IP Claims Process

Income Protection Claims Process Explained

Making an income protection claim can feel daunting when you're already dealing with illness or injury. Understanding the process in advance helps ensure smooth claim handling and faster benefit payments. Here's your comprehensive guide to the income protection claims process.

Overview: The Claims Journey

Timeline at a Glance

Week 1: Unable to Work

• Notify insurer immediately (don't wait for deferred period)
• Obtain initial medical evidence
• Complete claim notification form
• Receive acknowledgement and claims pack

Weeks 2-4: Deferred Period Begins

• Submit full claim form and evidence
• Insurer reviews claim
• Possible GP report requested
• Rehabilitation assessment offered

Week 4-8: Assessment Continues (13-week deferred period example)

• Ongoing medical evidence gathered
• Specialist reports if needed
• Financial evidence reviewed (self-employed)
• Occupational assessment may occur

Week 13: Deferred Period Ends

• Final claim assessment
• Claim decision communicated
• First payment (if approved)
• Ongoing claim management begins

Ongoing: During Claim

• Regular medical updates required
• Rehabilitation support offered
• Return to work planning
• Periodic claim reviews

Key Principle: Notify Early

Common Myth: "I'll wait until my deferred period ends to claim"

Reality: Notify your insurer as soon as you're unable to work, even if your deferred period is 13 or 26 weeks away.

Why Early Notification Matters:

1. Evidence gathering starts immediately - Medical evidence from onset is crucial
2. Rehabilitation can begin - Even during deferred period, support available
3. Prevents claim delays - Assessment happens during deferred period, payment ready when due
4. Added value benefits access - EAP, virtual GP, nurse advisery available immediately
5. Financial planning - Insurer can advise on budget management during waiting period

Step-by-Step: Making Your Claim

Step 1: Initial Notification (Day 1)

Contact Your Insurer Immediately:

Methods:

• Online portal (fastest - often instant acknowledgement)
• Phone claims line (speak to specialist claims handler)
• Email claims team
• Through your adviser/broker

Information Needed:

• Policy number
• Basic contact details
• Nature of illness/injury
• Date last worked
• GP details
• Employer details (if employed)

Example: James's Initial Call

James, 34, IT consultant with a 13-week deferred period, injured his back moving house:

Monday (injury day):
Called Legal & General claims team at 9am

Claims Handler Asked:

• "When did the injury occur?" (Saturday)
• "Have you seen a doctor?" (A&E Saturday, GP Monday)
• "What's your occupation?" (IT consultant, mostly desk work)
• "When did you last work?" (Friday before injury)
• "What's your deferred period?" (13 weeks)

Claims Handler Provided:

• Claim reference number
• Online portal access details
• Claim form (emailed immediately)
• Medical evidence requirements list
• Rehabilitation team contact details
• EAP access information
• "What happens next" guide

Time on Call: 12 minutes

Result: Claim formally registered, process began week 1 instead of week 13.

Step 2: Claim Form Completion (Week 1-2)

The Claim Form:

Comprehensive form requesting:

Personal Information:

• Full name, address, date of birth
• National Insurance number
• Policy details
• Contact preferences

Employment Details:

• Employer name and address
• Job title and description
• Usual work hours
• Date joined employer
• Earnings (with evidence)

For Self-Employed:

• Business type and description
• Typical working pattern
• Average annual earnings (last 3 years)
• Accountant details
• Most recent accounts

Medical Information:

• Condition preventing work
• Symptoms and limitations
• Date symptoms began
• Medical professional seen
• Current medications
• Previous related conditions
• Other health conditions
• GP name and address (consent for records)

Occupation Impact:

• Specific job duties you cannot perform
• Attempts to modify work or return
• Any work being done (partial claims)
• Employer sick pay received/receivable

Financial Information:

• Bank details for payment
• Other income sources
• State benefits claimed/claiming
• Other insurance policies
• Employer sick pay details

Top Tips for Form Completion:

✓ Be thorough - Incomplete forms delay claims by 2-3 weeks on average
✓ Be specific - "Cannot sit for more than 10 minutes due to sciatic nerve pain" beats "back hurts"
✓ Be honest - Non-disclosure can void your policy
✓ Keep copies - Of everything you submit
✓ Ask for help - Claims teams and advisers can guide you

Example: Good vs. Poor Answers

Question: "Describe how your condition prevents you from working"

Poor Answer:
"I have depression and can't work"

Good Answer:
"I have been diagnosed with moderate to severe depression by Dr. Smith on 15th March. I am unable to concentrate for more than 10 minutes at a time, experience severe fatigue making it impossible to complete 8-hour workdays, and have anxiety attacks when attempting work tasks. My role requires sustained concentration for financial analysis, client meetings, and detailed report writing - none of which I can currently perform. I am under psychiatric care and have been signed off work for at least 3 months."

Step 3: Medical Evidence Submission (Week 1-4)

Required Medical Evidence:

Initial Evidence (Submit Immediately):

1. Fit Note (Sick Note):

   • From your GP
   • Showing condition and expected duration
   • Must cover period from unable to work through deferred period
   • Renewed regularly if long-term

2. GP Letter (Some Insurers):

   • Confirming diagnosis
   • Describing limitations
   • Treatment plan
   • Prognosis

Additional Evidence (Requested by Insurer):

GP Medical Report:

• Full medical history from GP
• GP completes insurer's form
• Usually requested 4-6 weeks into claim
• Cost (£50-£200) paid by insurer
• Can take 2-4 weeks to obtain

Specialist Reports:

• From consultants treating you
• For complex conditions
• Surgical reports if applicable
• Psychiatric reports for mental health claims

Occupational Health Assessment:

• Assessment of workplace capability
• Functional capacity evaluation
• Adaptation possibilities
• Insurer may arrange and pay for this

Medical Records:

• Complete GP records
• Hospital correspondence
• Test results and scans
• Treatment records

Example: Sarah's Medical Evidence Timeline

Sarah, 41, teacher, claimed for chronic fatigue syndrome (13-week deferred period):

Week 1:

• GP fit note (4 weeks)
• GP letter describing symptoms

Week 4:

• Second fit note (8 weeks)
• Insurer requested GP medical report

Week 6:

• GP report received by insurer
• Insurer requested specialist report from chronic fatigue clinic

Week 9:

• Specialist report submitted
• Insurer arranged occupational health assessment

Week 11:

• Occupational health assessment completed
• Report confirmed inability to teach (requires sustained concentration, full days, classroom management)

Week 13:

• All evidence compiled
• Claim approved
• First payment issued week 14

Key Learning: Early submission of ongoing evidence meant no payment delays at week 13.

Step 4: Financial Evidence (Self-Employed/Commission-Based)

If Self-Employed:

Required Documents:

1. Last 3 Years' Accounts:

   • Accountant-prepared preferred
   • Profit and loss statements
   • Tax returns (SA302)
   • Tax year overviews from HMRC

2. Recent Trading Evidence:

   • Last 3-6 months bank statements
   • Recent invoices
   • Proof of regular income
   • Contracts or work agreements

3. Business Interruption Evidence:

   • Evidence work has stopped/reduced
   • Lost contracts or bookings
   • Client correspondence
   • Cancelled appointments/projects

Example: Michael's Self-Employment Claim

Michael, 45, self-employed plumber, Aviva IP paying 50% of average earnings:

Income Evidence Submitted:

Year 1 (3 years ago): £38,000 net profit
Year 2 (2 years ago): £42,000 net profit
Year 3 (last year): £44,000 net profit
Average: £41,333

Benefit Calculation:

• Average annual: £41,333
• Monthly average: £3,444
• 50% income replacement: £1,722/month
• Less employer sick pay: £0 (self-employed)
• Monthly benefit: £1,722

Documents Submitted:

• 3 years' accountant-prepared accounts
• 3 years' SA302 tax returns
• Last 6 months' business bank statements
• Diary showing cancelled jobs (4 weeks worth £6,800)
• Text messages from clients cancelling/rescheduling

Processing Time: 8 working days for financial assessment

Step 5: Claim Assessment and Decision (Weeks 4-13)

What Happens During Assessment:

Week 4-6: Initial Review

• Claims handler reviews all evidence
• Identifies any gaps or additional needs
• Requests further information if needed
• May contact GP or specialist directly

Week 6-10: Medical Assessment

• Medical team reviews clinical evidence
• Assessment against policy definition of incapacity
• "Own occupation" test applied
• Specialist input if needed

Week 10-12: Financial Assessment

• Income verification completed
• Benefit calculation performed
• Coordination with other insurance checked
• Employer sick pay confirmed

Week 12-13: Final Decision

• All evidence compiled
• Decision maker reviews complete file
• Rehabilitation assessment scheduled
• Decision letter prepared

Possible Outcomes:

1. Claim Approved

• Benefit amount confirmed
• Payment date provided
• Ongoing evidence requirements explained
• Rehabilitation support offered

2. More Information Needed

• Specific requests made
• Timeline for submission given
• Decision delayed until received

3. Claim Declined

• Reasons explained in detail
• Evidence reviewed listed
• Appeal process outlined
• Alternative support suggested

4. Partial Claim Approved

• Partial benefit if partially able to work
• Calculation explained
• Review dates set

Step 6: First Payment (End of Deferred Period)

Payment Timing:

13-Week Deferred Period Example:

• Last worked: Monday 1st January
• 13 weeks later: Monday 2nd April
• First payment due: Early April (for period 2nd April onwards)
• Ongoing payments: Monthly, advance or arrears (policy specific)

Payment Methods:

• BACS transfer to your bank account
• Usually monthly payments
• Some insurers offer weekly/fortnightly for hardship

First Payment Calculation:

Example: Emma's First Payment

• Deferred period ended: 15th April
• Monthly benefit: £2,100
• Payment frequency: Monthly in advance
• First payment covers: 15th April - 14th May
• Pro-rata first payment: Full monthly amount (started mid-month but paid in advance)

If Payment in Arrears:

• Deferred period ended: 15th April
• First payment: Mid-May
• Covers: 15th April - 14th May

Tax on Benefits:

• Income protection benefits are taxable income
• Paid gross (no tax deducted)
• You declare on self-assessment tax return
• Budget for tax liability

Example Tax Impact:

Pre-claim income: £45,000/year (£34,500 after tax)
Benefit during claim: £22,500/year (60% of gross)
Tax on benefit: Approximately £2,700
Net benefit: £19,800/year (£1,650/month)

Planning Point: Expect 12-15% tax on benefits depending on your tax bracket.

Step 7: Ongoing Claim Management

While Claiming:

Regular Requirements:

Monthly/Quarterly:

• Updated fit notes from GP
• Confirmation still unable to work
• Report any changes in condition
• Report any work attempts

Every 3-6 Months:

• Updated medical reports
• Review consultations with insurer
• Rehabilitation progress review
• Return to work planning

Annually:

• Comprehensive claim review
• Financial evidence update (self-employed)
• Policy anniversary review

What Triggers Reviews:

1. Condition improvement - Medical evidence shows recovery
2. Return to work attempts - Even unsuccessful ones
3. Time triggers - Set review dates (6 months, 12 months, etc.)
4. Rehabilitation milestones - Progress in therapy
5. Policy terms - Change in definition (e.g., own to any occupation)

Example: Ongoing Claim - Tom's 18-Month Claim

Tom, 39, accountant, serious car accident:

Months 1-6:

• Monthly fit notes submitted
• Month 3: GP report update
• Month 4: Began physiotherapy (insurer-funded)
• Month 6: Comprehensive review
  • Updated medical reports
  • Rehabilitation assessment
  • Return to work discussion

Months 7-12:

• Continued monthly fit notes
• Month 9: Attempted 2 days/week (unsuccessful, too painful)
• Month 10: Increased physiotherapy
• Month 12: Annual review
  • Full medical update
  • Occupational health reassessment
  • Agreed phased return plan for month 15

Months 13-18:

• Month 15: Successful phased return began (2 days/week)
• Partial benefit paid (3 days/week worth)
• Month 16: Increased to 3 days/week
• Partial benefit reduced
• Month 18: Return to full-time
• Claim closed
• Total benefit paid: £38,700

Common Claim Challenges and Solutions

Challenge 1: Claim Delays Due to Missing Evidence

Problem: "My deferred period ended 2 weeks ago but I still haven't been paid. The insurer says they're waiting for evidence."

Common Causes:

• GP report not returned by GP
• Specialist report not yet available
• Financial evidence incomplete (self-employed)
• Fit notes not covering full period

Solutions:

✓ Submit evidence early - Don't wait until week 12 of 13-week deferred period
✓ Chase GP directly - Don't rely on insurer alone to obtain reports
✓ Prepare financial evidence in advance - Have accounts ready
✓ Maintain fit note continuity - No gaps in coverage

Example Resolution:

Week 11: Sophie chased her GP directly for the medical report the insurer requested in week 6. Found it sitting in GP's admin pile. Collected same day and scanned to insurer. Claim approved by week 13, payment on time.

Challenge 2: "Own Occupation" Definition Disputes

Problem: "The insurer says I can do admin work so they're declining my claim. I'm a plumber - I can't do physical work."

Issue:

• Insurer interpreting "own occupation" narrowly
• Focusing on what you can do, not what your job requires
• Suggesting modifications unrealistic for your role

Solution:

✓ Detailed job description - Every physical task required
✓ Employer letter - Confirming role requirements, no alternatives available
✓ Occupational health support - Professional assessment of capability vs. role needs
✓ Specialist evidence - Medical confirmation of specific limitations

Example:

David, Plumber, Back Injury:

Initial Decline Reason:
"Can perform sedentary work such as answering phones, ordering supplies"

David's Response:

• Employer letter: "Plumbing role requires physical installation, repair work. No office-based roles available in our small company."
• Occupational health report: "Cannot lift over 5kg, cannot kneel, cannot work in confined spaces - all essential for plumbing work."
• Job analysis: Detailed breakdown of typical day - 90% physical tasks

Result: Claim approved on appeal within 2 weeks.

Challenge 3: Mental Health Claims

Problem: "I have depression and anxiety but the insurer wants more evidence. What more can I provide?"

Unique Challenges:

• Less "visible" than physical conditions
• Varying severity day-to-day
• Occupational impact harder to evidence
• Stigma and reluctance to disclose fully

Strong Evidence for Mental Health Claims:

1. Psychiatric Diagnosis:

   • From psychiatrist, not just GP
   • Specific diagnosis (e.g., "moderate to severe depressive episode")
   • DSM-5 or ICD-10 classification

2. Functional Impact Evidence:

   • Cannot concentrate for sustained periods
   • Fatigue preventing full workdays
   • Anxiety preventing workplace interactions
   • Cognitive impairment affecting job tasks

3. Treatment Evidence:

   • Medication tried (and outcomes)
   • Therapy sessions (type and frequency)
   • Hospital admissions if applicable
   • Treatment plan and expected duration

4. Occupational Assessment:

   • How condition prevents your specific role
   • What job tasks are impossible
   • Why modifications won't work
   • Specialist occupational health input

Example: Successful Mental Health Claim

Rachel, Marketing Manager, Severe Anxiety:

Evidence Submitted:

Medical:

• Psychiatric assessment: "Severe generalised anxiety disorder with panic attacks"
• GP report: "Unable to cope with workplace stress, frequent panic attacks, medication ongoing"
• Psychologist report: "Undergoing CBT, current functionality severely impaired"

Functional:

• "Cannot attend meetings without panic attacks (role requires daily client meetings)"
• "Unable to concentrate on campaign planning (core duty) for more than 15 minutes"
• "Severe decision-making paralysis affecting all work outputs"
• "Fatigue preventing 8-hour workdays"

Occupational:

• Occupational health report: "Current anxiety levels incompatible with client-facing marketing role requiring quick decision-making, presentations, and deadline management"

Result: Claim approved, benefit paid throughout 6-month treatment period.

