I want to submit a new claim for myself

Tell us what’s happened, and we’ll get your claim moving

Sorry, you need to enable JavaScript to use this form. If you are unable to do this, please return to our contact us page to find the relevant telephone number.

Your details

It’s important that you include this as it helps us identify your policy.

Please enter the date in the format dd/mm/yyyy

If the email address you give us isn’t the one we already have for you, we’ll get in touch by phone or post

Details of your claim

Does the issue affect the left, right or both sides of your body?

Please provide as much detail as possible around how this is affecting your daily life

Please enter the date in the format dd/mm/yyyy

Is this the first time you’ve had these symptoms?

Please enter the date in the format dd/mm/yyyy

Has there been any ongoing symptoms, consultations, investigation and/or treatment relating to the condition being claimed for?

Please tell us anything else you think is relevant or important

Such as having your documents in an alternative format or that you require additional support with communications (e.g. a translator or being hard of hearing).

We will update this on your client record for your health policy with Aviva

Declaration

Aviva uses your personal data as set out in our Privacy Policy. We use Google’s reCAPTCHA technology to protect our websites from spam and abuse. The Google Privacy Policy and Terms of Service apply to reCAPTCHA.