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Your Policy
This is Your Policy. Please read it carefully and be sure
You understand the cover provided.
Enclosed You will find Your Policy Schedule.
The Schedule and this Policy should be read as one
contract.
You have a contract with and are covered by:
AXA General Insurance Limited (the Insurer)
Registered Office:
107 Cheapside
London EC2V 6DU
Registered in England No. 141885
Introduction
The Insurer agrees to pay the Amount of Benefit shown
in the Policy Schedule, subject to the terms, conditions
and exclusions contained in this Policy.
Eligibility
A customer is eligible for this insurance provided that, at the
Commencement Date, he/she is in Employment and has
been continuously for the previous six months (twelve months’
continuous Self-Employment if Self-Employed), during
which time he/she has not been registered as Unemployed with
the relevant Government agency, and
a) is aged between 18 and 60 inclusive and
b) is in paid work for an average of 16 hours or more per week
and
c) is permanently resident in the United Kingdom, Channel Islands
or Isle of Man and
d) is not aware of any impending Unemployment and
e) has been accepted for cover by the Insurer.
Definitions
Certain words are defined in this Policy and its Schedule
and wherever they appear in bold they will have the meanings shown
below.
1 Amount of Benefit
You can select the level of monthly benefit for which You
wish to purchase protection under this Policy up to a maximum
of £1,000 per month.
The benefit level selected by You must not exceed 50% of
Your Pre-Disability/ Unemployment Earnings less Existing Benefits.
2 Benefit Period
The period commencing after the Exclusion Period for which the
Amount of Benefit is payable as shown in the Policy Schedule.
3 Ceased to Trade
Where You have provided Your final accounts to business cessation
and Your last tax return to Your tax office.
4 Commencement Date
The date cover is effective as shown in Your Policy Schedule.
5 Consultant
A medical specialist who is a member of an appropriate Royal College
which recognises the Consultant as a specialist.
6 Disability/Disablement
Total disablement from engaging in or giving attention to the Normal
Occupation resulting from accidental bodily injury or sickness,
as certified by a Registered Medical Practitioner, occurring after
the Commencement Date of this insurance. In the case of the Self-Employed,
total disablement that totally prevents You from
helping, managing, or carrying out any part of the day to day running
of Your business.
7 Employment
To be in paid work for an average of 16 hours or more per week
(i) on a permanent contract of Employment or
(ii) on a fixed term contract
Important note on fixed term contacts: If You have
been continuously employed on a contract of at least 12 months duration
with the same employer that has been renewed at least once or a
contract with the same employer for a continuous period of at least
24 months, You will be treated as being in permanent Employment.
If You are on a fixed term contract but cannot meet these
criteria, You will not be covered for non-renewal of Your
contract and benefit in respect of Unemployment will
not be payable beyond the date on which Your contract would
have terminated had You remained working for the original
intended period of the contract. If, at the Commencement Date
of this insurance, You are on a fixed term contract which
does not meet the criteria for permanent Employment but which
subsequently meets these criteria, You will be treated as
being in permanent Employment if a claim occurs after such
criteria have been met.
or
(iii) as a director (not covered by the definition of a Self-Employed
person) who is salaried and employed on a permanent basis and has
no control over his/her own Employment or
(iv) as a partner who is salaried and employed on a permanent basis
and under a contract of service and has no control over his/her
Employment or
(v) as a trainee with a permanent contract of Employment or
(vi) as a Self-Employed person
Important note on Self-Employment: A different definition of Unemployment
applies to the Self-Employed.
8 Exclusion Period
The number of days as shown in the Policy Schedule, of any period
of Disablement (if chosen) or Unemployment (if chosen), in respect
of which the Amount of Benefit is not payable
Should a period of Disablement merge into a period of Unemployment
(or vice versa) with absence from work remaining unbroken, only
one Exclusion Period is applicable and cover will not extend beyond
the Benefit Period shown in the Policy
Schedule.
9 Existing Benefits
These are:
(i) any other insurances You are entitled to as a result of accident,
illness or Unemployment and
(ii) any continuing salary, fees, wages or commission payable or
early retirement pension resulting from any Employment, trade, profession
or vocation, payable as a result of accident, sickness or Unemployment
10 Insurer/We/Us
AXA General Insurance Limited
11 Normal Occupation
The gainful occupation carried on by You immediately prior to the
commencement of Your Disablement or any similar gainful occupation
which You may be reasonably expected to undertake bearing in mind
Your knowledge and training.
12 Normal pregnancy and childbirth related conditions
Symptoms which normally follow a pregnancy and/or childbirth (including
those relating to multiple pregnancy) and which are generally of
a minor and/or temporary nature, not representing an unusual or
significant hazard to mother or baby.
