SHORTâTERMâINCOMEâINSURANCE
WITHâEMPLOYMENTâLEGALâPROTECTIONâ
INCLUDINGâHEALTHâASSISTANCE
Customer Helpline 0345 6011 050Claims Helpline 0345 601 1060
Policy DocumentCOV/PS/002
IncomeShield
Contents
PageShort Term Income Insurance1. Introduction
2. ChangingâYourâMindâ-âYourâCancellationâRightsâ&âImportantâNumbers
3. Eligibility
4. ImportantâNotesâ&âChangingâLevelâofâBenefit/Circumstances
5. AccidentâandâSicknessâ(Disability)âBenefitsâ-âwhatâisâcovered
7. AccidentâandâSicknessâ(Disability)âExclusionsâ-âwhatâisânotâcovered
8. UnemploymentâBenefitsâ-âwhatâisâcovered
12. YourâClaim
14. WhatâifâyouâwantâtoâseekâworkâinâtheâEuropeanâUnionâ(EU)?
16. Premiums
17. WhenâDoesâYourâPolicyâEnd
18. TermsâandâConditions,âInvalidâMonthlyâBenefitâPayments
19. GeneralâInformation
20. PromiseâofâService,âComplaintsâProcedure
21. DataâProtectionâAct
22. Definitions
Employment Legal Protection including Health Assistance25.âIntroductionâandâDefinitionsâforâEmploymentâLegalâProtectionâ
27.âTableâofâCoverâ
30.âGeneralâConditionsâ
33.âClaimsâandâHelplineâInformation,âCounsellingâService
34.âComplaintsâProcedure,âFinancialâServicesâCompensationâScheme,âDataProtection
IntroductionThis policy isâdesignedâtoâprotectâyour incomeâinâtheâeventâofâan accident, sickness and/orâunemployment,(dependingâonâtheâlevelsâofâcoverâselectedâbyâyou)âprovidingâyou meetâtheâeligibilityâcriteriaâsetâoutâinâtheâEligibilityââSectionâandâhaveâpaidâtheâmonthly premium whenâdue.ââThisâpolicy togetherâwithâthe certificateof cover providesâyou withâeverythingâyou needâtoâknowâaboutâyour coverâandâcontainsâallâtheâcontractualtermsâandâconditionsâofâyour coverâincludingâtheâexclusions.ââPleaseâmakeâsureâthatâyou:
⢠areâeligibleâforâtheâinsuranceâcover;⢠knowâwhatâthisâinsuranceâdoesâandâdoesânotâcover;⢠knowâwhatâinsuranceâcoverâyou haveâchosen;⢠understandâhowâchanges in your employmentâaffectâeligibility;âand⢠understandâtheâtermsâandâconditionsâforâmakingâaâclaim.
Thereâareâ3âlevelsâofâcoverâavailableâunderâthisâinsuranceâcover.ââTheâbenefitsâapplicableâtoâyou dependâontheâlevelâofâcoverâyou selectedâwhenâapplyingâforâthisâinsuranceâorâanyâchangesâyoumakeâduringâtheâlifetimeofâthisâpolicy andâwillâbeâshownâinâyour certificate of cover.ââTheâlevelsâofâcoverâare:
⢠Accident, Sickness andâUnemployment cover⢠Accident andâSickness cover⢠Unemployment cover
Thisâpolicy usesâwordsâandâphrasesâ thatâhaveâspecificâmeanings.â âYou willâ findâ theseâexplainedâ inâ theâDefinitionsââSection.ââDefinedâwordsâareâshownâinââboldââwhereverâtheyâappear.
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Short Term Income Insurance
Changing Your Mind â Your Cancellation Rights (i) Withinâtheââcoolingâoffâperiodâ -âifâyou decideâyou doânotâwantâtheâcoverâandâwishâtoâcancelâyour
policy,âyou canâdoâsoâbyâcontactingâPaymentshield withinâ30âdaysâofâtheâstart date orâtheâdateâyoureceiveâyour policy documents,âwhicheverâisâtheâlaterâ(theââcoolingâoffâperiodâ).ââYou willâreceiveâaâfullrefundâofâanyâmonthly premium paidâprovidedânoâclaimâhasâbeenâmadeâunderâtheâtermsâofâthisâpolicy.Ifâyou haveâmadeâaâclaim,ânoârefundâofâmonthly premium willâbeâpayable.
(ii) Outsideâtheââcoolingâoffâperiodâ -âifâyou cancelâyour coverâafterâtheâcoolingâoffâperiodâyoumayânotâbe
entitledâtoâanyârefundâofâpremiums,âinâorderâtoâdetermineâyour eligibilityâforâaârefundâpleaseâcontactPaymentshield atâtheâaddressâbelow.
(iii) Ifâwe changeâyour monthly premium and/orâvaryâorâwaiveâyour termsâandâconditionsâandâyou doânot
wishâtoâcontinueâyour coverâyou shouldâcontactâPaymentshield toâdiscussâyour options.âDependingâonyour circumstances,âyou mayâbeâableâtoâchangeâyour monthly benefit orâchangeâyour typeâofâcover.Alternativelyâyou canâcancelâwithoutânoticeâandâwithoutâpenalty.âAnyâcancellationâwillâtakeâeffectâatâtheendâofâtheâperiodâforâwhichâyou haveâalreadyâpaidâyour monthly premium.
(iv) Allâcancellationârequestsâshouldâbeâmadeâto:ââ
PaymentshieldâCustomerâServicesâTeam
PaymentshieldâLimited,âPOâBoxâ229,âSouthportâPR9â9WU
PaymentshieldâCustomerâHelpline:â0345â6011â050
Important NumbersIfâyou haveâanyâquestionsâaboutâyour eligibilityâforâthisâinsuranceâorâchangesâtoâyour circumstancesâyoushouldâcall:
PaymentshieldâCustomerâHelpline: 0345â6011â050Linesâopenâbetweenâ8.00am-7.00pmâMondayâtoâFridayâ(8.00am-1.00pmâSaturdays).
Toâregisterâaâclaimâ(orâcheckâprogressâonâaâclaim)âcall:â
PaymentshieldâClaimsâHelpline:â0345â601â1060Linesâopenâbetweenâ9:00amâ-â5:15pmâMondayâtoâFriday.
Ifâyou areâregisteringâaâclaimâyou shouldâreadâtheââYourâClaimââSectionâbeforeâcallingâtoâmakeâsureâyou havetheârelevantâinformationâavailable.âTelephoneâcallsâmayâbeârecordedâandâmonitored.â
CustomersâwithâDisabilitiesThisâpolicy isâalsoâavailableâinâlargeâprint,âaudioâandâBraille.âIfâyou requireâanyâofâtheseâformatsâpleaseâcontact
theâPaymentshield CustomerâHelpline.â
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Eligibility'Toâbeâeligibleâforâthisâinsuranceâyou must:
(i)â beâ18âyearsâorâoverâbutâlessâthanâ64âyearsâofâage;â
(ii)â beâworking forâatâleastâ16âhoursâperâweekâandâliveâinâtheâUnitedâKingdom.âYou willâalsoâbeâeligibleâforâcontinuedâcoverâifâyou worked andâlivedâinâtheâUnitedâKingdomâandâyou areâsubsequentlyâpostedâtoâwork outsideâtheâUnitedâKingdomâfor;
(a)ââtheâBritishâArmedâForcesâorâasâaâcivilâservantâatâaâBritishâEmbassyâorâConsulate;âor
(b)ââyour employerâwhichâisâaâUnitedâKingdomâcompanyâand youâareâassignedâtoâwork withinâtheâEuropeanUnion;âandâ
(iii)â haveâbeenâinâfull-time employment withâtheâcurrentâemployerâforâatâleastâ6âcontinuousâconsecutiveâmonths,âworking underâa fixed-term contract withâtheâcurrentâemployerâforâatâleastâ24âcontinuousâconsecutiveâmonthsâorâself-employment forâatâleastâ6âcontinuousâconsecutiveâmonths,âimmediatelyâbeforeâtheâstart date.
Inâadditionâtoâtheâeligibilityârequirementsâabove,âwe haveâusedâtheâinformationâsuppliedâbyâyou inâyourapplicationâforâthisâpolicy inâmakingâour decisionâtoâofferâyou coverâunderâthisâpolicy.
Self-employed and Fixed-term Contract Workers
Ifâyou areâself-employed orâyou work onâaâfixed-term contract(s) you areâeligibleâforâthisâinsuranceâbutyou shouldâreadâthisâpolicy carefullyâtoâmakeâsureâitâisâsuitableâforâyour needsâ-âyou shouldâpayparticularâattentionâtoâtheâdefinitionsâofâââself-employedâ and âceased tradingâ,âtheâUnemploymentâBenefitâ-âWhatâisâcoveredââSectionâandâtheââYourâClaimââSection.
Ifâyou areâself-employed andâwishâtoâclaimâunemployment benefitâyou willâneedâtoâprovidesatisfactoryâevidenceâthatâyou:â˘âhaveâinvoluntarilyâceased trading;â˘âareâregisteredâasâunemployed withâtheâDepartmentâforâWorkâandâPensionsâJobcentreâPlus;âandâ˘âfulfilâtheâdefinitionâofâunemployed.
Ifâanyâofâtheseâhappenâorâareâlikelyâtoâhappenâtoâyou orâifâyou haveâanyâquestionsâyou shouldcontactâus toâdiscuss.
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Youmustâcontinueâtoâmeetâtheâconditionsâ(i)âandâ(ii)âaboveâtoâremainâeligibleâforâtheâlevelsâofâcoverâthatâapplytoâyou. Ifâyour circumstancesâchangeâasâdescribedâinââChangingâLevelâofâBenefit/CircumstancesââSectionâoryou noâlongerâmeetâtheâconditionsâ(i)âandâ(ii)âaboveâyou shouldâcontact Paymentshield straightâawayâtodiscussâyour options.
Important NotesCertainâcircumstancesâmayâaffectâyour rightâto benefitâifâyou areâawareâofâthemâatâtheâstart date.ââWe willânotpayâanyâbenefitsâunderâthisâpolicy for:
⢠accident or sickness claims:âanyâcondition,âinjury,âillness,âdisease,âsickness orârelatedâconditionâand/orâassociatedâsymptomsâwhetherâspecificallyâdiagnosedâorânot,âwhichâmedicalâevidenceâshowsâyou knewâaboutâorâwereâexperiencingâsymptomsâthatâyou wouldâhaveâbeenâawareâofâatâtheâstart date or,âforâwhichâyou soughtâorâreceivedâadvice,âtreatmentâorâcounsellingâfromâaâdoctor duringâtheâ12âmonthsâimmediatelyâpriorâtoâtheâstart date.
However,âyou willâbeâableâtoâclaimâifâyou haveâbeenâsymptomâfreeâandâhaveânotâconsultedâaâdoctororâreceivedâtreatmentâforâtheâconditionâforâatâleastâ12âmonthsâafterâtheâstart date. PleaseâreferâtoâtheââAccidentâandâSicknessâ(Disability)âExclusionsâ-âwhatâisânotâcoveredââSection;
⢠sickness claims:âany sickness whichâoccursâwithinâtheâinitial exclusion period.âYour certificate of coverwillâconfirmâtheâexclusionâperiodâwhichâappliesâtoâyour policy;
⢠unemployment claims:âanyâunemployment whichâfollowsâanyâannouncementâorâactionâbyâyour employerpriorâtoâthe start date inârelationâtoâtheâdepartmentâorâdivisionâofâtheâbusinessâinâwhichâyou work, andwhichârelatesâtoâanyâredundancies,ââemployeeâconsultations,ârestructures,âmergersâorâreorganisationsthatâhaveâledâorâcouldâleadâtoâcompulsoryâjobâlosses,âmandatoryâreducedâworking hoursâorâmandatoryreductionâinâsalary;
⢠unemployment claims:âanyâunemployment whichâhappensâwithinâtheâinitial exclusion period.Your certificate of cover willâconfirmâtheâexclusionâperiodâwhichâappliesâtoâyour policy;
⢠aâCarerâCoverâclaimâunderâtheââUnemploymentâBenefitsâ-âwhatâisâcoveredââSection,âifâyour immediatefamily memberâ isâ inâ receiptâ ofâ anyâ disabilityâ benefitâ forâ his/herâ conditionâ asâ describedâ byâ theDepartmentâofâWorkâandâPensionsâJobcentreâPlus,âorâyou areâinâreceiptâofâCarerâsâAllowanceâinârelationtoâyour immediate family memberâsâdisability,âasâdescribedâbyâtheâDepartmentâofâWorkâandâPensionsJobcentreâPlus.
Changing Level of Benefit/CircumstancesIfâyouâneedâtoâadviseâusâofâaâchangeâinâyourâcircumstancesâorâwantâtoâapplyâtoâmakeâaâchangeâtoâyourinsurance,âpleaseâcallâtheâPaymentshieldâCustomerâHelpline.
⢠Weâwillâcheckâthatâyouâremainâeligibleâforâthisâinsuranceâand,âifâweâagreeâtoâtheâchange,âweâwillexplainâwhichâofâtheâtermsâandâconditionsâdetailedâinâthisâpolicyâwillâapplyâtoâyourâinsurance.âWeâwillâalsotellâyouâifâtheâchangeâresultsâinâanyârefundâorâchangeâtoâyourâpremiumâand/orâaâcancellationâofâyourinsuranceâasâspecifiedâinâtheââWhenâDoesâYourâPolicyâEndââsection.
⢠Weâwillâconfirmâeverythingâinâwritingâsoâyouâareâentirelyâclearâaboutâwhatâtheâchangesâmean.
ChangingâYourâCover
Youâcanâapplyâtoâmakeâchangesâtoâyourâcover.âIfâyouâchooseâtoâincreaseâyourâcoverâtheâstartâdateâofâthechangeâwillâbeâ90âdaysâfromâtheâdateâonâwhichâweâacceptâyourânotification.
Ifâyouâchooseâto;⢠reduceâyourâmonthlyâbenefitâamountâforâwhateverâreason⢠increaseâyourâqualificationâperiodâandâtype
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⢠reduceâyourâtypeâofâcoverâfromâaccident,âsicknessâ&âunemploymentâcoverâtoâaccidentâ&âsicknessâonlyâcover⢠reduceâyourâmaximumâbenefitâperiodâtheâstartâdateâofâtheâchangeâwillâbeâfromâtheâdateâweâreceiveâ
yourânotification
Youâcannotâalterâyourâcoverâorâmonthlyâbenefitâduringâaâperiodâofâclaim.
ReviewingâYourâMonthlyâBenefit
ItâisâYour responsibilityâtoâensureâthisâpolicyâandâtheâchosenâmonthlyâbenefitâcontinuesâtoâmeetâyourrequirements.
Accident and Sickness (Disability) Benefits - what is coveredThisâcoverâonlyâappliesâifâitâisâspecifiedâinâyour certificate of cover.
(i) Your certificate of cover willâshowâtheâtypeâofâcoverâyou haveâselectedâandâtheâqualification period thatappliesâtoâyou.
