income protection insurance

income protection policy wording

4. Cover Exclusions

Disability We will not pay You any Disability benefits resulting from the following circumstances

• if You did not elect to have Disability benefit on Your application form,
  
  
• the recurrence of any Disability, illness symptom or related condition for which You sought medical advice in the 12 month period immediately before the Start Date
  
  
• alcohol or drugs not taken under the advice or supervision of a Doctor,
  
  
• medical operations or treatments which are not medically necessary such as (but not limited to) cosmetic or beauty treatment,
  
  
• self inflicted injuries caused while sane or insane,
  
  
• any Disability which occurs while You are Working outside of the United Kingdom unless You are Working for the British Armed Forces, or as a civil servant in a British embassy or consulate, or unless You are Working on a specific project for less than 30 days outside the United Kingdom and were actually outside the United Kingdom for less than 30 days,
  
  
• backache and related conditions unless there is additional medical evidence (for example an MRI scan) of abnormality which We may require to validate Your claim,
  
  
• stress or stress related conditions including depression unless and until We may validate Your claim by reference to additional specialist medical evidence which We may require,
  
  
• normal pregnancy conditions causing morning sickness or fatigue, actual child birth or maternity leave. Pathological conditions lasting longer than 30 days and diagnosed by a member of the Royal College of Obstetricians are not excluded and neither are any other abnormalities during normal pregnancy.
  

Unemployment We will not pay You any Unemployment benefits resulting from the following circumstances

• if You did not elect to have Unemployment benefit on Your application form,
  
  
• if You were not in continuous Work for 6 months immediately before Your employment ended. If You were not in Work for 2 weeks or less, We will not count this as a break in Your employment,
  
  
• if, at the Start Date, You knew You were going to be made Unemployed or had reason to believe that it was likely to happen,
  
  
• if Your employment ends or You are notified, verbally or in writing, of Your employment ending, within 120 days of the Start Date,
  
  
• if Your Work is seasonal or if Unemployment is a regular feature of Your Work,
  
  
• if You are Working on a specific project and this project finishes,
  
  
• if You become voluntarily Unemployed (which includes ending Your Work voluntarily during a period of notice given by Your employer) or voluntary redundancy,
  
  
• if You Work on a fixed contract which ends. However, if You have been in continuous Work with the same employer for at least 2 years and Your contract has been renewed at least once and You had no reason to believe that it would not be renewed again, this exclusion will not apply,
  
  
• if Your work ends as a result of the expiry of an apprenticeship or training contract,
  
  
• if You are Self Employed and Your business temporarily stops trading,
  
  
• if You are Working outside of the United Kingdom unless You are Working for the British Armed Forces, or as a civil servant in a British embassy or consulate, or unless You are Working for an employer that is a United Kingdom registered company who assigns You to Work in a member country of the European Union on the same terms and conditions,
  
  
• if You are dismissed by Your employer as a result of misconduct, breaking the terms of Your employment contract, criminal offence or failing to meet the standards or targets laid down by Your employer,
  
  
• if You do not make a genuine and continuing effort to get Work.
  

General No benefit will be paid if disability or unemployment results directly or indirectly from the following circumstances

• civil unrest, war, radiation and radioactive contamination, or any related event,
  
  
• strike or lock-out or Your involvement in such,
  
  
• Human Immunodeficiency Virus (HIV) and/or any HIV related illness including Acquired Immune Deficiency Syndrome (AIDS) however such may be defined.
  

5. Claims Conditions

• You should contact Our Administrator, Adminicle Limited, Callidus House, Cirencester Business Park, Love Lane, Cirencester GL7 1XD or telephone 01285 886600 to request a claim form.
  
  
• You must complete the claim form fully and accurately and return it to Us at the address above. This claim form should be received by Us within 60 days of the date Your Disability or Unemployment began, or as soon as possible after this.
  
  
• We may ask You to fill in a continuing or supplementary claim form at Your own expense for each month You are claiming. You must send this to Us within 60 days of the date We last paid Your Monthly Benefit or as soon as possible after this.
  
  
• To properly validate Your claim You must give Us any proof We ask for otherwise We cannot pay any benefit. This is at Your own expense if any. We may also ask You for additional information during Your claim such as (but not limited to) being examined by a Doctor (at Our expense) or, certificates from Your employer stating that You are not presently working or, a copy of the Jobseekers Agreement that You signed with the Employment Service or, a certificate from Your last employer stating that You no longer Work for them.
  
  
• We will not pay Your claim if We cannot validate it because You are late sending Us Your claim form or any additional information that We may reasonably request. Any attempt to falsify any information provided to Us may invalidate Your claim and may result in Us cancelling this insurance immediately.
  
  
• If We start to pay Monthly Benefit because You are Disabled and You become Unemployed You must write and advise Us straight away. When deciding if Your claim is valid, We will ignore the fact that You have not been Working because of Your Disability. We will continue to pay Your Disability benefit while it remains valid. If You are still Unemployed once a Doctor says You are fit to return to Work, You must tell Us and We will ask You to complete an Unemployment claim form. If You change Your claim, the most We will pay for both Your Disability and Unemployment claims combined is 12 times the Monthly Benefit.
  
  
• If We start to pay Monthly Benefit because You are Unemployed and You become Disabled You must write and tell Us straight away. When deciding if Your claim is valid, We will ignore the fact that You have not been Working. You will no longer be eligible to claim benefits for Unemployment and You will have to complete a Disability claim form. If You change Your claim, the most We will pay for both Your Unemployment and Disability claims combined is 12 times the Monthly Benefit.
  
  
• If You are unable to meet Our conditions to claim for Disability benefit You can claim Unemployment benefit once You are fit to work. You must let Us know that You are no longer Disabled and You must meet Our conditions to claim Unemployment benefit. If Your claim is valid, the most We will pay is 12 times the Monthly Benefit which will include any Monthly Benefit We paid before Your Disability started.
  
  

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