|
CONTENTS:
Definitions
Paying
premiums and cancelling cover
Paying
claims
1 Disability benefit
2 Unemployment benefit
3 Claiming more than once
4 Suspending an unemployment
claim for temporary work
Circumstances
when you cannot claim
Fraud
General
conditions
How
to claim
Complaints
procedure
Goodfellows
income protection insurance wording
You
have applied for accident, sickness and unemployment protection
with certain underwriters at Lloyd’s. In return for the appropriate
premium, this insurance will insure you against disability and unemployment.
Your proposal and certificate are part of this insurance contact.
If you are insuring more than one person, we will provide cover
for the monthly payment as shown in the schedule if either person
claims.
Cover
provided
Cover provided
You can be covered under this contract if you:
-
are aged between 18 and 64 and are permanently resident within the
UK, Channel Islands or Isle of Man,
-
are actively working for more than 20 hours per week and have been
in continuous employment for more than six months before the
insurance start date. You cannot obtain this insurance if you work
in temporary or seasonal employment,
-
are in good health and know of no impending unemployment or
disability.
Definitions
Some of the words and phrases we use in the contract terms and conditions
have special meanings.
|
Amendment
date |
the
date any amendment to the cover shown on your certificate comes
into force. |
|
Benefit
period schedule. |
the
maximum number of monthly benefit payments that we would pay
for any one period of claim as shown on your schedule. |
|
Business
|
a
trade, industry or profession you own and operate either alone
or with others and which is registered in the United Kingdom. |
|
Certificate
of insurance |
the
insurance cover we provide under the conditions of this certificate. |
|
Claim
period |
any
separate period of time during which you are unemployed or disabled
and receiving monthly benefit under this insurance. |
|
Company
director |
a
director who owns more than 10% of the issued share capital
of the company (or you are a relative of a director who is working
for the same company as you and who owns more than 10% of the
issued share capital of that company). |
|
Contract
of employment |
you
are employed on a permanent fixed-term contract for at least
13 weeks and you have been in continuous employment with the
same employer for at least two years. Under the contract, you
will not be covered if your contract is not renewed and we will
stop paying the monthly benefit on the date your contract was
originally intended to finish. |
|
Disability
|
an
accident or sickness certified by a registered medical practitioner
in the UK (other than you or your husband or wife) which prevents
you from doing your normal work or any similar work for which
you are reasonably qualified and you are not doing any other
job for payment or reward. |
|
Disabled |
you are suffering from a disability. |
|
Dismissed
|
you
are employed and your employment ends because of circumstances
entirely beyond your control. |
|
Employed
|
you
are in permanent employment and your employer is taking PAYE
tax and national insurance contributions on your behalf. |
|
Exclusion
period |
the
period shown on your certificate, which immediately follows
the start date of this insurance. |
|
Finishing
date of cover |
when
you:
a die;
b retire from work or reach age 65, whichever is the earlier;
c stop living in the UK; or
d have received the maximum number of monthly benefit payments
we allow;
whichever is earlier. |
|
Insurance
start date |
the date the insurance begins as shown on your certificate of
insurance. |
|
Maximum
benefit |
the
maximum amount of cover we allow under this insurance (£2,500
each month). |
|
Monthly
benefit |
the
amount of cover you have chosen as shown on your insurance certificate. |
|
Period
of cover |
the
period between the certificate start date and the end date for
which you have paid
the correct premium. |
|
Permanent
employment |
you
are employed on a permanent basis and your job has no fixed
finishing date other than the normal retirement age for your
occupation. Or you have been in continuous employment either
on a yearly contract which has been renewed at least once or
on a renewable fixed-term contract with the same employer for
at least two years in a row. |
|
Pre-existing
conditions |
any
sickness, condition or injury which you knew about and which
you have received treatment
or advice for (including regular or routine examinations or
consultations to monitor the condition) in the 12 months before
the insurance start date. |
|
Premium
|
the
premium set out in your certificate of insurance. |
|
Self-employed
|
you
are in a profession or business alone or with others and paying
class 2 national insurance
contributions or you are a company director. |
|
Stops
trading |
when
your business permanently stops trading entirely because of
circumstances beyond your
control or the control of any director or partner in your business. |
Unemployed
or
unemployment |
a
period during which you must be:
a receiving Income Support or Jobseeker’s Allowance or
you do not qualify for these benefits because you have been
entitled to make reduced national insurance contributions
in the past;
b actively looking for work;
c registered as available for work at a Department of Education
and Employment Office;
d without any work; and
e not receiving wages instead of serving notice.
