Claim Forms

If you would like to download a copy of the claim form please search using the box below. Enter the product code within your policy number, this is the 3 characters in the middle, you will find this on your annual communications e.g. AD1, AR1, PA1, SE1
The Claim Form should be fully completed, signed and returned to us. You will find details of our address and contact number here. Please call us if you need help or have any questions. This also has our phone number which you can use if you need help completing the form.
To support your claim we will also need documents that can verify your accident/hospital stay, such as medical documents or accident reports.
If we have to request further information to be able to assess your claim we will always let you know. Once we have received all of the information required to assess your claim we will write to you and let you know our decision within 7 working days. If you do not see your policy type here please call us here.

Financial Ombudsman Service

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10 results match your search

Accident Cash Plan

September 27, 2020

This Accident Cash Plan pays out benefit for every day of hospitalization in the UK as a direct result of an accident in the UK or an out of country territory (AR1, 2AR, 3AR, AR4, XR1)

Download Accident Cash Plan Claim Form
| PDF | 32 KB | September 27, 2020

Accident Cash Plan Supplemental

September 27, 2020

This Accidental Cash Plan pays out benefit for every day of hospitalisation in the UK as a direct result of an accident in the UK or an out of country territory. Enhanced benefits are paid for every day of hospitalisation in an out of country territory as a direct result of an accident in an out of country territory. We agree to provide the insurance cover described in this supplemental policy to insured persons provided that the premium is paid when it is due and we agree to accept it. (ARR)
Download Hospitalisation Claim Form
| PDF | 32 KB | September 27, 2020

Accidental Death Claim Form

September 27, 2020

This Accidental Death Policy provides two distinct types of benefit: a one-off cash payment in the event of an insured adult suffering an accidental death, the amount depending on the type of accident; and a one-off cash payment in the event of an insured child suffering an accidental death (1AD, 2AD, AD1, AD5, AD7, RD1, UD1, XD1, U1D, A1D, XD2, 3AD)
Download Accidental Death Claim Form
| PDF | 34 KB | September 27, 2020

Cash Replacement Plan

September 27, 2020

This Cash Replacement Plan provides the policyholder with the following benefits: Incapacity benefits for each continuous day after the deferred period you are incapacitated due to a sickness or a bodily injury as a direct result of an accident; and (if indicated on the schedule) Unemployment benefits for each continuous day after the deferred period you are no longer in full-time work and are registered as being unemployed (AS1) Pleas select one form depending on the claim.

Disability Injury Supplemental Plan

September 27, 2020

This Disability Injury Plan provides the following benefits ; Incapacity benefits for each continuous day after the deferred period that an insured adult is incapacitated due to a bodily injury as a direct result of an accident that is certified by a doctor ; A one off permanent total disability benefit once the insured adult has received at least 12 incapacity benefit payments and is certified by a doctor as suffering a permanent total disability To take out this policy, you and your partner (if chosen to be covered) must be: have an active accidental death plan policy, accident cash plan policy or life protection plan policy provided by us (TDR)
Downloadability Injury Supplemental Plan Claim Form
| PDF | 59 KB | September 27, 2020

Disability Injury Supplemental Plan

May 12, 2021

This Disability Injury Plan provides the following benefits Incapacity benefits for each continuous day after the deferred period that an insured adult is incapacitated due to a bodily injury as a direct result of an accident that is certified by a doctor ; A one off permanent total disability benefit once the insured adult has received at least 12 incapacity benefit payments and is certified by a doctor as suffering a permanent total disability (TDP)
Download Loss of Use Claim Form
| PDF | 59 KB | September 27, 2020

Drivers Protection / Accidental Death Supplemental Plan

May 27, 2020

This Accidental Death Policy provides two distinct types of benefit: a one-off cash payment in the event of an insured adult suffering an accidental death, the amount depending on the type of accident; and a one-off cash payment in the event of an insured child suffering an accidental death. We will pay the benefit shown on the schedule under i. Road Traffic Accidents for the accidental death of an insured adult or an insured child as a direct result of; • a collision or crash of a motor vehicle on a public roadway while the motor vehicle is in motion and operated under its own power or; • being struck as a pedestrian by a motor vehicle on a public roadway while the motor vehicle is in motion and operated under its own power (RT1)
Download Accidental Death Claim Form
| PDF | 34 KB | September 27, 2020

Permanent Disability Injury Supplementall Plan

September 27, 2020

This Permanent Disability Injury Plan pays out a cash benefit in the event an insured adult or insured child suffers a permanent disability following an accident (PDR)
Download Loss of Use Claim Form
| PDF | 50 KB | September 27, 2020

Personal Accident Plan

September 27, 2020

This Personal Accident Policy provides the following four types of benefit: a one-off cash payment in the event of an insured adult or insured child suffering accidental death ; a one-off cash payment in the event of an insured adult or insured child suffering disability following an accident ; a daily cash payment in the event of hospitalisation in the UK following an accident in the UK or an out of country territory ; enhanced daily benefits for hospitalisation in an out of country territory as the direct result of an accident in an out of country accident (PA1, PA7, 4PA) Please select one form depending on what the claim is for.

Serious Illness Cash Plan

September 27, 2020

This Serious Illness Cash Plan pays out the following benefits : a daily cash payment in the event of hospitalisation in the UK as a direct result of an illness ; a cash payment for outpatient treatment at a hospital in the UK as a result of an illness (SE1)
Download Hospitalisation Claim Form
| PDF | 32 KB | September 27, 2020