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Make a claim

Online claims notification form

This form gives us basic details of your claim. When you’ve submitted it, one of our claims team will be in touch to let you know what happens next, and whether we need any more information from you.

Online claim form

Section 1: Choose type of claim

All fields marked with an * are mandatory.

Section 2: Deceased's details

Only complete this section if you are making a death claim.

Please list all the causes (including secondary causes) that are listed on the death certificate. If you have a coroner’s interim certificate, list the preliminary findings or state if no details were given.

Section 3: Claimant's details

Only complete this section if you are making a death claim.

If you’re completing this form on behalf of the claimant, please give us their relationship to the deceased, not your own.

Section 2: Claimant's details

Only complete this section if you are making a critical illness, terminal illness or total permanent disablement claim.

Section 3: Details of your claim

Only complete this section if you are making a critical illness, terminal illness or total permanent disablement claim.

Please give a brief description of the condition you're claiming for.

Please note, we are not open bank holidays or weekends.

Section 2: Claimant's details

Only complete this section if you are making a waiver of premium claim.

Section 3: Details of your claim

Only complete this section if you are making a waiver of premium claim.

Please tell us when the person covered last worked, what their job was, when they became incapacitated, why they are unable to work, and when they will be able to return to work (if known).

Please note, we are not open bank holidays or weekends.

WC05167 11/2012