Making a claim
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Your employee, their spouse, partner or a child, must have been diagnosed with a critical illness or undergone a specified operation that meets our policy definition, and have survived for at least 14 days.
You'll need to let us know about a claim as soon as possible, no later than three months after the diagnosis of a critical illness or operation covered by the policy (or as soon as reasonably practicable). Once we receive that information, we’ll aim to make things as simple as possible for you and your employee.
Starting a claim
A claim can be started by calling or emailing us. We'll then send out two claim forms:
- The first will be for you, as the policyholder, we'll ask you for confirmation of general cover details, and this form will need to be signed by one of your officials (often a director of the firm or your company secretary).
- The other form will be for your employee or their spouse/civil partner, asking for more specific information about the illness or operation and any treatment.
Everything is handled sensitively, and all of our documentation remains confidential. We realise that a claim like this can have a significant effect on staff morale, as well as affect productivity. We'll try to make everything as stress-free as possible and if we need extra information, such as birth certificates or medical reports, we'll let you know.
With our experience in the Group Protection market, we always try to provide support for you and your employees if they need to make a claim. We'll also help family members affected with the illness deal with the practical and financial strains. Our claims team are trained to deal with the sensitive and emotional nature of a Group Critical Illness claim, and we'll support and answer any queries you or your employees may have.
Assessing and paying a claim
When we have all the information we require, we'll assess the claim. If we require more medical details, we'll pay for all associated costs. There may be circumstances when we require an independent medical examination, but we'll let you know if this is the case.
When we accept a claim and agree to make a payment we will let you and your employee know and the lump sum will be sent directly to your employee. For claims relating to illness or operation suffered by a spouse, partner or an employee's child, once their claim has been paid out their cover will cease.
For claims relating to the employee, the cover will still continue for that employee but we won’t pay any second claim for the same related critical illness or operation (except for cancer relating conditions where we provide some cover for second and subsequent cancer conditions). We treat illness or operation in those circumstances as a pre-existing condition. However, if one of your employees has been paid a lump sum and then suffer a different critical illness or undergo a further operation covered by the policy, we may also pay a lump sum.
If we don't pay a claim and you disagree with our decision, we will consider any appeal with new medical evidence that supports the view that the diagnosis meets the definition within our policy. Please see our Group critical illness policy (PDF 910KB) or technical guide (PDF 1030KB) for full details.