What happens once you make a claim

From the day you stop work to the day a decision is made, here is what an insurer asks for and how it assesses what you're owed.

The sequence of a claim

What happens between stopping work and getting paid

A claim moves through a run of steps, from the moment you stop working to the day a payment lands in your account. Each step has its own timing, and missing one can slow down everything that comes after it.

  1. You tell the insurer

    A claim starts with telling the insurer you've stopped working. Most policies want to hear this well before the deferred period ends, because that's what lets them open a file and start asking for evidence while the deferred period is still running.

    Your own policy document sets out how much notice it expects, and it's worth checking.

  2. The deferred period runs

    The deferred period is the stretch between the day you stopped working and the day the policy could start paying. Nothing is paid during it, however strong the eventual claim turns out to be. The length you chose when you took out the policy is what decides how long that gap lasts.

  3. You send in the evidence

    The insurer asks for evidence to back the claim, usually medical evidence alongside proof of what you were earning beforehand. Gathering it can take time, particularly where income varies from year to year.

  4. The claim is assessed

    The insurer checks the evidence against the test your policy actually sets, whether that's your own occupation, a suited occupation or any occupation, and that test decides whether this particular absence counts as being unable to work under your contract. Which of the three applies to you is worth knowing before you ever need to rely on it, and the guide to what 'unable to work' means in a policy sets out how each one is applied.

  5. The insurer decides

    Once the assessment is complete, the insurer either accepts the claim or declines it, and tells you which.

    Accepted

    A start date is set for the monthly benefit, usually running from the end of the deferred period, and payments begin from there.

    Declined

    The insurer sets out which condition of the policy it says hasn't been met, and that's usually where the occupation definition decides the outcome.

  6. Payment begins

    Once a claim is accepted, the monthly benefit is paid for as long as you remain unable to work under the policy's test, up to the benefit period set out in the policy.

    Insurers typically ask for updates along the way.

Insurers vary in how they sequence these steps and in the notice periods they expect, so your own policy document is the final word on timing.

What evidence will the insurer ask for?

The medical evidence

Before an insurer can decide anything, it needs to know what's wrong with you and how it affects what you can do. That usually means a report from your GP, covering the diagnosis, the treatment you're having and how long it's expected to last.

Where you're under a specialist, the insurer is likely to want a report from them too, particularly for anything that needs an expert view on prognosis or capacity. You'll normally be asked to give your GP or specialist permission to send this information straight to the insurer.

Checked against your policy's definition

Once the medical evidence is in, the insurer reads it against one question: does your condition stop you doing the job your policy insures? The answer depends entirely on which definition your policy uses.

An own occupation policy asks whether you can do your own job, the one you were doing before you fell ill. A suited occupation policy asks a wider question, whether you could do a job suited to your training and experience. An any occupation policy asks the widest question of all, whether you could do any job at all. The same medical evidence can support a claim under one definition and fail under another, which is why it's worth reading what 'unable to work' means in a policy to see which test your own policy applies.

Rehabilitation support, and returning to work part-time

A claim doesn't have to be a straight switch between fully off work and fully back. Many insurers build some kind of rehabilitation support into the policy, on the basis that a policyholder who can be helped back into some form of work tends to do better than one left to manage alone, and the insurer carries the claim for less time too.

What rehabilitation support can involve

What's offered varies between insurers and between policies, so the detail sits in your own policy document. Support of this kind commonly covers things such as:

  • Physiotherapy or other treatment aimed at getting you back to your own occupation sooner
  • Access to counselling or mental health support where that's the cause of the claim
  • Help with workplace adjustments, such as equipment or a change in duties
  • Retraining or vocational support where a return to your previous occupation isn't realistic

None of this is guaranteed on every policy, and it's usually offered at the insurer's discretion, so it's worth checking what your own policy actually promises.

Returning to work part-time

If you're well enough to work some hours but not all of them, you don't automatically lose the benefit. Most policies are written so that a partial return reduces the payment, in proportion to the income you're earning again against what you earned before the claim.

So if you go back at half your previous hours and half your previous pay, you'd typically expect roughly half the benefit to continue. The exact mechanism, and how it's calculated, differs between insurers, which is another reason to read the policy document.

Whether you're still treated as unable to work at all, in the occupation the policy covers, also depends on which definition your policy uses, which is explained in what 'unable to work' means in a policy. The definition that applied when the claim was accepted doesn't necessarily stop mattering once you're back part-time.

What published claims figures actually tell you

Insurers that sell income protection publish figures each year showing what share of claims they received were paid out. Those figures exist because a buyer cannot see inside a policy before taking it out, and a claims-paid figure is one way insurers show how the product behaves once someone actually needs it.

What a figure on its own does not tell you

A claims-paid figure is only useful once you know exactly what it is counting. The same headline number can mean very different things depending on how it was put together.

  • Which insurer it comes from, and for which product, since the figure applies to that insurer's book of business and not to the market as a whole
  • Whether it covers income protection alone, or is combined with other protection products such as life cover or critical illness cover, since a combined figure can make income protection look as if it pays out more often than it does on its own
  • Which year the figure is for, since one year's result does not show whether the proportion is rising, falling or steady

Without those three things stated alongside it, a percentage is hard to act on.

Why the figure cannot answer your own question

A claims-paid figure tells you how a book of policies performed as a whole. It cannot tell you whether a claim built on your own circumstances would be paid, because that depends on the test written into your own policy rather than on how insurers perform in general. The definitions a claim is actually judged against, own occupation, suited occupation or any occupation, are set out on what 'unable to work' means in a policy, and that test matters more to your own outcome than any published percentage.