A step-by-step guide to making an Eleos income protection claim

Income protection is all about being prepared. You take out a policy while you’re healthy and working so you’ll be ready for times when you’re not. In the same way, it’s best to be prepared when you have to claim. This step-by-step guide on how to claim income protection will take you through the online insurance claim process, from understanding your cover and gathering the documents you’ll need to submit your claim, getting paid and what happens when your claim comes to an end. It’s a good idea to read this guide together with this article, which covers some of the issues in more detail.

If you get an illness or injury that’s serious enough to stop you from working for more than a few days, it’s easy for events to overtake you. If you’re employed, you could qualify for Statutory Sick Pay (SSP) on day 4; if you’re self-employed you’ll need to claim Employment and Support Allowance (ESA).

If you have an income protection policy you should start preparing your claim as soon as you can.

First things first. Are you covered for your illness or injury? As a general rule, income protection covers any illness or injury as long as it’s not expressly excluded from your policy.

General and personal exclusions

Income protection insurance exclusions take two forms.

General ones include pre-existing conditions (any condition you had when you took out your policy, and possible ones you’d had in the past); certain specified illnesses like diabetes; anything self-inflicted; and normal pregnancy.

Personal ones include conditions that have been picked up by our underwriter as specific to your medical history or lifestyle, such as a hazardous job or dangerous hobby.

These are just examples – you should see exactly what’s listed as excluded in your policy.

Waiting period

When you took out your policy you chose how many weeks you’d be happy to wait before receiving your first payment. Double check this so you can budget accordingly. Obviously, if your sickness is shorter than your waiting period you won’t be due any payments.

Benefit period

Make sure you know how long your payments could last, either 1 or 2 years.

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As well as the claim form itself, you’ll need proof of your income and evidence of your illness or injury. For the first 7 days we’ll except your own statement of your inability to work (self-certification) and after that we’ll need a Med3 certificate signed by a medical professional for each 7-day period.

You’ll find your digital insurance claim form in your online dashboard. Answer the questions as fully as you can and send it as soon as possible, together with the other documents you’re asked for. If you’re in hospital and that prevents you from claiming immediately we can usually give you an extension so it won’t delay your first payment.

Sometimes we might need additional information about the nature of your illness or injury, how it happened, or whether it’s related to any other condition, for example. Occasionally you may be asked to see a specialist nominated by our underwriter. There’s no need to worry about this – we just need to follow procedure and fill in any blanks. The sooner you can provide this, the sooner we can assess and approve your claim.

On the basis of the information you’ve supplied, our underwriters will assess your claim and give you their answer as quickly as possible.

Once your claim is approved and you’ve come to the end of your waiting period you’ll start receiving your income protection benefit in regular monthly payments. We’ll need you to send us a Med3 certificate – signed by a doctor or other healthcare professional – for each week of your claim and we’ll carry on paying you until the earliest of the following happens:

• A doctor confirms that you’ve recovered enough to go back to work. 
• You reach the maximum duration for a single claim, either 1 year or 2, which you’ll have chosen when you took out the policy.
• Your policy comes to an end because you’ve cancelled it or for any other reason.

Apart from sending the regular Med3 certificates, you need to keep us informed of any changes in your health or circumstances that might be relevant. For example, there may have been changes in the job you’re planning to return to or in the nature of your illness or injury. If you’re not sure whether we need to know you should tell us, to avoid potential problems later.

Once you’re fit to go back to work you must tell us. At this point your claim ends and your payments will stop. If a doctor confirms that you’re able to work again but you decide not to, we won’t be able to carry on paying you. When your claim has ended you’ll start paying your monthly premiums again.

Remember, you can claim as often as you need to while your policy is active and you keep paying the premiums. If you suffer a new illness or injury you can make a new claim. If the illness or injury you were claiming for recurs then you’ll be able to make what’s called a linked claim, but there are a few restrictions. 

Linked claims

• If you chose a 1-year benefit period you can make a linked claim – with no waiting period - if the previous condition reappears within 26 weeks of your return to work. There are more details in our Policy Conditions.
• If you chose a 2-year benefit period you can make a linked claim – with no waiting period - if the previous condition reappears within 26 weeks of your return to work. There are more details in our Policy Conditions.
• If you’ve returned to work against medical advice and your health has deteriorated as a result you won’t be able to claim.

Once you’ve reached the limit of your benefit period and your payments have ended, if you need to claim again for the same condition or a related one, you can’t do so until you have been back at your normal job for at least 12 months. The waiting period will apply.