If you are self-employed you must meet a to e above and have
stopped trading. If you are a company director, your company
must have been wound up by a creditor who is not a director
of that company.
|
|
Waiting
period |
the
period shown in your certificate during which you will need
to be continuously unemployed or disabled before you are entitled
to receive the monthly benefit. |
|
We
or us |
Compass
Underwriting Limited for certain underwriters at Lloyd’s. |
|
Working
|
paid
employment under a contract, permanent employment or self-employment
for 16 hours or more each week. You must also be paying the
appropriate national insurance contributions. |
|
You
or your |
the
person or people named on your certificate of insurance. |
| |
|
Paying premiums and cancelling
cover
a If you are paying the premium for this insurance by direct debit
(as shown in the schedule of insurance), this insurance will automatically
end if any payment is not made and you fail to put this right within
14 days.
b You may cancel this insurance within 10 days after the start date.
You must write to us and we will refund any premium and insurance
premium tax that we may have collected as long as we are not aware
of any claims. If you do not do this, we will assume you have accepted
this insurance and have agreed to keep to its terms and conditions.
c You have the right to cancel this insurance at any time by giving
us written notice at our registered office. The cancellation will
apply when we receive your written notice. We will return any unearned
premium you have paid for any period of cover which you have not
used. However, this only applies if you have not made a claim. You
will be responsible for cancelling the direct debit arrangement
(if this applies).
d We may cancel this insurance, for any reason, by giving written
notice to you at your last known address. This will confirm that
all cover will end 30 days after the date of our notice. We will
return a percentage of any premiums you have paid for any period
of cover which you have not used, unless you have made a claim.
e If you make a claim under this insurance, you must pay the rest
of the premium.
Paying
claims
1
Disability benefit
If you are in continuous employment and become disabled during the
period of insurance for longer than the waiting period, we will
pay you one monthly benefit on the 30th day that you are continuously
disabled following the waiting period. After that, we will continue
to pay you monthly benefit (at 1/30 of the monthly benefit for each
day you remain continuously disabled). We will pay benefit for the
month passed. We will continue to pay you until:
a the last day of your disability;
b the date you stop providing proof that you are still disabled;
c we have made the maximum number of monthly benefit payments we
allow in the benefit period; or
d the end date shown on your certificate of insurance or you stop
paying your monthly premium (if this applies);
whichever is earlier..
2
Unemployment benefit
If you are in continuous employment and become unemployed during
the period of insurance for longer than the waiting period, we will
pay one monthly benefit on the 30th day that you are still unemployed
following the waiting period. After that we will continue to pay
you monthly benefit (at 1/30 of the monthly benefit for each day
you remain continuously unemployed) for up to your chosen maximum
benefit.
We will continue to pay you until:
a the last day of your unemployment;
b the date you stop providing proof that you are still unemployed;
c we have made the maximum number of monthly benefit payments we
allow in the benefit period; or
d the end date shown on your certificate of insurance or you stop
paying your monthly premium (if this applies);
whichever is earlier.
Unemployment cover under this certificate of insurance will depend
on your employment status
-
Employed
(not including company directors, secretaries or their relatives
or contract workers)
a If you are working, we will insure you if you are dismissed.
