Income Assured Plus. Your Guide to Claims

Transcription

1 Income Assured Plus Your Guide to Claims

2 The need to protect your earnings when illness or accidental injury stops you from working and earning your living is as important today as it has ever been. Your financial commitments cannot be put on hold just because your earnings have been. At Cirencester Friendly we are committed to providing you with clear and helpful information. We have produced this document to help you understand how we pay our claims, what claims we pay and to guide you through the claims process, should you ever need it. Contents Page Financial support when you need it the most 3 How to make a claim 4 Frequently Asked Questions 6 Our claims history 9 What our Members have claimed for 11 Why we cannot pay some claims 13 Contact details 15 2

3 Financial support when you need it the most Many people are unaware of just how little financial support they may receive if they suffer a long term illness or accidental injury that prevents them from working. In many cases employer and State Benefits simply don t add up when illness or accident strikes leaving a large gap in your finances. Mind the gap! Did you know that the average salary in the UK is 27,000¹ per year? After National Insurance and tax that provides ² per week. Currently State Benefits would provide just ³ per week to cover your mortgage, household bills, food and cost of living. This would leave an income gap of per week. ¹ Office of National Statistics 2013 Annual Survey of Hours and Earnings ² This is for illustration purposes only. Amounts have been sourced using online tax calculator tools. For details of your own tax deductions please refer to HMRC. ³ Department for Work and Pensions (DWP) April 2014: based on Employment and Support Allowance per week for those in the Work Related Activity Group. Alternative benefits such as Incapacity Benefit and Statutory Sick Pay apply in some cases. For full details refer to the DWP. As a mutual business, Cirencester Friendly is run for the benefit of its Members so you can rest assured that we ll do all we can to be there when you need us most. Your Income Assured Plus contract can provide you with a secure regular income if you are unable to work and suffer a loss of earnings due to illness or accidental injury helping you to continue to meet payments on essential outgoings. Income Assured Plus - Your Guide to Claims 3

4 How to make a claim What type of Income Assured Plus contract do you have? Day One, 1 week or 4 week deferred period* 8 week, 13 week, 26 week or 52 week deferred period* 1) Within 7 Days of your Illness or Accidental Injury Contact the Society to request a claim form Call: or option 1 claims@cirencester-friendly.co.uk Write: Claims Department, Cirencester Friendly, 5 Dyer Street, Cirencester, Glos. GL7 2PP. 1) Within 1 Calendar Month of your Illness or Accidental Injury Contact the Society to request a claim form Call: or option 1 claims@cirencester-friendly.co.uk Write: Claims Department, Cirencester Friendly, 5 Dyer Street, Cirencester, Glos. GL7 2PP. 2) Within 14 Days of your Illness or Accidental Injury Complete and return the Claim Form with the supporting original medical and financial documentation showing your earnings in the last 12 months. 2) Not less than 1 Calendar Month before the Expiry of your Deferred Period Complete and return the Claim Form with the supporting original medical and financial documentation showing your earnings in the last 12 months. 4

5 3) What happens next? Your claim will be given to a dedicated handler who will deal with the assessment and guide you through the process if you need them too. We will tell you if we need any further information and whether you are eligible for benefit. Your claim will be paid on the 15th of the month and at the end of the month for the duration of the claim (This may vary if the dates fall on the weekends or a Bank Holiday. Please note that payments are made by BACS and take 2-3 working days to clear). We will keep in touch with you throughout your claim to ensure you continue to get the relevant benefit. It is important that you continue to send us medical certificates and updates on your incapacity as well as continuing to pay your premiums in order to continue receiving your benefit. *What is a deferred period? Some Members choose a period of time during which they feel they could cope without an income and live off savings or other funds. During this time they will not receive any benefit from their Income Assured Plus contract. We call this a deferred period. Income Assured Plus - Your Guide to Claims 5

