Making a claim

1. Notify us about a claim

Claims can be made by completing our online Absence Notification Form

2. Member statement

When we receive the Absence Notification Form we will contact the employee and ask them to complete a Member Statement. The employee will be able to complete this online if we are provided with their email address on the Absence Notification Form.

3. Claims management and support

Where appropriate we’ll refer the claim to our in-house rehabilitation team. They’ll assess what support we can provide to facilitate a return to work before the end of the deferred period. Your client will be kept updated throughout the process.

4. Claim payments

In some cases, an employee may not be able to return to work before the end of the deferred period. In these circumstances, provided medical information supports the absence and the claim meets the definition of incapacity on the policy, we'll start to pay benefits monthly in arrears to the employer.

We'll continue to review the employee’s condition regularly, to make sure the claim continues to meet the definition of incapacity on the policy. This will also help us understand, what support could help the employee return to work.

1. Notify us about a claim

Claims can be made by completing our online Claim Notification Form

2. Member claim form

When we receive the Claim Notification Form we may contact the insured person and ask them to complete a Member Claim Form. The insured will be able to complete this online if we are provided with their email address on the Claim Notification Form.

3. Claims management

We’ll assess the information on the claim form to check if the insured person is eligible for cover. We’ll also need medical information to help us check the claim against the insured condition definition as well as our pre-existing and related conditions exclusions. This medical information could be a report from the insured person’s doctor or medical consultant. We’ll pay the cost of any medical reports we ask for.

For most insured conditions we’ll pay the lump sum if the insured person survives for 14 days after meeting the definition for the insured condition.

4. Claim payments

Payment is made to the employee usually within 5 working days of a claim being accepted.

There is usually no limit to the number of claims that can be made while the policy is in force.

1. Employer to complete internal assessment

Employers should complete their usual human resources procedures to determine whether the employee qualifies for early retirement according to the rules of the pension scheme. Employers need to send us the employee’s completed medical consent form as this enables them to share medical evidence with us and allows us to request more information if appropriate.

2. Submit claim within 90 days of decision

Employer and employee need to complete a claim notification form (1.1mb pdf) and send it to us within 90 days of the decision to retire the employee due to ill health.

3. Claim assessed

We’ll assess whether the claim is valid under the policy terms and give the employer a decision within 5 working days of receipt of all necessary information. We may need to ask for additional information or clarity on the details received.

4. We’ll pay the benefit if:

a. the employee qualifies for and takes ill health early retirement under the rules of the pension scheme; and

b. after assessing all the medical evidence, the employee meets the definition of permanent incapacity under the policy.

5. Eligible claims paid within 5 working days

We aim to pay benefits within a further 5 working days of receiving all required information. The agreed amount will be paid to the pension scheme trustees. Whilst the amount is unlikely to exactly match the actual fund strain at the time of claim, it is designed to significantly reduce the employer’s liability.