Challenge 4: Self-Employed Income Disputes

Problem: "The insurer says my income was only £30,000 but I earned £40,000. They're paying me too little."

Common Issues:

• Fluctuating income year-to-year
• Recent business growth not fully reflected
• Expenses reducing "profit" figure
• Cash business with incomplete records

Solution:

✓ 3-year average - Smooths fluctuations
✓ Clear expense breakdown - Distinguish business vs. personal
✓ Recent trading evidence - Last 6 months' bank statements
✓ Accountant letter - Professional verification
✓ "Add-back" expenses - Car, business use of home may be added back

Example:

Mark, Self-Employed Electrician:

Initial Calculation (Insurer):

• Year 1: £28,000 profit
• Year 2: £32,000 profit
• Year 3: £35,000 profit
• Average: £31,667
• Monthly benefit (50%): £1,319

Mark's Challenge:

"Add-Back" Expenses:

• Business vehicle (personal use element): £4,000/year
• Business use of home (mortgage element): £3,000/year
• Professional subscriptions (personal benefit): £500/year

Revised Calculation:

• Year 1: £35,500 (profit + add-backs)
• Year 2: £39,500
• Year 3: £42,500
• Average: £39,167
• Monthly benefit (50%): £1,632

Increase: £313/month (24% higher)

Evidence Provided:

• Accountant letter explaining add-backs
• Vehicle log showing business vs. personal use
• HMRC guidelines on add-backs
• Comparative industry earnings

Result: Insurer agreed to £1,632/month benefit.

Partial Claims and Phased Returns

How Partial Claims Work

Scenario: You return to work part-time while recovering.

Calculation Methods:

Method 1: Proportionate Reduction

Example:

• Full-time salary: £40,000/year (£3,333/month)
• Full benefit: £2,000/month (60% of £3,333)
• Returning to work: 3 days/week (60% of full-time)
• Part-time earnings: £2,000/month (60% of £3,333)
• Partial benefit: 40% of full benefit = £800/month

Total income: £2,000 (earned) + £800 (benefit) = £2,800/month

Method 2: Earnings Threshold

Some policies pay full benefit until earnings reach certain threshold:

Example:

• Full benefit: £2,000/month
• Threshold: 80% of pre-disability earnings
• Pre-disability: £3,333/month
• 80% threshold: £2,666/month

Earnings below £2,666: Full £2,000 benefit paid
Earnings above £2,666: Proportionate reduction

Phased Return Benefits

Example: Successful Phased Return

Sophie, Office Manager, Post-Surgery:

Month 1-3: Full claim, £2,200/month benefit

Month 4: Phased Return Starts

• Working 2 days/week
• Earning: £880/month (40% of £2,200 salary)
• Benefit: 60% of £2,200 = £1,320/month
• Total income: £2,200/month (100% of normal)

Month 5:

• Working 3 days/week
• Earning: £1,320/month (60%)
• Benefit: 40% of £2,200 = £880/month
• Total income: £2,200/month

Month 6:

• Working 4 days/week
• Earning: £1,760/month (80%)
• Benefit: 20% of £2,200 = £440/month
• Total income: £2,200/month

Month 7:

• Return full-time
• Earning: £2,200/month
• Benefit: £0
• Claim ended successfully

Benefit: Maintained full income throughout recovery, no financial stress, sustainable return to work.

