Claim Notification

To begin the claim process, please can you complete and submit the form on this page with as much detail as possible. Our Customer Support Team will then provide this to your insurer.

Please be aware that Insync Insurance does not manage claims on behalf of policyholders. While we will inform your insurer of any reported incidents, it is your responsibility to communicate with the insurer and provide all necessary claim details. This includes submitting any additional information/ documentation and to follow up on the progress of your claim.

All further communication regarding your claim, including updates, requests for additional information, or clarification, must be conducted directly with your insurer.

We understand this is a stressful time, on completion of this form we will promptly send notification to your insurers.

Name *

First

Last

Phone *

Email *

Business name *

Date Of Incident *

Date Reported *

Type of Claim *

Has a claim officially been made, or is this notification of a potential claim? *

What treatment was carried out? *

Summary of the circumstances *

Note any injuries that have been sustained. *

Was a consent/consultation form completed prior to treatment? *

How was the consultation form completed? *

If applicable, was a patch test completed? *

If provided, how was after care advice given? *

Do you have any before & after photographs? *

Have you received a solicitors letter? *

Select refund status *

Supply any information regarding refunds, including amounts. *

Are details of the third party known? *

Name of Third Party *

First

Middle

Last

Summary of the circumstances *

List the names of any alleged responsible person and their status within the business. *

Provide the dates for the claim being made *

Provide any further information you wish to make us aware of as part of the claims notification (including any estimate losses) so that we can relay to the Underwriters. *

Summary of the circumstances *

Has any third party been identified as part of this claim? *

Please list below all details you have relating to them *

Have the Police been notified? *

List Police details below including any crime reference number. *

Provide any further information you wish to make us aware of as part of the claims notification (including any estimate losses) so that we can relay to the Underwriters. *

Summary of the circumstances *

Details of the employee involved in the claim *

Provide as much information as possible relating to injuries. *

Have you received a solicitors letter? *

Provide any further information you wish to make us aware of as part of the claims notification (including any estimate losses) so that we can relay to the Underwriters. *

Summary of the circumstances *

List all details you have relating to any third party, if you do not yet have this information then please advise TBC. *

Provide as much information as possible relating to injuries. *

Have you received a solicitors letter? *

Provide any further information you wish to make us aware of as part of the claims notification (including any estimate losses) so that we can relay to the Underwriters. *

Summary of the circumstances *

State below any actions you may have taken in order to limit the loss *

Provide details, inclusive of value or age (or both) for all items involved in a claim. Evidence of this will also be required from the Insurer. *

Have the Police been notified? *

List all Police details below including any crime reference number. *

Summary of the circumstances *

Your Annual Turnover (£) *

Provide as much information relating to estimated losses so that we can relay to the Underwriters, and the company details/purpose for each loss. *

Provide any further information you wish to make us aware of as part of the claims notification.

Provide the start and end dates of the period you wish to claim for *

Documents

Click or drag files to this area to upload. You can upload up to 40 files.

Copies of all solicitor/third party correspondence; Any photographic evidence to support the claim; Copies of Consultation and Consent forms; Copy of any aftercare advice given; Qualification certificates; Evidence of patch test results if applicable; Maintenance records / manufacturer guidelines where applicable and all communication between yourself and your client.

Information

Please be advised that your applicable excess will be payable to the Insurers once the claim has been accepted as the Insurers will incur defence costs immediately. Please do not discuss this claim with any third-party including comments on liability, or their representatives, and ensure any correspondence received from them remains unanswered and is sent to your insurer on receipt. Please also refrain from providing a third party, or their representative, with any copies of your policy documents.

Claim Notification

Information

Customers

Useful Links

Covers

Legal