Holloway Friendly | Start your claim Home Protector

Before you get started

Please remember, Home Protector doesn’t cover:

• any condition you had medication, treatment or medical advice for during the 2 years before your insurance began.

• any condition you knew about, or had symptoms of, during that time.

If you’re unsure whether something is covered, please call us on 0800 0931 535 or email us at [email protected].

Please note, you won’t be able to make a claim for bereavement or workplace stress. If you're affected by either of these, you can visit our wellbeing hub, where we provide a range of helpful resources and guidance.

You can also speak to Optima Health on 0800 484 0818, where trained advisers will offer you free and confidential support.

Start your claim

Please give us as much information as possible. Once you’ve submitted your claim, we’ll call you to discuss your case. We’ll call you Monday-Friday 9am-5pm and usually within 48 hours.

Your personal details

Holloway Friendly insurance number *

First name *

Last name

Date of birth *

Phone number *

Address *

Email address *

Confirm email address *

Your job

Job title *

Employment status *

Hours worked *

How many hours do you work in a normal week? *

Which days of the week do you normally work? *

Which duties of your role take up the most of your working time? *

Will your business continue to trade?

Do you have a second job? *

Your second job

Job title *

Employment status *

Hours worked *

How many hours do you work in a normal week? *

Which days of the week do you normally work? *

Which duties of your role take up the most of your working time? *

Will your business continue to trade?

Contacting your employer(s)

To assess your claim, we may need to contact your employer(s) to obtain information relevant to your claim. This may include details of your employment(s), earnings, job duties, sickness records, workplace adjustments, and your expected return-to-work date.

By ticking the box below, you authorise us to contact your employer(s) and request information reasonably required to assess, administer and manage your claim.

You understand that:

• we’ll only request information relevant to your claim;

• information received from your employer will be used in accordance with our Privacy Notice

• you may withdraw your consent at any time by contacting us, although this may affect our ability to assess or continue managing your claim.

Employer 1

Name *

Address *

Contact name *

Staff number *

National Insurance number *

Start date of employment

Phone number *

Email address *

Contacting your employer(s)

To assess your claim, we may need to contact your employer(s) to obtain information relevant to your claim. This may include details of your employment(s), earnings, job duties, sickness records, workplace adjustments, and your expected return-to-work date.

By ticking the box below, you authorise us to contact your employer(s) and request information reasonably required to assess, administer and manage your claim.

You understand that:

• we’ll only request information relevant to your claim;

• information received from your employer will be used in accordance with our Privacy Notice

• you may withdraw your consent at any time by contacting us, although this may affect our ability to assess or continue managing your claim.

Employer 1

Name *

Address *

Contact name *

Staff number *

National Insurance number *

Start date of employment

Phone number *

Email address *

Employer 2

Name *

Address *

Contact name *

Staff number *

National Insurance number *

Start date of employment

Phone number *

Email address *

Employer 2

Name *

Address *

Contact name *

Staff number *

National Insurance number *

Start date of employment

Phone number *

Email address *

ConsentI consent to Holloway Friendly contacting my employer(s) and obtaining information relevant to the assessment and management of my claim.

Your GP

Name *

Address *

Phone number

Email address

How many years have you been registered with a GP in the UK? *

Accessing your medical records

Data protection notice

Using your personal information

Holloway Friendly is the Data Controller for the information collected.

Your personal information will be used by Holloway Friendly to carry out an assessment of your claim and to collect any medical reports or additional information needed to administer and validate your claim. Any information which is provided in connection with your claim will be used only for claims assessment and validation, policy administration and reinsurance. A copy of the claim form and any supporting information, including medical reports, may be given to a reinsurer if the risk is shared with them.

Details of how we use your information can be found in our Privacy Notice which can be viewed at www.holloway. co.uk/privacy-notice/. You can choose not to give consent for information, but we may not be able to proceed with your claim if you do so.

Telephone calls may be monitored and recorded to help staff training and monitoring and for the purposes of security and fraud prevention.

Will third parties receive your information?

Holloway Friendly will not sell your information to another company or use it to market the products or services of other companies to you.

Some services are provided to Holloway Friendly by third parties for things such as claims control or for compliance or regulatory advice which warrant the disclosure of more than just your basic contract details.

Your information, including sensitive information, is sometimes shared with carefully selected third parties who supply specialist services to Holloway Friendly. We may request information from, and share information with other insurance companies you hold insurance with to help our assessment.

Holloway Friendly will only disclose your personal information in accordance with Data Protection legislation, including General Data Protection Regulation (GDPR) and will only allow third parties we appoint to send your information to countries outside the European Union when appropriate safeguards are in place. More information about the third parties we share data with is contained in our Privacy Notice.

Where can I find out more?

If you have any queries or concerns about how we handle your information or want to exercise your rights, please contact us at [email protected].

Access to Medical Reports Act

To assess your claim, we may need a medical report from a doctor who has cared for you.

Before we can ask any Doctor that you may have consulted to fill in a report, we need your permission under the Access to Medical Reports Act 1988 or the Access to Personal Files and Medical Reports (Northern Ireland) Order 1991.

