Claim Forms
The Claim Form should be fully completed, signed and returned to us. You will find details of our address and contact number here. Please call us if you need help or have any questions. This also has our phone number which you can use if you need help completing the form.
If we have to request further information to be able to assess your claim we will always let you know. Once we have received all of the information required to assess your claim we will write to you and let you know our decision within 7 working days. If you do not see your policy type below, please call us here.
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10 results match your search
Accident Cash Plan
September 27, 2020
This Accident Cash Plan pays out benefit for every day of hospitalization in the UK as a direct result of an accident in the UK or an out of country territory (AR1, 2AR, 3AR, AR4, XR1)
Download Accident Cash Plan Claim Form
| PDF | 32 KB | September 27, 2020
Accident Cash Plan Supplemental
September 27, 2020
This Accidental Cash Plan pays out benefit for every day of hospitalisation in the UK as a direct result of an accident in the UK or an out of country territory. Enhanced benefits are paid for every day of hospitalisation in an out of country territory as a direct result of an accident in an out of country territory. We agree to provide the insurance cover described in this supplemental policy to insured persons provided that the premium is paid when it is due and we agree to accept it. (ARR)
Download Hospitalisation Claim Form
| PDF | 32 KB | September 27, 2020
Accidental Death Claim Form
September 27, 2020
This Accidental Death Policy provides two distinct types of benefit: a one-off cash payment in the event of an insured adult suffering an accidental death, the amount depending on the type of accident; and a one-off cash payment in the event of an insured child suffering an accidental death (1AD, 2AD, AD1, AD5, AD7, RD1, UD1, XD1, U1D, A1D, XD2, 3AD)
Download Accidental Death Claim Form
| PDF | 34 KB | September 27, 2020
Cash Replacement Plan
September 27, 2020
This Cash Replacement Plan provides the policyholder with the following benefits: Incapacity benefits for each continuous day after the deferred period you are incapacitated due to a sickness or a bodily injury as a direct result of an accident; and (if indicated on the schedule) Unemployment benefits for each continuous day after the deferred period you are no longer in full-time work and are registered as being unemployed (AS1) Pleas select one form depending on the claim.
Disability Injury Supplemental Plan
September 27, 2020
This Disability Injury Plan provides the following benefits ; Incapacity benefits for each continuous day after the deferred period that an insured adult is incapacitated due to a bodily injury as a direct result of an accident that is certified by a doctor ; A one off permanent total disability benefit once the insured adult has received at least 12 incapacity benefit payments and is certified by a doctor as suffering a permanent total disability To take out this policy, you and your partner (if chosen to be covered) must be: have an active accidental death plan policy, accident cash plan policy or life protection plan policy provided by us (TDR)
Downloadability Injury Supplemental Plan Claim Form
| PDF | 59 KB | September 27, 2020
Disability Injury Supplemental Plan
May 12, 2021
This Disability Injury Plan provides the following benefits Incapacity benefits for each continuous day after the deferred period that an insured adult is incapacitated due to a bodily injury as a direct result of an accident that is certified by a doctor ; A one off permanent total disability benefit once the insured adult has received at least 12 incapacity benefit payments and is certified by a doctor as suffering a permanent total disability (TDP)
Download Loss of Use Claim Form
| PDF | 59 KB | September 27, 2020
Drivers Protection / Accidental Death Supplemental Plan
May 27, 2020
This Accidental Death Policy provides two distinct types of benefit: a one-off cash payment in the event of an insured adult suffering an accidental death, the amount depending on the type of accident; and a one-off cash payment in the event of an insured child suffering an accidental death. We will pay the benefit shown on the schedule under i. Road Traffic Accidents for the accidental death of an insured adult or an insured child as a direct result of; • a collision or crash of a motor vehicle on a public roadway while the motor vehicle is in motion and operated under its own power or; • being struck as a pedestrian by a motor vehicle on a public roadway while the motor vehicle is in motion and operated under its own power (RT1)
Download Accidental Death Claim Form
| PDF | 34 KB | September 27, 2020
Permanent Disability Injury Supplementall Plan
September 27, 2020
This Permanent Disability Injury Plan pays out a cash benefit in the event an insured adult or insured child suffers a permanent disability following an accident (PDR)
Download Loss of Use Claim Form
| PDF | 50 KB | September 27, 2020
Personal Accident Plan
September 27, 2020
This Personal Accident Policy provides the following four types of benefit: a one-off cash payment in the event of an insured adult or insured child suffering accidental death ; a one-off cash payment in the event of an insured adult or insured child suffering disability following an accident ; a daily cash payment in the event of hospitalisation in the UK following an accident in the UK or an out of country territory ; enhanced daily benefits for hospitalisation in an out of country territory as the direct result of an accident in an out of country accident (PA1, PA7, 4PA) Please select one form depending on what the claim is for.
Serious Illness Cash Plan
September 27, 2020
This Serious Illness Cash Plan pays out the following benefits : a daily cash payment in the event of hospitalisation in the UK as a direct result of an illness ; a cash payment for outpatient treatment at a hospital in the UK as a result of an illness (SE1)
Download Hospitalisation Claim Form
| PDF | 32 KB | September 27, 2020