Accident, Sickness & Unemployment

Income Protection: Accident, Sickness and Unemployment – ASU
Accident & Sickness or Unemployment Cover  or  both.
The maximum period of any claim is 12 or 18 months

Typical Rules for ASU:

Accident & Sickness Cover.
When will my benefit payments start, and for how long will you pay me?
If you are unable to work due to an accident or sickness for a period in excess of the chosen waiting period, benefits will be paid direct to you. If the qualifying days you are off work do not exceed the waiting period no benefits will be paid. 

The first qualifying day of a claim for disability is the date on which you see a Doctor, whether it be your own General Practitioner or a Doctor at a hospital, and are certified by them as being totally unfit to carry out your normal employment or occupation. You must continue to be certified as above throughout the period of your claim.

Unemployment
If you are unable to work as a result of Involuntary Unemployment, for a period in excess of the chosen waiting period, benefits will be paid direct to you, with the first month’s benefit payment becoming due as at the 1st  qualifying day of a claim period that exceeds the waiting period. If the qualifying days you are off work do not exceed the waiting period no benefits will be paid.

Involuntary Unemployment for employees:
Please note: If you or a close relative of yours is a director or you or close relatives of yours are holders, either alone or together, of more than 5% of the shares of your employer, then for the purpose of considering an unemployment claim, you are considered as self employed and should read this summary accordingly.

Involuntary Unemployment is any unemployment forced upon an individual by a third party and not a route they have taken themselves. Not restricted to redundancy.

Payment of benefits will only be made where an employee has become Involuntarily Unemployed, and is in continuous receipt of Jobseeker’s Allowance.

The first qualifying day of a claim for Involuntary Unemployment is the first day for which the claimant is actually paid Jobseeker’s Allowance. Claimants must be continuously registered with the Employment Service Jobcentre, and in receipt of Jobseeker’s Allowance throughout the entire period of claim.

Involuntary Unemployment for the self-employed:
A self-employed person is any person, working alone or in conjunction with others, in their own business on a self-employed basis, as declared to HM Revenue & Customs.

Benefit is payable where the self-employed person’s business has ceased trading as a result of the financial insolvency of the business arising or occurring after the inception of the policy (or the date on which unemployment is added to the cover provided if later) and they can provide:

Proof that HM Revenue & Customs has been notified, via a Qualified Accountant.

E540 booklet confirming registration at the Jobcentre.

Evidence of receipt of National Insurance Contribution Credits.

Full audited accounts demonstrating a previous net income sufficient to justify the cover hereunder.

The self-employed person’s business must also have been trading in sufficient profit to justify the amount of this cover for more than 6 months prior to the circumstances giving rise to a claim and the circumstances must be a specific event or events. You will not be covered for a lack of sufficient work resulting in you deciding to cease your business.

The first qualifying day of a claim for Involuntary Unemployment for the self-employed is the first day for which the claimant is actually paid the above credits. Claimants must be continuously registered with the Employment Service Jobcentre, and be in receipt of credits throughout the entire period of claim.

Involuntary Unemployment for contract workers:
Involuntary Unemployment is any unemployment forced upon an individual by a third party and not a route they have taken themselves. Not restricted to redundancy.
Benefits will be payable when at the point of claim you fall into any of the following categories:

Where you have been employed on a annually renewable contract with the same employer for at least 2 years and the contract has been renewed at least once.

Where you have been with the same employer on a short term contract for more than 6 months that has been renewed at least twice. In this event we would pay benefit for the balance of your contract term if terminated early.

The first qualifying day of a claim for Involuntary Unemployment for contract workers is the first day for which the claimant is actually paid Jobseeker’s Allowance. Claimants must be continuously registered with the Employment Service Jobcentre, and be in receipt of Jobseeker’s Allowance throughout the entire period of claim.

WHAT IS NOT COVERED? (EXCLUSIONS)

Involuntary Unemployment Exclusions. Unemployment claims due to or arising from any of the following will not be covered:

1.  When you are not registered for work with the Employment Service Jobcentre or when unemployment is known to be impending at the time of commencement of the insurance, or the time at which unemployment is added to the cover provided if later.
2.When unemployment is voluntary or of a normal seasonal nature.
3.If registered on a training scheme, unless you can prove that you are continuously and actively seeking work.
4. If you give up work to become a carer. (At our discretion we will consider a claim taking account of whether you are in receipt of a carer’s allowance, are required to care for a member of your immediate family and were or were not aware of the situation prior to the start of or last alteration to your cover).
5.  Unemployment which becomes known or expected in the 90 days following the start or alteration of cover. (If you have simultaneously cancelled other full unemployment cover covering the same commitment for the same amount and have held such cover for at least three months then this exclusion will be waived).
6.If you are not continually available for and actively looking for work or are unable to provide, on a continuing basis, third party documentation to support this.

General Exclusions. Any claims due to or arising from any of the following will not be covered:

1.Intentional self inflicted injury.
2.Stress, anxiety, depression, fatigue or other mental or nervous disorders, or conditions of a psycho-neurotic origin, unless diagnosed by and under the continuing care of a Consultant Psychiatrist.
3.Pre-existing medical conditions. If you have a sickness, disease, condition, or injury from which you have suffered or for which you have consulted or been treated by a registered medical practitioner in the 12 months prior to the commencement of the insurance (or the date on which your cover was last extended — whichever is the later), then that particular condition, or any claim attributable to it is excluded, until you have been clear of it for a continuous 24 month period prior to the commencement of claim.
4.Alcohol or drug use unless under the specific direction of a registered medical practitioner for any condition other than drug addiction.
5.The normal course of pregnancy.
6.War, riot, or civil commotion, or military or naval service outside Europe.

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