When Claims Are Declined

Common Decline Reasons

1. Not Meeting Definition of Incapacity:

   • Can still perform own occupation duties
   • Modifications available allowing work
   • Condition doesn't prevent work in policy terms

2. Pre-Existing Condition:

   • Condition existed before policy started
   • Symptoms present but not disclosed
   • Related to previous condition

3. Exclusions Apply:

   • Self-inflicted injury
   • Criminal activity
   • Excluded condition (specific policy exclusions)
   • War, terrorism (rare)

4. Non-Disclosure:

   • Failed to disclose medical history at application
   • Material non-disclosure discovered
   • Policy voided from start

5. Insufficient Evidence:

   • Medical evidence doesn't support claim
   • Cannot verify inability to work
   • Income evidence inadequate (self-employed)

Your Rights When Declined

1. Request Detailed Reasons

• Exact policy clause applied
• Specific evidence reviewed
• Why evidence deemed insufficient

2. Internal Appeal

• Most insurers have appeal process
• Submit additional evidence
• Medical opinion challenged
• Different decision maker reviews

3. Financial Ombudsman

• Free, independent review
• Can award up to £415,000 plus interest
• Investigates whether insurer acted fairly
• Decision binding on insurer

4. Legal Action

• Commercial litigation
• Usually only for very large claims
• Expensive (£10,000+ legal costs)
• Consider legal expenses insurance

Example: Successful Appeal

Tom, Declined Claim for Back Pain:

Initial Decline: "GP reports indicate able to perform sedentary work. Claim declined."

Tom's Appeal:

• Obtained occupational health assessment (independent)
• Assessment confirmed: "Cannot sit for more than 30 minutes due to severe pain"
• Tom's role: Software developer requiring 7-8 hours daily sitting
• Employer letter: "No alternative non-seated roles available"
• Specialist consultant report: "Chronic disc protrusion, surgery declined by patient, conservative management ongoing, prognosis uncertain"

Appeal Outcome:

• Claim approved
• Back-payment to original deferred period end date
• Ongoing claim managed
• Rehabilitation support offered

Timeline: 6 weeks from decline to appeal approval

Top Tips for Smooth Claims

Before You Claim

✓ Know your policy - Understand deferred period, benefit amount, definition of incapacity
✓ Keep policy documents safe - You'll need them
✓ Register on insurer's portal - Easier claim submission
✓ Know your adviser - They can support your claim

When Making a Claim

✓ Notify immediately - Don't wait for deferred period to end
✓ Be thorough - Complete forms fully first time
✓ Be specific - Detail exactly how condition prevents your work
✓ Be honest - Non-disclosure voids policies
✓ Keep copies - Everything you submit
✓ Follow up - Chase missing evidence proactively

During Your Claim

✓ Maintain communication - Update insurer on changes promptly
✓ Attend assessments - Insurer-requested appointments
✓ Engage with rehabilitation - Shows commitment to recovery
✓ Keep fit notes current - No gaps in medical certification
✓ Report work attempts - Even if unsuccessful
✓ Budget for tax - Benefits are taxable

Get Expert Claims Support

Navigating an income protection claim doesn't have to be done alone. Professional support can make the difference between smooth claim handling and months of frustration.

Our Claims Support Service:

✓ Pre-claim advice - What to expect, evidence needed
✓ Form completion help - Ensuring thorough, accurate submissions
✓ Evidence coordination - Chasing medical reports, financial evidence
✓ Insurer liaison - Communicating on your behalf
✓ Appeal support - If claims declined, we help challenge
✓ Rehabilitation coordination - Accessing added value benefits

Get free claims guidance - we'll help ensure your claim is handled smoothly and paid promptly.

Note: Claims processes vary between insurers and depend on individual circumstances. This guide provides general information about typical UK income protection claims handling. Specific requirements, timelines, and procedures differ by insurer and policy type. Evidence requirements and assessment criteria are case-specific. Some claims are more complex and may take longer to assess. Payment timings depend on your specific deferred period and policy terms. Professional financial advice and claims support recommended to navigate process effectively. FCA-regulated advice ensures your claim is managed properly and your rights protected.