Optionâ1â-â30âdayâqualification periodâ-âBackâtoâdayâ1âcover
Ifâafterâtheâstart date andâbeforeâtheâend date anâaccident orâsickness preventsâyou fromâworking for30âconsecutiveâdaysâorâmore,âwe willâpay:
(a) theâmonthly benefit forâtheâfirstâ30âdaysâyou areâunfitâforâwork;âand
(b) thereafter,â1/30th ofâtheâmonthly benefit forâeachâcontinuousâdayâyou remainâunfitâforâwork.
Optionâ2â-â30âdayâqualification periodâ-âExcessâcover
Ifâafterâtheâstart date andâbeforeâtheâend date anâaccident orâsickness preventsâyou fromâworking for30âconsecutiveâdaysâorâmore,âwe willâpayâfromâtheâ31st dayâonwards,â1/30th ofâtheâmonthly benefit foreachâcontinuousâdayâyou areâunfitâforâwork.
Optionâ3â-â60âdayâqualification periodâ-âExcessâcover
Ifâafterâtheâstart date andâbeforeâtheâend date anâaccident orâsickness preventsâyou fromâworking for60âconsecutiveâdaysâorâmore,âwe willâpayâfromâtheâ61st dayâonwards,â1/30th ofâtheâmonthly benefit foreachâcontinuousâdayâyou areâunfitâforâwork.
Optionâ4â-â90âdayâqualification periodâ-âExcessâcover
Ifâafterâtheâstart date andâbeforeâtheâend date anâaccident orâsickness preventsâyou fromâworking for90âconsecutiveâdaysâorâmore,âwe willâpayâfromâtheâ91st dayâonwards,â1/30th ofâtheâmonthly benefit foreachâcontinuousâdayâyou areâunfitâforâwork.
Optionâ5â-â180âdayâqualification periodâ-âExcessâcover
Ifâafterâtheâstart date andâbeforeâtheâend date anâaccident orâsickness preventsâyou fromâworking for180âconsecutiveâdaysâorâmore,âwe willâpayâfromâtheâ181st dayâonwards,â1/30th ofâtheâmonthly benefit foreachâcontinuousâdayâyou areâunfitâforâwork.
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Theâmonthly benefit willâbeâpaidâmonthlyâinâarrearsâprovidedâyou meetâtheâtermsâandâconditionsâofâthispolicy.
(ii) Toâreceiveâtheâmonthly benefit you must:
(a) beâinâfull-time employment orâself-employment whenâyour accident occursâorâsickness begins;
(b) beâunderâtheâregularâmedicalâcareâasâdirectedâbyâyour doctor;
(c) beâpreventedâfromâworking onlyâasâaâresultâofâtheâaccident orâsickness;
(d) notâbeâreceivingâtheâmonthly benefit forâunemployment forâtheâsameâperiod;âand
(e) giveâus anyâevidenceâ(asâlistedâinâSectionââYourâClaimââ(ii))âwe askâforâinâorderâtoâprove your claimisâvalidâandâcontinuesâtoâbeâso.
(iii) Whenâpayingâyour claim we willâconsiderâtheâfirstâdayâofâyour accident orâsickness toâbeâtheâdayâadoctor certifiesâthatâyou areâunfitâforâwork.
(iv) We willâcontinueâtoâpayâtheâmonthly benefit until:
(a) we haveâpaidâtheâmaximumânumberâofâmonthly benefit paymentsâinârespectâofâaâsingle accidentandâsickness claimâasâshownâonâyour certificate of cover;
(b) you returnâtoâfull-time employment orâself-employment;
(c) you failâtoâprovideâevidenceâ(asâlistedâinâSectionââYourâClaimââ(ii))âtoâproveâyour claimâremainsâvalidâandâcontinuesâtoâbeâso;âor
(d) theâend date;â
whicheverâhappensâfirst.
(v)âCanâyou work whilstâyou areâclaiming?
Ifâyou areâinâfull-time employment -âifâyou makeâaâvalidâclaimâandâyour doctor confirmsâthatâbecauseâofâ your conditionâyou mustâreturnâtoâwork graduallyâoverâaâperiodâofâtime,âwe willâcontinueâtoâpayâyour monthly benefit atâtheâsameârateâuntilâyou areâworking atâleastâ16âhoursâperâweek,âorâyourdoctor confirmsâyour accident or sickness noâlongerâpreventsâyou fromâworking forâatâleastâ16âhoursâperâweek,âsubjectâtoâtheâtermsâandâconditionsâofâthisâpolicy.
Ifâyou haveâmadeâanâaccident or sickness claimâandâthenâfindâalternativeâpart-timeâwork forâlessâthanâ16âhoursâperâweek,âyou willâstillâbeâableâtoâclaimâforâaccident andâsickness benefitâprovidedâthatâyou areinâreceiptâofâEmploymentâandâSupportâAllowance.
Ifâyou areâself-employed - you mustânotâdoâanyâworkâincludingâhelping,âmanagingâorâcarryingâonâanyâpartâofâtheârunningâofâaâbusinessâwhilstâyou areâclaimingâandâyou mustânotâbeâreceivingâanyâformâofâpaymentâwhilstâyou areâclaiming.
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(vi) FutureâClaims
(a) You mayâmakeâaâfurtherâaccident andâsickness claim:
(i) forâ anâ unrelatedâ condition -â ifâ you haveâ returnedâ toâ full-time employment orâ self-employment forâatâleastâ1âmonthâfollowingâtheâpreviousâaccident andâsickness claim,âunlessparagraphâ(b)âbelowâapplies;âor
(ii) forâtheâsameâorâaârelatedâcondition -âifâyou haveâreturnedâtoâfull-time employment orâself-employment forâatâleastâ3âconsecutiveâmonthsâfollowingâtheâpreviousâaccident orâsicknessclaim,âunlessâparagraphâ(b)âbelowâapplies.
However,â ifâ twoâaccident orâsickness claimsâ (eachâresultingâfromâtheâsameâorâaârelatedcondition)âareâseparatedâbyâlessâthanâ3âconsecutiveâmonthsâofâfull-time employment orâself-employment,âwe willâtreatâthemâasâoneâcontinuousâclaimâforâtheâpurposesâofâcalculatingâthemaximumâmonthly benefits payable,âbutânoâbenefitâwillâbeâpayableâforâtheâtimeâinâbetween.
(b) Ifâwe haveâpaidâtheâmaximumâmonthly benefits forâaâsingleâclaim,âyou mayâonlyâmakeâaâfurtheraccident andâsickness claimâ(whetherâresultingâfromâaârelatedâorâunrelatedâcondition)âprovidedyou haveâreturnedâtoâfull-time employment orâself-employment forâatâleastâ3âconsecutiveâmonths.
Statutoryâmaternityâorâpaternityâleaveâcanâformâpartâorâallâofâtheâ1âorâ3âmonthâperiodsâinâ(a)âandâ(b)above.
(vii) Pregnancy andâchildbirthâ-âwe willâpayâbenefitâforâanyâaccident or sickness resultingâfromâanyâsymptom(s)of,âorâcomplication(s)âofâpregnancyâandâchildbirthâwhichâaâdoctor certifiesâpreventsâyou fromâworking,andâwhichâisânotâexcludedâunderâanyâotherâexclusionsâlistedâinâthisâpolicy.ââHoweverânoâbenefitâwillâbepayableâforânormal pregnancy andâchildbirthârelatedâconditions.
(viii) Theâmaximumâmonthly benefit payableâunderâthisâpolicy isâÂŁ2,000âorâ65%âofâyour gross monthlyincome,âwhicheverâisâless.
(ix) Ifâyour doctor certifiesâthatâyou mustâreturnâtoâwork gradually,âwe willâdeductâyour monthlyâearningsfromâyour monthly benefit andâpayâyou theâdifference.
Accident and Sickness (Disability) Exclusions - what is not coveredWe willâ notâ payâ anyâ accident andâ sickness benefitâ ifâ your accident orâ sickness resultsâ fromâ orâ asâ aconsequenceâofâtheâfollowing:
(i) anyâsickness withinâtheâinitial exclusion period;
(ii) anyâpre-existing medical condition -âthisâexclusionâdoesânotâapplyâifâyou haveâbeenâsymptomâfreeâandhaveânotâconsultedâaâdoctor orâreceivedâtreatmentâforâtheâcondition,âforâatâleastâ12âmonthsâafterâthestart date;
(iii) aâself-inflictedâinjury;
(iv) civilâunrest,âterrorism,âriotâorâinsurrection,âwarâorâanyâactâincidentalâtoâwarâ(whetherâdeclaredâorânot)âorbeingâonâactiveânaval,âmilitaryâorâairâforceâduty,âserviceâorâanyâtypeâofâassociatedâorâsimilarâoperations;
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(v) beingâunderâtheâinfluenceâof,âorâbeingâaffectedâby,âalcoholâorâdrugsâunlessâprescribedâbyâaâdoctor (otherthanâprescribedâforâtheâtreatmentâofâdrugâaddictionâorâalcoholâdependency);
(vi) anyâsurgicalâprocedureâtakenâatâyour ownârequest,âwhichâisânotâmedicallyânecessaryâtoâsustainâyourqualityâofâlife,âorâcosmeticâsurgeryâunlessâdirectlyâattributableâtoâphysicalâinjury,âdiseaseâorâsickness;âor
(vii) ionisingâradiationâorâradioactiveâcontaminationâfromânuclearâfuel,âwasteâorâequipment.
Unemployment Benefits - what is coveredThisâlevelâofâcoverâonlyâappliesâifâitâisâspecifiedâinâyour certificate of cover.
(i) Your certificate of cover willâshowâtheâtypeâofâcoverâyou haveâselectedâandâtheâqualification period thatappliesâtoâyou.
Optionâ1â-â30âdayâqualification periodâ-âBackâtoâdayâ1âcover
Ifâafterâtheâstart date andâbeforeâtheâend date you areâunemployed forâ30âconsecutiveâdaysâorâmore,we willâpay:
(a) theâmonthly benefit forâtheâfirstâ30âdaysâyou areâunemployed;âand(b) thereafter,â1/30th ofâtheâmonthly benefit forâeachâcontinuousâdayâyou remainâunemployed.
Optionâ2â-â30âdayâqualification periodâ-âExcessâcover
Ifâafterâtheâstart date andâbeforeâtheâend date you areâunemployed forâ30âconsecutiveâdaysâorâmore,we willâpayâfromâtheâ31st dayâonwards,â1/30th ofâtheâmonthly benefit forâeachâcontinuousâdayâyou remainunemployed.
Optionâ3â-â60âdayâqualification periodâ-âExcessâcover
Ifâafterâtheâstart date andâbeforeâtheâend date you areâunemployed forâ60âconsecutiveâdaysâorâmore,we willâpayâfromâtheâ61st dayâonwards,â1/30th ofâtheâmonthly benefit forâeachâcontinuousâdayâyou remainunemployed.
Optionâ4â-â90âdayâqualification periodâ-âExcessâcover
Ifâafterâtheâstart date andâbeforeâtheâend date you areâunemployed forâ90âconsecutiveâdaysâorâmore,we willâpayâfromâtheâ91st dayâonwards,â1/30th ofâtheâmonthly benefit forâeachâcontinuousâdayâyou remainunemployed.
Optionâ5â-â180âdayâqualification periodâ-âExcessâcover
Ifâafterâtheâstart date andâbeforeâtheâend date you areâunemployed forâ180âconsecutiveâdaysâorâmore,we willâpayâfromâtheâ181st dayâonwards,â1/30th ofâtheâmonthly benefit forâeachâcontinuousâdayâyouremainâunemployed.
Theâmonthly benefit willâbeâpaidâmonthlyâinâarrearsâprovidedâyou meetâtheâtermsâandâconditionsâofthisâpolicy.
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(ii) Toâreceiveâtheâmonthly benefit you must:
(a) haveâbeenâinâfull-time employment forâatâleastâ9âcontinuousâconsecutiveâmonthsâ(6âifâyou areâaânewborrower),âorâself-employment orâworking onâaâfixed-term contract forâatâleastâ24âcontinuousconsecutiveâmonths,âimmediatelyâpriorâtoâtheâstart date;
(b) satisfyâtheâdefinitionâofâunemployed setâoutâinâtheââDefinitionsââSectionâ(andâifâyou wereâself-employed,âyou mustâhaveâceased trading);
(c) notâbeâreceivingâtheâmonthly benefit forâaccident or sickness forâtheâsameâperiod;âand
(d) provideâus withâanyâevidenceâwe askâforâ(asâlistedâinâSectionââYourâClaimââ(iii))ââinâorderâtoâproveâyour claimâisâvalidâandâcontinuesâtoâbeâso.
(iii) Whenâpayingâyour claim,âwe willâconsiderâyour firstâdayâofâunemployment toâbeâtheâdayâyou areâfirstregisteredâasâunemployed withâtheâDepartmentâforâWorkâandâPensionsâJobcentreâPlusâorâequivalentgovernmentâdepartmentâinâNorthernâIreland,âtheâChannelâIslandsâorâaâEuropeanâUnionâmemberâstate.You willânotâbeâconsideredâtoâbeâunemployed forâdaysâforâwhichâyou receiveâpaymentâinâlieuâofânotice.
(iv) We willâcontinueâtoâpayâtheâmonthly benefit until:â
(a) we haveâ paidâ theâ maximumâ numberâ ofâmonthly benefit paymentsâ inâ respectâ ofâ aâ singleunemployment claimâasâshownâonâyour certificate of cover;
(b) you returnâto full-time employment orâself-employment;
(c) you failâtoâsatisfyâtheâdefinitionâofâunemployment setâoutâinâtheââDefinitionsââSection;
(d) you failâtoâprovideâus withâevidenceâ(asâlistedâinâSectionââYourâClaimââ(iii))âtoâproveâyourclaimâremainsâvalidâandâcontinuesâtoâbeâso;âor
(e) theâend date;
whicheverâhappensâfirst.
CarerâCoverâ
(a) ifâyou areâunemployed asâaâresultâofâyou becomingâaâcarer,âwe willâconsiderâanâunemployment claimâifâyou canâprovideâevidenceâasâlistedâinâSectionââYourâClaimââ(iii)âthatâyou are:
(i)â requiredâtoâcareâforâaâmemberâofâyour immediate family; and
(ii)â inâreceiptâofâCarerâsâAllowanceâfromâtheâDepartmentâforâWorkâandâPensionsâJobcentreâPlusâorâsuchgovernmentâofficeâwhichâreplacesâit;âand
(b)â we willânotâpayâbenefitsâunderâthisâpolicy forâaâcarerâcoverâclaimâifâatâtheâstart date:
(i)â your immediate family memberâwasâinâreceiptâofâanyâaccident or sickness benefitâforâhis/herâconditionâasâdescribedâbyâtheâDepartmentâofâWorkâandâPensionsâJobcentreâPlus;âor
(ii)â you wereâinâreceiptâofâCarerâsâAllowanceâasâdescribedâbyâtheâDepartmentâofâWorkâandâPensionsâJobcentreâPlus.
