Unable to work as a result of illness or an accident?

Make sure you have a source of supplementary income and use your Guaranteed Income insurance

Unable to work as a result of illness or an accident?

Make sure you have a source of supplementary income and use your Guaranteed Income insurance

Notify us if you become unable to work

Make sure you have a source of supplementary income and use your Guaranteed Income insurance

Provide your insurance agent with the following documents or send them by post to KBC Insurance, Guaranteed Income Department, f.a.o. the consulting physician, Professor Roger Van Overstraetenplein 2, 3000 Leuven, Belgium.

  • A fully completed claim form
  • Any medical reports, documentation relating to check-ups, examinations and any hospital admissions

Note that medical costs are not reimbursed.

Decision regarding your file

We will open a file after receiving the claim form. Your file administrator will send you written confirmation, along with the decision of our consulting physician.

1. Your work disability has been accepted

What do you have to do?

Keep us notified at all times of the status of your disorder.

  • If you need to extend your work disability
    send us an extension certificate filled in by your doctor, together with the requisite medical reports that were recently drawn up
  • If you are going to partially resume work
    send us an extension certificate filled in by your doctor, together with the requisite medical reports that were recently drawn up
  • If you are going to fully resume work
    send us a personal declaration

What will KBC do for you?

Once the deferment period ends, you will receive the insured annuity at the end of each month for as long as KBC accepts you are unable to work.

2. Additional information is required for your work disability

What do you have to do ...

... if you have received a request for additional information?

  • The additional information we require will be set out in your letter
  • Consult your family doctor to get medical information
  • If there has been an accident, we sometimes ask you to provide information about it or to send us a copy of the official police report

... if you have received an invitation to be examined by the examining doctor?

  • Sometimes an examination of this kind is required to arrive at the right decision
  • If the proposed examination date does not suit, contact the doctor in question and arrange a new appointment
  • KBC will pay the medical expenses involved

What will KBC do for you?

We will take a decision regarding your work disability based on the additional information you provide.

3. Your work disability has been rejected

Disagree with the decision taken by KBC Insurance?

  • Contact your file administrator or intermediary
  • Send us a report from your attending doctor clarifying why you are unable to work
  • If there is still no agreement, you can initiate a joint medical assessment or start legal proceedings 

FAQ

When can I claim on my guaranteed income insurance?

Depending on the formula you chose in your insurance policy, you receive benefits as soon as you suffer a loss of income for a longer period (determined in the deferment period) through

  • An illness, an accident in the private sphere, a work-related accident or an accident while commuting to or from work (Formula A)
  • An illness or an accident in the private sphere (Formula B)
  • An illness (older contracts)

For how long am I entitled to receive benefits when I am unable to work?

You will receive benefits for as long as your work disability amounts to more that 25%, and this up to the expiry date specified when the contract was entered into.

You will lose the right to receive benefits

  • If you die
  • When you no longer officially reside in Belgium
  • As of the first premium due date for which the premium was not paid
  • When your policy ends (for instance, upon retirement or early retirement)

Which causes of work disability are not covered by my insurance contract?

The following is an overview of the most frequently occurring exclusions (see your contract for the full, exhaustive list)

  • Previously existing condition
  • Attempted suicide
  • Intent on the part of the insured person
  • Illnesses resulting from excessive consumption of alcohol or drugs
  • Accidents occurring in a state of drunkenness or under the influence of drugs
  • Subjective disorders without objective symptoms
  • Psychological disorders (see your contract for an exhaustive list of psychological disorders that are covered)
  • War and riots
  • Perpetration of violent acts against a person or persons
  • Accidents occurring when unreasonable risks are taken
  • Nuclear reactions, radioactivity and ionising rays, except for radiation treatment required for medical reasons after an insured illness or accident

There are a number of risks that are only covered when explicitly stated in your contract

  • Dangerous sports
  • Professional sports

Which benefits am I entitled to receive when I am unable to work?

If your degree of work disability is 25% or more, you get

  • A monthly annuity
  • A reimbursement of the premium you paid during the period you were unable to work

How is the insured annuity determined?

At the time you take out your guaranteed income insurance, you also have to specify an annual annuity. When you are incapacitated for work, you receive 1/12 of this annuity per month once the deferment period ends.