Your Rights are as follows:

1. Before we can apply for a medical report from a doctor who has cared for you, we need your agreement.

2. You do not have to give your consent but if you don’t, we may not be able to consider your Claim.

3. You can ask to see a report before your doctor sends it to us. If you have said you want to see it before it’s sent to us, we’ll let you know when the report has been requested and we’ll let your Doctor know they need to hold onto the completed report for 21 days so you can arrange to see it. If you haven’t arranged to see the report within this time, your Doctor will send the report to us.

4. If you choose not to see the report at this stage, you can ask your doctor to see a copy of the report for up to six months after it has been sent to us.

5. You can ask your Doctor to amend the report if you consider any aspect of the report to be incorrect or misleading. If your doctor refuses to make the amendments, you may add your comments to the report.

6. Your Doctor can refuse you access to the report if they feel it would cause harm to you or others.

Declaration and Consent

By signing this form:

1. I declare that I am aware of my legal rights under the Access to Medical Reports Act 1988 or Access to Personal Files and Medical Reports (Northern Ireland) Order 1991.

2. I agree that Holloway Friendly may ask for medical information from any doctor who at any time has attended me about anything that affects my physical or mental health.

3. I consent to Holloway Friendly or their appointed representatives seeking information in connection with my claim from any medical practitioner, hospital, specialist, employer or any other person or third-party source the company deems necessary. I understand that this may include but may not be limited to the Department of Works and Pensions, HM Revenue and Customs or reinsurers.

4. I consent to the processing and use of my personal and medical data supplied in connection with my claim by Holloway Friendly and other relevant third parties for the purpose of validation and claims assessment, financial crime, policy administration and reinsurance.

5. I authorise Holloway Friendly to request my medical information from my registered GP Practice, using a medical evidence gathering service, Medidata Exchange Limited trading as Medi2Data, working on Holloway Friendly’s behalf.

6. I agree to Holloway Friendly sharing my personal information with specialist advice and support services for the purposes of providing their personal advice and support to promote improvement of physical and psychological wellbeing and aid my rehabilitation. The information shared will comprise of my contact information, my normal occupation and my Doctor’s name and address as well as information about health conditions I suffer/have suffered from. Once this information has been shared with the specialist advice and support service provider, they will control and safeguard my information and become a data controller in their own right.

7. I understand that I can withdraw my consent at any time by contacting Holloway Friendly. Should my consent be withdrawn, it may not be possible to progress my claim.

I wish to see the medical report before it’s sent to Holloway Friendly or any Insurance Company.

I consent to you contacting my GP to access my medical records *

Your adviser

Can we tell your adviser about your claim? *

Your claim

What date did you stop working?

What illness or injury is preventing you from working? *

Please describe your symptoms *

When did you first notice your symptoms? *

Have you experienced this condition or similar symptoms before? *

What diagnosis have you been given (if any)? *

Is your condition: *

What treatment, medication or support are you currently receiving? *

Have you seen any specialists about this condition. Or have you been referred for any investigations? *

How does your illness or injury stop you from working? *

Which specific duties can you no longer perform? *

Describe the duties you can still perform despite your illness or injury *

Work status and return to work

What date do you expect to return to work?

Please tell us about any workplace adjustments that you've been offered *

If these adjustments are insufficient to allow you to work, please explain why. *

Have you undertaken any work since your claim started? *

Have you attempted a phased return to work? *

Has your employer discussed a return-to-work plan with you? *

Are you expecting to return to work: *

Please upload the following:

Medical information

Where you have them, please upload your:

Sick notes (we’ll need some extra medical evidence too, as sick notes on their own aren’t enough)
GP consultation notes
Hospital discharge letters
Consultant reports
Medical certificates

You can upload documents or screenshots from your NHS app.

Financial information

If you’re employed, please upload your:

last 3 payslips
most recent P60 (for the previous 12 months)

If you’re self-employed, please upload your:

business accounts
submitted personal tax return (SA100)

If you’re a company director, please upload your:

submitted personal tax return (SA100)
company accounts for the previous 12 months

Please note, we may also need to see additional payslips (if employed), your bank statements, and other relevant information.

Identification Documents

Please upload a copy of your:

Passport or driver’s licence.

If you can’t provide all your documents right now, you can still submit your claim. However, if we don’t have everything we need, your claim may be delayed.

Proof of hours worked

We’ll need evidence that you were working at least 16 hours a week (or your usual hours if you’re on a zero-hours contract) before becoming too unwell to work:

Employed

Please upload your:

latest payslip
contract or a letter from HR

Self-employed

Please upload:

recent invoices for your work

Proof of your mortgage or rental agreement

Please upload:

a copy of your mortgage or rental agreement (showing your name and the cost)
your most recent bank statement showing your mortgage or rent payment

Upload file

Extra support

To help us support you, please tell us if you have any sight, hearing or speech needs, or if there’s anything else you feel we should be aware of.

Would you like us to speak to someone else on your behalf?

I would like the person I’ve named below to be able to speak to Holloway Friendly on my behalf, about:

this claim only (this will last for 6 months or until your claim ends, if sooner)

anything to do with my insurance, including claims (this will last until I withdraw my consent)

Personal details

First Name

Last Name

Date of birth

Address

Email address

Phone number

Relationship to you

I understand I can update or withdraw my consent at any time by calling 0800 0931 535.

Declaration

By submitting this claim, I confirm that:

• The information I’ve provided is true and complete to the best of my knowledge.

• I understand that providing incorrect or incomplete information may affect my claim.

• I agree that you can use my information to assess my claim, in line with your privacy notice.