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(v) FutureâClaims
You mayâmakeâaâfurtherâunemployment claimâifâyou haveâreturnedâtoâfull-time employment orâself-employment forâatâleastâ3âconsecutiveâmonthsâfollowingâtheâpreviousâunemployment claim.
However,âifâtwoâperiodsâofâunemployment areâseparatedâbyâlessâthanâ3âconsecutiveâmonthsâofâfull-timeemployment orâself-employment,âwe willâtreatâthemâasâoneâcontinuousâperiodâofâunemployment fortheâpurposesâofâcalculatingâtheâmaximumâmonthly benefits payable,âbutânoâbenefitâwillâbeâpayableâfortheâtimeâinâbetween.
Statutoryâmaternityâorâpaternityâleaveâcanâformâpartâorâallâofâtheâ3âmonthâperiodâabove.
(vi) Fixed-term ContractWorkersâ-âIfâyou work onâaâfixed-term contract andâyour contractâisânotârenewedyou willâonlyâbeâentitledâtoâclaimâforâunemployment coverâifâyou meetâoneâofâtheâfollowingâcriteria:
(a) you haveâbeenâonâaâcontractâwithâtheâsameâemployerâforâatâleastâ12âmonthsâandâhadâtheâcontractrenewedâatâleastâonce;
(b) you haveâworked continuouslyâunderâcontractâwithâtheâsameâemployerâforâatâleastâ24âmonths;
(c) you wereâoriginallyâemployedâonâaâpermanentâbasisâbutâwereâtransferredâtoâaâfixed-term contractbyâtheâsameâemployerâwithoutâaâbreakâinâemployment;âor
(d) you haveâbeenâwithâtheâsameâemployerâandâareâunderâaâcontractâwhichâisânotâregularlyârenewablebutâisâindividuallyânegotiated,âandâwhichâhas:
(i)â beenâinâforceâforâatâleastâ6âmonths;
(ii)â beenârenewedâatâleastâtwice;âandâ
(iii)â terminatedâbeforeâitâwasâdueâtoânaturallyâexpire.
(vii) TemporaryâWorkâDuringâaâClaim
(a) Anâunemployment claimâmayâbeâsuspendedâforâaâperiodâofâtemporaryâwork,âprovided:
(i) you notifyâus beforeâyour temporaryâworkâstarts;âand
(ii) your temporaryâworkâlastsâforâatâleastâoneâweekâandânoâlongerâthanâ12âmonths,âwhetherâas
oneâcontractâorâaâseriesâofâcontracts.
Onceâyour temporaryâworkâhasâended,âwe willâcontinueâtoâpayâyour claimâasâaâcontinuationâofâyourearlierâclaimâupâtoâaâmaximumâofâ12âmonthly benefit paymentsâ inâtotal,âsubjectâtoâtheâtermsâand
conditionsâofâthisâpolicy.
(b) Ifâyou areâinâtemporaryâworkâwithâtheâsameâemployerâforâ12âmonthsâorâmoreâandâyou areâmade
unemployed,âwe willâpayâunemployment benefitâasâsetâoutâunderâtheââUnemploymentâBenefitsâ-
whatâisâcoveredâ(i)ââsubjectâtoâtermsâandâconditionsâofâthisâpolicy.
(c) Ifâyou haveâanâunemployment claimâbutâyou doânotâsubmitâyour claimâbecauseâyou takeâtemporary
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work,âyou mayâsubmitâyour claimâonceâtheâtemporaryâworkâhasâended.âWe willâthenâassessâyourclaim,âsubjectâtoâtheâtermsâandâconditionsâofâthisâpolicy,âasâifâyou hadâsubmittedâitâfollowingâyourinitialâunemployment.
(viii) MultipleâEmployment
Ifâyou areâinâfull-time employment withâmoreâthanâoneâemployerâandâyou are made unemployed from
oneâorâmoreâofâyour jobs,âyou willâbeâableâtoâclaimâforâunemployment benefitâifâyou areânoâlongerâworking 16âhoursâaâweekâorâmoreâinâtotalâandâyou meetâcriteriaâ(ii)âandâ(iii)âofâtheâdefinitionâofâ
unemployed, subjectâtoâtheâtermsâandâconditionsâofâthisâpolicy.
(ix) Theâmaximumâmonthly benefit payableâunderâthisâpolicy isâÂŁ2,000âorâ65%âofâyour gross monthlyincome,âwhicheverâisâless.
Unemployment Exclusions - what is not covered
We willânotâpayâanyâunemployment benefitâif:
(i) unemployment followsâanyâannouncementâorâactionâbyâyour employerâpriorâtoâtheâstart date inârelationtoâtheâdepartmentâorâdivisionâofâtheâbusinessâinâwhichâyou work, andâwhichârelatesâtoâanyâredundancies,employeeâ consultations,â restructures,âmergersâ orâ reorganisationsâ thatâ haveâ ledâ orâ couldâ leadâ to
compulsoryâjobâlosses,âmandatoryâreducedâworking hoursâorâmandatoryâreductionâinâsalary;
(ii) you areâmadeâunemployed, orâareâtoldâ(verballyâorâinâwriting),âthatâyou willâbeâmadeâunemployed within120âdaysâ(60âdaysâifâyou areâaânew borrower)âofâtheâstart date. Your certificate of cover willâconfirmâwhat
initial exclusion period appliesâtoâyour policy;
(iii) your work wasâseasonal,âcasualâorâtemporaryâ(otherâthanâasâsetâoutâunderâtheââUnemploymentâBenefits
-âwhatâisâcoveredâ(viii)ââSectionâaboveâorâunemployment isâaâregularâfeatureâofâyour work;
(iv) you finishâtheâjobâyou wereâspecificallyâemployedâtoâdo,âorâyou comeâtoâtheâexpectedâendâofâaâfixed-term contract unlessâyou satisfyâoneâofâtheâconditionsâsetâoutâinâtheââUnemploymentâBenefitsâ-âwhatâis
coveredââSection;
(v) you resignâorâyou acceptâvoluntaryâunemployment;
(vi) you loseâyour jobâbecauseâofâmisconduct,âpoorâperformance,âfraud,âdishonestyâorâasâaâresultâofâanyâact
you carriedâout;
(vii) you doânotâactivelyâseekâre-employment;âor
(viii) theâunemployment resultsâfromâanyâconditionâexcludedâunderâtheââAccidentâandâSicknessâExclusions
-âwhatâisânotâcoveredââSection.
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Your Claim(i)âYou shouldârequestâaâclaimâformâbyâtelephoningâ0345â601â1060âorâcontactingâus at:
ClaimsâTeam,PaymentshieldâLtd,
PaymentshieldâHouse,WightâMossâWay,Southport,PR8â4HQ
Theâfullyâcompletedâclaimâformâshouldâbeâreturnedâtoâus togetherâwithâanyâsupportingâevidenceâlistedâinâthisSectionââYourâClaimââasâsoonâasâpossible,âbutânoâlaterâthanâ90âdaysâafterâyour claimâfirstâarises.ââAllâthe
relevantâsectionsâshouldâbeâcompletedâtoâavoidâaâdelayâinâreceivingâbenefits.
ContinuingâClaimâFormsâ-âtoâconfirmâyour ongoingâeligibilityâforâbenefit,âwe willâaskâyou toâfillâinâaâcontinuingclaimâformâeachâmonth.âYoumustâsendâthisâtoâus asâsoonâasâpossible,âbutânoâlaterâthanâ90âdaysâfromâtheâdate
we lastâpaidâyour monthly benefit.
Completionâandâpostageâofâtheâclaimâformâandâtheâcontinuingâclaimâformâwillâbeâatâyour expense.
Ifâ anyâ documentsâ requestedâ underâ thisâ Sectionâ âYourâ Claimââ areâ notâ receivedâ promptlyâ ourâ claimsassessmentâprocessâwillâbeâdelayedâwhichâmayâpreventâus payingâyour claim.
Ifâtheânameâofâanyâdocumentâchangesâe.g.â"P45"âorââFitâNoteâ,âwe willârequireâyou toâsendâus theâdocumentwhichâtakesâitsâplace.
We willâonlyâaskâforâinformationârelevantâtoâyour claim.âIfâyou areâunableâtoâsupplyâanyâevidencelistedâinâthisâSection,âwe mayâaskâyou forâalternativeâevidenceâtoâsupportâyour claim.
(ii)â Accident &âsickness coverâclaims
(a)â Toâbeâableâtoâprocessâyour claimâquicklyâwe willâalwaysârequestâthatâyou sendâus aâfullyâcompletedclaimâ formâalongâwith:
(i)âFitâNotesâsuppliedâtoâyou byâyour doctor orâconsultant;âand
(ii)âevidenceâfromâyour employerâconfirmingâyour absenceâfromâwork dueâtoâaccident or sickness.Ifâthisâisânotâavailableâwemayârequireâaâcopyâofâyour contract ofâemployment,âP60âand/orâwageslips;
(b)â Toâenableâus toâassessâhowâlongâyouwillâbeâunableâtoâwork for,âwemayâalsoâ(atâourâcost)âthroughouttheâdurationâofâtheâclaimâcontact:
(i)âyour employer;
(ii)âaâqualifiedâmedicalâprofessional;
(iii)âyou orâyour authorisedârepresentative.
Whenâmakingâanâaccident or sickness claimâyoumayâneedâtoâhaveâaâmedicalâexaminationâatâour expense.â
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Ifâyou refuseâorâtheâappointmentâisânotâkept,âwe willâbeâunableâtoâvalidateâandâpayâyour claim.
Ifâyou areâself-employed:âwe willârequireâyou toâprovideâallâtheâinformationâdescribedâaboveâhowever,âasâwe areâunableâtoârequestâevidenceâfromâanâemployerâtoâsupportâyour claim,âwe willârequireâyou toâprovideâtheâfollowingâalternativeâinformationâatâyour expense:
(c)â we willârequireâcopiesâofâbusinessâand/orâpersonalâbankâstatementsâshowingâbusinessââtransactionsforâtheâ2âmonthsâpriorâtoâtheâdateâlastâworked (andâthroughoutâtheâdurationâofâtheâclaimâifâwerequestâthis)âalongâwithâsalesâinvoicesâforâtheâsameâperiod;
(d)â wemayâalsoâcontactâyour accountant,âHMâRevenueâ&âCustoms,âqualifiedâmedicalâprofessional,âyouorâyour authorisedârepresentativeâthroughoutâtheâclaim.
We willâconsiderâtheâfirstâdayâofâyour claimâtoâbeâtheâdayâaâdoctor certifiesâthatâyour accident or sickness preventsâyou fromâworking.â
Ifâyou completeâaâself-certificationâformâwhenâyour accident occursâorâsickness beginsâwemayâconsiderâ
theâfirstâdayâofâyour claimâtoâbeâupâtoâ7âdaysâbeforeâtheâdateâofâtheâdoctorâs certificate.
(iii)â Unemployment coverâclaims
(a)â Toâbeâableâtoâprocessâyour claimâquicklyâwe willâalwaysârequestâthatâyou sendâusâaâfullyâcompleted
claimâform.âWemayâalsoârequestâtheâfollowingâdocumentsâwhichâwillâbeâprovidedâatâyour expense:
(i)âlettersâfromâyour employer,âincludingâtheâletterânotifyingâyou ofâtheâterminationâofâyouremployment;
(ii)âcopiesâofâyour contractâofâemployment,âpayslips,ââP60âandâP45âprovidedâbyâyour employer;
(iii)âJobseekersâawardâletters.âIfâyou areânotâinâreceiptâofâJobseekerâsâAllowance,âlettersâconfirming
you areâinâreceiptâofâanotherâmoreâappropriateâbenefit;
(iv)âcopiesâofâanyâcompromiseâagreements;
(v)âdetailsâofâjobâapplications;
(vi)âanyâletter(s)âconfirmingâperiodsâofâtemporaryâemployment;
(vii)âanyâemploymentâtribunalâdecisions.
We mayâalsoâwriteâtoâyour formerâemployerâand/orâtheâbenefitsâoffice.
Afterâtheâfirstâmonthâofâtheâclaimâwe mayârequestâadditionalâinformationâfromâyou fromâtheâlistâabove;
Toâcontinueâtoâqualifyâforâbenefit,âyou mustâbeâactivelyâseekingâemploymentâduringâtheâcourseâofâyourclaim.âToâevidenceâthis,âwe willâaskâyou toâcompleteâaâcontinuingâclaimâformâonâaâmonthlyâbasisâandâto
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provideâus withâdetailsâofâjobâapplicationsâyou haveâmadeâandâlettersâwhichâconfirmâanyâperiodsâofâtemporary
employmentâyou haveâmanagedâtoâsecure.
(b)â Ifâyou areâaâcarer,âwe willârequireâyou toâprovideâcopiesâof:
(i)â CarerâsâAllowanceâawardâletterâfromâtheâDepartmentâforâWorkâandâPensionsâJobcentrePlusâorâsuchâgovernmentâofficeâwhichâreplacesâit;
(ii) medicalâevidenceâinârespectâofâtheâpersonârequiringâyour careâfromâtheirâqualifiedâmedicalâprofessional;
(iii)â fullyâcompletedâcontinuingâclaimâformsâwithâcopiesâofâbankâstatementsâshowingâongoingâreceiptâofâCarerâsâAllowance.
We mayâalsoâcontact:âtheâqualifiedâmedicalâprofessional,âyour formerâemployer,âbenefitâoffice,âyou orâyour authorisedârepresentative.
(c) Ifâyou areâself-employed we willârequireâyou toâprovideâus (atâyour expense)âwith:
(i)â copiesâofâbusinessâbankâstatementsâshowingâbusinessâtransactionsâforâtheâtwoâyearsâpriorâtoâtheâdateâlastâworked alongâwithâsalesâinvoicesâforâtheâsameâperiod;âand
(ii)ââ copiesâofâtheâlastâtwoâyearsâtradingâaccountsâorâifâtheseâareânotâavailableâevidenceâofâtheâlastâtwoâyearsâgrossâincome;âand
(iii)â copiesâofâcessationâofâtradingâaccountsâplusâanyâHMâRevenueâ&âCustomsacknowledgementâletters.â
We mayâalsoâwriteâtoâyour accountantâand/orâtheâbenefitsâoffice.â
(iv) What if you are not eligible for Jobseekerâs Allowance?
Ifâyou areâineligibleâforâJobseekerâsâAllowance,âyoumustâprovideâongoingâalternativeâevidenceâtoâus (aslistedâinâSectionââYourâClaimââ(iii))âthatâyou areâunemployed andâactivelyâseekingâwork. Thisâcouldâincludeâcopiesâofâjobâapplications,âinvitationsâtoâinterviews,âapplicationâresponsesâandâregistrationâwithemploymentâagencies.
(v) What if you want to seek work in the European Union (EU)?
