ABBEY TAX PROTECTION
BUSINESS INTERRUPTION CLAIM FORM
The following claim form can be used in connection with claims made under
the following circumstances:
1. 1 Agency Default: Business Failure of the Agency
If an Agency suffers bankruptcy whilst a IPSE Plus Member is engaged on an
assignment and as a result that Member is not paid for work, which has been verified
by the End Client as having been undertaken, and is not subsequently paid by
another Agency which may take over the administration of that engagement, then the
IPSE Plus Member will be entitled to ask the IPSE to make a claim on its policy for
losses suffered to a maximum of £10,000 (net of VAT).
1.2 Agency Default: Failure of the Agency to honour contractual arrangements.
The IPSE’s policy allows a claim to be made on behalf of a IPSE Plus Member for a
maximum £1,000 in the where the contracted role is not as described by the Agency
and/or contracted for by the member and the contract is terminated by the Agency;
2. Client Default where a Plus Member is working directly to an End Client
This is similar to the 1.1 Agency Default above, but relates to where the member is
contracted directly to the End Client
3. Jury Service
The IPSE’s policy provides cover for Jury Service Cover to all IPSE Plus Members
and their employees
4. Enquiry Interruption
The IPSE’s policy includes Enquiry Interruption Cover for IPSE Plus Members whose
fee earners are taken away from the business to attend visits with HMRC and/or the
Designated Agent.
5. Extended Absence
The IPSE’s policy also provides Extended Absence Cover for IPSE Plus Members in
respect of fee earners who whilst in an engagement which commenced a minimum of
four weeks prior to any unplanned absence due to ill health and who are absent from
the business for three weeks or more due to an unplanned illness or operation as
certified by a doctor or hospital (i.e. any period of self certification does not form part
of the absence period).
With the exception of jury service claims, there is a “Waiting Period” of 60
Days from the date from which a Member joins, or upgrades to, Plus
membership during which a claim will not be accepted. Any losses arising
before the commencement of or during the Waiting Period will not be accepted.
A summary of the Business Interruption Service is to be found at
https://www.ipse.co.uk/business-interruption-services
Please complete this page in respect of any Business Interruption Claim.
Claim Number: IPSE/
Your Details
Name
_______________________________________________________________
Trading as:
___________________________________________________________
Address
______________________________________________________________
___________________________________________________________________
___________________________________________________________________
Tel. Number: ___________________
E-mail address: _____________________
IPSE Membership Number ___________________
Date Joined/Upgraded to Plus ________________
Are you still a Member? YES/NO
Description of Business: _____________________________________________
Your signature: _____________________________________________
Please now complete the relevant section of this form and
enclose any documentation requested.
By completing and signing the declaration page(s) of the claims form,
you consent to Abbey Tax approaching the relevant third parties (HMRC,
liquidators, administrators, the Court Service, medical practitioners) to
provide any information/documentation needed to verify a claim.
1.1 Claim Details for Business Failure of the Agency
(i)
When did you become aware that your fees were at risk?
___________________________________________________________________
(ii)
On which date were you advised that the Employment Agency went into
liquidation?
(iii)
What efforts have you made to recover the fees?
___________________________________________________________________
(iv)
Please provide details of the amount being claimed and the period to which it
relates.
___________________________________________________________________
___________________________________________________________________
(v)
Please provide details of any further background information which may be
relevant.
___________________________________________________________________
___________________________________________________________________
1.2 Failure by the Agency to honour contractual arrangements
(i)
When did you become aware that the contractual arrangements were unlikely
to be honoured?
___________________________________________________________________
(ii)
Has the Agency found you an alternative assignment, or have you found an
alternative assignment? If so please provide details of the commencement
date and the rates
___________________________________________________________________
___________________________________________________________________
Supporting Documentation
Please provide the following documentation for either claim:



The contract signed between your company and the agency together
with the schedule detailing your hourly/daily rates.
Any correspondence since the contract/contract extension was signed
Any subsequent contract signed to establish the losses incurred
Business Failure only:


Copies of the timesheets signed off by the client showing the amounts
outstanding
Correspondence relating to the bankruptcy/administration
2. Claim Details for Business Failure of the Client
(i)
When did you become aware that your fees were at risk?
___________________________________________________________________
(ii)
On which date were you advised that the Client went into liquidation?
(vi)
What efforts have you made to recover the fees?
___________________________________________________________________
(vii)
Please provide details of the amount being claimed and the period to which it
relates.
___________________________________________________________________
___________________________________________________________________
(viii)
Please provide details of any further background information which may be
relevant.
___________________________________________________________________
___________________________________________________________________
Supporting Documentation
Please provide the following documentation for either claim:



