dg mutual: sickness benefit cover for members

dg mutual is a UK mutual society that pays a weekly benefit to members who cannot work because of sickness or injury. It is run for the benefit of its policyholders, and its income protection plan lets a member choose when payments start, from day one or after a set deferral period¹. Membership also includes free access to a GP 24/7 service and a wellbeing counselling service for the member and their family¹.

The society's income protection plan lets a member choose when payments start: from day one, or after a choice of deferred periods¹. That choice is the single biggest thing that shapes both the cost of membership and how quickly money arrives after illness or injury stops someone working.

Membership also comes with free access to a GP service around the clock and a wellbeing counselling service for the member and their family¹. Membership is open to UK residents and is governed by the society's Memorandum and Rules².

What dg mutual offers: sickness benefit cover for members

The core product is a sickness and accident benefit: a regular payment made while a member is unable to work because of illness or injury. It sits in the same family as protection insurance, where income protection pays out when someone cannot work, rather than life cover which pays on death.

The plan is built around a deferral period, sometimes called a waiting period. A member chooses at the outset whether payments begin from the first day of incapacity or after a choice of deferred periods¹. A shorter deferral means money arrives sooner after a claim starts; a longer one means the member carries more of the early weeks themselves. The society sets out how the premium is worked out on its own site, and the figures change with age, occupation, the amount of benefit chosen and the deferral period, so the current numbers sit with dg mutual rather than here.

Alongside the benefit itself, membership includes free access to a GP service 24 hours a day and a wellbeing counselling service, both available to the member and their family¹. That is a membership extra rather than a separate insurance product, and it applies while membership is in force.

Membership is subject to the society's Memorandum and Rules, and the terms and conditions set out how the plan operates, including the promotional offers that run from time to time². Those offers apply to new members only and can be withdrawn at any time².

Immediate or deferred benefit: how the claim deadlines differ

The deferral period is the gap between becoming unable to work and the first payment. dg mutual provides benefit from the first day of incapacity or from a choice of deferred periods¹.

The practical effect is a trade-off. A plan that pays from day one puts money in a member's account almost immediately after a claim begins, but the member pays for that convenience through the premium. A plan with a 6 or 12 month deferral costs less to run but leaves the member to cover that period from savings, sick pay or other income. Most people who choose a long deferral do so because their employer provides sick pay for the first months of absence, so the insurance only needs to pick up where the employer stops.

Two things are worth checking before choosing. First, whether the deferral runs from the first day of absence or from the date the claim is accepted, because the two produce different waiting times. Second, whether a claim that starts during one deferral period and continues into another is treated as one claim or two. Both answers sit in the society's terms and conditions².

How to make a sickness benefit claim

A claim starts with telling dg mutual that illness or injury has stopped the member working. The society then asks for medical evidence to support the claim, which normally means a form completed by a GP or another healthcare professional who has seen the member about the condition.

The pattern is familiar from other benefit claims. For Attendance Allowance, for example, a claimant asks their GP, hospital doctor or nurse to sign a form called a SR1⁴. For Universal Credit, a claimant who cannot look for work because of a health condition provides medical evidence such as a fit note from day 8 onwards⁵. Income protection claims work the same way: the insurer needs a medical opinion, in writing, from someone qualified to give it.

The practical steps are:

1. Tell dg mutual as soon as the absence begins, so the deferral period and the claim start date are agreed.
2. Ask the GP or treating clinician to complete the medical form the society provides.
3. Send the completed form and any supporting evidence to the society.
4. Keep copies of everything sent, and note the date each item was posted or uploaded.

The society's terms and conditions set out the exact evidence it requires and the timescales for providing it². Claims that arrive without the supporting medical evidence, or that are sent after the deadline in the terms, take longer to assess.

Who pays for the GP form and medical reports

The cost of medical evidence usually falls on the claimant. A GP practice may charge for completing a private form or writing a report, and that charge is separate from any benefit the society pays. The society's terms and conditions set out what it will and will not reimburse².

There is a contrast worth knowing about in the public benefits system. Funeral Support Payment applicants can have the cost of medical certificates paid for them, though that does not apply in Scotland⁶. Private insurers generally do not follow that model, and a member should expect to pay their GP practice directly and then check whether the society reimburses any part of it.

Where the society asks for a medical examination by a doctor it appoints, rather than a report from the member's own GP, the arrangement is normally different and the society covers the cost. The terms and conditions say which is which².

Staying on claim: progress forms and medical examinations

A claim is not assessed once and then left alone. While benefit is being paid, the society can ask for progress forms confirming that the member is still unable to work, and it can ask the member to attend a medical examination.

This mirrors how public bodies handle continuing claims. The Department for Work and Pensions can ask a claimant to complete another claim form or attend another medical assessment where circumstances have changed⁷. Where a claim has been stopped because the department did not accept the reason for a delay, the claimant can make a new claim, challenge the decision, or do both⁷.

For a dg mutual member, the practical points are:

• Return progress forms by the date given, because a late form can hold up payment.
• Attend any medical examination the society arranges, and tell the society in advance if the date or location is a problem.
• Tell the society about any change in circumstances, including a return to work, a change of occupation or a change of address.