Ifâyou wishâtoâseekâwork inâanâEUâcountry,âyou mustâmakeâarrangementsâwithâtheâDepartmentâforâWorkâandâPensionsâJobcentreâPlusâtoâhaveâthemâregisterâyou asâunemployed inâtheâcountryâyou areâgoingâtoâseekâwork inâandâapplyingâtoâtheâInternationalâPensionâCentreâforâyour Jobseeker'sâAllowancetoâbeâexportedâtoâthatâcountry.â
Ifâtheâapplicationâisâsuccessful,âyou shouldâreceiveâconfirmationâfromâtheâDepartmentâforâWorkâandâPensionsâJobcentreâPlusâthatâyour Jobseeker'sâAllowanceâwillâbeâpaidâatâtheâUKârateâwhilstâsearchingâforâwork inâtheâEU.â
Uponâreceiptâofâaâcopyâofâthisâconfirmationâfromâyou,âwe willâcontinueâtoâpayâyour unemploymentclaimâforâaâperiodâofâupâtoâ3âmonthsâfromâtheâdateâyou leaveâtheâUnitedâKingdom.
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If,âduringâtheâ3âmonthâperiodâreferredâtoâabove,âyou findâwork and/orâyou relocateâtoâaâEuropeanâUnionmemberâstateâoutsideâtheâUnitedâKingdom,âyou shouldânotifyâus asâsoonâasâpossibleâasâyou mayânoâlongerâbeâeligibleâforâbenefitsâorâcoverâunderâthisâpolicy.
(vi) What if youâre receiving state benefits?
Ifâyou orâyour partnerâareâreceivingâanyâstateâbenefits,âyou shouldâadviseâtheâappropriateâauthorityâifâyouareâalsoâclaimingâunderâthisâpolicy.âInâsomeâcircumstances,âtheâamountâofâmonthly benefit you receiveunderâthisâpolicy mayâaffectâyour entitlementâtoâstateâbenefits.âYour localâbenefitsâagencyâwillâbeâabletoâprovideâyou withâfurtherâinformation.
(vii) Do you need to continue paying your monthly premium when making a claim?
AsâdescribedâinâSectionââWhenâDoesâYourâPolicyâEndâ,âyou mustâcontinueâtoâpayâyour monthly premium whileâyou areâmakingâaâclaimâunderâthisâpolicy toâensureâthatâcoverâcanâcontinueâafterâyourclaimâhasâended.ââIf,âduringâaâclaim,âyou cancelâyour policy orâfailâtoâpayâtheâmonthly premium whenâdue,âwe willâcontinueâtoâpayâtheâmonthly benefit providedâthatâtheâclaimâwasâmadeâpriorâtoâtheâdateâonâwhichâyou cancelledâorâfirstâfailedâtoâpayâtheâmonthly premium whenâdue.âYou willânot,âhowever,âbecoveredâforâanyânewâclaimâmadeâonâorâafterâthatâdate.
(viii) Fraud and misleading information
W e haveâaâregulatoryâobligationâtoâpreventâfraud.âInâtheâeventâofâaâclaim,âanyâinformationâyou haveâsuppliedârelevantâtoâthisâinsuranceâandâonâtheâclaimâform,âtogetherâwithâotherâinformationârelatingâtoâtheâclaimâmayâbeâsharedâwithâotherâinsurersâinâorderâtoâpreventâfraudulentâclaims
(ix) Switching Claims
(Onlyâapplicableâifâyour certificate of cover confirmsâyou haveâselectedâaccident, sickness andâunemployment cover.)
You canâswitchâbetweenâanâaccident orâsickness claimâandâanâunemployment claimâ(orâviceâversa)âwithoutâinterruptionâ(i.e.ânoâadditionalâqualification period willâbeâapplied),âsubjectâtoâaâmaximumâofâ12âmonthly benefits beingâpaidâinâtotal.ââAllâotherâtermsâofâthisâpolicy willâstillâapplyâandâbothâclaimsâmustbeâvalid.
(x) Back to Work
WeâofferâaâfreeâBackâToâWorkâserviceâifâyou areâunableâtoâworkâdueâtoâunemployment.âYou willâbeâcontactedâbyâourâBackâtoâWorkâserviceâspecialist.âThisâserviceâisâfree,âconfidentialâandâdesignedâtoâprovideâadviceâandâassistanceâtoâhelpâyou makeâaâspeedyâreturnâtoâwork.âOurâBackâtoâWorkâserviceâprovides:â˘â Self-helpâguideâ˘â Accessâtoâaâspecialistâwebsiteâ˘â Telephoneâadviceâprovidingâaccessâtoâemploymentâcounsellorsâandâspecialists.â˘â Confidentialâadviceâandâongoingâsupportâthroughoutâyour searchâon:
-â seekingâwork,âcareerâchanges,âstateâbenefits-â managingâyourâtimeâeffectivelyâwhileâsearchingâforâemployment-â tipsâonâpreparingâyour CV-â helpâwithâpreparingâforâinterviews
15
Premiums(i) âEachâmonthly premium coversâyou forâoneâmonth.âTheâfirstâmonthly premium paymentâtoâbeâcollected
mayâbeâforâaâlargerâamountâthanâyour subsequentâmonthly premiums.âThisâisâtoâensureâthatâyour firstmonthly premiums paymentâisâsufficientâtoâcoverâyou forâtheârelevantâperiodâfromâtheâstartâofâyourcoverâtoâtheâdateâwhenâitâisâintendedâthatâyour regularâmonthly premium paymentsâareâtoâbeâmade.
(ii) Thisâpolicy hasâreviewableâpremiums,âwhichâmeansâthatâyour monthly premiummayâchangeâsubjectâtous givingâyou 30âdaysâânotice.âWhenâreviewingâyour premiums,âwe willâonlyâconsiderâanyâfutureâimpactofâoneâorâmoreâofâtheâfollowing:
(a) changesâdueâtoânewâinformationâarisingâfromâour ownâexperienceâsuggestingâthatâour futureâclaimsexperienceâisâ likelyâtoâbeâbetterâorâworseâthanâpreviouslyâassumed.âThisâ informationâincludeschangesâtoâtheânumberâofâclaimsâwe expectâtoâpay,âchangesâtoâtheâaverageâexpectedâdurationâofour claimsâpaymentsâorâchangesâtoâtheâaverageâexpectedâamountâpaidâperâclaim;
(b) changesâdueâtoânewâinformationâarisingâfromâexternalâsourcesâsuchâasâgeneralâindustry,âpopulationorâreinsurerâexperienceâsuggestingâthatâour futureâclaimsâexperienceâisâlikelyâtoâbeâbetterâorâworsethanâpreviouslyâassumed.âThisâincludesâindustryâorâgeneralâpopulationâunemployment experience;
(c) relevantâchangesâtoâour previousâassumptionsâinârelationâto:
(i) expensesârelatedâtoâprovidingâtheâinsurance;
(ii) policy lapseâratesâwhichâmeansâtheâaverageâtimeâpoliciesâareâheld;
(iii) interestârates;
(iv) taxârates;
(v) theâcostâofâanyâlegalâorâregulatoryârequirements.
(iv) Anyâchangesâtoâyour premiumâwe makeâwillânot:
(a) beâmadeâasâaâresultâofâanyâreasonâotherâthanâchangesâinâtheâassumptionsâmentionedâabove;
(b) beâbasedâonâwhetherâyou haveâmadeâaâclaim;âor
(c) beâmadeâtoârecoverâanyâpreviousâlosses.
(v) We willâreviewâyour premiumâatâleastâannuallyâandâyou willâbeâgivenâatâleastâ30âdaysââwrittenânotice,âatyour lastâknownâaddress,âofâanyâalterationâtoâtheâpremiumâratesâunderâthisâpolicy unlessâtheâchangeâisdueâtoâlegislative,âtaxâorâregulatoryârequirements.âIfâyour premiumâisâchangedâdueâtoâlegislative,âtaxâorregulatoryârequirementsâwhichâareâoutsideâour control,âthenâwe mayânotâbeâableâtoâgiveâyou 30âdaysânotice.
(vi) Wemayâreviewâyour premiumâmoreâfrequentlyâthanâannuallyâifâitâbecomesânecessaryâdueâtoâsignificantchangesâinâanyâofâtheâassumptionsâreferredâtoâabove.âExceptâwhereâyour premiumâisâchangedâdueâtolegislative,âtaxâorâregulatoryârequirements,âtheâminimumâperiodâbetweenâconsecutiveâpremiumâchangeswillâbeâ6âmonths.
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(vii) Asâaâresultâofâtheâpremiumâreview,âyour monthly premium mayâgoâup,âstayâtheâsameâorâgoâdown,âandthereâisânoâlimitâtoâtheâamountâofâanyâchange.
(viii) Ifâwe changeâyour monthly premium andâyou doânotâwishâtoâcontinueâyour coverâyou shouldâcontactPaymentshield toâdiscussâyour options.âDependingâonâyour circumstances,âyoumayâbeâableâtoâchangeyour monthly benefit orâchangeâyour typeâofâcover.âAlternativelyâyou canâcancelâasâsetâoutâinâtheâChangingâYourâMindâââYourâCancellationâRightsââSectionâabove.
(ix) You mustâcontinueâtoâpayâyour monthly premium whenâyou areâmakingâaâclaimâunderâthisâpolicy toensureâthatâcoverâcanâcontinueâafterâyour claimâhasâended.ââIf,âduringâaâclaim,âyou cancelâyour policyorâfailâtoâpayâtheâmonthly premium whenâdue,âwe willâcontinueâtoâpayâtheâmonthly benefit providedthatâtheâclaimâwasâmadeâpriorâtoâtheâdateâonâwhichâyou cancelledâorâfirstâfailedâtoâpayâtheâmonthlypremium whenâdue.âYou willânot,âhowever,âbeâcoveredâforâanyânewâclaimâmadeâonâorâafterâthatâdate.
When Does Your Policy End(i) Allâcoverâunderâthisâpolicy andâallâbenefitsâshallâautomaticallyâendâonâtheâearliestâtoâoccurâofâtheâfollowing:
(a) theâdateâyou reachâ65âyearsâofâage.âHowever,âifâyou areâclaimingâaâmonthly benefit fromâthisâpolicyandâyou reachâ65,âtheâclaimâwillâcontinueâuntilâtheâendâofâyour claimâperiodâbutâpremiums willâceaseâatâageâ65.ââFollowingâtheâendâofâtheâclaim,âtheâpolicy willâend;
(b) theâdateâyou permanently retire;
(c) theâdateâyou die;â
(d) theâdateâyou doânotâpayâtheâmonthly premium whenâdue;â
(e) Thereâisâanyâdishonestâorâintentionallyâexaggeratedâorâfraudulentâbehaviourâbyâyou orâanyoneâactingâforâyou inârelationâtoâaâclaimâunderâthisâpolicy. Inâsuchâcases,âyou mayâhaveâtoâreturnâanyâbenefitsâpaidâinârelationâtoâtheâclaim,âandâwillâhaveânoâcoverâfromâtheâdateâofâtermination.
(f) theâdateâyou,âwe orâPaymentshield cancelâyour insuranceâasâsetâoutâunderâtheâtermsâofâthisâpolicy.
(ii) Ifâyou areâalreadyâreceivingâbenefitsâforâaâvalidâclaim,âwe willâcontinueâtoâpayâtheâmonthly benefitprovidedâthat:
(a) theâeventâleadingâtoâyour claimâoccurredâpriorâtoâtheâdateâyou cancelledâyour policy orâtheâdatetheâmonthly premium wasânotâpaidâwhenâdue;âandâ
(b) cancellationâwasânotâdueâtoâdishonestyâorâexaggeratedâbehaviour,âmisrepresentationâorâwhen
asked,âfailureâtoâdiscloseâaâmaterialâfactâbyâyou (orâbyâsomeoneâactingâonâyour behalf).ââ
You willânotâbeâcoveredâforâanyânewâclaimâarisingâafterâtheâpolicy ends.
Whenâthisâpolicy endsâitâwillânotâhaveâanyâcashâorâsurrenderâvalue,âotherâthanâanyâpremiumârefundâthatâmay
ariseâunderââChangingâYourâMindâ-âYourâCancellationâRightsââSection.
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Terms and Conditions(i) Wemayâvaryâorâwaiveâtheâtermsâandâconditionsâofâthisâpolicy toâreflectâchangesâinâtheâassumptionsâset
outâinâtheââPremiumsââSectionâ(iii)â(c)âaboveâwhichâwe useâtoâdesignâandâpriceâyour cover.âSuchâchangesmayâhaveâtheâeffectâofâincreasingâorâreducingâtheâcoverâpreviouslyâprovidedâunderâthisâpolicy.
(ii) Whenâchangingâyour termsâandâconditionsâwe willâonlyâconsiderâanyâfutureâimpactâofâchangesâinâoneorâmoreâassumptionsâdueâtoâtheâreasonsâsetâoutâinâtheââPremiumsââSectionâ(iii)â(c)âabove.
(iii) Inâaddition,âwe mayâalsoâvaryâorâwaiveâyour termsâandâconditionsâto:
(a) improveâyour cover;
(b) complyâwithâanyâapplicableâlawsâorâregulations;
(c) reflectâanyâchangesâtoâtaxation;
(d) correctâanyâtypographicalâorâformattingâerrorsâthatâmayâoccur.
(iv) You willâbeâgivenâatâleastâ30âdaysââwrittenânoticeâtoâyour lastâknownâaddressâofâanyâalterationâtoâthetermsâandâconditionsâofâcoverâunderâthisâpolicy unlessâtheâchangeâisâdueâtoâlegislative,âtaxâorâregulatoryrequirements.âIfâyour coverâisâchangedâdueâtoâlegislative,âtaxâorâregulatoryâchangesâwhichâareâoutsideour control,âthenâwe mayânotâbeâableâtoâgiveâyou 30âdaysâânotice.
(v) Exceptâwhereâtheâtermsâandâconditionsâofâcoverâunderâthisâpolicy areâchangedâdueâtoâlegislative,âtaxorâregulatoryâchanges,âtheâminimumâperiodâbetweenâconsecutiveâchangesâwillâbeâ6âmonths.
(vi) Anyâchangesâtoâyour termsâandâconditionsâwe makeâwillânot:â
(a) beâmadeâasâaâ resultâofâanyâ reasonâotherâ thanâchangesâ inâ theâassumptionsâmentionedâ inâ theâPremiumsââSectionâ(iii)â(c)âaboveâorâforâtheâreasonsâsetâoutâinââTermsâandâConditionsââSectionâ(iii)above;
(b) beâbasedâonâwhetherâyou haveâmadeâaâclaim;âor
(c) beâmadeâtoârecoverâanyâpreviousâlosses.
(vii) Ifâwe varyâorâwaiveâyour termsâandâconditionsâandâyou doânotâwishâtoâcontinueâyour coverâyou shouldcontactâPaymentshield toâdiscussâyour options.âDependingâonâyour circumstances,âyoumayâbeâableâtochangeâyour monthly benefit orâchangeâyour typeâofâcover.âAlternativelyâyou canâcancelâasâsetâoutâintheââChangingâYourâMindâ-âYourâCancellationâRightsââSection.