6 Surname Forename(s) of the car / / Cost/Market value Gross amount / / Cash equivalent Cash equivalent Cash equivalent Taxable amount A 1A 1A 1A Postcode Postcode Frequently Asked Questions What documents do I need to provide you when I make a claim? In the event of a claim we will need to see original documentary evidence of your earnings in the 12 month period immediately before you became unable to work through your incapacity. We will return these documents to you. If you are employed we will require printed payslips, P60 and, if applicable your P11D. Becoming self-employed and registering for National Insurance contributions and/or tax If you are self employed - we will require your most recent business accounts and latest agreed HM Revenue & Customs Tax Computation/Return. If you are employed as a shareholder director within a private limited company with no more than 3 other shareholder directors we will require evidence of the dividends you have received from your company s normal regular business and your company accounts as well as printed payslips your P60 and where applicable your P11D. P11D(2010) HMRC 08/09 Employer name Employer PAYE reference Employee name If a director tick here Works number/department National Insurance number A B Everyone starting out as self-employed needs to register with HM Revenue & Customs (HMRC). You should tell us as soon as you start working for yourself (you can t register in advance). If you have delayed registering, you may have to pay an initial penalty. You will also have to pay further penalties if payments become due and have not been met. Please complete this form in capital letters, taking particular care to complete all the questions relevant to you. P11D Expenses and benefits About you Note to employer Complete this return for a director, or an employee who earned at a rate of 8,500 or more a year during the year to 5 April Send the completed form to your HM Revenue & Customs office by 6 July Your employer has filled in this form, keep it in a safe place. You will need it to complete your Tax Return if you get one. The box numberings on this P11D are the same as on the Employment Page of the Tax Return, for example, boxes Your current home address Title enter Mr, Mrs, Miss, Ms, or other title Note to employee First name(s) Surname or family name Other names Assets transferred (cars, property, goods or other assets) Description of asset = Payments made on behalf of employee Description of payment Tax on notional payments not borne by employee within 90 days of receipt of each notional payment Vouchers or credit cards = Living accommodation Cash equivalent of accommodation provided for employee, or his/her family or household Mileage allowance and passenger payments Amount of car and mileage allowances paid to employee for business travel in employee s own vehicle, and passenger payments, in excess of maximum exempt amounts (See P11D Guide for exempt rates) Cars and car fuel If more than two cars were made available, either at the same time or in succession, please give details on a separate sheet Car 1 Car 2 Make and Model Date first registered Approved CO 2 emissions figure for cars registered on or after 1 January 1998 Tick Engine size cc cc Type of fuel or power used Please use the Dates car was available From / / to / / From / / to / / List price of car Including car and standard Accessories All non-standard accessories, Capital contributions (maximum 5,000) the employee made towards the cost of car or accessories Amount paid by employee for private use Date free fuel was withdrawn / / / / Cash equivalent of each car Total cash equivalent of all cars made available in Cash equivalent of fuel for each car Total cash equivalent of fuel for all cars made available in E F Employers pay Class 1A National Insurance contributions on most benefits. These are shown in boxes which are brown and have a 1A indicator C D Please ensure your entries are clear on both sides of the form. Value of vouchers and payments made using credit cards or tokens (for qualifying childcare vouchers the excess over 55 a week) box if the car does not have an approved CO 2 figure key letter shown in the P11D Guide Do not complete the From box if the car was available on 5 April 2009 or the To box if it continued to be available on 6 April 2010 classic car, employers see booklet 480 accessories only: if there is no list price, or if it is a see P11D Guide Tick if reinstated in year (see P11D Guide) Previous surname (if applicable) Date surname changed DD MM YYYY Reason name changed (married, divorced, widowed or other) Your date of birth DD MM YYYY Your reference numbers See P11D Guide for details of cars that have no approved C0 2 figure Your National Insurance (NI) number Amount made good or from which tax deducted Amount made good or from which tax deducted We need a NI number to effectively administer your National Insurance record. You must also have a NI number before you can be registered for Self Assessment. If you do not have one, phone Jobcentre Plus on to make an appointment to attend an evidence of identity interview to get one. Without a valid NI number we will not be able to provide you with a Unique Taxpayer Reference (UTR) Your previous home address For official use only System Action Complete NPS TBS SA PAYE Are you a UK resident? Yes Go to question 12 No If you have come to the UK from abroad within the last 12 months please tick this box 12 Have you been self-employed before? g/km g/km Date of birth in figures (if known) D D M M Y Y Y Y Gender M Male F Female See P11D Guide for details of cars that have no approved CO 2 figure No Go to question 14 Yes Tell us your tax reference number. It will be the ten digit reference (the UTR) in the top left-hand corner on page 1 of your tax return. CWF1 Page 1 HMRC 02/ If you have selected the Houseperson definition, we reserve the right to obtain, where relevant, proof of income. If you don t fully complete the claim form and supply evidence of your earnings and incapacity, your benefit may be affected. What evidence do I need to provide during the claim period? When claiming benefit from us, evidence of your continuing illness or accidental injury must be provided to avoid a loss of benefit. This should be in the form of an original doctor s certificate. This will be returned to you on request. You may also be required to provide other continuing evidence throughout your claim. 6

