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Income protection policy wording:
This Document Certifies that in accordance with the authorisation
granted by the National Insurance & Guarantee Corporation
Ltd (NIG) and in consideration of the premium, Underwriters
are hereby bound to insure in accordance with the terms and
conditions contained herein or endorsed hereon.
This Document Certifies that in accordance with the authorisation
granted by the National Insurance & Guarantee Corporation
Ltd (NIG) and in consideration of the premium, Underwriters
are hereby bound to insure in accordance with the terms and
conditions contained herein or endorsed hereon.
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 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.
2. 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 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 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 Applicants, We
will pay to each of You in the percentages shown on Your application
Schedule.
- The maximum combined 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. 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 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 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 Insurance Brokers Council are
members of the General Insurance Standards Council.
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