Invalid Monthly Benefit PaymentsIfâwemakeâanyâpaymentsâasâaâresultâofâdishonestyâorâexaggeratedâbehaviourâbyâyou (orâbyâsomeoneâactingonâyour behalf),âyou willânoâlongerâbeâentitledâtoâanyâbenefitsâunderâthisâpolicy andâwe mayâdemandâthatanyâpaymentsâalreadyâmadeâbyâus areâpaidâback.âWemayâtakeâlegalâactionâagainstâyou forâtheâreturnâofâsuchmoniesâandâwe mayâdemandâthatâyou reimburseâus forâanyâcostsâincurred.
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AdministrationYour policy willâbeâadministeredâbyâPaymentshield onâour behalfâandâtheyâwillâbeâresponsibleâforâtheâdayâtodayârunningâofâyour policy.â
General Information
(i) Your policy isâunderwrittenâbyâCoveaâInsuranceâplc.âCoveaâInsuranceâplcâisâauthorisedâbyâtheâPrudentialRegulationâAuthorityâ(PRA)âandâregulatedâbyâtheâFinancialâConductâAuthorityâ(FCA)âandâtheâPrudential
RegulationâAuthority.
(ii) AnyâpremiumâorâpremiumârefundsâheldâbyâPaymentshield willâbeâheldâonâour behalf.
(iii) Paymentshield reservesâtheârightâtoâchangeâitsâchosenâinsurer.âAnyâsuchâchangeâmayâtakeâplaceâatâany
timeâbyâPaymentshield cancellingâthisâpolicy andâtransferringâtheâinsuranceâcoverâtoâaânewâinsurer.Paymentshield willâcontactâyou notâlessâthanâ30âdaysâbeforeâmakingâsuchâaâchangeâwithâdetailsâofâthe
newâproposedâinsurersâandâtermsâonâwhichâcoverâmayâbeâprovidedâbyâtheânewâinsurer.âAccordingly,âin
orderâtoâensureâcontinuityâofâyour insuranceâyou authoriseâPaymentshield toâcancelâyour existinginsuranceâandâtransferâyour dataâtoâanyânewâproposedâinsurerâtoâprovideâyou withâtheâreplacement
cover.â Whenâ contactingâ you withâ detailsâ ofâ theâ newâ insurerâ andâ itsâ offerâ ofâ insuranceâ forâ yourconsiderationâPaymentshield willâexplainâhowâyou mayârevokeâthisâauthorityâandâprovideâdetailsâofâhow
you mayâcancelâthisâpolicy,âifâyou doânotâwishâtoâcontinueâyour policy withâtheânewâinsurer.
(iv) Theâmonthly benefit cannotâbeâpaidâtoâanyoneâelseâorâinâanyâwayâotherâthanâasâdescribedâinâthisâpolicy.
(v) Whenâyour coverâunderâthisâpolicy endsâitâwillânotâhaveâanyâcashâorâsurrenderâvalue.
(vi) Theârightsâgivenâunderâthisâpolicy cannotâbeâtransferredâtoâanyoneâelse.â
(vii) Aâpersonâwhoâisânotâaâpartyâtoâtheâcontractâofâinsuranceâsetâoutâinâthisâpolicy shallâhaveânoârightsâundertheâContractsâ(RightsâofâThirdâParties)âActâ1999â(theââActâ)âtoâenforceâanyâtermâofâthisâpolicy providedthatâthisâshallânotâaffectâanyârightâorâremedyâofâanyâpersonâwhichâexistsâorâisâavailableâotherwiseâthanpursuantâtoâtheâAct.
(viii) We andâPaymentshield willâuseâtheâEnglishâlanguageâinâallâdocumentsâandâcommunicationsârelatingâtothisâpolicy.
(ix) Toâimproveâtheâqualityâofâservice,âwe andâPaymentshield willâbeâmonitoringâandârecordingâtelephonecalls.
(x) Youmustârespondâhonestlyâtoâanyârequestâforâinformationâwemakeâwhenâyou takeâoutâcoverâunderâthispolicy, orâapplyâtoâvaryâyour coverâunderâthisâpolicy. Inâtheâeventâthatâanyâstatementâofâfactâyou make
isâ untrueâorâmisleading,âthisâmayâaffectâtheâvalidityâofâyour policy, andâwhetherâyou canâmakeâaâclaim.
(xi)â Failureâtoâcomplyâwithâanyâconditionâofâthisâpolicy mayâresultâinâtheâsuspensionâorâtheâstoppingâofâmonthly benefit;
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20
(xii)â TheâLaw
Thisâpolicy isâgovernedâbyâEnglishâlaw.ââAnyâlegalâproceedingsâwillâbeâheldâinâtheâcourtsâofâEnglandâandWalesâunlessâyou liveâinâScotlandâorâNorthernâIrelandâinâwhichâcaseâyou willâbeâentitledâtoâcommenceâlegalâproceedingsâinâyour localâcourts.
(xiii)â FinancialâServicesâCompensationâScheme
We areâcoveredâbyâtheâFinancialâServicesâCompensationâSchemeâ(FSCS).âIfâwe areâunableâtoâmeetâourliabilitiesâtoâyou, youmayâbeâentitledâtoâcompensationâfromâtheâFSCS.âFurtherâinformationâisâavailablefromâtheirâwebsite:âwww.fscs.org.uk
Promise of Service Our andâPaymentshieldâs goalâisâtoâgiveâexcellentâserviceâtoâallâcustomers,âwhilstârecognisingâthatâthingsâdogoâwrongâoccasionally.âAllâcomplaintsâreceivedâareâtakenâseriouslyâandâresolvedâpromptly,âwhereverâpossible.Toâensureâwe andâPaymentshield provideâtheâkindâofâserviceâyou expectâyour feedbackâisâwelcome.âYourcommentsâwillâbeârecordedâandâanalysedâtoâmakeâsureâtheâserviceâwe andâPaymentshield offerâcontinuallyimproves.âMostâcustomersââconcernsâcanâbeâresolvedâquicklyâbutâoccasionallyâmoreâdetailedâenquiriesâareneeded.âIfâthisâisâlikely,âyou willâbeâcontactedâandâprovidedâwithâanâexpectedâdateâofâresponse.
Complaints Procedure(i) Stepâ1
(a) SalesâComplaintsâ-âifâyou areâunhappyâwithâanyâaspectâofâtheâsaleâofâyour policy orâhaveâcauseâforcomplaint,âyou shouldâinitiallyâcontactâtheâpersonâwhoâarrangedâtheâcoverâforâyou.
(b) Ifâyou areâunhappyâwithâanyâaspectâofâtheâhandlingâofâyour insuranceâpleaseâcontactâtheâPaymentshieldCustomerâServicesâTeamâbyâtelephoneâorâinâwritingâbyâemailâorâletterâto:
TheâPaymentshieldâCustomerâServicesâTeam
PaymentshieldâLimited,âPOâBoxâ229,âSouthportâPR9â9WU
PaymentshieldâCustomerâHelpline:â0345â6011â050
(ii) Stepâ2
Ifâyou haveâaâcomplaintâaboutâanyâaspectâofâour service,âyou shouldâcontactâus inâtheâfirstâinstance.âIfâyouremainâdissatisfiedâwithâourâresponseâorâ8âweeksâhaveâelapsedâfromâtheâdateâwe receivedâyour complaint,
youmayâbeâeligibleâtoâreferâyour complaintâtoâtheâFinancialâOmbudsmanâServiceâ(FOS).âFOSâwasâsetâupâby
parliamentâtoâresolveâcomplaintsâthatâcustomersâandâfinancialâbusinessesâareânotâableâtoâresolve.âFOSâisâan
independentâserviceâfreeâtoâcustomers.âTheâcontactâdetailsâforâtheâOmbudsmanâcanâbeâfoundâbelow:
TheâFinancialâOmbudsmanâServiceExchangeâTower
LondonE14â9SR
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FinancialâOmbudsmanâServiceâisâopenâfromâMondayâââFriday,â8amâââ8pm,âSaturday,â9amâââ1pm
Telephone:â0800â0â234â567â(callsâtoâthisânumberâareânowâfreeâonâmobileâphonesâandâlandlines).
Or
Telephone:â0300â123â9â123â(callsâtoâthisânumberâcostânoâmoreâthanâcallsâtoâ01âandâ02ânumbers).
Thisâprocedureâwillânotâprejudiceâyour rightâtoâtakeâlegalâproceedings.ââHowever,âpleaseânoteâthatâthereâaresomeâinstancesâwhenâtheâFOSâcannotâconsiderâcomplaints.â
Aâleafletâdetailingâour fullâcomplaints/appealsâprocessâisâavailableâfromâus onârequest.
Data Protection Act(i) Information Users
ForâtheâpurposesâofâtheâDataâProtectionâActâ1998,âtheâDataâControllersâinârelationâtoâanyâpersonalâdatayou supplyâareâCoveaâInsuranceâplcâandâPaymentshield.
(ii) Insurance Administration
Informationâyou supplyâmayâbeâusedâforâtheâpurposesâofâinsuranceâadministrationâbyâtheâDataâControllers,âour associatedâcompaniesâandâagents,âbyâreinsurersâandâPaymentshield.âItâmayâalsoâbeâdisclosedâtoâregulatoryâbodiesâforâtheâpurposesâofâmonitoringâand/orâenforcingâour andâPaymentshieldâs complianceâwithâanyâregulatoryârules/codes.âYour informationâmayâalsoâbeâusedâforâresearchâandâstatisticalâpurposesâandâcrimeâprevention.âItâmayâbeâtransferredâtoâanyâcountry,âincludingcountriesâoutsideâtheâEuropeanâEconomicâAreaâforâanyâofâtheseâpurposesâandâforâsystemsâadministration.âWhereâthisâhappens,âwe andâPaymentshield willâensureâthatâanyoneâtoâwhomâwe andâPaymentshield passâyour informationâagreesâtoâtreatâyour informationâwithâtheâsameâlevelâofâprotectionasâifâwe andâPaymentshield wereâdealingâwithâit.âIfâyou giveâus andâPaymentshield informationâaboutâanotherâperson,âinâdoingâsoâyou confirmâthatâtheyâhaveâgivenâyou permissionâtoâprovideâitâtoâus andâforus andâPaymentshield toâbeâableâtoâprocessâtheirâpersonalâdataâ(includingâanyâsensitiveâdata)âandâalsothatâyou haveâtoldâthemâwhoâwe andâPaymentshield areâandâwhatâwe andâPaymentshield willâuseâtheirdataâfor,âasâsetâoutâinâthisânotice.â
Inâtheâcaseâofâpersonalâdata,âwithâlimitedâexceptions,âandâonâpaymentâofâtheâappropriateâfee,âyou havetheârightâtoâaccessâandâifânecessaryârectifyâinformationâheldâaboutâyou.â
(iii) Sensitive Data
Inâ orderâ toâ assessâ theâ termsâ ofâ theâ insuranceâ contractâ orâ administerâ claimsâwhichâ arise,âwe andPaymentshield mayâneedâtoâcollectâdataâwhichâtheâDataâProtectionâActâdefinesâasâsensitiveâ(suchâasmedicalâhistoryâorâcriminalâconvictions).âByâproceedingâwithâthisâinsurance,âyou signifyâyour consentâtosuchâinformationâbeingâprocessedâbyâus,âPaymentshield andâour agents.â
Ifâyou haveâanyâquestionsâaboutâtheâuseâofâpersonalâinformationâbyâus orâPaymentshield,âorâifâyoubelieveâour recordsâareâinaccurate,âyou shouldâwriteâto:â
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TheâDataâProtectionâOfficerPaymentshieldâLimited,âPOâBoxâ229,âSouthportâPR9â9WU
DefinitionsTheâfollowingâwordsâandâphrasesâwillâhaveâtheâfollowingâmeaningsâwhereâtheyâappearâinâbold type.
âaccidentâmeansâaâbodilyâinjuryâwhichâpreventsâyou fromâdoingâyour normalâoccupationâ(orâanyâjobâwhichyou areâreasonablyâableâtoâdo,âgivenâyour experience,âeducationâorâtraining)âandâforâwhichâyou areâreceivingtreatmentâfromâaâdoctor.ââIfâyou areâself-employed,âyou mustânotâbeâreceivingâanyâformâofâpaymentâorâbehelping,âmanagingâorâcarryingâonâanyâpartâofâtheârunningâofâtheâbusinessâwhilstâyou areâclaiming;
âceased tradingâ meansâwhereâyou haveâinvoluntarilyâceased trading asâaâresultâofâyour businessâhavinginsufficientâassetsâtoâmeetâitsâdebtsâandâliabilitiesâand:
(i)â finalâclosingâaccountsâforâyour businessâhaveâbeenâpreparedâandâsubmittedâtoâHMâRevenueâ&âCustoms(HMRC);
(ii)â your businessâhasâbeenâputâinâtheâhandsâofâanâinsolvencyâpractitioner;âorâ
(iii)â your businessâisâaâpartnershipâwhichâhasâbeenâorâisâbeingâdissolvedâandâfinalâclosingâaccountsâhavebeenâpreparedâorâareâbeingâpreparedâandâsubmittedâtoâHMRC.
