There will be some basic checks completed. The level of each check will depend on the insurers own experience of claims and the individual claims circumstances.
- The claim event has happened.
- The claim is covered by the policy.
- There are no exclusions which apply.
The insurer will ask for appropriate evidence to establish the above facts.
Planning how the claim will be handled
Once the claim has been handled, it will need to be looked at again. At this point the insurer needs to review how long to diary the claim. Employment claims may be diarised and looked at every month, accident and sickness may be reviewed every doctors certificate. Each insurer will use his own experience.
Payment
Once the above has been done, then payment needs to be considered in line with the policy coverage. This may be a one off payment or regular payments so long as the right to claim exists.
Review
Where the claim is of the regular payment type, then the customer will be sent a continuation claim form to complete so that is can be established that the right to claim (sickness/accident stopping work or unemployment) continue to exist. This cycle will continue until the loan is repaid, the customer returns to work and the right to claim falls away or the maximum payment benefit has been paid. Which ever occurs first.
Evidence
The insurers will want to know that the claim is valid. There will therefore select appropriate evidence for the customer to send in.
Life
Original death certificate although some insurers will accept a certified copy.
Unemployment and redundancy
For redundancy the insurer will want to see a formal redundancy letter from the employer.
For all unemployment and redundancy claims the customer will need to register with the Job centre to prove a Job seekers Agreement exists and that the claimant is indeed seeking work. The insurer relies on the Benefits Agency to monitor ongoing claimants.
Form AB1 is a standard industry form designed to check that claimants are still seeking work and are indeed still unemployed.
Each continuation claims form must be accompanied by a new AB1.
If the customer has been self employed they have to advise the Inland Revenue that their businesses can no longer produce enough to meet their basic needs and that it has ceased trading. This is normally advised to the Inland Revenue by the firm’s accountant. The insurer would need a copy of that letter.
Some mortgage protection insurer’s polices insist on compulsory liquidation of self employed companies before benefit can be paid. As part of a recent insurer initiative this harder stance is dropping away.