The contract signed between your company and the agency together
with the schedule detailing your hourly/daily rates.
Any correspondence since the contract/contract extension was signed
Any subsequent contract signed to establish the losses incurred
Business Failure only:


Copies of the timesheets signed off by the client showing the amounts
outstanding
Correspondence relating to the bankruptcy/administration
3. Jury Service Claim Form
Insurers agree to indemnify the IPSE for claims made on its policy in connection
with loss of earnings by a Designated Member - IPSE Plus members only - as a
result of Jury Service, providing the court requires the Designated Member (or
Designated Member’s employee) to be in attendance or requires the Designated
Member to be available on specified days.
A claim can only be made by a Plus Member who had been a Plus member for 60
days prior to the date of initial summons by the Court Service. Jury service can be
deferred, but it is the date of the initial summons which determines whether cover
will be provided.
The Jury Service Allowance will be limited to a maximum of 10 days at £500 per
day less a deduction of any amount recovered from the relevant court.
In order to arrive at the daily amount payable, the Member must provide details
from which it will be possible to calculate a daily rate. This will either be the length
and value of the current engagement, the last year’s P&L account, or if the claim is
on behalf of an employee, the employee’s wage-slip.
Please attach with this claim form the documents requested at 1 (a) & (b), 2 (d)
and the relevant proof of earnings from section 3 and tick the box to show that
these are attached.
1. When were you advised by the court that you were required to undertake
Jury Service?
(a) Please attach a copy of the original Jury Summons Notice
(Page 2 of the Notice in England & Wales)
0
(b) PLEASE ATTACH COPY OF COURT ATTENDANCE SLIP
0
2. Details of Jury service
(a) Number of days in
attendance: (b) Dates attended
(c) Payment received from the Court
in respect Jury Service:
£
(d) PLEASE ATTACH COPY OF PAYMENT ADVICE SLIP
3. Proof of Loss of Earnings
PLEASE ATTACH COPY OF ONE OF THE FOLLOWING:
(a) Copy of last year’s Profit & Loss A/Cs:
0
Monthly earnings based on last year’s Accounts £
(b) Copy of current engagement showing current rates:
Monthly earnings based on the value of the
current engagement
£
(c) If claim on behalf of employee, copy of
wage or salary slip:
£
Gross Monthly Salary
4. Calculation of Loss of Earnings
(a) Daily rate calculated as
Monthly earnings (from 3a, b or c) divided by 21 = £ ____
(b) Number of days:
(c) Total loss of earnings (4a x 4b)
£
(d) Payment Advice Slip Total (2c)
£(
)
(e) Total due from ATP (4c – 4d)
£
*
*The maximum payable is £500 per day subject to a maximum of £5,000.
I/we declare that the information above is to the best of my/our
knowledge true and complete.
I/We undertake to advise insurers or their agents of any additional
information that comes to our notice, which may affect this claim.
I/We confirm that I/we do not have the benefit of indemnity under
any other insurance policy in respect of this claim.
I/We confirm that I/we were not aware of the Jury Service prior to taking
out IPSE Plus.
Signed:
Date:
4. Enquiry Interruption
Insurers agree to indemnify the IPSE for claims made on its policy in connection with
loss of earnings by members as a result of a Designated Member (or Designated
Member’s employee) to be in attendance for meetings with or visits by HMRC and/or
meetings with the Designated Agent during the course of an enquiry; e.g. meetings
will include a meeting at HMRC’s offices, meeting with the Designated Agent to
prepare for and attend a Tribunal. (This is not intended to be an exhaustive list).
Please provide details of dates and the number of days or half days that you were
required by the Designated Agent to attend a meeting with the Designated Agent
and/or HMRC during the course of the enquiry:
_________________________________________
Based on the above, please calculate the value of the claim (Number of days @ a
maximum of £500 per day)
________________
Please provide details of the name of the representative of the Designated Agent
who authorised the meetings:
_________________________________________
For office use only:
Was the absence authorised by an employee of the Designated Agent?
Y/N
Name of Authorising Consultant _________________________________________
Supporting Documentation:

If not already in our possession, a copy of the contract signed between
your company and the agency / end client, together with the schedule
detailing your hourly/daily rates.
5. Extended Absence
PSE’s policy also provides Extended Absence Cover for IPSE Plus Members in
respect of fee earners who whilst in an engagement which commenced a minimum of
four weeks prior to any unplanned absence due to ill health and who are absent from
the business for three weeks or more due to an unplanned illness or operation as
certified by a doctor or hospital (i.e. any period of self certification does not form part
of the absence period).
The IPSE’s policy will make a single payment of £2000 to the Member’s business in
respect of the first three full weeks that a Member is certified as being unfit to work by
a doctor or hospital.
The policy will not pay where the member is absent due to a planned operation,
medical procedure or other scheduled absence arranged before the contract has
commenced.
Period of extended absence for which this claim is being made:
From ______________________ To _________________________
If the absence is linked to an unplanned or unexpected operation, please provide the
date that you were aware that the operation would need to take place:
_____________________
Date of the operation: _____________________
Name & Address of doctor or hospital which has certified the absence
Surgery/ Hospital Name _____________________________
Address
_____________________________
_____________________________
_____________________________
_____________________________
Telephone
_____________________________
Contact
_____________________________
Supporting Documentation

Please provide a copy of the doctor’s or hospital certification
determining absence from work will be required. The absence period
must extend to three weeks or more

A copy of the contract signed between your company and the agency /
end client, together with the schedule detailing your hourly/daily rates.
Notes
With the exception of Jury service claims, there is a 60-Day Waiting Period after
becoming a Plus Member in which a claim cannot be made, nor can a claim be made
after the 60-day Waiting Period which relates to an event which occurred in the 60Day Waiting period.
Agency & Client Default Claims
In order for a claim to be validated, the work must be verified by the End Client as
having been undertaken.
No fees will be reimbursed for work undertaken after the Agency or Client has been
declared bankrupt or gone into liquidation.
All reasonable attempts must be made to pursue the debt and seek reimbursement
from the Agency (Agency Default) or Client (Client Default), and any claim must take
into account amounts recovered from the administrators or the courts.
In the event of an Agency suffering bankruptcy, administration or liquidation it is not
uncommon for another Agency to step in and take over the administration of that
engagement. Where this happens and where the Agency agrees to pay for any of
the weeks for which a claim is being made, then this will be deducted from the value
of the claim.
The losses will be limited to hours/days worked which the Agency or Client was due
to reimburse and will not include expenses that may have been incurred at the
request of the End client, which were due to be reimbursed by the End Client.
Claims cannot be made where payments are delayed by the Agency, or where the
Agency is disputing the amount due because of failure of the Member to claim for
work undertaken.
Payments will be made net of VAT and are treated as claims for compensation,
thereby allowing the IPSE Plus Member to claim bad debt relief from HMRC for the
unpaid VAT.
The maximum amount per claim under this policy shall be limited to:





Business Failure of the Agency per individual claim - £10,000.
Business Failure of any one Agency – all claims £100,000
Business failure of the Client per individual claim - £10,000
Business Failure of all Agencies or Clients in a full 12-month policy period £500,000.
Failure of the Agency to honour contractual arrangements - £1,000
In order to clarify the above, the policy aggregate limit of £500,000 covers all claims
made in any one period of insurance, but there is an aggregate limit per individual
agency of £100,000 which operates as follows: if an agency was to fail with 50 IPSE
Plus members facing financial loss, then the maximum payout for each individual
member would be £2,000. If the full aggregate limit has been reached, no further
claims would be accepted.
Where the value of claims exceeds the aggregate limit in any period of insurance, the
individual claims amount will be pro-rated accordingly.
5. Declaration
I/We declare that the information above is to the best of our knowledge true
and complete.
I/We undertake to advise the Insurers or their agents of any additional
information that comes to our notice, which may affect this claim.
I/We authorise Abbey Tax Protection to discuss with the Agency and/or the
Administrator for the Agency any issue relating to the Claim.
I/We agree to make available to Abbey Tax Protection any document or
correspondence necessary for settlement of the claim.
I/We confirm that I/we do not have the benefit of indemnity under any other
insurance policy in respect of this claim.
Signed _________________________
Date ____________________
Name _________________________
Status___________________
Please return with supporting documentation to:
IPSE, Heron House, 10 Dean Farrar Street, London, SW1H 0DX
Tel: 0845 125 9899 Fax: 0208 622 3200