âcertificate of coverâ meansâtheâdocumentâthatâconfirmsâtheâcurrentâdetailsâofâyour coverâandâtheâlevelâofcoverâselectedâbyâyou.âIfâyou haveâbeenâissuedâwithâmoreâthanâoneâdocument,âtheâmostârecentâwillâapply;
âconsultantâ meansâaâmedicalâspecialistâwhoâhasâexpertiseâinâtheâconditionâorâsymptomsâyou areâclaiming
forâandâisâregisteredâunderâtheâMedicalâActâ1983â(asâamended).ââAâconsultant mustâbeâaâmemberâofâa
recognisedâRoyalâCollegeâ(forâexample,âtheâRoyalâCollegeâofâSurgeons)âandâisârecognisedâbyâthatâRoyal
Collegeâtoâbeâaâconsultant.âItâdoesânotâincludeâyou, your spouse,âcivilâpartner,âaârelativeâorâsomeoneâwho
livesâwithâyou;
âdoctorâ meansâaâfullyâqualifiedâmedicalâpractitionerâregisteredâwithâtheâGeneralâMedicalâCouncilâand
working inâtheâUnitedâKingdom.ââTheâdoctor whoâconfirmsâyour accident orâsickness whenâyou areâmaking
aâclaim,âcannotâbeâyou,âyour spouse,âcivilâpartner,âaârelativeâorâsomeoneâthatâlivesâwithâyou;
âend dateâ meansâtheâdateâyour coverâendsâasâsetâoutâinâtheââWhenâDoesâYourâPolicyâEndââSection;
âfixed-term contract(s)â meansâworking forâ atâ leastâ 16â hoursâ aâweekâ underâ aâpermanentâ contractâ of
employment,âforâaâfixedâdurationâorâforâaâspecificâtask,âdirectlyâwithâanâemployer.âYou mustâbeâreceivingâa
salaryâorâwagesâandâbeâpayingâtheâappropriateâNationalâInsuranceâcontributions;
âfull-time employmentâ meansâworking forâ atâ leastâ 16â hoursâ aâweekâ underâ aâ permanentâ contractâ of
employmentâthatâdoesânotâhaveâaâfixedâorâimpliedâend date.ââYou mustâbeâreceivingâaâsalaryâorâwagesâand
payingâClassâ1âNationalâInsuranceâcontributions.â
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âgross monthly incomeâ means
(i) ifâyou areâinâfull-time employment -âyour averageâmonthlyâsalaryâbeforeâtaxâ(includingâanyâcommission
and/orâbonusâpaymentsâyou receive)âforâtheâ12âmonthsâimmediatelyâpriorâtoâtheâstart date orâtheâdateyou requestâaâchangeâinâmonthly benefit;âorâ
(ii) ifâyou areâself-employed -âtheâmonthlyâaverageâofâyour incomeâforâtheâ12âmonthsâimmediatelyâpriorâtotheâstart date orâtheâdateâyou requestâaâchangeâinâmonthly benefit asâdeclaredâonâyour selfâassessmentreturnâforâtheâpreviousâtaxâyearâasâconfirmedâbyâHMâRevenueâ&âCustoms;
âimmediate familyâ meansâyour spouse,âcivilâpartner,âpartnerâofâ theâsameâorâoppositeâsexâwhomâyoucurrentlyâliveâwithâandâhaveâlivedâwithâforâaâcontinuousâperiodâofâatâleastâ1âyear,âparent,âchildâorâstepâchildwhomâyou currentlyâliveâwithâandâhaveâlivedâwithâforâatâleastâ1âyear,âorâfromâbirthâifâtheyâareâagedâbelowâone;
âinitial exclusion periodâ meansâtheâperiodâimmediatelyâfollowingâtheâstart date,âorâtheâdateâyou requestaâ changeâ inâ cover,â asâ specifiedâ inâ your certificate of cover,â duringâ whichâ anyâ sickness occursâ orunemployment begins,âthat you willânotâbeâeligibleâforâanyâbenefit,âorâincreaseâinâbenefit,âunderâtheâtermsofâ thisâ policy.â Theâ initial exclusion period forâ sickness isâ 60â days.â â Theâ initial exclusion period forunemployment isâ120âdaysâ(orâ60âdaysâifâyou areâaânew borrower);âthisâincludesâyou beingâadvisedâ(verballyorâinâwriting)âofâimpendingâunemployment duringâthisâperiod.
Your certificate of cover willâconfirmâtheâlengthâofâtheâinitial exclusion period thatâappliesâtoâyour policy;
âmonthly benefitâ meansâtheâamountâchosenâbyâyou andânotifiedâtoâus atâtheâtimeâyou applyâforâcoverunderâthisâpolicy.ââTheâmonthly benefit willâbeâpaidâinâarrearsâandâwillâonlyâbeâpaidâifâyoumeetâtheâtermsâandconditionsâofâthisâpolicy.
Theâmaximumâmonthly benefit allowableâshallânotâexceedâÂŁ2,000âorâ65%âofâyour gross monthly income,whicheverâisâless;
âmonthly premiumâ meansâtheâmonthlyâsumâpayableâbyâyou eachâmonthâforâinsuranceâcoverâunderâthispolicy;
ânew borrowerâ meansâyou applyâforâthisâinsurance:
(i) whenâtakingâoutâa new credit agreement ;âor
(ii) withinâ60âdaysâofâyour new credit agreement startâdate;
ânew credit agreementâ meansâa newâsecuredâorâunsecuredâcreditâagreementâincludingâfurtherâadvanceâforaâfirstâchargeâmortgage.ââThisâexcludesâaânew credit agreement forâaâcreditâcardâorâstoreâcard,âanâoverdraftfacilityâorâaâtenancyâagreement;
ânormal pregnancyâ meansâsymptomsâwhichânormallyâaccompanyâpregnancyâwhichâareâofâaâminorâand/ortemporaryânatureâ(suchâasâmorningâsickness andâdizzyâspells)âandâwhichâdoânotârepresentâaâsignificantmedicalâhazardâtoâmotherâorâbaby;
âPaymentshieldâ meansâ Paymentshield Limited.â Paymentshield areâ responsibleâ forâ theâ generaladministrationâofâyour policy;
âpermanently retireâ meansâretirementâwhereâyou haveâtoldâus, orâwe haveâevidenceâthatâyou haveânointentionâofâreturningâtoâwork;
âpolicyâ meansâtheâtermsâandâconditionsâsetâoutâinâthisâdocument;
âpre-existing medical conditionâmeansâanyâcondition,âinjury,âillness,âdisease,âsickness orârelatedâconditionand/orâassociatedâsymptoms,âwhetherâspecificallyâdiagnosedâorânot:
(i) whichâmedicalâevidenceâshowsâyou knewâaboutâorâwereâexperiencingâsymptomsâthatâyou wouldâhaveâbeenâawareâofâatâthe start date;âor
(ii) forâwhichâyou soughtâorâreceivedâadvice,âtreatmentâorâcounsellingâfromâanyâdoctor duringâtheâ12âmonthsimmediatelyâbeforeâtheâstart date;
âqualification periodâ meansâtheânumberâofâdaysâatâtheâbeginningâofâaâclaimâwhichâyou mustâwaitâbeforeyou areâeligibleâforâanyâbenefit.ââTheâqualification period forâeachâbenefitâisâshownâinâyour certificate ofcover;
âself-employed/self-employmentâ meansâyou areâworking forâanâincomeâforâatâleastâ16âhoursâaâweek,payingâClassâIIâNationalâInsuranceâcontributionsâ(whereâappropriate).
(i)â helpingâwith,âmanagingâorâcarryingâonâaâbusinessâandâliableâtoâpayâtaxâchargedâunderâSectionâ5âofâtheIncomeâTaxâ(TradingâandâOtherâIncome)âActâ2005âinâtheâUnitedâKingdom;âor
(ii)â aâpartnerâinâaâpartnership;âor
(iii)â aâpersonâwhoâexercisesâdirectâorâindirectâcontrolâoverâaâcompany;
âsicknessâmeansâanâillnessâorâsickness whichâpreventsâyou fromâdoingâyour normalâoccupationâ(orâanyâjobwhichâyou areâreasonablyâableâtoâdo,âgivenâyour experience,âeducationâorâtraining)âandâforâwhichâyou arereceivingâtreatmentâfromâaâdoctor.ââIfâyou areâself-employed,âyoumustânotâbeâreceivingâanyâformâofâpaymentorâbeâhelping,âmanagingâorâcarryingâonâanyâpartâofâtheârunningâofâtheâbusinessâwhilstâyou areâclaiming;
âstart dateâ meansâtheâdateâPaymentshield confirmâwe haveâacceptedâyou forâcoverâunderâthisâpolicy asshownâinâyour certificate of cover;
âunemployed/unemploymentâ means:
(i)â beingâentirelyâwithoutâpaidâworkâorâtemporaryâworkâ(whichâincludesâtheâassisting,âmanagingâand/orâthecarryingâonâofâanyâpartâofâtheâdayâtoâdayârunningâofâaâbusiness);âand
(ii)â forâtheâdurationâofâtheâclaim,âbeingâavailableâfor,âandâactivelyâseekingâwork, beingâableâtoâprovideâthedocumentationâlistedâinâSectionââYourâClaimââandâregisteredâwith:
(a)â theâDepartmentâforâWorkâandâPensionsâJobcentreâPlus;âor
(b)â theâDepartmentâforâSocialâDevelopmentâinâNorthernâIreland;âor
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(c)â theâStatesâInsuranceâAuthoritiesâinâtheâEuropeanâUnionâmemberâstate.
(iii)â You mustâhaveâsignedâaâJobseekerâsâagreementâwithinâtheâUnitedâKingdom,âorâequivalentâagreementinâNorthernâIrelandâorâaâEuropeanâUnionâmemberâstate.
âwe, our, usâ meansâCoveaâInsuranceâplc,âtheâunderwriterâofâthisâpolicy whichâisâauthorisedâbyâtheâPrudentialRegulationâ Authorityâ (PRA)â andâ regulatedâ byâ theâ Financialâ Conductâ Authorityâ (FCA)â andâ PrudentialRegulationâAuthorityâandâwhoseâregisteredâofficeâaddressâis:âNormanâPlace,âReading,âRG1â8DA.
âwork, worked, workingâ means beingâinâfull-time employment,âself-employment orâworking underâaâfixed-term contract;
âyou, yourâ meansâtheâpersonâwhoâhasâbeenâacceptedâforâinsuranceâcoverâunderâthisâpolicy.
Theâsingularâshallâincludeâtheâpluralâandâviceâversa.ââWithinâthisâpolicy,âheadingsâareâonlyâincludedâtoâhelpyou andâdoânotâformâpartâofâtheâinsuranceâcontract.
Employment Legal Protection including Health AssistanceTheâPolicy forâEmploymentâLegalâProtectionâincludingâHealthâAssistanceâhasâbeenâsuppliedâbyâMotorplusLimitedâandâisâunderwrittenâbyâUKâGeneralâInsuranceâLimitedâonâbehalfâof:âGreatâLakesâReinsuranceâ(UK)SE.âRegisteredâinâEnglandâNo.âSE000083.âRegisteredâOffice:âPlantationâPlace,â30âFenchurchâStreet,London,âEC3Mâ3AJ.â
MotorplusâLimitedââandâUKâGeneralâInsuranceâLimitedâareâauthorisedâandâregulatedâbyâtheâFinancialConductâAuthority.
GreatâLakesâReinsuranceâ(UK)âSEâisâauthorisedâbyâtheâPrudentialâRegulationâAuthorityâandâregulatedâbytheâFinancialâConductâAuthorityâandâtheâPrudentialâRegulationâAuthority.âYouâcanâcheckâthisâonâtheFinancialâServicesâRegisterâbyâvisitingâwww.fca.org.uk/register,âorâbyâtelephoningâ0800â111â6768.
Important Information
ThisâisâaâcontractâofâinsuranceâbetweenâYou andâGreatâLakesâReinsuranceâ(UK)âSE.âTheâinsuranceâprovidedcoversâLegal Costs subjectâtoâtheâterms,âlimitsâofâindemnity,âexclusionsâandâconditionsâcontainedâherein,inârespectâofâanâinsuredâeventâwhichâoccursâwithinâtheâTerritorial Limits andâduringâtheâPeriod ofInsurance forâwhichâYou haveâpaidâorâagreedâtoâpayâtheâpremium.
UnlessâexpresslyâstatedânothingâinâthisâPolicy willâcreateârightsâpursuantâtoâtheâContractâ(RightsâofâThirdParties)âActâ1999.âThisâcontractâofâinsuranceâisâpersonalâtoâyouâtheâpolicyholderâandâus.
Weâwillânotâbeâboundâbyâanyâagreementâbetweenâyouâandâyourâappointedârepresentative,âorâyouâandâanyotherâpersonâorâorganization.âYouâmayânotâassignâanyâofâtheârightsâunderâthisâpolicyâwithoutâourâexpresspriorâwrittenâconsent.
DefinitionsTheâwordsâandâphrasesâlistedâbelowâwillâhaveâtheâfollowingâmeanings:
Appointed representativeTheâsolicitor,âsolicitors'âfirm,âbarristerâorâotherâsuitablyâqualifiedâpersonâappointedâbyâus toâactâforâyou.
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Civil proceedingsCivilâcourt,âcivilâtribunalâorâcivilâarbitrationâproceedings,âwhichâareâsubjectâtoâtheâjurisdictionâofâtheâcourtsofâtheâUnitedâKingdom.
Date of eventTheâdateâofâanyâeventâwhichâmayâleadâtoâaâclaim;âwhereâthereâisâmoreâthanâoneâsuchâevent,âtheâdateâofâthefirstâofâthese.
DisbursementsAnyâsumâspentâbyâanâappointed representative onâyour behalfâinârespectâofâservicesâsuppliedâbyâaâthirdparty.â
Disbursements mayâinclude,âforâexample,âbarristersââfeesâ(providedâthatâtheâbarristerâisânotâactingâunderâaconditionalâfeeâagreementâorâequivalentâarrangement)âorâexpertâreportâfees
InjuryYour bodilyâinjuryâorâdeath,âorâanyâdisease,âillnessâorâshockâsufferedâbyâyou.
Part 36 OfferAnyâofferâmadeâtoâsettleâaâclaim,âwhereâblameâisâacceptedâorânot,âmadeâbyâeitherâpartyâthroughoutâtheclaim.âToâbeâaccepted,âtheâofferâmust:
⢠beâinâwriting;⢠callâitselfâaâPartâ36âOffer;⢠beâopenâforâatâleastâ21âdays,âwhenâtheâofferorâwillâpayâtheâopponentâsâcosts,âifâaccepted;⢠specifyâcoversâtheâwholeâclaim,âpartâofâit,âorâanâissueâthatâarisesâinâitâand,âifâso,âwhich:⢠adviseâwhetherâanyâcounterclaimâisâfactoredâin.
Period of insuranceTheâperiodâofâtimeâduringâwhichâcoverâunderâthisâpolicy isâinâforce.âCoverâshallâcommenceâonâtheâstartâdateshownâonâtheâpolicyâscheduleâandâcontinueâuntilâtheâdateâonâwhichâyou ceaseâtoâpayâtheâmonthlyâpremium,orâcancelâthisâpolicy,âwhicheverâoccursâfirst.
PropertyYour permanentâprimaryâresidenceâwithinâtheâterritorial limits.â
Territorial limitsa)â InârespectâofâSectionâ1âPersonalâClaims:
Worldwide.b)â InârespectâofâSectionâ2âEmployment:
TheâUnitedâKingdom.
You/yourTheâpersonânamedâonâtheâpolicyâschedule,âbeingâtheâindividualâforâwhomâthisâinsuranceâprovidesâlegalexpensesâcover.âThisâcoverâextendsâtoâalsoâincludeâtheâfollowing,âwhoâpermanentlyâresideâwithâyou atâtheproperty:â
a)â your spouseâorâpartner;b)â your parentsâorâparents-in-law;âc)â your children.
We/our/usMotorplusâLimited.
Table of Cover
27
Section The following areinsured
Restrictions Exclusions
The insurer willâpayLegal Costs forâthefollowingâSectionsâ1
andâ2,âinâorderâto
pursueâcivilproceedings directlyarisingâfromâoneâor
moreâofâtheâfollowing
eventsâorâcauses:
We agreeâtoâprovideâthecoverâinâthisâPolicy subjecttoâtheâterms,âconditions,
exclusionsâandâlimitations,
providedâthat:
⢠theâlegalâactionâor
criminalâprosecution
occursâwithinâthe
territorial limits;⢠theâdate of event iswithinâtheâperiod ofinsurance;
⢠theâpremiumâhasâbeen
paid;âand
⢠We deemâthatâthereâare
reasonable prospects ofsuccess.â
Theâmostâwe willâpayâforanyâoneâclaimâisâÂŁ50,000
(fiftyâthousandâpounds).
legal costs incurredâinâanyappealâproceedingsâwillâbe
coveredâprovidedâthat:
⢠We agreeâtoâcoverâtheoriginalâclaim;
â˘ââtheâmatterâhasââââ
reasonable prospects;âand
â˘ââWe areânotifiedâofâtheâdecisionâtoâappealâatâ
leastâ7âdaysâbeforeâtheâ
deadlineâtoâappeal.
