Virgin Travel Insurance Claim

Virgin Travel Insurance Claims
PO Box 5927
Warrior Square
Southend-on-Sea
SS1 9HU
0844 888 3902
Dear Sir/Madam
Virgin Travel Insurance Claim
Thank you for getting in touch with us about your travel insurance claim. Please find
enclosed a claim form for you to complete.
Please fill in all the sections relevant to your claim and include all original supporting
documents – an incomplete application may delay your claim.
We recommend you send all documents by recorded delivery. Unfortunately, we are
unable to accept responsibility for items that are sent by first or second class post and
get delayed or lost. Please also keep copies of all correspondence for your own records.
Once received, we will scan your documents and add them to your claims file. Unless
you request otherwise, we will destroy the documents after three months and we will
only hold electronic copies on our system.
Please note, in line with your policy terms and conditions, you must declare if you
have any other travel, household or other insurance which may be in place at the time
of your claim. Withholding this information will delay your claim.
If you have any questions or need help completing your claim form, your personal
claims handler will be happy to help you. Please call us on 0844 888 3902*. We are
here from 9am to 5pm, Monday to Friday. Please have your claim or policy number to
hand when you call.
Yours faithfully
Andy Elkington
Director, General Insurance
*Calls are charged at your service providers prevailing rate and may be monitored and recorded. For 0844 calls from a BT line there is a maximum charge of up to 5p per minute.
Virgin Travel Insurance is a trading name of Insure & Go Insurance Services Ltd. Travel Claims Services Limited is a wholly owned subsidiary company of Insure & Go Insurance Services Ltd who are
authorised and regulated by the Financial Conduct Authority (Firm Reference Number 309572). Registered address: 10th Floor Maitland House, Warrior Square, Southend-on-Sea, Essex SS1 2JY.
Registered in England and Wales (Company Number: 04056769).
VM3698 (valid from 14.02.14)
Travel Insurance
Claim Form.
Virgin Travel Insurance Claims
PO Box 5927, Maitland House,Warrior Square,
Southend-on-Sea,Essex.SS1 9HU.
*webvmclaims*
Claim Ref:
Date Sent:
Please answer all the questions contained in this claim form, leaving items blank, using ticks, dashes and N/A may make it necessary for us
to return your claim forms or lead to us asking unnecessary questions thus delaying the processing of your claim.
Personal Details - Required for all Claims
Home Address
Claimant Mr/Mrs/Miss/Ms
Details
Surname
Forenames
Date of Birth
Occupation
Postcode
National Ins No.
Home Tel.
Nationality
Email
Policy and Holiday Details
Policy Number
Work Tel
Type and Amount of Claim
Policy Bene t
£ Amount
Claimed
Missed Departure
Date Issued
Cancellation or Curtailment
Declared Health
Problem(s)
Medical Expenses
Legal Expenses
Hospital Benefit
Loss of Passport
Mugging Benefit
Hijack
Personal Accident
Ski Equipment
Personal Belongings
Ski Hire
Personal Money
Ski Pack
Personal Public Liability
Piste Closure
Travel Agent &
Branch
Tour Operator
Date of Booking
Holiday
Depart Date
Return date
No. in Party
£ Amount
Claimed
Policy Bene t
Travel Delay
Total Days
Total Amount Claimed
Country
Important Note: Some of the benefits detailed may not be available upon the policy
you hold.
Resort/Town
Have you purchased any additional travel insurance options e.g. Hazardous Activities?
YES
NO
If yes please state which.
It is against the law to submit a fraudulent insurance claim.
All fraud is taken seriously if your claim is found to be fraudualent the claim will be declined and Insurers will pursue recovery by the use of civil action.
1. I/We hereby declare that all information, answers, and documents given in connection with this claim are true and correct to the best of my/our knowledge and belief. I/We have
not omitted any material information, which would effect the Underwriters judgment of the claim. I confirm that where a claim or claims are made on behalf of others, I have their full
authority to act on their behalf, and I confirm that I understand that neither Travel Claims Services nor the underwriters will accept responsibility if any payments are not distributed
proportionately to the persons concerned.
2. I/We understand that the information on this form will be passed to or used by Travel Claims Services for my insurance, this includes underwriting, processing, handling claims
and preventing fraud and could include passing details to agents or other Insurers.
3. I/We subrogate all rights of recovery to Travel Claims Services Ltd. and also consent to them seeking reimbursement of any medical expenses paid by them.
I have read and fully understand the declarations above (ALL persons claiming must sign)
Claimants Name
Claimants Signature
D.O.B
Dated
Cancellation, page 1.
Claim Ref:
*webvmclaims*
Travel Claims Services Ltd
Reason for Cancellation - Please Tick ONE Box Only
Death
Illness
Injury
Non Medical
Documents You Need to Send Us - SEND ORIGINAL DOCUMENTS BUT PLEASE KEEP COPIES FOR YOUR RECORDS
1. Insurance policy schedule/certificate of insurance/tour operators booking
invoice showing payment of your insurance premium.
2. The original booking invoice showing a full breakdown of the total holiday cost.
3. The original holiday cancellation invoice. If your booking was flight only you
may not be able to obtain this document, if this is the case please provide a
written statement to this effect from the travel agent.
4. All unused travel tickets, itineraries etc
5. If cancellation is due to redundancy we require a letter from your former
employer which confirms that you have been made redundant and are due to
receive a payment under current Redundancy Payment Legislation, the position
you held and your length of service.
6. If cancellation is on medical grounds, including death, the attached medical certificate(s) must be
completed by the usual medical practitioner of the individual whose condition has led to the
submission of the claim.
7. If cancellation is due to a death we require a certified copy of the death certificate. In addition if the
deceased was insured under the certificate upon which this claim has been submitted we require a
copy of the Grant of Probate issued in respect of the deceased's estate.