-
Employed
company directors, secretaries or their relatives
a
If you own less than 10% of the issued share capital of the business
you are working for, or you are a relative of a company director
or company secretary who owns less than 10% of the issued share
capital of the business you are working for, we will insure you
if you are dismissed.
b If you own more than 10% of the issued share capital of the
business you are working for, or you are a relative of a company
director or company secretary who owns more than 10% of the issued
share capital of the business you are working for, you
will be insured if that business stops trading.
-
Employed
contract workers
a If you have been working on a renewable fixed-term contract
with the same employer for more than two years in a row, we will
insure you if you are dismissed.
b If you have been working on a renewable fixed-term contract
with the same employer for less than two years in a row we will
insure you if you are dismissed during the term of your contract.
We will not insure you if your contract is not renewed and any
entitlement to monthly benefit under this insurance will automatically
end on the date your contract was originally intended to finish.
-
Self-employed
and their relatives
If you are the sole proprietor or a partner in the business you
are working for, or you are a relative of the sole proprietor
or a partner in the business you are working for, we will insure
you if that business stops trading.
3
Claiming more than once
We will treat a claim which happens within three months of a separate
claim you have made as the same period of claim. You can make a
new claim as long as you have been in continuous employment for
at least three months between each claim.
4
Suspending an unemployment claim for temporary work
If you are eligible to claim for unemployment under this insurance
and you are offered a temporary job, you can suspend your claim
as long as:
a you tell us who you will be working for (even if you will be self-employed),
how many hours you will be working for and how long the temporary
employment will last;
b your temporary job lasts for at least one week and no longer than
six months and you do not have more than three separate jobs during
any one period of claim; and
c you continue to meet the conditions of this insurance and tell
us immediately if any of the above circumstances change.
You are eligible to claim for unemployment when a temporary job
ends. We will begin paying you again (up to your chosen maximum
benefit payments for any one period of claim).
Circumstances
when you cannot claim
A Unemployment
We
will not pay if:
-
you
have not been in continuous employment for at least six months
before your first period of unemployment under this contract;
-
you
are told about the unemployment within the initial exclusion period
even though your unemployment may not take place until after this
period;
-
your
work is seasonal or temporary;
-
your
fixed-term contract ends (but, depending on the other conditions
of this contract, you may be entitled to benefit during your fixed-term
contract);
-
you
accept voluntary redundancy, resign or retire;
-
you
are dismissed by your employer as a result of misconduct, or breaking
your contract;
-
you
knew about the possibility of unemployment (or in our reasonable
opinion you should have known about it) at the contact start date;
-
you
are made unemployed because of a civil commotion, riot, terrorist
activity, war or any similar event;
-
you
are made unemployed due to any of the disability exclusions; or
-
your
unemployment happens while you are away from the EU for a period
of more than 90 days. This clause will not apply if your reason
for leaving the EU is because you:
a work for the British Armed Forces; or
b work as a civil servant in a British embassy or consulate.
B You
will not be entitled to any benefit for any period in which you
are receiving pay instead of serving notice.
C Disability
We will not pay benefit if:
-
your
disability is due to or arises from AIDS or being infected by
HIV, unless a specialist certifies that that condition prevents
you from working;
-
you
deliberately injure yourself or your disability is caused by alcohol,
solvent abuse or drugs (other than drugs taken under the direction
of a doctor or consultant and not to treat drug addiction);
-
your
disability arises from stress, anxiety or depression or any mental
or nervous disorder unless a specialist certifies that that condition
prevents you from working;
-
your
disability results from any condition, injury or illness, disease
or sickness which came about as a result of a pre-existing condition;
-
your
disability is caused by pregnancy, childbirth, miscarriage or
abortion other than a medical complication which directly occurs
as a result of your pregnancy or pregnancy-related conditions;
-
your
disability is due to a back-related condition unless there is
radiological evidence of a medical abnormality or visible wound,
or a specialist certifies that that condition prevents you from
working;
-
your
disability arises from medical operations or treatments which
are not medically necessary, including cosmetic or beauty treatments;
or
-
your
disability is caused by any of the unemployment exclusions.
