Claims

General conditions for making a claim

The policy only pays out if: 

your unemployment or disability occurs after the start date and before the end date; 

you meet all the claim requirements under these policy terms and conditions;

you have paid all your premiums; and you give us all the evidence we need to check your claim.

You cannot claim for unemployment and disability at the same time. 

If you restrict your insurance to unemployment only cover or disability only cover, the administrator will only pay for a claim arising from the specific type of cover you have selected.

The administrator will reduce your monthly benefit if it is more than 65% of your normal income.

If you have any other unemployment or disability insurance, the administrator reserves the right to reduce your monthly benefit by an amount equal to the claim benefits you receive under that insurance.

You can transfer a claim between unemployment and disability (or vice versa) but if you do, the administrator will not pay more than 12 monthly benefit payments for that period of claim. 
You can make a completely new claim under the policy as long as you have returned to work for at least 90 days in a row. The administrator will treat two claims separated by less than 90 days work in a row as the same period of claim and you will only be entitled to receive the balance of any monthly benefit payments left from the previous period of claim. The administrator will reduce this period to 30 days for any claim arising from a medical condition that is not related to the disability that brought about the previous claim.

The administrator will not pay any monthly benefit if you give us any false, misleading or fraudulent information, or if you fail to tell us about any important fact.

If you make a claim for unemployment and you are offered a temporary job, you can suspend your claim provided that:

you tell the administrator beforehand who you will be working for;

your temporary job lasts for at least one week and no longer than six months; and

you do not have more than three separate temporary jobs during any one period of claim.

What to do if you have to make a claim

If you want to make a claim under the policy, you should contact:

Paymentshield Claims Department
P O Box 229, Southport, PR9 9WU.
Phone: 0870 759 4020; Fax: 0870 759 4021

They will send you a claim form which you must fill in and return as soon as possible, together with any further evidence needed. You will also need to provide the following information:

unemployment - evidence that you are still unemployed and actively looking for work; or 

disability - evidence that you are still disabled and that you are still under the regular care and attendance of a doctor (or consultant).

When the administrator will make claim payments

Your initial claim payment will be made on the first day immediately after the waiting period. 
After that, the administrator will pay an amount equal to 1/30th of the monthly benefit for each day you are still unemployed or disabled. The administrator will continue to make payments monthly in arrears until the earliest of the following events:

the last day you are unemployed or disabled;

the date on which you stop giving us evidence that you are still unemployed or disabled;

the date on which you have received 12 monthly benefit payments for any one claim; or

the end date of the policy.

Obligations and rights when making a claim

You must have an independent medical examination if the administrator believes it necessary to validate your claim (the administrator will pay the cost of the examination). If you fail or refuse to have a medical examination and you do not give the administrator a satisfactory reason, the administrator will not pay any monthly benefit.

The administrator reserves the right to contact any other person or organisation that they consider necessary to assist in the validation of your claim and where necessary, you must provide the relevant authority to obtain this information. The administrator can also ask to see your personal bank or financial statements.

The administrator may arrange a personal interview with you to help you look for further permanent work.

The administrator will only begin to make monthly benefit payments when they receive full and satisfactory evidence of your eligibility to claim. If you delay sending the claim form or any other evidence required, your claim may be harder to check. This may lead to paying monthly benefit late or not paying it at all.