a fixed contract which ends. However, if You have been in continuous Work with the same employer for at least 2 years and Your contract has been renewed at least once and You had no reason to believe that it would not be renewed again, this exclusion will not apply,

if Your work ends as a result of the expiry of an apprenticeship or training contract,

if You are Self Employed and Your business temporarily stops trading,

if You are Working outside of the United Kingdom unless You are Working for the British Armed Forces, or as a civil servant in a British embassy or consulate, or unless You are Working for an employer that is a United Kingdom registered company who assigns You to Work in a member country of the European Union on the same terms and conditions,

if You are dismissed by Your employer as a result of misconduct, breaking the terms of Your employment contract, criminal offence or failing to meet the standards or targets laid down by Your employer,

if You do not make a genuine and continuing effort to get Work.

General No benefit will be paid if disability or unemployment results directly or indirectly from the following circumstances

civil unrest, war, radiation and radioactive contamination, or any related event,

strike or lock-out or Your involvement in such,

Human Immunodeficiency Virus (HIV) and/or any HIV related illness including Acquired Immune Deficiency Syndrome (AIDS) however such may be defined.

5. Claims Conditions
You should contact Our Administrator, Adminicle Limited, Callidus House, Cirencester Business Park, Love Lane, Cirencester GL7 1XD or telephone 01285 886600 to request a claim form.

You must complete the income protection insurance claim form fully and accurately and return it to Us at the address above. This claim form should be received by Us within 60 days of the date Your Disability or Unemployment began, or as soon as possible after this.

We may ask You to fill in a continuing or supplementary claim form at Your own expense for each month You are claiming. You must send this to Us within 60 days of the date We last paid Your Monthly Benefit or as soon as possible after this.

To properly validate Your claim You must give Us any proof We ask for otherwise We cannot pay any benefit. This is at Your own expense if any. We may also ask You for additional information during Your income protection insurance claim such as (but not limited to) being examined by a Doctor (at Our expense) or, certificates from Your employer stating that You are not presently working or, a copy of the Jobseekers Agreement that You signed with the Employment Service or, a certificate from Your last employer stating that You no longer Work for them.

We will not pay Your claim if We cannot validate it because You are late sending Us Your claim form or any additional information that We may reasonably request. Any attempt to falsify any information provided to Us may invalidate Your claim and may result in Us cancelling this insurance immediately.

If We start to pay Monthly Benefit because You are Disabled and You become Unemployed You must write and advise Us straight away. When deciding if Your claim is valid, We will ignore the fact that You have not been Working because of Your Disability. We will continue to pay Your Disability benefit while it remains valid. If You are still Unemployed once a Doctor says You are fit to return to Work, You must tell Us and We will ask You to complete an Unemployment claim form. If You change Your claim, the most We will pay for both Your Disability and Unemployment claims combined is 12 times the Monthly Benefit.

If We start to pay Monthly Benefit because You are Unemployed and You become Disabled You must write and tell Us straight away. When deciding if Your claim is valid, We will ignore the fact that You have not been Working. You will no longer be eligible to claim benefits for Unemployment and You will have to complete a Disability claim form. If You change Your claim, the most We will pay for both Your Unemployment and Disability claims combined is 12 times the Monthly Benefit.

If You are unable to meet Our conditions to claim for Disability benefit You can claim Unemployment benefit once You are fit to work. You must let Us know that You are no longer Disabled and You must meet Our conditions to claim Unemployment benefit. If Your claim is valid, the most We will pay is 12 times the Monthly Benefit which will include any Monthly Benefit We paid before Your Disability started.

6. General Conditions
All cover under this insurance will end and all Monthly Benefit will stop automatically if You die or, when You reach the age of 65 or Permanently Retire before then or, when You miss paying any premium(s) which may be due to Us under this insurance.

If Joint Applicants are covered under this insurance and one of You reaches 65 or Permanently Retires before then, that person will no longer be covered. If You write and tell Us about this however, the other person can then receive all the Monthly Benefit if a claim needs to be made.

You may not transfer or assign Your rights or interest in this insurance to any other person. This insurance does not have any value at the End Date nor does it acquire any surrender value during the period of insurance.

We reserve the right to amend the terms of a monthly premium renewable insurance contract by giving You notice of Our intention to do so as follows; to withdraw, terminate or cancel the cover, 90 days notice, to vary the cover provided, 30 days notice, to alter the rates of premium (other than any statutory tax changes) charged during the period of cover, 30 days notice. The minimum period between consecutive changes will be 180 days. If You do not have a monthly premium renewable insurance contract, then You will not be affected by these possible changes.

If You are not satisfied that this insurance is suitable for Your requirements, You may write to Us within 14 days of the Start Date and We will cancel Your cover from the Start Date without charge.