The society's terms and conditions set out how often progress evidence can be requested and what happens if it is not provided².

What dg mutual will not pay for

Every income protection plan excludes some conditions and circumstances, and dg mutual's are set out in its terms and conditions². The exclusions typically cover claims arising from conditions the member already had before joining, claims where the member was not truthful on the application, and claims that do not meet the definition of being unable to work.

The Financial Ombudsman Service has published a case study showing how these disputes usually turn out. In that case, the ombudsman upheld the insurer's rejection of a claim, saying it was reasonable for the insurer to reject the claim because the terms excluded pre-existing medical conditions⁸. The lesson for a member is that the wording of the exclusion, and what was disclosed at application, decides the outcome.

If a claim is declined, the member can complain to dg mutual first. If the complaint is not resolved, it can go to the Financial Ombudsman Service, which is free to the consumer. The ombudsman can consider complaints made out of time if there were exceptional circumstances, for example if the customer was incapacitated⁹.

Where sickness benefit does not apply abroad

The plan is designed around being unable to work, so a holiday does not by itself create or end a claim. What matters is whether illness or injury has stopped the member working and whether the medical evidence can be provided.

If a member is already on claim and travels abroad, the society needs to know. The terms and conditions set out what a member must do while claiming, including any notification requirements². A member who travels without telling the society risks a delay in payment while the position is checked.

It is also worth separating the insurance from the travel itself. A GHIC card is not a replacement for travel insurance, because it will not cover all of the medical bills a person could incur if they fall ill or are injured abroad, for example if they need an air ambulance, treatment in a private facility, ski or mountain rescue, or being flown back to the UK¹⁰. Travel policies are commonly suggested to carry a minimum of £2m of medical cover in Europe and £5m worldwide¹⁰.

Living outside the UK: suspending and restarting membership

Membership of dg mutual requires the member to be a UK resident². That condition matters for anyone planning to move abroad, whether for work or retirement.

The society's rules allow membership to be suspended and restarted in some circumstances, and the terms and conditions set out how that works². The practical step is to speak to dg mutual before the move, not after, so the suspension is agreed and the restart conditions are clear. A member who simply stops paying without agreeing a suspension may find the position harder to resolve later.

Moving abroad has wider consequences that sit outside the insurance. UK nationals wanting to live in an EU country may need a visa and should check the country's living in guide for information about their rights¹¹. Some countries do not recognise dual citizenship, and a person may have to give up their British citizenship or nationality to become a citizen of their destination country¹¹. You may not be entitled to free medical treatment in the UK if you move abroad permanently¹¹.

On the state side, Statutory Sick Pay, if a person qualifies for it and goes abroad, will still be payable as long as they can prove they are still sick¹². Income-based Jobseeker's Allowance cannot be paid abroad except for a temporary absence, under special circumstances¹². You cannot get many income-related benefits, like Pension Credit and Housing Benefit, if you are abroad for more than 4 weeks¹¹. State Pension can be claimed abroad if enough UK National Insurance contributions have been paid to qualify¹³.

How dg mutual is regulated and protected

dg mutual is authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority³. It also appears on the Bank of England's list of insurers incorporated in the UK and authorised to carry out contracts of insurance¹⁴. Mutual organisations carrying out financial services activities such as deposit-taking and making investments are regulated by the FCA and the Bank of England's Prudential Regulation Authority under the Financial Services and Markets Act 2000 and the Financial Services and Markets Act 2000 (Regulated Activities) Order 2001¹⁵.

The society's permissions include accepting deposits³. That matters for the protection question, because deposit-taking and insurance are covered by different safety nets.

For deposits, the Financial Services Compensation Scheme protects eligible deposits if a firm fails. Claims can be made online, progress can be saved and returned to at any point, and a claimant can check the claim's progress at any time in their online account¹⁶. Where a claim is rejected, the scheme has an appeals process, and exceptional circumstances in that process do not include when a new legal basis of claim becomes available to the customer after the expiry of the time limit, for example following a Court judgment that changes the law about an issue relevant to the claim¹⁸.

For insurance, the position is different. The scheme's protection does not extend to debt advice, which is listed among the things it does not cover¹⁹. A member with a complaint about how a claim was handled should use the firm's complaints process first and then the Financial Ombudsman Service.

Contacting dg mutual and complaining

The society's website is at www.dgmutual.co.uk³. Contact details, including the address for claims and membership enquiries, are published there and in the terms and conditions².

If something goes wrong, the route is the same as for any firm authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority:

1. Complain to dg mutual in the first instance, using the complaints procedure it publishes.
2. If the complaint is not resolved to your satisfaction within the firm's final response, take it to the Financial Ombudsman Service.
3. The ombudsman service is free to the consumer and can look at complaints made out of time where there were exceptional circumstances, for example if the customer was incapacitated⁹.

The ombudsman publishes case studies showing how it decides disputes, including one where it upheld an insurer's rejection of a claim because the terms excluded pre-existing medical conditions⁸. Reading those decisions is a useful way to understand how the wording of a policy is applied in practice.