13 Policy (including its Schedule)
The documentary evidence of the contract of insurance between You
and the Insurer.
14 Your Pre-Disability/Unemployment Earnings
These are Your gross taxable earnings for the previous 12 months
(currently shown on a P60) and, for the Self-Employed, personal
earnings for the previous 12 months as assessed for Income Tax and
as shown on an Agreed Notice of Assessment provided by the Inland
Revenue.
15 Registered Medical Practitioner
A doctor who is registered with the General Medical Council and
is working in the United Kingdom, the Channel Islands or the Isle
of Man.
16 Self-Employed/Self-Employment
You are:
(i) Actively working for profit in a business or profession, alone
or in association with others, and paying Class 2 National Insurance
Benefit Contributions or
(ii) A non-salaried partner in a partnership or
(iii) A director of (or someone who has a shareholding in) a private
limited company with an issued and fully paid share capital of less
than £1,000
17 Unemployment (in respect of employees)
A period beginning after the Commencement Date of this insurance
as shown in the Policy Schedule, during which You are no longer
in Employment and are registered as unemployed at the relevant Government
agency. You must also be in receipt of National Insurance Contributions
credits and be available for and actively seeking alternative Employment.
Unemployment (in respect of the Self-Employed only)
A period beginning after the Commencement Date of this insurance
as shown in the Policy Schedule, during which You
have Ceased to Trade, are registered with the relevant Government
agency and are in receipt of National Insurance Contributions credits.
You must be available for and actively seeking alternative
Employment.
18 Unemployed
In a state of Unemployment.
19 You/Your
Any customer who is invited to join the scheme and who is aged
between 18 and 60 inclusive on the date the application is completed
for this insurance and as shown in the Policy Schedule.
Disablement Cover
Your Policy Schedule will show whether this cover has been selected.
If You suffer Disablement as defined above and Disability continues
beyond the Exclusion Period, the Insurer will pay, in arrears, one
thirtieth of the Amount of Benefit to You for each further day of
Disablement. The Amount of Benefit will become payable 30 days after
the expiry of the Exclusion Period and thereafter will be paid at
30 day intervals throughout the continuance of Disablement up to
the maximum period of cover provided by the Benefit Period for any
period of Disablement.
Disablement shall be deemed not to commence before the day on which
You first consult a Registered Medical Practitioner (other than
allowing for the statutory period of self-certification) for the
condition giving rise to the Disablement.
The Amount of Benefit will not be paid for any period of Disablement
after You attain State retirement age (or Your normal retirement
date as specified in Your contract of Employment if earlier), nor
for any period of Disablement during which the Amount of Benefit
is being paid for Your Unemployment.
Where twelve payments of the Amount of Benefit in respect of any
one Disability claim have been made, You must have returned to Employment
for at least
1 Six months before You will be entitled to claim again for the
same Disability or
2 One month before You can claim again for a different unrelated
Disability or
3 One month before You are able to claim under a different section
of the Policy
Where We have made less than twelve payments of the Amount of Benefit
in respect of any one Disability claim,
1 You must have returned to Work for at least one month before
You can claim again for a different unreleated Disability or
2 If there is a recurrence of the same Disability within three
months of Your return to Work, Your claim will be treated as a continuation
of the original claim. The Exclusion Period will not be reimposed
and in total We will pay a maximum of twelve payments.
Exclusions
The Insurer will not pay the Amount of Benefit for any period of
Disablement:
(i) arising from any existing physical or mental defect, infirmity,
recurring disease or chronic or continuing disease
a) for which You have received treatment or advice during the
12 months immediately preceding the Commencement Date of insurance
b) of which You were aware at the Commencement Date of insurance
ii) arising from any psychiatric illness or mental or nervous disorder
(including anxiety, depression, stress and stress-related conditions)
unless investigated and diagnosed by a Consultant
iii) arising from any surgery which is not medically necessary
to sustain or maintain Your quality of life and which is undertaken
solely at Your request
iv) for which substantiating medical evidence has not been provided
by a Registered Medical Practitioner
v) for which the Amount of Benefit is being paid under this Policy
in respect of Your Unemployment
vi) arising directly or indirectly from Normal pregnancy and childbirth
related conditions.
vii) caused by any back complaint or associated condition unless
there is specialist medical evidence made available to Us.
Special Note: When a claim is made by You for a pregnancy or childbirth
related condition, the Insurer may refer to a doctor or Consultant
who specialises in Obstetrics for an opinion as to whether the condition
is a Normal pregnancy and childbirth related condition. We will
consider this opinion to be final.
See also General Exclusions
Unemployment Cover
Your Policy Schedule will show whether this cover has been selected.
