Thank you for your interest in an insurance policy arranged through Premium
Medical Protection. Please carefully read the following information before
proceeding with your application.
Premium Medical Protection only arranges cover for the specialties listed
under question 1 of the Activities section of the application form. Please
only proceed with an application if your specialty is listed. If your
specialty is not listed we are unable to arrange cover and you should not
continue with the application. Premium Medical Protection does not arrange
cover for Obstetrics, General Practitioners and Paramedics amongst others.
Please note you will be required to provide a confirmed claims
experience covering your private practice for the past 10 years.
You must provide complete and accurate answers to the questions we ask you
when you purchase a policy for the first time, make changes to your policy,
or renew your policy.
Insurance is based on the information that you give to the insurer and if
this information is wrong or incomplete, there may be adverse consequences:
claims may not be paid in full or at all, your policy may have special
terms imposed or be cancelled, your policy may be voided, and the premium
paid may not be returned. If you are in doubt, please seek independent
advice or contact us for clarification.
You must provide us with a “fair presentation” of the risk. This is one:
which discloses every “material circumstance” which you know, or
ought to know, or which puts the insurers on notice that it needs to make
further enquiries for the purpose of revealing those material
in which every material representation as to a matter of fact is
substantially correct, and every material representation as to a matter of
expectation or belief is made in good faith.
A “material circumstance” is one which would influence the judgment
of a “prudent insurer” in fixing the premium or determining whether
to cover the risk.
You must make this disclosure in a manner which would be reasonably clear
and accessible to a “prudent insurer”.
Additionally, once the policy has come into effect, the policy itself
contains specific terms requiring you to notify us in a timely fashion
regarding incidents and circumstances that are reasonably likely to result
in a claim being made against you.
This application form must be completed by the proposed individual. All
questions must be answered. If there is insufficient space to provide
answers, additional information should be provided on the proposers’
Premium Medical Protection is an appointed representative of Harley Street
Insurance Group Limited, which is authorised and regulated by the Financial
Conduct Authority (FRN: 570717).
This is a legally binding document and requires a signature from the
applicant. A copy of the application that you have completed online will be
emailed to you for signature. On receipt, please sign and return by Fax to
0207 806 0810 or by post to Premium Medical Protection, 25 Athena Court,
Athena Drive, Tachbrook Park, Warwick, CV34 6RT. The insurer requires a
signed copy of the application for any policy of insurance to become valid.
Provision of Run-Off Cover – Claims Made Policies
Please note that additional terms apply in respect of run-off cover. If
you are likely to retire from private practice in the next 36 months
please contact us to discuss your options prior to making an
4. Your Data
We will only use your information insofar as it is necessary to administer
your insurance contract or in connection with a claim. Please see our
Privacy Notice for more information on how we handle your data.