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Information and Services

Our medical section provides access to useful information and services

How do I make a claim?

You must contact us to authorise your claim if you are referred to a Specialist or therapist, to give you the peace of mind of knowing that your claim is covered.

Phone us to make a claim, phone lines are open Monday-Friday 8am-7pm and Saturday 9am-12pm. Click here to view the real-time telephone statistics.

Guidance for Customers - how to make an insurance claim

If you need to make a claim, the following guide outlines what to do next.

All treatment should be initiated by your General Practitioner (GP); most Specialists will decline to see you unless you have a referral from your GP. Your GP will refer you to the most appropriate Specialist or therapist for your needs.

I have been referred to a Specialist
When you first see your Specialist you should remember that you are entering into a contractual relationship with him/her. The Specialist has a number of obligations including a requirement to ensure that their charges are clearly presented.

If you have an excess or Shared Responsibility (co-payment) on your policy we will deduct this, leaving you the legal responsibility to pay the balance to the provider of your treatment. We will write and tell you the details when we settle your claim.
I have been admitted to Hospital
If your Specialist tells you that you need to be admitted to hospital, once again you must contact us to authorise your treatment before it starts (see above). In this way we can provide you with the peace of mind that your claim is covered.

As with your Specialist, the contract for treatment lies between you and the hospital who provide your treatment. WPA covers you, within your policy rules, for the medical costs that you incur, provided that your policy is in force when you have your treatment. Bear in mind that if you are admitted to hospital for treatment your Specialist will send you a bill for his or her fees over and above the hospital charges.
What will my Specialist charge?
Specialists are legally free to charge patients whatever they feel appropriate. This is why it is important to discuss the fee with your Specialist before treatment takes place.
What will WPA pay?
WPA will reimburse charges that are considered to be customary and reasonable, subject to the specific terms of your policy and the policy being in force. (If you have a corporate healthcare trust with WPA Protocol all eligible claims will automatically be deducted from your annual claims fund).

The maximum benefits payable towards the fees charged by your Specialist are shown in the WPA Schedule. These are determined by WPA´s Medical Advisory and Governance Committee, and based on what the majority of Specialists charge, which is made up of leading Specialists, who also consult widely with all branches of the medical profession and their organisations and societies.

In the event that your Specialist charges in excess of these guidelines, then in all likelihood you will be personally responsible for the difference, known as a shortfall.

If your treatment proves to be more complicated than the procedure described, then we will be happy to consider paying further benefit provided that your Specialist writes to us and explains the circumstances.