If You suffer Unemployment as defined above and Unemployment continues
beyond the Exclusion Period, the Insurer will pay, in arrears, one
thirtieth of the Amount of Benefit to You for each further day of
Unemployment. The Amount of Benefit will become payable 30 days
after the expiry of the Exclusion Period and thereafter will be
paid at 30 day intervals throughout the continuance of Unemployment
up to the maximum period of cover provided by the Benefit Period
for any period of Unemployment.
The Amount of Benefit will not be paid for any period of Unemployment
after You attain State retirement age (or Your normal retirement
date as specified in Your contract of Employment if earlier), nor
for any period of Unemployment during which the Amount of Benefit
is being paid for Your Disablement. Where You receive payment in
lieu of notice from Your employer, no Amount of Benefit will be
payable in respect of the period covered by the payment in lieu.
The Exclusion Period shall be deemed not to commence until such
period has expired.
If it is unclear what period is covered by the payment in lieu,
the period shall be calculated in weeks by dividing the amount of
the payment by Your average gross earnings per week for the 13 weeks
immediately preceding the commencement of Unemployment.
If there are less than 6 consecutive months of Employment between
two periods of Unemployment, We will treat these two periods as
one continuous claim. We will not pay any benefit for the time You
were in Employment between the two periods of Unemployment. In total,
We will pay a maximum amount equal to twelve payments. Where twelve
payments have been paid for any one claim You must have returned
to Work for at least
1 Six months before You are able to claim again for Unemployment
or
2 One month before You are able to claim under a different section
of this Policy.
If Your claim changes from Unemployment to Disability or from Disability
to Unemployment We will pay in total, a maximum amount equal to
twelve payments.
Exclusions
The Insurer will not pay the Amount of Benefit for any Unemployment:
(i) effective prior to the date of application for this insurance
(ii) which has not immediately been preceded by at least six months’
continuous Employment (or twelve months’ continuous Self-Employment
if You are Self-Employed)
(iii) which You knew to be impending on the date of signing the
application form
(iv) occurring within 120 days of the Commencement Date
(v) where You are not available for and are not actively seeking
alternative Employment
(vi) when You were not registered as Unemployed with the relevant
Government agency and/or and were not in receipt of National Insurance
Contributions credits
(vii) which results from
– industrial action in which You are directly involved or
– Your own misconduct or
– Your voluntarily leaving Your existing Employment or
– Your tendering Your resignation for whatever reason
(viii) following voluntary redundancy or in the form of short-time
working
(ix) which is a normal incident or seasonal occurrence in Your
occupation or, in the case of You changing Your occupation, is known
to be impending at the time of such change in occupation
(x) occurring or continuing:
a) whilst You are outside the United Kingdom, Channel Islands
and the Isle of Man for a period intended by You to be of more
than 30 consecutive days’ duration
b) when You have been outside the United Kingdom, Channel Isles
and the Isle of Man for more than 90 days in total in any one
year
(xi) for a period for which the Amount of Benefit is being paid
under this Policy in respect of Your Disablement
The Insurer will not pay the Amount of Benefit for any period of
temporary Employment undertaken during a claim.
In respect of clients on fixed term contracts, the following additional
exclusions apply:
(a) Unemployment which commences at the expiry of a fixed term
contract
(b) Unemployment beyond the date on which the fixed term contract
would have terminated had You remained working for the original
intended period of the contract
unless, You have been continuously employed on a contract of at
least 12 months duration with the same employer that has been renewed
at least once or a contract with the same employer for a continuous
period of at least 24 months.
See also General Exclusion
General Exclusions
The Insurer will not pay the Amount of Benefit for any period of
Disablement or Unemployment
(i) arising from War Invasion Act of Foreign Enemy Hostilities
(whether War be declared or not) Civil War Rebellion Revolution
Insurrection Military or Usurped Power
(ii) where a claim is a result of attempted suicide or wilful exposure
to danger (except in an attempt to save human life)
(iii) where a claim is a result of intentional self-inflicted injury
or the influence or effect of intoxicating liquor or drugs (other
than drugs taken under medical supervision and not for the treatment
of drug addiction)
(iv) arising directly or indirectly from Normal pregnancy and childbirth
related conditions.
Special Note: When a claim is made by You for a pregnancy or childbirth
related condition, the Insurer may refer to a doctor or Consultant
who specialises in Obstetrics for an opinion as to whether the condition
is a Normal pregnancy and childbirth related condition. We will
consider this opinion to be final.
(v) for the Exclusion Period shown in the Policy Schedule
(vi) attributable, directly or indirectly to HIV (Human Immunodeficiency
Virus) and/or any HIV-related illness including Acquired Immune
Deficiency Syndrome (AIDS) and/or mutant derivatives or variations
thereof
(vii) after You attain State retirement age (or Your normal retirement
date as specified in Your contract of Employment if earlier).