We reserveâtheârightâtowithdrawâcoverâatâanyâtime
whereâuponâreviewâof
reasonable prospects.
Allâclaimsâmustâbeâreported
toâus withinâaâreasonable
Theâexclusionsânotedâapplytoâbothâsectionsâofâcover.
1.ââCoronersââInquestsâandFatalâAccidentâEnquiries;
2.ââAllegedâfailureâtocorrectlyâdiagnoseâanymedicalâcondition;
3.ââAnyâillnessâorâbodilyinjuryâorâpsychologicalinjuryâthatâoccursâgraduallyorâisânotâcausedâbyâasudden,âspecificâevent;
4.ââAnyâclaimsâcausedâbyâorarisingâoutâofâthedeliberate,âconsciousâorintentionalâdisregardâofyour obligationâtoâtakeâallreasonableâstepsâtopreventâbodilyâinjury.
Anyâclaim:⢠forâwhichâtheâdate ofevent isâbeforeâtheâdateofâinceptionâofâthisPolicy.
⢠Ifâwe orâtheâappointedrepresentative doânotbelieveâthereâarereasonable prospects inpursuingâyour claim,âtheinsurer willânotâpayâforanyâcostsâarisingâfromâasubsequentâorâadditionalclaimâtoâdeterminereasonable prospects.
Legal Costs incurredbeforeâour writtenacceptanceâofâaâclaim.
Anyâinsuredâincidentâwhichoccursâasâaâresultâofâadeliberateâactionâbyâyou.
War,âinvasion,âforeignenemyâhostilitiesâ(whetherwarâisâdeclaredâorânot),âcivilwar,âterrorism,ârebellion,revolution,âmilitaryâforceâorcoup.
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timeâframeâafterâtheâDate ofEvent.â
Whereâanâawardâof
damagesâisâtheâonlyâlegal
remedyâtoâaâdisputeâand
theâcostâofâpursuingâCivilProceedings isâlikelyâtoexceedâtheâvalueâofâany
suchâawardâofâdamages,âthe
mostâwe willâpayâinârespectofâlegal costs isâtheâvalueâoftheâlikelyâawardâof
damages.
Canâbeâdealtâwithâbyâaâcourt
ofâcompetentâjurisdiction
withinâtheâterritorial limits.
Radiationâorâradioactivecontamination.
Irradiation,âorcontaminationâbyânuclearmaterial;âorâtheâradioactive,toxic,âexplosiveâorâotherhazardousâorâcontaminatingpropertiesâofâanyradioactiveâmatter;âorâanydeviceâorâweaponâwhichemploysâatomicâorânuclearfissionâorâfusionâorâothercomparableâreactionâorradioactiveâforceâorâmatter.
Anyâclaimâorâexpenseâofanyâkindâcausedâdirectlyâorindirectlyâbyâpollutionâorcontaminationâwhich:
a)âwasâtheâresultâofâanâintentionalâact;
b)âwasânotâsuddenâandâunforeseen
Theâbalanceâofâanyâlegalcosts incurredâbeforeâwehaveâgivenâour writtenacceptanceâofâyour claim,orâbeforeâtheâinceptiondateâofâthisâpolicy.
JudicialâReview.
Finesâorâpenaltiesâorâanydamagesâwhichâyou areorderedâtoâpayâbyâaâcourt,tribunalâorâotherâauthority.
Anyâremarkâorâcomment,whetherâpermanentlyrecordedâorânot,âwhichâmaydamageâyour reputation.Anyâclaimârelatingâtoviolenceâorâdishonestyâonyour part.Anyâdisputeâwhatsoeverarisingâbetweenâyou andâusorâtheâinsurer orâyourinsuranceâbroker,âotherthanâtheâcoverâprovidedunderâtheâArbitrationConditionâofâthisâpolicy.
29
1. Personal Claimsâ˘âanâeventâthatâââsubsequentlyâcausesâyour death;
â˘âaâbodilyâinjuryâtoâââyou.
Clinicalânegligenceâclaims.
Anyâinjuryâwhichâisâgradualorâprogressiveâorâisânotcausedâbyâaâspecificâorsuddenâaccident.
Anyâmotorâvehicleâownedbyâyou orâanyoneassociatedâwithâyou,âorâanyincidentsârelatingâtoâroadtrafficâaccidents,âexceptunderâSectionâ1âofâtheCoverâsectionâofâthisâpolicywhereâyouâareâinjuredâasâapedestrianâorâcyclist;
Anyâclaimârelatingâtoâwills,probateâorâinheritance.
Theâinsurerâwillânotâcoverlegalâcostsâandâexpenses indefendingâyourâlegalârights,butâwillâcoverâlegalâcostsandâexpenses inâyoudefendingâaâcounterâclaim.
Proceedingsâbefore,âorreferenceâtoâtheâEuropeanCourtâofâJusticeâorâtheEuropeanâCourtâofâHumanRights.
Divorce,âseparationâorotherâmatrimonialâdisputes;cohabitationâdisputesâoranyâlegalâactionâbroughtaboutâbetweenâmembersofâyour familyâorhousehold.
2. EmploymentTheâinsurer willâprovidecoverâforâlegal costsincurredâinâtheâpursuitâofcivil proceedings againstyour employer,âinâmattersrelatingâtoâanydiscriminatoryâactionâasspecifiedâinâtheEmploymentâTribunalsActâ1996.
Your employerâsâinternaldisciplinaryâhearingsâandinternalâgrievanceprocedures.
Claimsârelatingâsolelyâtopersonalâinjury.Your business,âtradeâorprofession,âanyshareholding,âdirectorshiporâpartnershipââorâanyâothercommercialâinterestâ(otherthanâyour contractâasâanemployee).â
Whereâyour employmentstatusâisânotâthatâofâanemployeeâ(worker,âself-employedâorâcontractor);
Anyâclaimâbroughtâoutsideofâtheâemploymentâtribunal(e.g.âcountyâcourtâorâhighcourt);
Fines,âpenaltiesâordamagesâwhichâyouâareorderedâtoâpayâbyâaâcourt,tribunalâorâotherâauthority;
Anyâclaimsârelatingâtoâasettlementâagreementwhilstâyouâareâstillemployed.
30
General ConditionsThisâisâaâlegallyâbindingâcontractâofâinsuranceâbetweenâYou andâtheâinsurer.â
Theâfollowingâconditionsâapplyâtoâallâsectionsâofâthisâpolicy.âYou mustâcomplyâwithâthemâwhereâapplicableinâorderâforâyourâinsuranceâtoâremainâinâfullâforceâandâeffect.â
1.âClaims
Anyâclaimâthatâisânotânotifiedâtoâusâasâsoonâasâisâreasonablyâpossibleâafterâtheâdateâofâeventâwhenâtheclaimâmayâbeâprejudicedâaâlateânotification,âwhereâcoverâisâprovidedâbyâtradeâunionâmembership.â(Wherecoverâisâavailableâbutâdoesânotâprovideâprotectionâforâyour claimâwrittenâconfirmationâwillâbeârequiredâtothisâeffect);âIfâatâtheâtimeâaâclaimâisâmadeâbyâyou underâthisâpolicyâthereâisâanyâotherâinsuranceâcoveringâthesameâliability,âtheâinsurerâwillânotâbeâliableâtoâpayâorâcontributeâmoreâthanâourâproportionâofâanyâclaimâandtheâlegalâcostsâ inâconnectionâwithâthis.
a)âYouâwillâgiveânoticeâtoâusâasâsoonâasâreasonablyâpossibleâofâanâinsuredâevent.Inâtheâeventâofâaâclaimâforâpersonalâbodilyâinjury,âweâhaveâtheârightâtoâhaveâaâmedicalâexaminationâcarriedoutâofâanyâinjuredâpersonâatâourâexpense.
b)âYouâwillâtakeâallânecessaryâprecautionsâtoâreduceâtheâriskâofâaâclaimâandâtoâpreventâorâminimiseâlegalcosts whereverâpossible
c)âAllâprofessionalâfees,âexpenses,âdisbursementsâandâanyâotherâcostsâmayâonlyâbeâincurredâwithâourâpriorconsent;
d)âLegalâcosts willânotâbeâpaidâonâanâinterimâbasisâthroughoutâaâclaim;
e)âAuthorisationâwillâneedâtoâbeârequestedâinâwritingâinârespectâofâallâdisbursementsâbeforeâtheyâareincurred;
f)âAllâlegalâcosts areâsubjectâtoâanâindependentâassessmentâtoâensureâthatâtheyâhaveâbeenâincurredreasonably;
g)âYouâwillâtakeâallâstepsânecessaryâtoâassistâinâtheârecoveryâofâlegalâcosts fromâaâthirdâpartyâwhereappropriateâandâwhereâyouâareâableâtoâdoâso;
h)âYouâwillânotâenterâorâofferâtoâenterâintoâanyânegotiationâtoâsettleâtheâclaimâwithoutâourâpriorâwrittenapprovalâtoâdoâso;
i)âYouâwillânotâunreasonablyâwithholdâconsentâfor yourâappointedârepresentative toâmakeâanâofferâtoâsettletheâlegalâaction;
j)âIfâanâofferâofâsettlementâ(whichâmayâincludeâaâPartâ36âoffer)âisâmadeâthatâweâorâtheâappointedrepresentative wouldâdeemâfairâandâyouâdoânotâacceptâit,âtheâinsurerâwillânotâbeâliableâforâanyâfurtherâcostsincurred;
k)âYouâwillânotâwithdrawâfromâanyâlegalâactionâwithoutâourâpermissionâtoâdoâso;
l)âInâsomeâcircumstances,âwhereâweâdecideâitâisâappropriate,âtheâinsurerâmayâelectâtoâpayâyouâtheâsumâofdamagesâthatâyouâareâseekingâandâthenâendâorânotâbeginâcivilâproceedings,âandâtheâinsurerâwillânotâbeliableâforâanyâfurtherââcostsâincurred;
31
m)âTheâinsurerâreserveâtheârightâto:
i)âTakeâoverâanyâclaimâorâcivilâproceedings atâanyâtimeâandâconductâthemâinâyourâname;
ii)âNegotiateâorâsettleâanyâclaimâor civilâproceedings onâyourâbehalf;â
iii)âContactâyouâdirectlyâatâanyâpointâconcerningâyourâclaim.
n)âYourâproperty mustâbeâinsuredâforâstandardâbuildingsâand/orâcontentsârisksâthroughoutâtheâperiodâofinsurance.
2.âAppointedârepresentative
a) i)âBeforeâlegalâproceedingsâareâissued,âanâappointedârepresentative fromâourâpanelâwillâbeâappointedâtoâactâforâyouâtoâpursue,âdefendâorâsettleâanyâclaimâweâhaveâacceptedâinâaccordanceâwithâtheâtermsâandâconditionsâofâthisâpolicy;
ii)âShouldâlegalâproceedingsâneedâtoâbeâissuedâorâhaveâbeenâissuedâagainstâyou,âorâwhereâthereâisâaâconflictâofâinterest,âyouâcanâchooseâaânon-panelâsolicitor ofâyourâchoosing.âYouâmustâinformâusâinâwritingâofâtheâfullânameâandâaddressâofâtheârepresentativeâyouâwantâtoâactâforâyou.
iii)âIfâthereâisâanyâdisputeâoverâyourâchoiceâofânon-panelâsolicitor youâwillâbeâaskedâtoânominateâanâalternative.âIf,âafterâhavingâdoneâso,âweâareâstillânotâableâtoâagree,âyouâmayâescalateâtheâmatterâinâaccordanceâwithâGeneralâConditionâ5âââArbitration,âwhichâcanâbeâfoundâonâpageâ32âofâthisâpolicy.âUntilâtheâcomplaintâhasâbeenâresolved,âorâuntilâsuchâtimeâasâanâarbitratorâhasâreachedâaâdecision,âweâshallâbeâentitledâtoâappointâanâappointedârepresentativeâfromâourâpanelâinâorderâtoâprotectâyourâinterestsâinâanyâlegalâproceedings.
b)âIfâyouâdoâselectâtoâappointâyourâownânon-panelâsolicitor,âthisâinsuranceâwillânotâcoverâexpensesâoverâandaboveâtheâcostsâthatâourâpanelâwouldâchargeâinâequivalentâcircumstances.âForâyourâinformation,âthismeansâthatâweâwouldâtakeâintoâaccountâtheâseriousnessâofâtheâclaimâandâtheâlocationâandâclassâofânon-panelâsolicitor thatâyouâchoose.âTheâhourlyârateâisâcurrentlyâsetâatâÂŁ125â+âVAT.ââWeâreserveâtheârightâtoassessâeachâcaseâonâitsâmerits,âandâmayâagreeâtoâpayâadditionalâfeesâifâweâfeelâtheâsituationâwarrantsâit.Thisâwillâremainâentirelyâatâourâdiscretion;
c)âTheâappointedârepresentativeâorânon-panelâsolicitor willâhaveâdirectâcontactâwithâusâandâmustâfullycooperateâwithâusâatâallâtimes,âandâyouâmustâcooperateâwithâyourârepresentative,âprovidingâallânecessaryinformationâandâassistanceâtoâthemâasârequired;
d)âAny non-panelâsolicitor thatâyouâappointâmustâsignâourâstandardâtermsâofâappointmentâandâadhereâtoallâofâitsâterms.ââYouâagreeâtoâusâhavingâaccessâtoâtheâappointedârepresentativeâs or non-panelâsolicitorâs (astheâcaseâmayâbe)âfileârelatingâtoâyourâclaim.ââYouâwillâbeâconsideredâtoâhaveâprovidedâexpressâconsentâtousâorâourâappointedâagentâtoâaccessâtheâfileâforâauditing,âqualityâandâcostâcontrolâpurposes.
3. Cancellation
Ifâyou decideâthatâforâanyâreasonâthisâpolicyâdoesânotâmeetâyour insuranceâneedsâthenâpleaseâreturnâittoâyour insuranceâbrokerâwithinâ30âdaysâfromâtheâdayâofâpurchaseâorâtheâdayâonâwhichâyou receiveâyourpolicyâdocumentation,âwhicheverâisâlater.âThisâisâcalledâtheââcoolingâoffâperiodâ.âOnâtheâconditionâthatânoclaimsâhaveâbeenâmadeâorâareâpending,âtheâinsurer willârefundâyour premiumâinâfull.
You mayâcancelâthisâinsuranceâpolicyâatâanyâtimeâafterâthisâ30âdayâperiod,âhoweverânoâreturnâofpremiumâwillâbeâavailable.