7 Do I have to pay my premiums whilst I am claiming? You must continue to pay your premiums throughout the period of claim, however you do get these back as a refund from the 29th day of being off work if on a Day One contract or from your chosen deferred period. Please bear in mind that if you are over insured you will only receive a proportionate refund of your premium. Talk to your Financial Adviser at least annually to make sure you have the right amount of cover. How much benefit will I receive? We only protect part of your earnings (up to a maximum of 60%) as the benefit you receive is tax free and it therefore equals a higher proportion of your take home pay before you became ill or injured. Sick pay benefit from an income protection contract is not intended to put you in a position where you are financially better off than when you were working. Can I resume work and still get benefit? Following a period of claim; if you are able to return to your occupation, but at first can only work restricted hours because of your incapacity, you can apply for rehabilitation benefit to help you until you can work your normal hours. If you cannot return to your own occupation because of your incapacity but you decide to follow a different occupation you can apply for proportionate benefit. This benefit is offered at the discretion of the Society and will be paid for a limited time to assist you with the change in your occupation. If however, you choose to do a different occupation even though you are able to perform your original occupation, then you will not be eligible to apply for either of these benefits. Does the cost of my premium go up if I have made a claim? No, the Society produces pre-published premium rate tables which can be obtained from our website or by request. Changes to the premiums follow advice from our Actuary, and are based on our overall claims experience plus a number of other variables and can only be changed with the approval of Members at a General Meeting. Income Assured Plus - Your Guide to Claims 7

8 Frequently Asked Questions (Continued) What might affect the amount of benefits I get when I am claiming? We will reduce your benefit if any of the following take your potential benefit to a level greater than 60% of your earnings: Continuing payments from your occupation, such as sick pay and wages Pension payments if they arise because of your incapacity Income and payment protection benefit from other providers We may ignore Department of Work and Pensions benefits and unearned income that is not dependent upon your working (for example investment income from stocks held) which is not covered under the contract. If you are working and your earnings fall below 4550 per year you may not be entitled to benefit in the event of a claim. What can I do if I am unhappy with the outcome of my claim? We want you to be happy with your claim and will maintain contact throughout the process. When we reach a conclusion on your claim we will write to you to explain our decision. If you are unclear on how we have reached our decision we urge you to contact us without delay and we will provide any further explanations or information you may need to understand our reasoning. We appreciate that on occasion some Members may not agree with our decision. If you are unhappy with a decision and have not received a satisfactory response to your enquiry you can write to the Society s Compliance Officer and ask that the matter be reviewed. Contact details are provided at the end of this booklet. In the event that you remain unhappy after the Society s Compliance Officer has investigated the matter you can take your complaint to the Financial Ombudsman Service (FOS), where an independent adjudicator will consider your case. 8

