Insurance Application Form - British Chiropractic Association

Your Work

Additional Activities

Over the last few years, chiropractors have expanded their role and undertake additional activities adjunct to their chiropractic care.
You can notify your insurer of additional activities you wish to undertake here. The following is not an exhaustive list, but covers many of the common areas that our members notify the insurer regarding.
There is always scope to notify of items not on this list so that the insurer can establish whether cover can be extended.

Please tick any additional activities you undertake as part of your work.*

If you select the 'Other' option, please give further details in the field that appears below.

Treatments must only be provided when acting within an area of competence and expertise and following additional training/qualifications, as applicable.

PLEASE DO NOT TICK ITEMS YOU ARE NOT YET TRAINED OR QUALIFIED TO CARRY OUT.
Once you are ready to add any additional items in the future, contact please contact the BCA team by email

* Use of Chinese Herbal Medicine must be provided solely within the context of chiropractic care and as an adjunct to conventional treatments. Treatments must only be provided when acting within area of competence and expertise and following additional training and qualifications. Qualifications in this area must be recognised by a legitimate UK register, and registration with this body must be maintained at all times.

If you ticked 'Other', please give details here and include activity name, activity description, % income derived from activity and qualifications (and where gained).

If you have ticked any activities above, please provide detail here. Please state activity name, activity description as well as the training/qualifications you have for each activity (and where gained). BCA Insurance Services may need to contact you for further information.

Use of X-ray

Please confirm that you have recieved undergraduate and/or post graduate training in the interpreting of and/or taking of X Ray imaging and have an appropriate competancy.

Please note that BCA members have access to the iRefer Clinical Radiation Guidelines, which are considered best practise by the GCC. https://chiropractic-uk.co.uk/x-ray-referral-guidelines/

GCC Guidance: https://www.gcc-uk.org/ionising-radiation-and-the-use-of-x-rays

BCA Guidance: https://chiropractic-uk.co.uk/x-ray-compliance-guidelines/

Confirm competency regarding the interpreting of X Ray and imaging*

Yes
No, not able to confirm competency at present

Confirm competency regarding the taking of X Ray and imaging*

Yes
No, not able to confirm competency at present

WIll you be using X-ray facilities within any of your practice locations?*

Yes
No

Overseas Work

Do you undertake any chiropractic work overseas (including virtual)?*

No
Yes

Do you undertake any work in a territory where the Foreign Office advise against all non-essential travel?*

No
Yes

Do you work overseas more than 30 days in any one period of insurance (i.e. a calendar year)?*

No
Yes

Do you comply with local regulatory, licensing and statutory obligations (unless clients are UK Ministry of Defence personnel, of UK nationality and the work is undertaken on sovereign UK MoD bases).*

Yes
No

Where you provide virtual services, such as video or telephone consultations, from the UK for clients overseas, do you comply with local regulatory, licensing and statutory requirements.*

Yes
No

Elite Athletes

Any person(s) who at the time of treatment competes in any of the sports listed below:
• Association football at English Premier League or Championship level, or the equivalent in any other country
• PGA / MENA / LIV Golf Tours
• Premiership Rugby
• Formula 1 or Superbikes
• Boxing (WBF, IBF, WBA)
• Mixed Martial Arts
• Any other sport with actual or anticipated earnings similar to or greater than any of the above.

Do you treat any person(s) who could be considered an Elite Athlete(s) defined above?*

No
Yes

What type of elite athletes do you treat?*

Association football at English Premier League or Championship level, or the equivalent in any other country
PGA / MENA / LIV Golf Tours
Premiership Rugby
Formula 1 or Superbikes
Boxing (WBF, IBF, WBA)
Mixed Martial Arts
Any other sport with actual or anticipated earnings similar to or greater than any of the above

Will you be working as a club / team chiropractor, treating professional athletes?*

Yes
No

If so, which club(s) or team(s)

Names of individual(s), where treating the athlete(s) on an individual basis.*

Names provided will only be used for the purposes of this insurance application and will be held in accordance with the privacy policies referenced at the end of this application.

Approx how many elite athletes will you be likely to treat in a 12-month calendar period (1/1 – 31/12)?

Age range of those individuals being treated.

Give some idea of approximately how long have you been involved with providing treatment for the clubs/teams/individiuals outlined above.

Please confirm all pre-existing injuries (dating to prior to your work with the athletes) are being recorded in the healthcare history.*

Yes, I confirm
No, unable to confirm

Abuse or Molestation Cover

With regard to providing care, (or overnight services or one-to-one services) to children and / or adults at risk. There are three requirements of you from your insurer.

You act in accordance with the requirements of the GCC Code.

You keep a written record of all concerns, reporting matters as appropriate through established local procedures.

You (or the clinic you work for) maintain a safeguarding policy.

With regard to providing care, (or overnight services or one-to-one services) to children and / or adults at risk, You act in accordance with the requirements of the GCC Code.*
Yes
No

With regard to providing care, (or overnight services or one-to-one services) to children and / or adults at risk, You keep a written record of all concerns, reporting matters as appropriate through established local procedures.*
Yes
No

With regard to providing care, (or overnight services or one-to-one services) to children and / or adults at risk, You (or the clinic you work for) maintain a safeguarding policy.*
Yes
No

If you answer no to any of these questions, BCA Insurance Services may be in touch for further information.