32
Theâinsurer willânotâbeâboundâtoâacceptârenewalâofâanyâinsuranceâandâmayâatâanyâtimeâcancelâanyinsuranceâdocumentâbyâgivingâ30âdaysâânoticeâinâwritingâwhereâthereâisâaâvalidâreasonâforâdoingâso.âAcancellationâletterâwillâbeâsentâtoâyou atâyour lastâknownâaddress.âValidâreasonsâforâtheâinsurer tocancelâthisâinsuranceâpolicyâincludeâbutâareânotâlimitedâto:
a)âFraudb)âNon-paymentâofâtheâpremiumc)âThreateningâorâabusiveâbehaviourd)âNon-complianceâwithâpolicyâtermsâandâconditions
If theâinsurerâcancelsâtheâpolicy,âyou willâbeâentitledâtoâaâreturnâofâpremiumâonâaâpro-rataâbasis.
4.âCounselâsâOpinionWhereâreasonableâandânecessary,âwe mayâobtainâatâour ownâcost,âadviceâonâprospectsâforâyour claimâfromanâindependentâbarrister.âThisâwillâbeâinâtheâeventâthatâthereâisâaâdisputeâonâtheâprospectsâofâsuccessâforyour claim,âbetweenâyour choiceâofâappointedârepresentativeâandâour panelâsolicitors.â
5.âArbitrationâClauseIfâthereâisâaâdisputeâbetweenâyou andâus,âorâyou andâtheâinsurer,âwhichâarisesâfromâthisâinsurance,âyou canmakeâaâcomplaintâtoâus inâaccordanceâwithâtheâcomplaintsâprocessâwhichâcanâbeâfoundâonâpageâ2.âIfâwe,orâtheâinsurer,âareânotâableâtoâresolveâtheâmatterâsatisfactorilyâandâtheâmatterâcanâbeâdealtâwithâbyâtheFinancialâOmbudsmanâService,âyou canâaskâthemâtoâarbitrateâinâtheâmatter.IfâtheâmatterâcannotâbeâdealtâwithâbyâtheâFinancialâOmbudsmanâService,âitâcanâbeâreferredâtoâarbitrationbyâaâsingleâarbitratorâwhoâwillâbeâagreedâbyâbothâyou andâus.âTheâarbitrationâshallâbeâinâaccordanceâwiththeâArbitrationâActâ1996âandâwillâbeâbindingâonâbothâparties.âTheâcostsâofâtheâarbitrationâshallâbeâatâthediscretionâofâtheâarbitrator.
Ifâweâareânotâableâtoâagreeâonâtheâappointmentâofâanâarbitrator,âweâshallâaskâtheâPresidentâofâtheCharteredâInstituteâofâArbitratorsâtoâdecide.âTheirâdecisionâwillâbeâfinalâandâbindingâonâbothâparties.
6.ââFraudulentâClaims
Ifâyou makeâaârequestâforâpaymentâunderâthisâpolicyâknowingâitâtoâbeâfraudulentâorâfalseâinâanyârespect,âoryou oughtâreasonablyâinâtheâcircumstancesâtoâknowâitâtoâbeâfraudulentâorâfalse,âthisâpolicyâwillâbecomevoid.âTheâinsurer willâgiveâyou noticeâofâtermination,âandâfollowingâthisâterminationânoâreturnâofâpremiumwillâbeâmade.âIfâaâclaimâisâtaintedâbyâfraud,âyou willâforfeitâtheâentireâclaimâandâwillânotâbeâableâtoârecovertheâpartâofâtheâclaimâthatâgenuinelyâwouldâhaveâbeenâpayable.âPreviousâvalidâclaimsâarisingâpriorâtoâthefraudulentâactâwillâbeâunaffected.â
7.ââStatutoryâRegulations
Inâallâmattersârelatingâtoâtheâperformanceâofâthisâinsuranceâcontract,âitâisâtheâresponsibilityâofâbothâyou andus thatâwe bothâcomplyâwithâallâActsâofâParliamentâandâwithâallâorders,âregulationsâandâbylawsâmadeâwithstatutoryâauthorityâbyâGovernmentâDepartmentsâorâbyâlocalâorâotherâauthorities.âTheâcostâofâmeetingâtherequirementsâofâthisâclauseâwillâbeâpayableâbyâyou andâus inâourâownârightsârespectively.
8.ââSeverabilityâClause
Ifâanyâtermâofâthisâcontractâofâinsuranceâisâtoâanyâextentâinvalid,âillegalâorâincapableâofâbeingâenforced,suchâtermâwillâbeâexcludedâtoâtheâextentâofâsuchâinvalidity,âillegalityâorâunenforceability,âallâotherâtermsâwillremainâinâfullâforceâandâeffect.
33
9.ââProportionalityWhereâanâawardâofâdamagesâisâtheâonlyâlegalâremedyâtoâaâdisputeâandâtheâcostâofâpursuingâcivilproceedings isâlikelyâtoâexceedâtheâvalueâofâanyâsuchâawardâofâdamages,âtheâmostâtheâinsurer willâpayâinrespectâofâlegalâcosts isâtheâvalueâofâtheâlikelyâawardâofâdamages.
10.âActsâofâParliament
AllâreferencesâtoâActsâofâParliamentâinâthisâpolicyâshallâincludeâtheâequivalentâlawsâinâScotland,âNorthernIreland,âtheâIsleâofâManâandâtheâChannelâIslandsâandâshallâincludeâanyâsubsequentâamendments,âre-enactmentsâorâregulations.
Making a Claim 24/7Inâtheâeventâofâaâclaimâpleaseâdoânotâappointâyour ownâsolicitorâasâthisâwillâinvalidateâtheâcoverâprovidedbyâthisâPolicy.
Pleaseânoteâthatâyou mustâreportâanyâclaimâtoâus withinâaâreasonableâtimeâframe.
CALLâ0345 601 1060
PleaseâquoteâEmployment Legal Protection inâallâcommunications.
REMEMBER Theâclaimsâlineâisâopenâ24âhoursâaâday,â365âdaysâaâyear.Telephone Legal Advice Helpline
Availableâ24âhoursâaâdayâthroughoutâtheâyearâtoâprovideâyou withâconfidentialâtelephoneâadviceâaboutâanypersonalâlegalâproblemâinâtheâUK.
European Legal Advice Service
We willâgiveâyou confidentialâlegalâadviceâoverâtheâphoneâonâanyâpersonalâlegalâproblem,âunderâtheâlawsofâtheâEU,âSwitzerlandâandâNorway.
Health & Medical Information Service
We canâprovideânon-diagnosticâinformationâaboutâhealthâandâfitness,âandâdetailsâofâself-helpâgroupsâandfamilyâhealthâserviceâassociations.ââThisâincludesâinformationârelatingâtoâallergies,âdrugsâandâtheirâsideeffects,âpatientârights,âsocialâsecurityâandâsocialâserviceâmatters,âandâhospitalâwaitingâlists.ââ
Counselling Service
We provideâconfidentialâtelephoneâcounsellingâincludingâreferenceâtoâprofessionalâorâvoluntaryâservices.
Toâcontactâallâtheâaboveâhelplineâservices,âphone:â01603 420033,âquotingâtheâreferenceâEmploymentLegal Protection.
Toâhelpâus monitorâour serviceâstandards,âtelephoneâcallsâ(exceptâthoseâtoâtheâCounsellingâService)âmaybeârecorded.ââ
PleaseâdoânotâphoneâtheâHelplineâtoâreportâaâgeneralâinsuranceâclaim.âWe willânotâacceptâresponsibilityâiftheâHelplineâservicesâareâunavailableâforâreasonsâwe cannotâcontrol.
We doânotâprovideâdiagnosticâadviceâorâinformation.
34
Complaints Procedure
Ifâyou areâunhappyâaboutâclaimsâhandlingâonâtheâpolicy forâLegalâExpensesâcoverâyou shouldâcontact:
The Quality Assurance ManagerMotorplusâLimitedKircamâHouseWhifflerâRoadNorwichNR3â2AL
Tel:â 0333â241â9574Fax:â 01603â420â010Email: [email protected]
Pleaseâensureâyour policy numberâisâquotedâinâallâcorrespondenceâtoâassistâaâquickâandâefficientâresponse.
Ifâitâisânotâpossibleâtoâreachâanâagreement,âyou haveâtheârightâtoâmakeâanâappealâtoâtheâFinancialOmbudsmanâService.âTheâFinancialâOmbudsmanâServiceâ(FOS)âwasâsetâupâbyâparliamentâtoâresolvecomplaintsâthatâcustomersâandâfinancialâbusinessesâareânotâableâtoâresolve.âFOSâisâanâindependentâservicefreeâtoâcustomers.âThisâalsoâappliesâifâyou areâinsuredâinâaâbusinessâcapacityâandâhaveâanâannualâturnoverofâlessâthanââŹ2âmillionâandâfewerâthanâtenâstaff.âYou mayâcontactâtheâFinancialâOmbudsmanâServiceâat:â
The Financial Ombudsman ServiceTheâFinancialâOmbudsmanâServiceExchangeâTowerLondonE14â9SRTel: 0800â023â4567Email: [email protected]
Theâaboveâcomplaintsâprocedureâisâinâadditionâtoâyour statutoryârightsâasâaâconsumer.âForâfurtherinformationâaboutâyour statutoryârightsâcontactâyour localâauthorityâTradingâStandardsâServiceâorâCitizensAdviceâBureau.
Financial Services Compensation Scheme
GreatâLakesâReinsuranceâ(UK)âSEâisâcoveredâbyâtheâFinancialâServicesâCompensationâScheme.âYou mayâbeentitledâtoâcompensationâfromâtheâschemeâinâtheâunlikelyâeventâthatâGreatâLakesâReinsuranceâ(UK)âSEcannotâmeetâtheirâfinancialâresponsibilities.âYou canâobtainâfurtherâinformationâaboutâcompensationschemeâarrangementsâfromâtheâFSCSâatâwww.fscs.org.uk,âorâbyâphoningâ020â7741â4100â(MondayâââFriday,8.30amâââ5.30pm)
Data Protection Act 1998
Pleaseânoteâthatâanyâinformationâprovidedâtoâus willâbeâprocessedâbyâus andâour agentsâinâcompliancewithâtheâprovisionsâofâtheâDataâProtectionâActâ1998,âforâtheâpurposeâofâprovidingâinsuranceâandâhandlingclaims,âifâany,âwhichâmayânecessitateâprovidingâsuchâinformationâtoâthirdâparties.âWe mayâalsoâsendâtheinformationâinâconfidenceâforâprocessâtoâotherâcompaniesâactingâonâtheirâinstructionsâincludingâthoselocatedâoutsideâtheâEuropeanâEconomicâArea.
35
A Guide to Direct Debit Payments(this section does not form part of the policy conditions)TheâpremiumâforâyourâpolicyâisâcollectedâbyâmonthlyâDirectâDebitâfromâyourâbankâaccount.
We canâacceptâyourâinstructionâinâoneâofâtheâfollowingâways:⢠FromâaâsignedâDirectâDebitâmandate
⢠Fromâaâtelephoneâinstructionâyouâhaveâgivenâtoâus
⢠Electronicallyâ(ifâcollectedâbyâyourâintermediary)âorâthroughâtheâinternet
The Direct Debit Guarantee
â˘â ThisâGuaranteeâisâofferedâbyâallâbanksâandâbuildingsâsocietiesâthatâacceptâinstructionsâtoâpayâDirectâDebits
â˘â Ifâthereâareâanyâchangesâtoâtheâamount,âdateâorâfrequencyâofâyourâDirectâDebitâPaymentshieldâLimitedâwillnotifyâyouâ10âworkingâdaysâinâadvanceâofâyourâaccountâbeingâdebitedâorâasâotherwiseâagreed.âIfâyouârequestPaymentshieldâLimitedâtoâcollectâaâpayment,âconfirmationâofâtheâamountâandâdateâwillâbeâgivenâtoâyouâatâthetimeâofâtheârequest.
â˘â IfâanâerrorâisâmadeâinâtheâpaymentâofâyourâDirectâDebit,âbyâPaymentshieldâLimitedâorâyourâbankâorâbuildingsociety,âyouâareâentitledâtoâaâfullâandâimmediateârefundâofâtheâamountâpaidâfromâyourâbankâorâbuildingâsociety
-âifâyouâreceiveâaârefundâyouâareânotâentitledâto,âyouâmustâpayâitâbackâwhenâPaymentshieldâLimitedâasksâyouâto
â˘â You canâcancelâaâDirectâDebitâatâanyâ timeâbyâsimplyâcontactingâyourâbankâorâbuildingâsociety.âWrittenconfirmationâmayâbeârequired.âPleaseâalsoânotifyâus.
TheâIncomeShieldâproductâisâarrangedâbyâPaymentshieldâLimitedâwhoâareâauthorisedâandâregulatedâbyâthe
FinancialâConductâAuthorityâ(FCA)âunderâregistrationânumberâ312708.
TheâinsuranceâforâIncomeShieldâisâunderwrittenâbyâCoveaâInsuranceâplcâwhoâareâregisteredâin
EnglandâandâWalesâNo.â613259âRegisteredâOffice:âNormanâPlace,âReading,âRG1â8DA.âAuthorisedâbyâtheâPrudential
RegulationâAuthorityâ(PRA)âandâregulatedâbyâtheâFCAâandâPRA.
TheâinsuranceâforâEmploymentâLegalâProtectionâincludingâHealthâAssistanceâisâsuppliedâbyâMotorplusâLimitedâandâis
underwrittenâbyâUKâGeneralâInsuranceâLimitedâonâbehalfâofâGreatâLakesâReinsuranceâ(UK)âSE,âwhichâisâauthorisedâby
theâPrudentialâRegulationâAuthorityâandâregulatedâbyâtheâFinancialâConductâAuthorityâandâPrudentialâRegulation
AuthorityâunderâregistrationânumberâSE000083.
MotorplusâLimitedâisâauthorisedâandâregulatedâbyâtheâFinancialâConductâAuthorityâ(FCA)âunderâregistrationânumber
309657.
GreatâLakesâReinsuranceâ(UK)âSEâisâregisteredâinâEnglandâNo.âSE000083.âRegisteredâOffice:âPlantationâPlace,â30
FenchurchâStreet,âLondon,âEC3Mâ3AJ.
DetailsâofâtheâaboveâcompaniesâcanâbeâcheckedâonâtheâFinancialâServicesâRegisterâbyâvisitingâtheâFCAâsâwebsiteâor
byâcontactingâtheâFCAâonâ0800â111â6768âorâ0300â500â8082.â
Paymentshield andâtheâShield logoâareâregisteredâtradeâmarksâofâPaymentshieldâLimited.
TelephoneâcallsâtoâPaymentshieldâmayâbeârecordedâforâtrainingâandâquality.
ŠâPaymentshieldâLimited,â2014.âAllârightsâreserved.âNoâpartâofâthisâdocumentâmayâbeâcopiedâorâreproducedâwithout
theâpriorâwrittenâpermissionâofâPaymentshieldâLimitedâorâasâpermittedâbyâlaw.
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