9 Our claims record Our Claims department handled 882 applications for sick pay benefit in Of these, 1.8% were not eligible for consideration due to: The claim ending before the expiry of the deferred period. Some Members choose a period of time during which they feel they could cope without an income and live off savings or other funds. During this period they will not receive any benefit from their Income Assured Plus Contract. We call this a deferred period. If you return to work during the deferred period you have chosen your claim will be invalid as your cover does not start until after this period of time. The claim being for an excluded medical condition. Sometimes medical conditions, where there is a history of problems either for the claimant or their family, may be excluded from your contract. That means that you will not be able claim for those specific medical conditions. This left 866 claims to be considered. During 2013 we paid out on 94% ¹ of claims Most of these claims were for Accidents and Injuries Back, Neck, Shoulder, Muscular, Arthritis Other illnesses such as Hernia, Cerebral condtions, Influenza, Ears, and eyes. 94% 6% Claims paid Claims declined ¹ For a copy of our full Claims Statistics contact Customer Care on or download it from our website Income Assured Plus - Your Guide to Claims 9

10 Only 6% of claims were declined in 2013 Why were these claims declined? The Member suffered no loss of earnings due to their illness or accidental injury. Income Assured Plus is an Income Protection product therefore if you do not lose your earnings from your work as a result of your illness or accidental injury there can be no claim. The Member failed to provide full and accurate information when they applied for their contract. This is what we call non-disclosure this means that the Member failed to tell us about an existing medical condition when they applied for their contract. Usually the knowledge of this condition would prompt an exclusion by our underwriters or may have resulted in Membership being declined. Remember... Income Assured Plus is an Income Protection product. In order to make a claim you must be able to demonstrate a loss of earnings from your work caused by your illness or accidental injury. If you are not working at the time of your illness or accidental injury you will not have suffered any loss of earnings from your work and will not be able to make a claim. 10

11 What our Members have claimed for When illness or accidental injury occurs we aim to deal with your claim quickly and efficiently, just like the Members in the case studies below. Accidental injury Mark, a 45 year old, self-employed mechanic from Sheffield had an unexpected fall and suffered severe skull and brain damage. Without his Income Assured Plus contract Mark would have received just the basic Government Statutory Sick Pay of only per week (The amount available from the Government at the time). He had 10 units of cover which equalled an additional income of 105 per week, tax free for the full length of his claim. Help with rehabilitation Theresa is a 55 year old partner in a catering company. In January 2006 she was diagnosed with a tumour in her liver and had to stop work. Without her, the business couldn t function to full effect and needed to close early each day. Theresa suffered a loss of earnings due to her illness and was able to make a claim during the period she was off work. In October 2006 she underwent chemotherapy and later returned to work for a few hours each day. As she was returning to work at reduced hours she was eligible for rehabilitation benefit, this meant that she could return to work part time and receive a reduced rate of benefit. After working approximately 8 hours per week in a supervisory role and undertaking light duties, she has now been able return to work full-time. Theresa received full benefit for just over 8 months and a partial benefit in the form of Rehabilitation Benefit for a further 9 months supporting her until she was ready to return full time. Accident cover from Day One Paul, a self employed meat trimmer from Gloucestershire, suffered tendon damage to his hand whilst working. In order to keep costs low Paul had chosen to defer his sickness benefit for 52 weeks, however he had also added the Day One Accident Protection option to his contract. This meant that from day one Paul was able to claim for loss of earnings caused by his accident. He was paid per week for 3 months until the tendons healed and he was able to return to work. Thanks to Day One Accident Protection, Paul was able to keep the costs of his income protection contract low, but could still make a claim for loss of income and concentrate on making his recovery. The cases described in this guide are based on real claims, but the names and personal details have been changed to protect the identity of each individual. Income Assured Plus - Your Guide to Claims 11

12 Did you know... Over a quarter of claims made in 2012 were as a result of an accidental injury. Income Assured Plus contracts with a deferred period have the option to add Day One Accident Protection. If you have selected cover to begin after 1, 4, 8, 13, 26 or 52 weeks and do not have any other forms of income to cover you during this period you might like to consider our accident protection option. For an additional premium you can protect yourself against loss of earnings as a result of an accidental injury from Day One, even though your benefit payments for illness would start from your chosen deferred period. Talk to your Financial Adviser about adding Day One Accident Protection to your Income Assured Plus contract. 12

