Mortgage protection insurance - policy wording

19. Obligations and rights when making a claim

You must have an independent medical examination if we believe it necessary to validate your claim (we will pay the cost of the examination). If you fail or refuse to have a medical examination and you do not give us a satisfactory reason, we will not pay any monthly benefit.

We reserve the right to contact any other person or organisation that we consider necessary to assist in the validation of your claim and where necessary, you must provide us with the relevant authority to obtain this information. We can also ask to see your personal bank or financial statements.

We may arrange a personal interview with you to help you look for further permanent work.

We will only begin to make monthly benefit payments when we receive full and satisfactory evidence of your eligibility to claim. If you delay sending us the claim form or any other evidence we require, your claim may be harder to check. This may lead to us paying monthly benefit late or not paying it at all.

20. The paying of premiums

Premiums are payable monthly in advance by direct debit. If you make a claim under the policy, you must continue to pay your premium as it falls due. We will increase your monthly benefit to reimburse any premium you have paid during a period of claim.

We can change your premium by giving you 30 days notice in writing.

The premium you pay includes Insurance Premium Tax at the current rate. If we are required by law to increase the level of Insurance Premium Tax or to make any other charges, we will increase your premium from the date any such changes are implemented.

21. Making sure your mortgage is protected

If your mortgage payment alters due to interest rate changes, you can amend your monthly benefit (without notice) provided that you tell us within 30 days of the notification from your lender.

If you want to alter your monthly benefit for any other reason or you want to amend the type of cover or benefit split you hold under the policy, you will need to give us 90 days written notice.

22. Important facts you will need to disclose on or before the start date

You must tell us if:

• You are under the age of 18 or over 64.
  
• You work or live outside the UK.
  
• You would not be eligible to register as unemployed in the UK.
  
• You are not actively working for at least 16 hours a week.
  
• You are aware of any impending unemployment which may affect you.
  
• You are aware of any redundancies, restructure or reorganisation within the business you work in, even if you do not believe these actions will result in you becoming unemployed.
  
• You are aware of any financial or contractual threat to the business you work in, even if you do not believe these actions will result in you becoming unemployed.
  
• You have been registered as unemployed within the last 12 months.
  
• Your employer has taken any disciplinary action against you including performance related issues.
  
• 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 have a pre-existing condition which may result in you having to take time off work or you are currently unable to work because of a disability (including any maternity leave).
  
• You are using your mortgage for commercial purposes (including buy to let mortgages) or you are not living in the mortgaged property.
  

23. Circumstances that may affect your continuing cover under the policy

You must tell us if:

• You start to work or reside outside the UK.
  
• You resign, retire or stop working voluntarily.
  
• Your status changes from employed to self-employed (or vice versa).
  
• You start working for less than 16 hours a week.
  
• Your mortgage ends or your lender issues proceedings against you because you have missed too many mortgage payments.
  
• You have, or take out, any other unemployment and/or disability insurance.

24. General conditions that apply to the policy

• If you do not keep to the policy conditions, we will not pay any monthly benefit.
  
• We will cancel your policy and 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. Under these circumstances, we may refund a percentage of any premium you have already paid.
  
• Unless we agree otherwise in writing, English law is the law that will apply to this policy.
  
• The contract between you and us is made up of:
  
  • the policy;
    
  • the certificate;
    
  • any endorsements;
    
  • your proposal; and
    
  • any other written statement or information you give us.
    
• The policy will not have any cash-in value.
• We may change the policy by adding an endorsement to it. We will let you know at least 30 days before any endorsement comes into force. If we add an endorsement to the policy, we will not be entitled to make any further endorsement within the next 180 days.
  
• All administration procedures will be carried out on our behalf by the administrator.
  
• We will pay the monthly benefit covering your mortgage payment to your lender.
  We will deduct from your monthly benefit any amounts we are required to deduct by law.

25. What you should do if you have a complaint

We try to provide a first-class standard of service. If you do have a complaint, please write to:
The Managing Director,
Paymentshield Limited, PO Box 229, Southport PR9 9WU
Phone: 0870 759 4010 or Fax: 0870 759 4011
If the matter is not sorted out to your satisfaction, please write to:
The Chief Executive,
Hamilton Insurance Company Limited
North Street, Winkfield, Windsor, Berkshire SL4 4TD.
If you are still not satisfied, you can ask either of the following organisations to review your case:

• The Insurance Ombudsman (IOB):
  135 Park Street, London SE1 9EA. Phone: 0845 600 6666; or
  
• The Association of British Insurers (ABI):
  51 Gresham Street, London EC2V 7HQ. Phone: 0207 600 3333.
  

If you contact the Insurance Ombudsman (IOB) or the Association of British Insurers (ABI), this will not affect any right of legal action you may have under the policy. Your interests are also protected under the Policyholders’ Protection Act. You can get details from the Policyholders’ Protection Board at the Association of British Insurers (ABI).

26. Access to medical records

We may ask the doctor (or consultant) who is caring for you to fill in a medical report so we can deal with your proposal for this insurance. To do this, we need your permission. Please sign the Access to Medical Reports Act 1988 (in Northern Ireland The Access to Personal Files and Medical Reports (Northern Ireland) Order 1991) declaration contained on the proposal.

You do not have to give your permission to our Chief Medical Officer being given the report. However, under these circumstances, we may be unable to process your proposal. If you give your permission, you have the right to tell your doctor (or consultant) that you want to see the report before it is sent to us. In this case, your doctor (or consultant) cannot send it to us unless you have either seen the report or 21 days have passed without you contacting your doctor (or consultant) to arrange to see the report. If at first you decide that you do not want to see the report but you change your mind before your doctor (or consultant) sends us the report, you can tell your doctor (or consultant). You will then have 21 days to see the report. We may not be able to go ahead with your proposal without medical information. As a result, the sooner you act, the quicker we can consider your proposal for this insurance. Whether or not you ask to see the report before it is sent to us, your doctor (or consultant), if you ask, must let you see a copy for up to six months after they send it to us. If you ask for a copy of the report, your doctor (or consultant) may charge a reasonable fee to cover the cost.

If you see the report before it is sent to us, your doctor (or consultant) cannot send it to us until he or she has your permission. You can ask your doctor (or consultant) to change any part of the report, and if they refuse you can ask your doctor (or consultant) to send us a separate statement with the report giving the reasons why you consider it to be wrong or misleading. Your doctor (or consultant) can refuse to let you see any part of the report that in his or her opinion would be likely to cause you or others any physical or mental harm. They can refuse if any part of the report may reveal information about another person unless that person gives permission or has cared for you in a professional way. In these cases, your doctor (or consultant) must tell you. You could then see any other part of the report. If it is the whole report that is affected, your doctor (or consultant) must not send it to us unless you give your permission.

27. Data protection act notification

We may use the personal details provided by you, or any third parties, to:

• give you quotations and administer your policy;
  
• support the development of our business by including your details in client surveys; or
  
• assist in market research
  

We have a set of practices in place to ensure that confidential information (including medical & lifestyle) about you is held securely. We may also share these details with other insurance organisations to help offset risks, administer your policy, handle claims and prevent fraud.

We will store your details on computer but we will not keep them for longer than necessary. Under the terms of the Data Protection Act 1998 you are entitled to a copy of all the information we hold about you for which a reasonable fee may be charged.

28. The insurer and administrator

The policy is underwritten by Hamilton Insurance Company Limited, North Street, Winkfield, Windsor, Berkshire SL4 4TD.

The policy administrator is Paymentshield Limited, PO Box 229, Southport PR9 9WU.

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