What is a pre-exsiting condition?

Any condition, injury, illness, disease or related condition and/or associated symptoms, whether diagnosed or not, which you suffered in the 36 months immediately before the start date of this insurance which an insured person knew about or should reasonably have know about or had seen a doctor or consultant about.

Are pre-exsiting conditions excluded?

We will not pay any benefit for any pre-existing medical condition unless the insured person has been symptom free and has not required treatment or medical advice for at least 24 months in a row immediately after the policy start date

If the cause of your sickness or injury which has caused work-absence longer than 30 days is not deemed directly or indirectly related to your condition when you come to claim, then your benefit will, of course, be paid.

Want to know more about how this affects you? Click here to contact us.

Claims

The professional claims team at Compass Underwriting have you covered. Since 1986 they’ve been one of the UK’s leading independent accident & health underwriting agencies, serving over 250,000 customers in that time.

We understand how important your claims are, so we always do our absolute best to get them resolved quickly.

Once we have received all of our initial requirements we endeavour to respond to all claims within 10 working days to help your family get back on their feet as soon as possible.

Exclusions

We will not pay any benefit for:

• Any conditions, injury, illness disease or related condition and/or associated symptoms whether diagnosed or not, which you suffered in the 36 months immediately before the start date of the insurance which an insured person knew about or should reasonably have known about or had seen a doctor or consultant about. The exclusion is then automatically removed if the insured person has been symptom free and has not required treatment or medical advice for at least 24 months in a row immediately after the policy start date.

• Any back related condition, unless there is radiological evidence of a medical abnormality or a visible wound or bruising, or a doctor or consultant certifies that this is the only condition which prevents the insured person from attending their usual place of employment.

• Any claim for psychological, psychotic or mental disorders unless a consultant certifies that this is the only condition preventing the insured person from attending their usual place of employment

• The insured person taking part in a criminal act.

• The insured person taking part in hazardous activities (as shown in the policy wording).

• The insured person’s blood alcohol limit exceeding 80mg per 100ml of blood, solvent abuse or taking an overdose of drugs (whether prescribed or not) An insured person engaging in any sport as a professional or semi professional.

• Any surgery or treatment that is not medically necessary, cosmetic surgery, reversing cosmetic surgery or any corrective treatment as a result of previous cosmetic surgery.

• The insured person committing suicide or attempting to commit suicide, or deliberately injuring themselves or putting themselves in danger (unless they were trying to save another human life).

Please see section four in the policy document for the full list of exclusions.

Coronovirus Exclusion:

This Insurance does not cover any claim in any way caused by or resulting from:

a) Coronavirus disease (COVID-19);

b) Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2);

c) any mutation or variation of SARS-CoV-2;

any fear or threat of a), b) or c) above.

FAQs

Can’t find the answer to your question on this page? You can either:

• Email us at info@getesmi.co.uk with your question.
• Visit our Sick Pay Insurance FAQs.
• Or you can read the policy document in full.

Documents

Policy Document

Policy Summary