When can you claim on income protection?
You can claim on income protection insurance when you are unable to work due to illness, injury, or disability. The policy pays a regular monthly income — typically 50–70% of your pre-incapacity gross earnings — to replace lost salary. Claims can be for both physical and mental health conditions.
The definition of incapacity that triggers a valid claim varies between policies: own occupation (you cannot perform your specific job), suited occupation (you cannot perform any job suited to your skills), and any occupation (you cannot perform any work at all). Own occupation is most favourable for policyholders.
The claims process step by step
- Step 1 — Notify your insurer: Contact your insurer or adviser as soon as you know you will be off work for an extended period
- Step 2 — Complete the claim form: Provide personal details, policy number, condition details, and employer information
- Step 3 — Medical evidence: GP reports, consultant letters, and sometimes an independent medical examination
- Step 4 — Employer confirmation: Your employer confirms employment status, income, and absence details
- Step 5 — Assessment: The insurer reviews all evidence against your policy terms
- Step 6 — Decision: You receive a written decision accepting or declining the claim
The entire process from notification to first payment typically takes four to eight weeks after the deferred period ends.
The deferred period and when payments start
Every income protection policy has a deferred period — the time between becoming unable to work and when the policy pays out. Common options are 4 weeks, 8 weeks, 13 weeks, 26 weeks, and 12 months. Payments do not begin until the deferred period has elapsed and the claim is accepted.
Choose a deferred period aligning with your employer's sick pay. If your employer pays full sick pay for six months, a 26-week deferred period keeps premiums lower without creating an income gap.
Evidence you will need
- GP medical records: Full medical history, which can take 2–4 weeks to prepare
- Specialist reports: Consultant reports carry significant weight
- Fit notes: Issued by your GP confirming you are not fit for work
- Occupational health assessments: Useful supporting evidence if available
- Treatment records: Details of any treatment, therapy, or rehabilitation
💡 Keep a detailed personal record of your symptoms, medical appointments, treatments, and how your condition affects daily life and work. Even brief diary entries noting good and bad days can be invaluable if your claim is disputed.
Common reasons claims are declined
- Non-disclosure: Failing to disclose a relevant medical condition when the policy was taken out
- Exclusion period not met: The deferred period has not fully elapsed
- Excluded conditions: Some policies exclude specific conditions like back pain or mental health
- Insufficient evidence: Medical evidence does not adequately demonstrate incapacity
- Definition not met: You may be unable to do your own job but the policy requires inability to do any suited occupation
⚠️ If your claim is declined, do not simply accept it. Request a detailed explanation in writing. You can appeal, provide additional evidence, and complain to the Financial Ombudsman Service (FOS). Many initially declined claims are overturned on appeal.
Ongoing claims and reviews
Once accepted, the insurer makes regular monthly payments but conducts periodic reviews with updated medical reports and possibly independent medical examinations. Many insurers also provide rehabilitation support including physiotherapy, counselling, or workplace adaptations to help you return to work. Engaging with rehabilitation is viewed positively and does not jeopardise your claim.
Returning to work after a claim
Most policies include provisions for a phased return. If you return part-time while still partially incapacitated, the policy may make a proportionate payment to top up reduced earnings. Some policies offer a recovery benefit continuing for a short period after you return to full-time work.
Get expert help with income protection
Whether considering income protection or needing help with a claim, professional advice is invaluable. Nesto matches you with experienced income protection advisers who can guide you through every step.