Full policy wording

Policy Terms and Conditions HICL/PS/919

1. The special words we use

The special words we use in these terms and conditions are shown below with their meanings alongside them. Except where the context otherwise requires, the masculine shall include the feminine, the singular shall include the plural and vice versa as appropriate.

2. How the uk mortgage payment insurance policy works

• You select the amount of cover you need to protect your mortgage payment. Where your mortgage agreement allows you to make variable payments to your lender (e.g. a flexible mortgage plan), this should be the average monthly amount you intend to pay;
  
• You select the type of cover you require.
  
• You select the benefit split you require.
  
• You pay a monthly premium to keep the policy in force.
  
• We pay a fixed monthly benefit for up to 12 months if you are unemployed or disabled (as applicable) for longer than the waiting period.

Important note - The most we will pay as a monthly benefit is £1,500 or an amount equal to 65% of your normal income, whichever is the lower.

3. The type of cover the policy provides

The type of cover provided under the policy is unemployment and disability insurance. This will offer you maximum protection in the event of a claim. You can (if required) restrict your policy to unemployment only cover or disability only cover but you must be aware of the following facts:

• if you take out unemployment only cover you will not be able to claim for any disability. If you suffer a disability during any period of unemployment, your monthly benefit payments will be suspended until you are able to continue actively seeking work; or
• if you take out disability only cover you will not be able to claim for any unemployment. If you become unemployed during any period of disability, you will only be able to continue to receive monthly benefit while you remain disabled.
  

4. The number of people who can be insured (the benefit split)

• If your mortgage is in your name only, or your mortgage is in joint names and you are the only person who is eligible for cover, we will issue single cover in your name.
• If your mortgage is in joint names and both of you are eligible for cover, you have the following options:
  
  • you can take out single cover in your name and be insured for 100% of the monthly benefit provided that you are the main income earner. The restriction relating to main income earner will be waived if both parties to the mortgage wish to be insured for 100% of the monthly benefit by taking out two separate policies; or,
    
  • you can take out split cover and you will both be insured for a percentage of the monthly benefit. If you make a claim, we will divide your monthly benefit in the same percentage as the normal income of each person at the commencement of the claim.

5. Free cover for new borrowers

If you are a new borrower, you will receive three months free cover.
If you restrict your policy to unemployment only cover or disability only cover, we will also restrict your free cover to the same type of cover.

6. Free cover for existing borrowers

If you are an existing borrower, you will receive three months free cover.
If you are an existing borrower, you will not be insured against unemployment during the three month initial exclusion period.
If you restrict your policy to disability only cover, we will also restrict your free cover to the same type of cover. If you have restricted your policy to unemployment only cover, you will only be insured against disability during the free cover period.

7. Transferring cover from another insurer

If you transfer your cover from another insurer, we will ignore the unemployment exclusion period for existing borrowers as long as your existing policy has been in force for at least six months and you have not made a claim under that policy.

8. The eligibility requirements of the policy

You are eligible for cover under the policy if:

• you are at least 18 and under 65;
  
• you live and work in the UK;
  
• you are taking out the policy to protect the mortgage on the private residential property you live in; and
  
• you agree to keep to the policy conditions.

You are not eligible for cover under the policy if:

• you are aware of any circumstances that may result in you becoming unemployed;
  
• your work is of a casual, temporary or seasonal nature;
  
• you work for a temporary employment agency;
  
• unemployment is a regular feature of your particular job; or
  
• you are currently disabled. This clause does not apply if you are on maternity leave.
  

9. The waiting period under the policy

The policy has a 30 day waiting period during which you will not be entitled to receive any monthly benefit if your unemployment or disability lasts for 30 days or less. After that, you will receive an amount equal to one monthly benefit payment on the 31st day you are still unemployed or disabled (Our "back to day one" cover ensures that you receive full cover from the first day of your sickness/disability as long as the sickness/disability lasts more than 30 days).

10. When the policy pays out for unemployment

Subject to the exclusions detailed in section 11, we will pay out for unemployment if:

• you are unemployed and you are registered as available for work (unless you are exempt) at an employment office (or equivalent) in the UK; and
  
• you can provide independent evidence that you are actively looking for permanent work.
  

We will consider the first day of your unemployment to be the day you are first registered as unemployed and available for work (unless you are exempt) at an employment office (or equivalent) in the UK and receiving the appropriate national insurance credits. If you are receiving payment in lieu of notice the waiting period will not begin until your payment in lieu of notice period has ended.

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.
  

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.