How to make a claim
When can I claim?
As a Mutual, PG exists to look after the needs of our members. We aim to handle all valid claims sympathetically and promptly.
Here is some information about how to make a claim, which we hope is helpful. If you have questions, please call us on 01727 840 095.
If you are incapacitated and unable to work due to illness or accident you are entitled to make a claim from the first day of incapacity. Valid claims do, however, need to comply with the Society’s rules. You should, where possible, inform us of your intention to claim within three days of the commencement of the illness or accident, and then return the claim form within fourteen days. Failure to do so may result in penalties.
Please see our How to Claim Form
What evidence will I need to provide?
- Completion of a claim form by you
- Occupational details
- Completion of a Confidential Medical Certificate by your GP or Consultant/Specialist.
What happens next?
Once your claim form is received, we may need to request reports from your GP and/or Consultant depending on the nature of the claim. We may require a medical examination either by your own doctor or an independent doctor. We will tell you if we need any further information to process your claim.
How is my claim assessed?
All information submitted will be considered in order to determine if your claim is valid.
- We will compare the requirements of your occupation and then determine, based on the relevant definition of incapacity in the Society’s Rules, how you are prevented from working
- We will check that the condition claimed for has not been excluded, either under the Rules of the Society or as part of your individual membership terms to confirm that you meet our definition of incapacity
- We will check whether you were working at the time of your claim. Activities of daily living will apply if you were not working immediately prior to your incapacity.
Please see our Key Features Document
Admitted claims
All admitted claims are paid by Direct Debit into your personal bank account and will always be confirmed to you in writing.
Declined claims
If your claim is not admitted, you will be advised of this in writing with the reason.
Payment of Income Benefit
All Income Benefit is paid in arrears. Every effort will be made to process your claim without unnecessary delay. In some circumstances, delays may occur, such as when a medical report has been requested. If a delay does occur, once admitted, payment will be backdated from the commencement date.
If the claim is likely to be ongoing, you will be required to provide regular certification from your doctor and payment will be made monthly in arrears. In addition, we may require further medical evidence to substantiate the claim and you will be advised and kept up to date of any such requirements.
For how long will I receive Income Benefit?
Benefit will continue to be paid for as long as the evidence continues to show that you are incapacitated in accordance with appropriate definition of ‘incapacity’, as defined in the Rules of the Society.
If you are incapacitated on a long-term basis, benefit will be paid as follows:
Reducing Benefits:
- For the first two years of any claim, you will receive 100% of your original Income Benefit
- For the third year of your claim, your will receive 50% of your original Income Benefit; and
- From the fourth year, you will receive 30% of your original Income Benefit until either your sixty-fifth birthday or you cease to be incapacitated in accordance with the Rules of the Society.
Level Benefits:
We will pay you at the rate of Benefit for which you have subscribed for the duration of the claim.
Please note that both types of cover exclude payment of Benefits for any deferral period selected.
When will I cease to be eligible for Income Benefit?
Excluding death, you cease to be eligible when
- You return to work
- Your membership is terminated
- You reach your sixty-fifth birthday
- You cease to be ‘incapacitated’ in accordance with the appropriate definition under the Rules of the Society
- Or you are found to have made an improper, false or fraudulent claim for Income Benefit from the Society.
What happens if I resume work and become incapacitated again?
If you return to work after having been in receipt of Income Benefit for less than 6 months and you become incapacitated again within 3 months this will be deemed a continuation of the original claim, unless there is medical evidence to indicated to the satisfaction of the Committee of Management that the second illness arose from causes wholly unconnected with the first illness.
If you return to work after having been in receipt of Income Benefit for more than 6 months and you become incapacitated within 9 months, this will be deemed a continuation of the original claim, unless there is medical evidence to indicated to the satisfaction of the Committee of Management that the second illness arose from causes wholly unconnected with the first illness.
Claim Form
If you would like to make a claim, please use the claim form below.