If your work disability period does not start on the first day or end on the last day of a month, you will receive benefit payments for this period that are commensurate with the number of days you were unable to work.

The higher your degree of work disability, the higher the annuity you receive

  • If your degree of work disability is less than 25%, you do not receive any benefits
  • If your degree of work disability is between 25% and 66% inclusive, you receive a benefit commensurate with that degree of work disability
  • If your degree of work disability is greater than 66%, you receive the entire insured benefit

Am I covered for my specific profession?

Under certain conditions, you are covered for your specific profession only in the first year that you are incapacitated for work.

For longer periods of work disability, we examine which possibilities are open to you for returning to the labour market based on your disorder. 

I took out a contract with a bought determent period

You are entitled in certain cases to benefit payments from the first day you are unable to work.

Does my policy also cover incidences of work disability abroad?

Your policy applies worldwide. To qualify for benefits, however, you must officially reside in Belgium.

What happens if I resume work and a short time later I become incapacitated for work again?

In the event of relapse, the deferment period is not restarted. A relapse is when

  • a new degree of work disability occurs within the three months following the end of an insured period of work disability
  • the new work disability is attributable to the same disorder

If your new work disability does not meet these conditions, we will open a new file on your behalf and your deferment period starts again.

Detailed information on how the procedure for a joint medical assessment works

If the insured person's doctor and KBC Insurance's consulting doctor continue to disagree about the degree and/or duration of the work disability, a third, independent doctor can be appointed to rule on the dispute.

KBC Insurance will only propose doctors who are qualified to conduct the joint medical assessment. The insured person may make a counter-proposal, but the proposed doctors will need to possess the requisite competences.

After approval of the assignment has been received, an agreement to appoint a third doctor will be drawn up and sent in triplicate to the insured person for signing. The independent doctor starts the procedure, sends an invitation to the various parties and draws up a preliminary report. Both the insured person's doctor and KBC Insurance's doctor may add further comments, after which the final report is drawn up.

The decisions set out in the final report are binding for both parties. Therefore – depending on the decisions – an additional payment may be made, but it is also possible that an amount can be claimed back from the insured person.

The fees and any additional costs of the third doctor will be borne jointly by the insured person and KBC Insurance, each paying half. The costs depend on the fees charged by the third, independent doctor and whether or not additional examinations are required.

Glossary

Private sphere

The moments in your life when you do not exercise a profession or cannot invoke the Workers' Compensation Act.

Previously existing condition

A disorder or complaint that already existed at the time you took out your contract.

Deferment period

De periode die je bij een arbeidsongeschiktheid zelf financieel moet overbruggen. Deze periode is vastgelegd in je contract en The period that you have to provide for yourself financially if you become unable to work.

Relapse

A situation where the same disorder renders you unable to work again (degree of work disability of at least 25%) within three months of your previous file being closed.

Annual annuity

The sum you wish to receive annually if you become incapacitated for work. You decide on this amount when you take out your contract. Besides the amount of the annual annuity, you can also specify how this amount changes over time.

Degree of work disability

The degree of work disability is a percentage indicating the extent to which you would be either totally or partially unable to perform work. The degree of work disability is determined according to

  • The capacity of the insured person to adapt to another profession
  • The knowledge and skills of the insured person

Economic disability or work disability

Economic disability or work disability is the reduction in the capacity to exercise a profession as a consequence of impaired physical or psychological integrity. This is determined based on medical evidence.

Physiological disability or physical disability

Physiological disability or physical disability cover is usually provided as a supplement to work disability cover. This cover ensures that you (also) receive a benefit when there is a diminution of bodily soundness. No account is taken of your capacity to exercise your profession.

The degree of physical disability is established by medical decision and is based on the official Belgian disability scale (Officiële Belgische Schaal ter bepaling van de Graad van Invaliditeit).

Total/partial work disability

Compensation is paid for both total and partial work disability.

Degree of work disability Compensation provided by KBC Insurance
less than 25% no benefit is paid
25% - 66% benefit is proportional to the degree of work disability
67% or higher full insured annual annuity is paid (considered as total work disability)

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