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INVALIDITY Claim Checklist

  • Claim Form – N.I. 38. This form is completed upon medical certification from a Registered Medical Practitioner of an incapacity which renders the insured unable to engage in ANY kind of gainful employment or is UNABLE to perform ANY work for wage or profit for a period of NOT LESS THAN twelve months as a result of mental or bodily disease or injury.
  • Below the age of 60 years.
  • ALL fields must be completed. ALL changes MUST be initialed and / or stamped.

    • Section “A” The form MUST be signed and dated by the applicant.

    • If the insured is unable to sign, the thumbprint will be certified at the NIBTT.
    • If the claim is being submitted by a third party, at the “Particulars of Witness to Mark” the thumbprint should be certified by an approved authority.
    • Question #13 should be completed in full detail. For the period 1972 – the period of retirement, each period of employment or unemployment should be stated. Additional paper should be utilized where necessary.
    • Question #14 If the answer is yes, the Social Security number MUST be provided.
    • Question #15 The insured’s last date of employment MUST be accurately stated.

    Section “B” to be completed by a Registered Medical Practitioner.

    • The insured’s name MUST be correctly stated.
    • The date the insured was examined MUST be clearly stated.
    • The effective date and period of the incapacity MUST be clearly stated. The form MUST be signed, dated and stamped by the Registered Medical Practitioner.
    • The Registered Medical Practitioner’s registration number MUST be correctly stated.
  • Identification Card of the Insured.
  • Original & Copy of the Birth Certificate / Affidavit / Deed Poll / Divorce Decree Absolute / Death Certificate of Spouse.
  • All relevant documentation to support employment, if available, e.g. original & copy of certified payslips, TD4s, Job letters etc. should be submitted.
  • If the method of payment is Financial, the bank statement reflecting the name of the bank, the account number and the branch should be submitted. If the method of payment is Postal a utility bill, no older than three (3) months should be submitted.
  • If the claim is being submitted by a third party, the Identification Card of the third party MUST be presented.
  • The claim MUST be submitted within three (3) months from the date of certification of the incapacity, if not a letter MUST be written with an explanation for the late submission.