13 Why we cannot pay some claims Our aim is to provide financial support when you need it the most. For us that means doing our utmost to pay every claim. Unfortunately on occasion we cannot pay claims. To help you avoid disapointment in the event of a claim, the examples below show why the Society is unable to provide benefit to some Members. In 2013 we were unable to pay 6% of claims Not giving the Society all the facts at application - Non disclosure Andrew, a shop owner joined the Society in September When he completed his application form he told his Financial Adviser that he had not had any previous medical history of note that the Society would be interested in. As a result the health section of his application form gave no details of previous illnesses or conditions. Later Andrew submitted a claim and as part of the claims process we obtained medical notes from his doctor. From the notes received by his doctor and following a review by our underwriters it became clear that Andrew had a signifcantly poor medical history. If we had been made aware of this when Andrew applied we would not have offered Andrew a contract. As a result of Andrew not providing the full facts we were unable to consider his claim and were forced to cease his contract. The need to provide full and complete facts about your health at application is vital to the fulfillment of the contract's objectives. If you want to avoid the disappointment that Andrew suffered or have any doubts about how much to tell the Society our advice is to provide as much information as possible. The cases described in this guide are based on real claims, but the names and personal details have been changed to protect the identity of each individual. Income Assured Plus - Your Guide to Claims 13

14 Not reviewing cover regularly - Over-insurance Sarah, a self-employed bookkeeper, took her contract out in 2002 declaring personal taxable earnings for the previous 12 months of 17,500. In May 2008, she submitted a claim for a back injury. To support her claim she was required to provide proof of her earnings. She did this by means of her latest HM Revenue and Customs tax calculation, which showed that her taxable earnings had fallen considerably since joining the Society. Whilst her claim was valid and she was paid benefit, Sarah was disappointed not to receive the level of benefit she thought she was entitled to. Sarah was over-insured because she did not review her cover to ensure it remained appropriate to her circumstances. To avoid disappointment it is very important to keep your cover under frequent review (speak to your Financial Adviser at least annually). This will help ensure you do not pay for something you will not be able to benefit from. Remember the Society does not refund overpaid premiums. Amendments to your contract can only take effect when we know about them. If you are unsure if a change in your circumstances will impact on your contract we strongly recommend that you contact your Financial Adviser to ensure the action you are taking is right for you. If you do not have an Financial Adviser, provides an independent listing of Financial Advisers in your area. Lack of Evidence - Validation of claim Peter, who was a self-employed builder, submitted a claim following an accident at work. So that we can prove employment and calculate benefit entitlement, we asked for evidence of his earnings to calculate the level of his benefit. This took the form of his latest trading accounts and tax calculation. Unfortunately Peter had not submitted a tax return or completed business accounts for two years. As a result he was unable to provide us with any evidence to support his employment or earnings. This meant we were unable to pay him any sick pay benefit. At the time of claim it is absolutely vital to produce evidence of incapacity and earnings to prove entitlement to claim benefit. If you are unsure as to what is required consult your Financial Adviser or the Society without delay because it could be the difference between having your claim admitted or declined. 14

15 Contact details To register your claim please contact our Claims Department; Call or and select option 1 claims@cirencester-friendly.co.uk Cirencester Friendly Society Limited, 5 Dyer Street, Cirencester, Glos. GL7 2PP If you need to contact our Compliance Officer please use the address above and clearly mark your letter for the attention of The Compliance Officer. Tel: Fax: Income Assured Plus - Your Guide to Claims 15

16 Keep a note of useful information here... My Membership Number is Notes Cirencester Friendly Society Limited, 5 Dyer Street, Cirencester, Glos. GL7 2PP Tel: / Fax: info@cirencester-friendly.co.uk Cirencester Friendly is a trading name of Cirencester Friendly Society Limited. Registered and Incorporated under the Friendly Societies Act Reg. No. 149F. Cirencester Friendly Society Limited is Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority under registration number THIS ITEM HAS BEEN PRINTED BY AN ISO14001 ACCREDITED ENVIRONMENTAL PRINTER. THE MATERIALS USED TO PRODUCE THIS BOOKLET ARE ELEMENTAL CHLORINE FREE AND WOOD FIBRE FROM SUSTAINABLE FORESTS. IT IS ALSO FULLY RECYCLABLE AND BIODEGRADABLE. V3 (Apr 2014)