(HICL/PS/921)

1. The special words we use in these policy terms and conditions

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

2. The general aims of the policy

• To pay a monthly benefit if you become unemployed or disabled.
  
  
• To provide the type of cover that is most suitable for you.
  
  
• To provide the amount of cover you need to protect your mortgage payment, life premium and household premium. You can also take out 25% extra cover over and above the combined total of your mortgage payment, life premium and household premium to protect other items of household expenditure.
  

Where your mortgage agreement allows you to make variable payments to your lender (e.g. a flexible mortgage), your mortgage payment should be the average monthly amount you intend to pay your lender.

Whatever cover you choose, the most we will pay as a monthly benefit (including the 25% extra cover) is £1,500 or 65% of your normal income, whichever is the lower.

3. The type of cover the policy provides

You can take out unemployment and disability insurance and this option will provide you with the maximum level of protection in the event of a claim. Alternatively, you can take out unemployment only cover or disability only cover, but you must be aware of the following points:

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

4. The free cover you receive

• If you are a new borrower, you receive three months free cover against unemployment or disability (unless you select unemployment only cover or disability only cover).
  
  
• If you are an existing borrower, you receive three months free cover against disability. You will not be insured against unemployment for the first three months of the policy (this is known as the exclusion period). Any unemployment cover provided under the policy, will only begin at the end of the three month free cover period.
  

If you take out unemployment only cover or disability only cover, your free cover will be the same type of cover.

5. The eligibility requirements of the policy

You are eligible for cover under the policy if:

• you are at least 18 and under 65 years of age;
  
  
• you live and work in the United Kingdom;
  
  
• you are taking out the policy to protect your mortgage; and
  
  
• you agree to keep to the policy conditions.

You are not eligible for cover under the policy if:

• you know of any circumstances that could 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.

6. Important facts you will need to disclose before the start date

In addition to the underwriting questions on your proposal, you must tell us if any of the following should apply.

• You cannot register as unemployed within the United Kingdom.
  
  
• You are employed on a fixed-term contract and you have less than 2 years service with your current employer.
  
  
• You are employed on a fixed-term contract and your contract has 6 months or less to run.
  
  
• You are aware of any proposed redundancies or reorganisation in the business you work for.
  
  
• You are aware of any financial or contractual threat to the business you work for.
  
  
• Unemployment is a regular feature of your particular job.
  
  
• You have a pre-existing condition.
  
  
• You are currently unable to work due to a disability (including any maternity leave).
  
  
• You are an existing borrower and your mortgage is in arrears.
  
  
• You are using your mortgage for commercial purposes (including buy to let mortgages).
  
  
• You are not living in the property named on your proposal.
  
  
• You are acting as a guarantor on the mortgage (even if you are named on the mortgage agreement).
  
  
• You already have unemployment and/or disability insurance.

7. 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 you will be insured for 100% of the monthly benefit (subject to you being the main income earner); 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 start of the claim.
    

The main income earner restriction for single cover is waived if both parties to the mortgage wish to be insured for 100% of the monthly benefit and both parties take out individual cover by completing two separate proposals.

8. Transferring cover from another insurer

If you transfer your mortgage payment protection cover from another insurer, we will waive the exclusion period provided that your previous insurance has been in force for at least six months and you have never made a claim under your previous insurance.

9. Making sure your mortgage remains protected

If your mortgage payment alters due to any 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 cover under the policy for any other reason, you will need to give us 90 days written notice.

10. The payment 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.

Your first premium becomes due for payment in the month immediately following the free cover period.

We can change your premium by giving you 30 days notice in writing. The premium 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 charges are implemented.

11. When the policy pays out for unemployment

If you become unemployed, then subject to the policy exclusions, we will pay out for unemployment if:

• you are registered as being unemployed and available for work at a benefits office (unless you are exempt); and
  
  
• you can provide us with satisfactory independent evidence that you are actively looking for permanent work.
  

We will consider the first day of your unemployment to be the date on which you are first registered as being unemployed and available for work at a benefits office (unless you are exempt) and you are receiving (at least) national insurance credits.

If you are receiving payment in lieu of notice, the qualification period you have selected under the policy will not begin until your payment in lieu of notice period has ended.

12. What stops us paying out for unemployment (the exclusions)

We will not pay out for unemployment if any of the following should apply.

• You do not tell us about your claim within six months of the event.
  
  
• You knew before the start date of any circumstances that could result in you becoming unemployed or, in our reasonable opinion, you should have known.
  
  
• Your unemployment occurs within the exclusion period or, you are told within the exclusion period about any future unemployment, even if your unemployment does not occur until after the exclusion period has ended.
  
  
• You were not in continuous work for six months immediately before your first claim for unemployment. This exclusion will be waived if you were in continuous work for six months immediately before the start date.
  
  
• Your work is of a casual, temporary or seasonal nature (including any work for a temporary employment agency).
  
  
• Unemployment is a regular feature of your particular job.
  
