John Lewis Claim Form PDF Details

The John Lewis Claim Form specifically caters to those needing to file ongoing vet treatment claims for their pets under the John Lewis Pet Insurance policy. Available round-the-clock, each day of the year, the form begins with access to a free helpline number staffed by qualified vet nurses. For those looking to make a claim, the process is outlined clearly, offering options to submit the completed form via mail or for a faster response, via email. It's essential for policyholders to note that this form is designated solely for ongoing conditions and any new conditions require a separate form available through the John Lewis Insurance website. The form requests detailed information about the policyholder, the pet, and the condition being claimed, including treatment dates and costs. Policyholders are given options for how they wish to receive the claim payout, whether directly, to their vet, or to another named individual, though it is underscored that the policyholder remains responsible for any fees not covered by insurance. Additionally, the form clarifies the involvement of attending veterinarians, specifying that while they do not need to be affiliated with John Lewis Pet Insurance, they are required to provide a detailed breakdown of the treatment costs. This detailed approach ensures that every claim is supported by comprehensive documentation, streamlining the process for both the policyholder and the insurance company. Notably, John Lewis Insurance acts as an intermediary for Royal & Sun Alliance Insurance plc, highlighting the partnership that underpins the pet insurance offering.

QuestionAnswer
Form NameJohn Lewis Claim Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesjohn lewis dog insurance claim form, john lewis pet insurance claim form no download needed, john lewis pet insurance form, john lewis ongoing claim form

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vetfone: 0800 316 7119

Speak to a qualified Vet nurse 24 hours a day 365 days a year on our free helpline number.

Ongoing vet treatment claim form

Claims Helpline: 0845 078 7585

8am-8pm Mon to Fri, 9am-5pm Sat Claims@johnlewis-petinsurance.com

To be completed and returned to: John Lewis Pet Insurance Claims, PO Box 10482, BIRMINGHAM B3 2WX, or for a quicker way of submitting your claim to us please email a scanned copy to claims@johnlewis-petinsurance.com

A. About you (the Policyholder)

If your name or address has changed, please tick

Name, address and postcode

If you provide us with your mobile number and email address, we can let you know we have received your claim form.

Telephone number (mobile preferred)

Email

Policy number

Please note that this claim form is for ONGOING VET FEE CLAIMS only. If your claim is for a new condition, please visit our website www.johnlewis-insurance.com/pet for the correct claim form. Select ‘How to make a claim’. On the next screen select ‘Pet Insurance claims’, then click on the link to download a claim form.

You and your vet must sign the form if your claim is for an ongoing condition that is not medication only.

Claims for ongoing medication only – If you are claiming for medication only, it is not necessary for your veterinary surgeon to complete Section E.

B. About your pet

Your pet’s name (*multipet)

*If you have more than one pet insured with us, please ensure you enter the correct pet’s name and only one claim form per pet.

C. About your pet’s condition (must be completed by the policyholder)

Condition 1

Condition 2

Name of condition as advised by your vet.

From

To

From

To

Please provide the treatment dates for this claim.

Please advise the cost of treatment incl. VAT. if known

D. Your signature and who to pay

(Policyholder – please complete one of the following boxes (a, b or c) to tell us who to pay)

I declare, to the best of my knowledge and belief, that all the information provided in this form is true and complete. I agree that John Lewis Pet Insurance may seek any information it requires from any vet. I accept that the information provided may be released to other companies who provide a service to John Lewis Pet Insurance in connection with managing and handling claims.

a. Please pay my claim direct to me:

Printed name:

Policyholder’s signature

Date:

b. Please pay my claim direct to my vet:

Printed name:

Policyholder’s signature

Date:

c. Please pay my claim direct to the person named below:

Printed name:

Policyholder’s signature

Date:

Please note: if we decide we cannot pay some or all of your claim, it is your responsibility to pay your vet. BACS (Bankers Automated Clearing System) payment option is only available if payment is to be made to the policyholder or if you pay your premium by direct debit.

E. The attending vet or a person authorised by the vet must fill in and sign this section only if the claim contains treatment costs that are not for medication

I declare, to the best of my knowledge and belief, that all information provided in this claim form is true and complete. The fees I have charged are no more than the fees I would normally charge my clients.

Printed Name:

Practice Stamp

Signature:Date:

Postcode:

Please note that the Veterinary Surgeon does not have to be an appointed representative of John Lewis Pet Insurance in order to fill in this section of the claim form for you because it is not a regulated activity under Financial Conduct Authority regulations.

IMPORTANT: Please ensure that a dated and itemised breakdown of all treatment costs is attached to the claim form before you send it to us. This can be either an itemised computer printout or an itemised invoice which must state fees for consultations, prescription charges, hospitalisation, X-rays, tests/pathologies, general anaesthetic, surgery, medication and any other fees charged. The Veterinary Surgeon must apportion costs clearly for each illness or injury on the itemised breakdown.

John Lewis Insurance is a trading name of John Lewis plc. Registered in England no. 00233462. Registered office 171 Victoria Street London SW1E 5NN.

John Lewis plc is an appointed representative of Royal & Sun Alliance Insurance plc.

John Lewis Pet Insurance is underwritten by Royal & Sun Alliance Insurance plc (No. 93792). Registered in England and Wales at St. Mark’s Court, Chart Way, Horsham, West Sussex, RH12 1XL.

Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority. 453989 (11-13)

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1. You'll want to fill out the johnlewis pet insurance claim form properly, therefore pay close attention when working with the sections comprising all of these blanks:

Stage number 1 of filling in john lewis pet insurance claim form

2. Once your current task is complete, take the next step – fill out all of these fields - Condition, Condition, Name of condition as advised by, Please provide the treatment dates, Please advise the cost of, From, and From with their corresponding information. Make sure to double check that everything has been entered correctly before continuing!

Filling out segment 2 in john lewis pet insurance claim form

3. In this specific part, review Printed name, Printed name, Printed name, Policyholders signature, Policyholders signature, Policyholders signature, Date, Date, Date, Please note if we decide we cannot, E The attending vet or a person, I declare to the best of my, Practice Stamp, Printed Name, and Signature Date. All these will have to be filled out with utmost awareness of detail.

john lewis pet insurance claim form writing process outlined (step 3)

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