Generali PanEurope Group Income Protection Employer CLAIM FORM AND GUIDE TO THE Claims Process
2 Group Income Protection Employer s Guide to the Claims Process Group Income Protection is designed to provide employees with an income where they are unable to work for a long period of time due to illness or accident. Having Group Income Protection cover in place is also an effective measure to help protect a business from the increasing cost of long term absenteeism. Generali PanEurope Limited (Generali PanEurope) combines valuable financial assistance with a positive and proactive approach to reintegrating absent employees back into the workforce using practical support services such as early intervention and vocational rehabilitation. The Group Income Protection policy is effected between you and Generali PanEurope and is governed by the policy Terms and Conditions. You have decided who is covered under the policy, what benefits are provided, the Deferred Period and the ceasing age. Income Protection policies have a Deferred Period during which time no benefit is payable. During this period the employee will be subject to the terms of your sick leave policy. If the claim is admitted the benefit will be paid to you (as the employer) to pay to the relevant employee via payroll after deduction of any relevant taxes and social insurance. If you require further information, please contact your broker in the first instance or Generali PanEurope on +353 (0)46 9099 700. Please note that claims will not be paid until all requested information has been provided and any outstanding premiums on the policy have been paid. We reserve the right not to accept any claims notified to us more than one year after the end of the Deferred Period. Information Needed To assess a claim, Generali PanEurope requires evidence from you that the claimant is covered by the policy together with their job description and details of their absence over the last 12 months. What you should do Complete and sign the Employers Claim Form. Provide the employee s most recent job description. Provide a copy of absence record for the previous 12 months. Provide three months payslips. From the Employee, we need: A completed and signed Employee Claim Form. A certified copy of their Birth Certificate, Driver s Licence or Passport. Completed and signed forms and supporting documentation should be: Scanned and emailed to gpe.eb.claims@generali.ie or Posted to: Group Income Protection Claims Management Team, Generali PanEurope Limited, Generali House, Navan Business Park, Athlumney, Navan, Co. Meath When you should do it Forms should be received by Generali PanEurope at least four weeks before the end of your policy s Deferred Period. The aim is to have the claim assessed and a decision made by the end of the Deferred Period. Updates & Decision Generali PanEurope will send updates on the assessment process to you and chase any outstanding medical evidence at regular intervals. Once sufficient information has been received to reach a decision on the claim this decision will be communicated to you. In the event that a claim is declined, Generali PanEurope will outline the rationale for the decision. If you are unhappy with the decision you can lodge an appeal within three months of receiving the decision. Please see the factsheet on the Claims Appeal Process for further information.
3 Employer Details Policy number Claim number (if known) Employer name Correspondence address Name of individual dealing with claim Telephone number Email address Broker Details Broker name Contact name Telephone number Email address Copy updates to broker* Yes No *Updates will not include medical information Employee s Details Name Title Address Home phone number Mobile number Date of birth Email address Employee job title Date of joining the company Length of time in current position
4 Employee s Incapacity Details Reason for incapacity First date of absence Is the employee seeking legal compensation against a third party, in connection with the declared incapacity? Yes No If Yes, please provide details Has the employee worked since the date of incapacity? If Yes, please provide details Yes No Duties undertaken Dates Hours worked Salary paid Is the employee s position still available to them? Yes No Could the position be undertaken part-time if the employee s health prevented them from working full time? Yes No Is there an alternative position that could be made available to the employee? Yes No If Yes, please describe the position
5 How do you keep in contact with the employee? Please also state frequency of contact Frequency Please provide details of all medical or other information you have received regarding the employee s inability to work Describe the Employee s Work Describe the employee s duties and any special skills or qualifications required Is a driving or other type of licence necessary for the employee to perform their duties? Yes No If Yes, please provide details
6 How many staff directly report to your employee? How many hours is the employee contracted to work per week? What is the start and finish time? Have you discussed returning to work with your employee? Yes No If Yes, please provide details Duty % of day spent on duty Does the incapacity prevent them from carrying out this duty? Yes/No Please list all the duties involved in your employee s insured occupation and the percentage of their working day spent on each
7 Financial Information What was the employee s pre-disability salary? What date will salary payment to the employee cease? If pension contributions are covered under the policy, please confirm the following: Type of pension scheme i.e. Defined Benefit, Defined Contribution How contribution is calculated Normal Retirement Age under the pension scheme Additional Information Please provide any additional information that you feel would help us to assess this claim
8 Claim Payment Employer bank name Branch address Account name Sort code Account number IBAN number Claim payments will be made by Electronic Funds Transfer (EFT) Declaration and Consent (Please read carefully) On behalf of the policyholder of this Group Income Protection policy I wish to apply for the payment of this claim based on the details set out above and in accordance with the Policy s Terms and Conditions. I declare that the details set out above are complete and correct to the best of my knowledge. I acknowledge that failure to provide correct and complete answers could result in a claim payment being refused. To be signed by an authorised signatory of the Employer as Policyholder: Signature Full name in CAPITAL LETTERS Position in company Date
Generali PanEurope Limited Business Address: Generali House, Navan Business Park, Athlumney, Navan, Co. Meath Tel: +353 (0)46 909 9700 Fax: +353 (0)46 909 9848 E-mail: gpe.eb.claims@generali.ie www.generalipaneurope.ie Generali PanEurope Limited is regulated by the Central Bank of Ireland. Generali PanEurope Limited is a limited company registered in Ireland (Number 311420) with a registered office at 25-28 North Wall Quay, Dublin 1, Ireland. Generali PanEurope Limited is part of the Generali Group. Generali Group has a listed number in the Italian Insurance Group Register of 026. GPE EB EMP ER GCP 09/13 BROKER