  
• Your unemployment occurs as a result of:
  
  
  • your resignation, retirement or voluntary unemployment;
    
    
  • you accepting early retirement in lieu of unemployment;
    
    
  • your misconduct, including fraud, dishonesty, breach of contract or any other circumstance that led to your employer taking disciplinary action against you;
    
    
  • your failure to meet any of the performance standards or targets laid down by your employer;
    
    
  • your participation in any industrial action; or
    
    
  • your apprenticeship or training contract coming to an end.
    
    
• Your unemployment occurs as a result of civil unrest, war, radioactive contamination or any other related event.
  
  
• Your unemployment occurs while you are working away from the United Kingdom for more than 90 days in a row.
  

  This exclusion will not apply if you:
  

  • work for the British Armed Forces;
    
    
  • work as a Civil Servant in a British Embassy or Consulate; or
    
    
  • are subsequently required by your employer to work at another location within the European Union.
    
    
• You are receiving payment in lieu of notice.
  
  
• You are doing any job (either employed or self-employed) for any form of payment or reward.
  
  
• Your unemployment occurs as a result of a disability.
  

13. When the policy pays out for disability

If you become disabled, then subject to the policy exclusions, we will pay out for disability if:

• you were actively in work when your disability occurred;
  
  
• you cannot work as a result of the disability you are claiming for; and
  
  
• you are not receiving any form of payment or reward (other than your normal or statutory sick pay entitlement).
  

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

14. What stops the policy paying out for disability (the exclusions)

We will not pay out for disability if any of the following should apply.

• You do not tell us about your claim within six months of the event.
  
  
• You knew before the start date of any circumstances that could result in you becoming disabled or, in our reasonable opinion, you should have known.
  
  
• 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. This exclusion will be waived if 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 any normal pregnancy related condition (other than a specific medical complication which happens as a result of your pregnancy).
  
  
• Your disability is caused by backache, or any other back related condition, where there is no physical or radiological evidence of a medical abnormality. This exclusion will be waived if a suitably qualified consultant certifies that the condition prevents you from working.
  
  
• Your disability arises from any type of operation or treatment that is not medically necessary (including cosmetic or beauty treatment).
  
  
• You are doing any job for payment or reward or, you are receiving any form of payment or reward for managing or carrying out any part of the day to day running of the business you work for.
  
  
• Your disability is caused by any of the unemployment exclusions.

15. General conditions for making a claim

• The policy only pays out if:
  
  
  • your unemployment or disability occurs between the start date and the end date;
    
    
  • you meet all the policy conditions for making a claim;
    
    
  • 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.
  
  
• You cannot alter your cover under the policy during a period of claim.
  
  
• If you take out 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 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 in total for that period of claim.
  
  
• You can make a completely new claim as long as you have returned to work for at least 90 days in a row. Two claims separated by less than 90 days continuous work are treated as the same period of claim and you will only be entitled to receive the balance of any monthly benefit payments that are left over from the previous period of claim.
  

This period is reduced to 30 days continuous work for any claim that arises from a medical condition that is not related to the disability that brought about the previous claim.

• We will not pay out any monthly benefit if you give us any false, misleading, or fraudulent information.
  
  
• We will not pay out any monthly benefit if you fail to tell us about any important facts.
  
  
• If you are making a claim for unemployment and you are offered a temporary job, you can suspend your claim provided that:
  
  
  • you tell us in advance, who you will be working for;
    
    
  • your temporary job lasts for at least one week and for no longer than six months in a row; and
    
    
  • you do not have more than three separate temporary jobs during any one period of claim.

16. 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:
PO 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
  independent evidence that you are still unemployed, registered as being unemployed and available for work at a benefits office and, actively looking for work.
  
  
• disability
  independent evidence that you are still disabled and that you remain under the regular care and attendance of a doctor or consultant. We may also require proof that you are not receiving any form of payment or reward (other than your normal or statutory sick pay entitlement).

17. When your claim becomes due for payment

The period of time you will have to wait before you can start to receive any claim benefits will depend on the qualification period option you have selected. Details of how the different qualification period options will affect the payment of claim benefit, is provided below.

• Back to Day One cover with a 30 day qualification period - if you choose this qualification period option, we will not pay any monthly benefit if your unemployment or disability lasts for less than 30 days in a row.
  
  If your unemployment or disability lasts for at least 30 days in a row, we will pay an amount equal to one monthly benefit payment on the 31st day. From the 31st day onwards, we will pay an amount equal to 1/30th of the monthly benefit for each day you are still unemployed or disabled and this will be paid monthly in arrears.
  
  
• Back to Day One cover with a 60 day qualification period - if you choose this qualification period option, we will not pay any monthly benefit if your unemployment or disability lasts for less than 60 days in a row.
  
  If your unemployment or disability lasts for at least 60 days in a row, we will pay an amount equal to two monthly benefit payments on the 61st day. From the 61st day onwards, we will pay an amount equal to 1/30th of the monthly benefit for each day you are still unemployed or disabled and this will be paid monthly in arrears.