For
unemployment and disability sections
You cannot claim disability and unemployment benefit at the same
time.
We will not pay benefit as a result of:
-
war,
revolution, riot, or any similar event; or
-
radioactive
contamination from ionising radiation or contamination from any
nuclear fuel, or from any nuclear waste arising from burning nuclear
fuel; or the radioactive, toxic, explosive or other dangerous
effect of any explosive nuclear equipment or part of that equipment.
Fraud
If you have given us any incorrect information or missed out any
information which affects this contract, or any claim under this
contract, you will lose all rights to claim.
Transferring
this contract to someone else
You may transfer the benefits of this contract to someone else if
we send you written confirmation that this is acceptable.
General
conditions
a This contract and any endorsements together with the proposal
and certificate and any written statement of medical or other information
you have made make up the contract between you and us.
b This contract or any of the terms of this contract cannot be changed
unless this is done in writing by one or more of our
authorised officials. If in doubt please contact your intermediary.
c You and we are free to choose the law which applies to this insurance
contract. Unless we and you agree otherwise this
insurance will be governed by English law and the English courts
will deal with any disputes.
d If at the time any condition of this contract becomes invalid,
illegal, or cannot be enforced, it will not affect the rest of the
contract.
e All benefits under this insurance will not be taxed, although
this may change in line with any amendments to legislation. If this
happens, we will take from any monthly benefit any amounts which,
by law, we have to take.
f If you miss out any important information or provide false statements
in your application for this insurance or any claim, we may not
pay benefits under this insurance. Important information is information
which is likely to influence whether we accept your application
or claim for insurance. If you are not certain whether a fact is
important, you should tell us anyway. If you make a claim which
we consider to be fraudulent or exaggerated, you will lose all benefits
under this contract and we will try to recover any benefits we have
paid under that claim.
g We will process any information you give us according to the conditions
of the Data Protection Act 1998 for the purpose of
providing insurance and handling claims. This may involve passing
your information to other organisations.
How
to claim
You must write to us about a claim, within 30 days of becoming unemployed
or disabled or as soon as reasonably possible. Write to our claims
department at Compass Underwriting Limited, Minerva House, Spaniel
Row, Nottingham, NG1 6EP or phone our customer service desk on 0115
934 8999 to ask for a claim form.
We will send you the claim form. You will need to fill this in and
return it to us as soon as reasonably possible, giving us all the
information we ask for so we can process your claim. This should
include wage slips, your termination notice and your P60, or if
you are self-employed a bank statement, invoices and annual accounts
and Inland Revenue and national insurance records. You will be responsible
for giving us the proof we need. If you delay in sending in a claim
to us it may make your claim harder to confirm. It could also lead
to a delay in paying your claim or not paying your claim at all.
If we want you to have a medical you must have one, or we may refuse
to pay your claim. We will pay any costs involved for the medical.
We will pay the benefit when we receive satisfactory evidence of
your entitlement to claim. Throughout the period for which you claim
under this contract we will need you to provide evidence of your
disability or unemployment. We will not pay benefit for any period
of disability or unemployment for which you do not provide evidence.
We may ask you to produce this certificate as proof. Once we have
accepted a claim, we will pay your benefit for the month passed.
Complaints
procedure
We always try to provide a first-class standard of service.
However, if you have a complaint, you should contact the
intermediary who arranged this insurance for you.
If they cannot sort the matter out, please write to the Managing
Director of Compass Underwriting Limited at Asia House, 31/33 Lime
Street, London EC3M 7HT.
If you are still not satisfied with the way a complaint has been
dealt with, you may ask the Complaints and Advisory Department at
Lloyd’s to review your case. This will not affect your right to take
legal action. Their address is: Complaints and Advisory Department,
Lloyd’s, One Lime Street, London EC3M 7HA.
|