8. If this claim is being submitted as a result of an injury please provide a full description of the
incident leading to the injury, if a third party was involved please provide their details and those of
their insurer if available.
9. If cancellation is for a reason other than those detailed in points 4 and 5 please forward
independent written evidence of the incident or circumstances that have resulted in the submission
of a claim.
If you are unable to supply any of the documentation requested please provide a written explanation as to why.
Please answer ALL Questions Below - BLOCK CAPITALS PLEASE
1. Date and time you became aware of the need to cancel your holiday:
2. Date and time you informed your travel agent or tour operator of the need to
cancel your holiday:
/
/
/
/
3. If cancellation was due to a person not booked to travel please state their name and relationship to you.
Name
4. Details of holiday cost and cancellation charges.
Ticket Costs
Accommodation Costs
Pre-Booked Excursions
Deduct refunds received or advised
Total amount claimed
6. Please detail the reasons for cancellation below, giving details
of any third party involved (continue on a separate sheet if
necessary).
Relationship
5. Names and dates of birth of all those cancelling.
Name
DOB
Cancellation, page 2.
Claim Ref:
*webvmclaims*
Travel Claims Services Ltd
7. Other Insurance
a. Are the expenses for which you are claiming insured by any other policy you have (e.g) Annual/Credit Card Policy?
NB (A contribution payment is normal practice where 2 policies cover the same loss)
YES
NO
b. If yes, please supply the following details:
Company
Name and
Address
Policy No
8. Previous Claims
a. Have you made any previous claims on this type of insurance?
YES
NO
b. If yes, please give details:
9. Health Conditions
At the date of arranging your trip were you or any member of your party:
a. Aware of any medical condition or set of circumstances that could reasonably be expected to give rise to a claim?
YES
NO
i) an ongoing medical condition (or any medical complication directly attributable to that condition) investigated by a
registered medical practitioner?
YES
NO
ii) a medical condition for which there had been prescribed medication or treatment other than a minor ailment by a
registered medical practitioner during 30 days (or 90 days per person of 70 years of age or over) immediately preceding
the period of insurance?
YES
NO
iii) been receiving or on a waiting list for in-patient treatment in a hospital or nursing home?
YES
NO
iv) expected to give birth before or within two months of the date of arrival home?
YES
NO
v) been travelling against the advice of a medical practitioner or for the purpose of obtaining medical treatment abroad?
YES
NO
vi) been given a terminal prognosis?
YES
NO
Did you obtain a letter concerning any of the above from your doctor? If yes please forward a copy of the letter.
YES
NO
b. Did you or any other person upon whom holiday plans depended (including non family companions) have:
If you answered yes to any of the above please give further details of the condition or circumstance:
Medical Certificate
Claim Ref:
Virgin Travel Insurance Claims
*webvmclaims*
PO Box 5927, Maitland House,Warrior Square,
Southend-on-Sea,Essex.SS1 9HU.
This Certificate is to be completed by the Registered General Medical Practitioner of the person whose illness/injury has given rise to the claim
Note - Any charge made for the completion of this certificate is the responsibility of the insured and is not refundable under the Insurance Policy.
- Please answer all questions. Ticks, dashes, N/A etc will not be acceptable.
-This information will be treated as Private and Confidential.
- A Certificate not containing the specific information requested will not normally suffice.
- Please complete date insurance purchased and date of booking in Q7 prior to submission to the doctor.
1.
Full Name of Patient/Person whose condition has given rise to the claim.
2.
Date of Birth.
3.
Are you the regular medical attendant/from the same practice?
(a) If yes, for how long.
(b) If no, what is your involvement with this matter.
4.
State precise nature of :Medical condition/illness/injury cause of death, that gives rise to the claim.
If injury, state how this was caused.
5.
Has the patient suffered from same or a related condition in the past five years?
6.
(a) State exact date of onset as in 4.
7.
What ongoing medical condition(s), or medical complication directly attributable to
the condition(s), was being investigated by a registered medical practitioner at:
If so, date(s)?
(b) Date first consulted.
(c) Date of any serious deterioration, if applicable.
a) The date the trip insurance was purchased
b) The date the trip was booked?
Please give details of any prescribed medication, dates of
consultation/treatment, referrals and tests.
Date insurance purchased
Date of booking
8.
Is the illness/injury attributable to HIV or HIV related illness, including AIDS?
9.
Has the person named in 1 above received a terminal prognosis?
(a) the person named in 1 above.
If yes, what date was the terminal prognosis given to:
(b) the claimant, if not the same person.
10. Has the person named above been referred to or seen by a hospital doctor or
surgeon, or needed inpatient treatment in the last year.
11. Please state: (a) whether the patient consulted you prior to their journey as to the
advisability of undertaking the holiday or journey. If so, on what
date.
(b) whether, in your opinion the patient was fit to travel at the time
of departure.
12. Please provide details of patient's
state of health at the time insurance
purchased and date of booking trip.
13. If claim is a result of pregnancy, please advise :-
(a) Date pregnancy confirmed.
(b) LMP.
(c) ECD.
14. If cancellation state exact reason for the cancellation.
15. Please advise the date when it first became apparent that the holiday should be cancelled.
16. Please state the exact date you advised the need to cancel.
17. Are you prepared to certify that, solely due to the condition described in 4 above, the claimants are compelled to cancel the holiday arrangements?
To be completed by the Usual Medical Practitioner
I have examined the patient and/or referred to his/her medical records and I declare that the information given is correct and that no details relevant to
the case have been omitted.
Name (Please print)...........................................................................................................
Qualifications...............................................................................
Address ...................................................................................................................................................................................................................................
Surgery Stamp.
Signature
...........................................................................................................
Date..........................
......................