18. When your claim payments will stop

Claim payments will stop on the first of the following events:

• the date on which your unemployment or disability ends;
  
  
• the date on which you stop giving us satisfactory evidence that you are still unemployed or disabled;
  
  
• the date on which you stop giving us satisfactory evidence that you meet the policy conditions for making a claim;
  
  
• the date on which we have made 12 monthly benefit payments for any one period of claim; or
  
  
• the end date of the policy.
  

19. Obligations and rights when making a claim

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

We may contact any other person or organisation that we consider necessary to assist in checking your claim and where necessary, you must provide us with a signed authority to obtain this information.

We may ask to see your personal bank or financial statements.

We may arrange an interview with you to help you look for work.

We will only make monthly benefit payments when we receive satisfactory evidence of your entitlement to claim.

If you delay sending us a completed claim form or any other evidence we require, your claim could take longer to check. This may lead to us paying the monthly benefit late, or not paying the monthly benefit at all.

20. Circumstances that may affect your cover

You must tell us if at any time:

• you start to live or work outside the United Kingdom;
  
  
• you resign, retire or stop working voluntarily;
  
  
• your status changes from employed to self-employed (or vice versa);
  
  
• you start working on a fixed-term contract basis;
  
  
• you start working for less than 16 hours a week;
  
  
• you no longer live in the property named on your proposal;
  
  
• you change the number of people who are named on your mortgage agreement;
  
  
• your mortgage ends;
  
  
• your lender issues proceedings against you because you have missed too many mortgage payments; or
  
  
• you take out any other unemployment and/or disability insurance.

21. Cancellation rights under the policy

You can cancel your cover by writing to us and your cover will end on the date we receive your written request.

If you cancel your cover within 30 days of the start date, we will refund any premium you have paid. We will not refund any premium if you cancel your cover more than 30 days after the start date.

We can cancel your cover by giving you 90 days written notice. This will not affect your right to receive claim benefits for any unemployment or disability that occurred before the cancellation date.

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

Cover will end on the first of the following events:

• the date on which you die;
  
  
• the date on which you retire from work or reach the age of 65;
  
  
• the date on which your mortgage comes to an end (unless we have agreed to transfer your cover);
  
  
• the date on which your home becomes the subject of repossession proceedings in a county court or high court;
  
  
• the date on which your premium is more than 30 days overdue;
  
  
• the date on which you no longer live in the United Kingdom; or
  
  
• the date on which you or we cancel your cover.

23. General conditions that apply to the policy

• We will cancel your cover and not pay any monthly benefit if you:
  
  
  • do not keep to the policy conditions;
    
    
  • give us any false, misleading or fraudulent information; or
    
    
  • do not tell us about any important facts;
    
    

  If this happens, we may (at our discretion) refund a percentage of any premiums you have already paid.
  

• Unless we agree anything different with you 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. If we do, we will write to you at least 30 days before any endorsement comes into force. If we add an endorsement to the policy (other than as a legal requirement), we will not make any further endorsement within the next 180 days.
  
  
• All procedures relating to the policy, are carried out on our behalf by the administrator (Paymentshield Limited).
  
  
• We will pay the part of your monthly benefit that covers your mortgage payment directly to your lender (unless your lender has agreed anything different with us in writing).
  
  
• We will deduct from your monthly benefit, any amounts that we are required to deduct by law.

24. 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 by signing 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.

25. What you should do if you have a complaint

Our aim is to provide you with a first-class standard of service. If you do have a complaint, please write to:

• The Head of Compliance and Service Standards:
  Paymentshield Limited, PO Box 313, Southport PR9 9WZ.
  Phone: 0870 759 4010. Fax: 0870 759 4011.
  

If the matter is not sorted out to your satisfaction, please write to:

• The Managing Director:
  Hamilton Insurance Company Limited, North Street, Winkfield, Windsor, Berkshire SL4 4TD.
  

If you are still not satisfied, you can ask the following organisation to review your case:

• The Financial Ombudsman Service (FOS):
  South Quay Plaza, 183 Marsh Wall, London E14 9SR.
  

If you contact the Financial Ombudsman Service, this will not affect any right of legal action you may have under the policy. Your interests are also protected under the Financial Services Compensation Scheme. You can get details from the FSCS at 7th Floor, Lloyds Chambers, Portsoken Street, London E1 8BN.

26. Data Protection Act Notification

We may use the personal details provided by you (or any third party) to:

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

We may also share these details with other insurance organisations to help offset risks, administer your policy, handle claims and prevent fraud.

We have set procedures in place to ensure that confidential information (including medical and lifestyle) about you is held securely. 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. If you do request a copy, we may charge you a reasonable fee.

27. Hamilton Insurance Company Limited

Hamilton Insurance Company Limited is an incorporated company limited by shares (Registered in England No. 1655888). Registered office: North Street, Winkfield, Windsor, Berkshire SL4 4TD.