Mortgage protection insurance - policy wording

11. What prevents the policy paying out for unemployment (the exclusions)

We will not pay out for unemployment if:

• You do not tell us about your claim for unemployment within six months of the event.
  
• You were aware at the start date of any circumstance that would lead to you making a claim for unemployment, or in our reasonable opinion, you should have been aware.
  
• You were not in continuous work for the six month period immediately before your first claim for unemployment. This clause will be waived if you were in continuous work for the six month period immediately before the start date.
  
• Your work is of a casual, temporary or seasonal nature (including any work for a temporary employment agency), or unemployment is a regular feature of your particular job.
  
• You resign, retire, leave your occupation voluntarily or you accept early retirement in lieu of unemployment.
  
• Your unemployment occurs as a result of:
  
  • your misconduct including fraud, dishonesty, breach of contract or any other circumstance that resulted in your employer taking disciplinary action against you;
    
  • your failure to meet the standards or targets laid down by your employer
  • your participation in any industrial action;
    
  • the expiry of an apprenticeship or training contract;
    
  • civil unrest, war, radioactive contamination or any other related event.
• Your unemployment happens while you are working away from the UK for more than 90 days in a row. This clause will not apply if you:
  
  • work for the British Armed Forces or as a Civil Servant in a British embassy or consulate;
  • work for a company that is registered within the UK and your employer asks you to work within the European Union.
  • You are receiving payment in lieu of notice.
• Your unemployment occurs as a result of any disability.
  

12. When the policy pays out for disability

Subject to the exclusions detailed in section 13, we will pay out for disability if:

• you were actively working when your disability occurred; and
  
• you cannot work as a result of the disability you are claiming for and you are under the regular care and attendance of a doctor (or consultant).
  

We will consider the first day of your disability to be the day on which a doctor (or consultant) first certifies that you are unable to work due to the disability you are claiming for.

13. What prevents the policy paying out for disability (the exclusions)

We will not pay out for disability if:

• You do not tell us about your claim for disability within six months of the event.
  
• You were aware at the start date of any circumstance that would lead to you making a claim for disability under the policy, or in our reasonable opinion you should have been aware.
  
• Your disability is caused by a self-inflicted injury, alcohol abuse, drug abuse or you fail to follow any medical advice.
  
• Your disability is caused by stress, anxiety, depression or any other nervous disorder unless a suitably qualified consultant certifies that the condition prevents you from working.
  
• Your disability is caused by any pre-existing condition.
  
• Your disability is caused by pregnancy or a normal pregnancy related condition (other than a medical complication which happens as a result of your pregnancy).
  
• Your disability is caused by backache or a back related condition where there is no physical or radiological evidence of a medical abnormality unless a suitably qualified consultant certifies that the condition prevents you from working.
  
• Your disability arises from any operation or treatment which is not medically necessary.
  
• You are doing any other job for payment or reward or you are receiving any form of payment or reward for helping, managing or carrying out any part of the day to day running of your business.
  
• Your disability is caused by any of the unemployment exclusions.
  

14. Cancellation rights under the policy

You can cancel the policy by writing to us and your cover will end on the day we receive your written request. If you cancel the policy within 30 days of the start date, we will refund any premium you have paid. We will not refund any premium if you cancel the policy more than 30 days after the start date.
We can cancel the policy by giving you 90 days written notice. This will not affect your right to receive claim benefits for any unemployment or disability which occurred before the cancellation date.

15. When cover under the policy will terminate (the end date)

Cover will end on the date that one or more of the following events should occur:

• you die;
  
• you retire from work or reach the age of 65;
  
• your mortgage comes to an end (unless we have agreed to transfer your cover);
  
• the property named on your mortgage agreement becomes the subject of repossession proceedings in a county court or high court;
  
• your premium becomes more than 30 days overdue;
  
• you no longer reside in the UK; or
  
• you or we cancel the policy.
  

16. General conditions for making a claim

• The policy only pays out if:
  • your unemployment or disability occurs after the start date and before the end date;
  • you meet all the claim requirements under these policy terms and conditions;
    
  • you have paid all your premiums; and
    
  • you give us all the evidence we need to check your claim.
    
• You cannot claim for unemployment and disability at the same time.
• If you restrict your insurance to unemployment only cover or disability only cover, we will only pay for a claim arising from the specific type of cover you have selected.
  
• We will reduce your monthly benefit if it is more than 65% of your normal income.
  
• If you have any other unemployment or disability insurance, we reserve the right to reduce your monthly benefit by an amount equal to the claim benefits you receive under that insurance.
  
• You can transfer a claim between unemployment and disability (or vice versa) but if you do, we will not pay more than 12 monthly benefit payments for that period of claim.
• You can make a completely new claim under the policy as long as you have returned to work for at least 90 days in a row. We will treat two claims separated by less than 90 days work in a row as the same period of claim and you will only be entitled to receive the balance of any monthly benefit payments left from the previous period of claim. We will reduce this period to 30 days for any claim arising from a medical condition that is not related to the disability that brought about the previous claim.
  
• We will not pay any monthly benefit if you give us any false, misleading or fraudulent information, or if you fail to tell us about any important fact.
  
• If you make a claim for unemployment and you are offered a temporary job, you can suspend your claim provided that:
  
  • you tell us beforehand who you will be working for;
    
  • your temporary job lasts for at least one week and no longer than six months; and
    
  • you do not have more than three separate temporary jobs during any one period of claim.

17. What to do if you have to make a claim

If you want to make a claim under the policy, you should contact:

Paymentshield Claims Department
P O Box 229, Southport, PR9 9WU.
Phone: 0870 759 4020; Fax: 0870 759 4021

We will send you a claim form which you must fill in and return to us as soon as possible, together with any further evidence we may need. You will also need to provide the following information:

• unemployment - evidence that you are still unemployed and actively looking for work; or
  
• disability - evidence that you are still disabled and that you are still under the regular care and attendance of a doctor (or consultant).
  

18. When we will make claim payments

Your initial claim payment will be made on the first day immediately after the waiting period.
After that, we will pay an amount equal to 1/30th of the monthly benefit for each day you are still unemployed or disabled. We will continue to make payments monthly in arrears until the earliest of the following events:

• the last day you are unemployed or disabled;
  
• the date on which you stop giving us evidence that you are still unemployed or disabled;
  
• the date on which you have received 12 monthly benefit payments for any one claim; or
  
• the end date of the policy.
  

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