You must submit any claim after a medical procedure has been performed on an insured person within 90 days of their treatment date.
Should you wish to make a claim under this policy or if you have any questions as to whether a condition or procedure is covered by this policy, please call the MyRecoveryCheque Helpline on 0800 319 6048 or 0207 398 0100 between 9am to 5pm Monday to Friday or send an email to firstname.lastname@example.org.
When calling the Helpline you should be aware that the administrator will need to ask certain questions in order that it can confirm cover. It will help if you have the following information available:
Please remember that certain medical procedures are not covered. Please refer to the EXCLUSIONS in your Policy Document for full details.
You or any other insured person must comply with the following conditions to have the full protection of this policy. If these conditions are not complied with, we may refuse to deal with the claim or reduce the amount of any claim payment.
1.The administrator must receive notification together with any other relevant information that it may require within 90 days of the date of the treatment date giving rise to the claim. If the administrator is not notified or supplied with the relevant information within 90 days and this prejudices the administrator’s ability to verify the claim then no benefits will be paid for the claim.
2.The claims process will be fully explained to you when the administrator is contacted and a claim form will be sent. The form will need to be completed, signed and returned by you to the administrator together with any supporting documents that it has requested.
3.The insured person’s permission for the administrator to see their medical records and/or report(s) will need to be given or obtained in accordance with the requirements of the Data Protection Act and/or the Access to Medical Reports Act 1988. If we want the insured person to have a medical examination, they must do so or the claim may not be paid. We will pay any out of pocket expenses or costs incurred in attending and/or undergoing the medical examination.
4.You must continue to pay your premium for the period of cover in which your claim began, or we may, at our discretion, deduct any outstanding premium from any claim payment due.
Once the claim has been approved by the administrator and it has been presented with evidence of the insured person having undergone a medical procedure or suffered from a heart attack, the appropriate benefit applicable to the medical procedure or heart attack will be paid in accordance with the classification of medical procedure and the level of cover that you have chosen. Payment will be made by cheque or bank transfer directly to you within 5 working days.
Payments for any claims relating to your children will be paid to you
Please note that calls to the MyRecoveryCheque Helpline may be monitored or recorded for training and quality assurance purposes
We take a robust approach to fraud prevention in order to keep premium rates down so that you do not have to pay for other people’s dishonesty. If any claim made by you or anyone acting on your behalf under this insurance is fraudulent, deliberately exaggerated or intended to mislead, we may:
- not pay that claim; and
- recover from you any payments we have already made in respect of that claim; and
- terminate your insurance from the time of the fraudulent act; and
- inform the police of the fraudulent act.
If your insurance is terminated from the time of the fraudulent act, we will not pay any claim in relation to any medical procedure or heart attack which happens after that time and may not return any of the premiums already paid.