The effective date and period of insurance
Insurance under this Policy will become effective on the date on
which the application form for insurance is accepted.
The period of insurance is the period during which calendar monthly
premiums are paid to and are accepted by the Insurer.
The insurance cover provided by this Policy is automatically renewed
each month. The Insurer and BIBA reserves the right to withdraw,
terminate or vary the cover provided and/or alter the rates of premium
charged at any time.
We will give You at least 30 days’ written notice prior to
any alteration taking effect.
Termination of individual insurance
1 Your insurance will terminate on whichever of the following occurs
first:
(i) the date on which You attain State retirement age or Your
normal retirement date if earlier
(ii) the date when the next monthly insurance premium is due
in the event of the Insurer refusing to continue providing cover
after giving You written notice of such refusal.
(iii) the date when the next monthly insurance premium is due
in the event of the premium not being paid by You
(iv) on receipt of Your written authority
(v) the date on which Your circumstances change if such a change
renders the insurance invalid.
Change in circumstances
AXA General Insurance Limited must be notified of any changes in
Your circumstances. A change in occupation may lead to an increase
or decrease in premium or cover may be terminated depending on whether
the new occupation is of a more/less hazardous nature or involves
greater/less physical or manual work.
Claims
Note: As part of our commitment to customer care, We occasionally
arrange for claims negotiators to visit our claimants in order to
ensure that their claim is being handled effectively.
1 In the event of a claim You must
a) notify Quantum Claims Management Limited of Matthew House,
Matthew Street, Dunstable, Beds, LU6 1SD, Tel: 01582 501300, Fax:
01582 501301 who will issue a claim form.
b) complete the claim form fully in all respects and arrange
for a Registered Medical Practitioner or official of the relevant
Government agency to complete the appropriate section.
c) return the fully completed form to the above address.
2 No claims will be considered by the Insurer where notification
is received by the Insurer more than twelve calendar months after
the claim first arose.
3 It is a condition precedent to any liability under this Policy
that You are permanently resident in the United Kingdom, Channel
Islands or Isle of Man.
4 When a claim for Disablement occurs You will supply all certificates,
information and evidence which the Insurer may require at Your own
expense. The Insurer may request and will pay for You to be medically
examined on behalf of the Insurer by a doctor appointed by the Insurer.
The Amount of Benefit will not be payable for any claim where You
fail to undergo such medical examination.
5 If You are claiming for Unemployment the Insurer shall be entitled
to make enquiry of Your immediate past employer or otherwise as
deemed necessary. You must ensure that You register with the relevant
Government agency immediately You are entitled to do so.
6 Claims payments will be paid direct to You.
7 Premiums must continue to be paid during a claim
Fraudulent Claims
You must not act in a fraudulent manner
If You or anyone acting for You:
- make a claim under the Policy knowing the claim to be false
or fraudulently exaggerated in any respect or
- make a statement in support of a claim knowing the statement
to be false in any respect or
- submit a document in support of a claim knowing the document
to be forged or false in any respect or
- make a claim in respect of any loss or damage caused by Your
wilful act or with Your connivance
Then We:
- shall not pay the claim
- shall not pay any other claim which has been or will be made
under
the Policy
- may at Our option declare the Policy void
- shall be entitled to recover from You the amount of any claim
already
paid under the Policy
- shall not make any return premium
- may inform the Police of the circumstances
Should You have any query please contact Your Insurance Advisor
Caring for our Customers
We at AXA General Insurance Limited make every effort to provide
a good service to all Our Policyholders. If on any occasion Our
service falls below the standard You would expect Us to meet,
the procedure below explains what You should do:
Your first point of contact should be with Your BIBA Insurance
Broker.
Alternatively, or if, following contact with the above, You feel
that You require further assistance, please write to the Head of
Customer Care who will review the details of Your case and arrange
for an investigation on behalf of the Chief Executive:
Customer Care
AXA General Insurance Limited
Civic Drive
Ipswich
IP1 2AN
Telephone: 01473 205926
Fax: 01473 205101
Or You may use email: customercare@axa-insurance.co.uk
If You are still not satisfied You may refer Your case to the Financial
Ombudsman Service (FOS).
The FOS is an independent body that arbitrates on complaints after
We have provided You with written confirmation that Our Internal
complaints procedure has been exhausted.
Financial Ombudsman Service
South Quay Plaza
183 Marsh Wall
London
E14 9SR
Telephone: (0845) 080 1800
Fax: (020) 7964 1001
Referral to the FOS will not affect Your right to take legal action
against Us.
Law applicable to this contract
You are free to choose the law applicable to this Policy. Your
Policy will be governed by the law of England and Wales unless You
and We have agreed otherwise.
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