7. Definitions
In this Certificate, Your application and Insurance Schedule or anything attached to or subsequently endorsed hereon, the following words and expressions have the following meaning(s) wherever they may appear

Administrator Adminicle Ltd, Callidus House, Cirencester Business Park, Love Lane, Cirencester GL7 1XD

Disability, Disabled An illness, disease, condition or injury which stops You from doing Your job or any similar job. It must also stop You from doing any paid Work which Your experience, education or training reasonably qualifies You to do. If You are Self Employed, a Disability must stop You from helping, managing or carrying out any part of the day-to-day running of a business.

Doctor A registered medical practitioner, practicing in the United Kingdom. This does not include You or Your relatives except when disclosing a pre-existing condition as detailed in Sections 1 and 4 of this Certificate.

End Date The date that cover ceases under this insurance as detailed in Section 6 of this Certificate.

Exclusion Period The period shown in Section 4 above and on Your schedule of insurance. This period immediately follows the Start Date of Your insurance

Joint Applicants Two people who are responsible for the regular monthly payments stated in the application Schedule.

Monthly Benefit The amount equal to the payments that You must make every month under any Mortgage, Rental and/or Loan agreement(s) plus all other regular payments as stated on Your application Schedule up to a total of £1,000 or 50% of Your gross monthly income whichever is the less (unless Your schedule of Insurance shows a different amount). If You are Joint Applicants, the Monthly Benefit will be the percentage shown in Your application and Insurance Schedule.

Permanently Retire When You have stopped Working and You have no intention of returning to work in the future.

Self Employed Means that You are helping with, managing or carrying on a business in the United Kingdom and are liable to pay tax under Schedule D Case I, II, IV and V of the Income and Corporation Taxes Act 1988. We will also consider You to be self employed if You are a partner in a partnership or, a person who exercises direct or indirect control over a company (but not necessarily the majority shareholder or holder of the majority voting rights) or, if You are Working for a company which is in any way connected with a relative (by blood or marriage) who has control over that company.

Start Date The requested date stated on Your application as shown on Your Schedule of Insurance.

Unemployment, Unemployed Being out of Work and receiving the correct class of National Insurance credits by reason of Unemployment, unless You have been entitled to make reduced National Insurance contributions in the past or You are a woman who has reached the state retirement age of 60. You must be actively looking for Work. We will not consider You as Unemployed for any day that You receive pay in lieu of notice.

We, Us, Our, Underwriters The National Insurance & Guarantee Corporation Ltd

You, Your, Insured The person or persons stated in the application, each satisfying the eligibility requirements set out in Section 1 of this Certificate.

Work, Working Working in paid employment for at least 20 hours or more a week in the United Kingdom. This includes You if You are Self Employed. You must also be paying the correct class of National Insurance Contributions.

8. Important Notices
Data Protection. The data supplied by You will only be used for the purposes of processing Your policy of insurance, including underwriting, administration and handling any claim which may arise. The data supplied will not be passed to any other parties other than those which are mentioned below. It is important that the data You have supplied is kept up to date. You should therefore notify Us promptly of any changes so that We may update Our records.

You are reminded that it is essential You provide all material information likely to influence the acceptance and assessment of this insurance. If You have any doubts as to whether a fact is material, it should be disclosed. Failure to disclose any material facts may invalidate Your policy or may result in Your policy not operating fully. We may also respond to enquiries by the Police concerning Your policy in the normal course of their investigations. Where it is necessary to administer Your policy effectively or to protect Your interests, We may disclose the personal data You have supplied to other third parties such as solicitors, loss adjusters, other insurers etc. We may also if necessary contact other parties requesting sensitive data, these may include doctors, hospitals, consultants, employers etc., but We will ensure that We obtain Your consent to approach such other parties prior to doing so. You should show this notice to any person directly or indirectly insured under this Policy about whom personal information has been supplied.

If You are a resident of the European Union, then the parties completing this Contract are free to choose the law applicable to this Contract. However, unless it is specifically agreed to the contrary, the Contract shall be subject to English Law.

Any enquiry or complaint You may have about this contract should be addressed in the first instance to the Administrator. Please be ready to quote Your Certificate Number so that Your enquiry or complaint may be dealt with promptly. If You are not satisfied with the way that Your enquiry or complaint has been dealt with, You may contact the Underwriters to review Your case without prejudice to Your rights in Law, the address is:

The National Insurance & Guarantee Corporation Ltd, Special Risks Division, Crown House, 145 City Road, London EC1V 1LP

If the matter remains unresolved and once the above have been contacted, then You can approach the Financial Ombudsman Service at South Quay Plaza, 183 Marsh Street, London E14 9SR.

The Underwriters, Adminicle and Goodfellows are members are regulated by the Financial Services Authority (FSA).

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