When Should I Claim?

The TopCover policy states:

1. The Insurer will not accept liability for any claim that is not notified in writing to the Insurer within one (1) year of the calendar date of the event giving rise to the claim.

Every claim is different and depends upon the medical condition (accidental injury or illness) and the individual prognosis, and also which of the 3 benefits you are claiming for. We recommend the following NOTIFICATION PROCEDURE to ensure that you comply with the policy and notify your claim to the insurer:

NOTIFY THE INSURER when:

• Income Protection Claim.

if you have been sick or injured for 60 days, or
as soon as possible if you know or suspect that you may be off work for 180 days

• Personal Accident

if you have been off work with an accidental injury for more than 60 days, or
as soon as possible if the accident has, or may have, caused a permanent injury.
In the event of accidental death your next of kin or nominee should notify the insurer as soon as practicable.
(All insured persons are recommended to complete a Nomination of Beneficiaries form)

• Critical Illness

as soon as possible after the diagnosis of the Critical Illness

FOR ALL CLAIMS:

Ensure you notify the insurer no later than 1 year from the first day of illness/injury (the first day you could not carry out you flying duties).

The Claim Process

Income Protection Claims

All claims require Objective Medical Evidence of the illness or injury giving rise to the claim. This is usually straightforward and available from your doctor. It can take some time for a diagnosis and a final prognosis to be established. Do not delay, but provide the medical evidence as it arises so that your claim can be processed and your benefits will be available when you need them.

Benefits are payable when:

1. The Waiting Period is over (180 days)
2. The Objective Medical Evidence has been received
3. Your loss of income is established.

TopCover is Loss of Income insurance. If you are still employed by your company, on a reduced salary, your policy will top you up to a maximum of 100% of your pre-disability income. Therefore you can claim and get paid when still employed.

If your company terminates you, then you will receive your full insured benefit.

If you return to work in the future for another airline/company as a pilot, or in any other regular income-earning role, then your policy will ‘top-up’ those earnings, based upon your original income and the percentage of that income you had insured. See the ‘Proportionate Benefit Formula’ in the policy booklet or wording.

Personal Accident Claims

Personal Accident claims are for serious and permanent injuries, or accidental death. These claims often require the assistance of the next of kin or nominated beneficiary.

Evidence of bodily injury, or death, enables a claim to be paid very quickly. A Nomination Form can speed the release of benefits that may otherwise be held up by probate or other legal requirements, especially if the insured person does not have a Will.

Critical Illness Claims

As soon as you have a diagnosis of one of the named Critical Illnesses, submit your claim to the insurer. These claims are normally paid very quickly upon receipt of the Objective Medical Evidence supporting the diagnosis.