About Your Practice

As part of your insurance Package through the BCA, Entity Cover of £5,000,000 Aggregate is provided as standard where all practitioners within Your practice are BCA members.
There is an additional charge of £50, including tax, per non-BCA chiropractor or non-chiropractor practitioner.
Entity cover may be provided on request for your Limited Company or LLP.
If you need to discuss this aspect of cover, please click here to send the BCA team an email

Please Note: Entity Cover automatically covers non practicing/administrative staff e.g. secretaries however cover does not extend to include other persons or practices under Your premises, not associated with You e.g. a physiotherapist renting space at Your address but not practicing under Your name.

Do You require cover for Your Practice (Entity Cover)?*
Yes
No
If you select Yes, please go to this link and complete the Entity Proposal Form
https://chiropractic-uk.co.uk/entity-proposal-form/
Once complete, send by email to bcainsurance@lloydwhyte.com

Insurance and Loss History

BCA Insurance Services may get in contact to discuss aspects of your responses, as applicable.

In the last five years, in respect of the malpractice and public and products liability cover, have you suffered any claims or losses?*
No
Yes

In the last five years, in respect of the malpractice and public and products liability cover, have You suffered more than three claims or losses?*
No
Yes

In the last five years, in respect of the malpractice and public and products liability cover, have You suffered any claims or losses of a repetitive nature?*
No
Yes

In the last five years, in respect of the malpractice and public and products liability cover, does the total value of all your claims and losses, including reserve value exceed £25,000.*
No
Yes

In the last five years have You ever suffered any Personal accident claims?*
No
Yes

Are You aware of any fact, circumstance, incident or escalating level of complaint which may give rise to a claim to a claim to Hiscox (BCA Indemnity Insurance provider).*
No
Yes

Have You had a proposal refused or declined or ever had an insurance cancelled, renewal refused or had special terms imposed?*
No
Yes

Within the last 10 years have You, including any of your directors, partners or other board members, or any entities for which such persons act or acted as board members, been the subject of any insolvency process?*
No
Yes

Have You (including any directors, partners or other board member), ever been disqualified from acting as a director of a limited company or member of a limited liability partnership?*
No
Yes

Have You, (including any directors, partners or other board member), ever been convicted of or charged with a criminal offence, other than a conviction spent under the Rehabilitation of Offenders Act 1974 or any successor legislation?*
No
Yes

Have you ever been subject to any regulatory hearings or proceedings?*
No
Yes

If are switching from another insurer, please state the retroactive date of that policy. This only applies if you are currently insured with a UK-based insurer.

Declaration & Important Information

Important Notice Concerning Disclosure

Hiscox shall be entitled to rely upon the material accuracy of this proposal form and any other information supplied by or on behalf of the Proposer to them in relation to the entering into of this Policy (this proposal form and such other information together forming the “Proposal”). For avoidance of doubt your BCA membership application will form part of the Proposal.

The Proposer shall ensure that the Proposal contains such information as is reasonably necessary to enable Hiscox to:

properly assess the risks to be insured under this Policy; and

decide whether and, if so, to what extent they will provide you with insurance cover in respect of such risks referred to in (a) above

If you are in any doubt as to whether any information is material, it should be disclosed.

You should retain a copy of this Proposal for your records

Financial and Trade Sanctions

Hiscox is unable to provide insurance in circumstances where to do so would be in breach of any financial or trade sanctions imposed by the United Nations or any government, governmental or judicial body or regulatory agency.

Data Protection

Hiscox will treat your personal information fairly and lawfully in accordance with relevant data protection regulations and laws.

Declaration

I/We declare that the statements and information contained in the Proposal are true and accurate in all material respects.

I/We undertake to provide details of any material alteration to or in respect of such statements and/or information of which I/we become aware before the start date of this Policy.

For the purposes of making this Proposal, I/we agree that the Intermediary (which I/we have appointed to advise in relation to this policy) is acting on my/our behalf and not as an agent of the Insurer.

Name*

Position*

Please use the space below to add further detail to any questions within this proposal form or to add further information.

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BCA Insurance Application - 2024 onwards

Step 1 of 3

About You

Clinic Details

Note: If there are further clinic locations where you work, these can certainly be added. Please contact the BCA team here once your application has been processed.

Membership and Insurance

Confirmation

Your Work

Additional Activities

Use of X-ray

Overseas Work

Elite Athletes

Names provided will only be used for the purposes of this insurance application and will be held in accordance with the privacy policies referenced at the end of this application.

Abuse or Molestation Cover

If you answer no to any of these questions, BCA Insurance Services may be in touch for further information.

About Your Practice

Insurance and Loss History

Declaration & Important Information

Important Notice Concerning Disclosure

Financial and Trade Sanctions

Data Protection

Declaration

Enclosures

Note

Declarations

PRIVACY POLICY

Insurance Declaration

Your access has been blocked for security reasons.

BCA Insurance Application - 2024 onwards

Step 1 of 3

About You

Clinic Details

Note: If there are further clinic locations where you work, these can certainly be added. Please contact the BCA team here once your application has been processed.

Membership and Insurance

Confirmation

Your Work

Additional Activities

Use of X-ray

Overseas Work

Elite Athletes

Names provided will only be used for the purposes of this insurance application and will be held in accordance with the privacy policies referenced at the end of this application.

Abuse or Molestation Cover

If you answer no to any of these questions, BCA Insurance Services may be in touch for further information.

About Your Practice

Insurance and Loss History

Declaration & Important Information

Important Notice Concerning Disclosure

Financial and Trade Sanctions

Data Protection

Declaration

Enclosures

Note

Declarations

PRIVACY POLICY

Insurance Declaration