Indemnity enquiry form

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RCN indemnity scheme may cover you against the financial consequences of a claim against you for clinical negligence. It is very important that you check the terms and conditions as outlined on our RCN indemnity scheme page.

There’s no need to pay anything extra. RCN indemnity is included in your membership fee, provided you meet the eligibility criteria.

Note that if you are employed, your employer has responsibility to provide you with indemnity and legal support in any such event. The RCN scheme would not apply in this case.

If you need to provide proof of membership, please login to MyRCN, where you can download a copy of your confirmation of membership letter, which includes a link to the scheme details.

If you have read our terms and conditions, and the FAQs about the scheme, and would like to ask us a question about the scheme, or you have been contacted about making a claim, please complete our form below. Note that you must have been in the correct category of membership on the date that the incident occurred to make a claim.

Please confirm that you have read our advice

Contact details

Full name: RCN membership number: Address: Best contact number:

Please note that RCN Direct will not usually call you. Where an onward referral is required, provided you were in the correct category of membership at the time of the incident, we will provide these contact details to the RCN鈥檚 Legal Department.

Do you give us your consent to pass on this information? Yes No Can we leave you a voicemail? Yes No Can we contact you on this matter by email? Yes No If we need to pass your enquiry to your local RCN office or a specialist RCN department, would you like any emails from them to be password protected? Yes No Email address you would like us to reply to Please confirm the email address you would like us to reply to Please list any times that you are unavailable for calls during the next week (9am-5pm):

Employment details

Place of work Employer When did you start working with your current employer? Ward or department Job category Job title Weekly contracted hours Do you have any meetings scheduled? Yes No If yes, please give date, time and location: Are you already being supported by a rep? Yes No If yes, please include details below: Are you in the UK on a visa? Yes No If yes, please include details below (including how long you have been in the UK):

Indemnity

Do you have a question about our indemnity scheme or making a claim?

Please provide details of your query, including your employment status, and whether your work is/was being carried out on behalf of the NHS:

Have you received any correspondence regarding a claim? Yes No Is there a deadline? Yes No If yes, please include details: What was the date of the incident to which the claim relates? What is the name of the patient involved in the incident? (State 鈥楴ot known鈥� if you do not know their name) Please provide full details of the claim, including your employment status, and whether your work is/was being carried out on behalf of the NHS: Are any other members subject to proceedings: Yes No If yes, please include details:

Other enquiry

Please give details of your enquiry:

Can we update your personal details if any of the above does not match the data we currently hold on your record? Yes No

By submitting this form, you are giving the RCN permission to contact you about your submission.

You can control the information you receive from the RCN by updating your preferences at MyRCN.

We don’t update your contact details unless you ask us to. The best way to check and update the details we hold for you is by visiting MyRCN.

The information you provide in this form will be stored by the RCN.

Protecting your privacy is very important to us. Please view our privacy policy to find out more about the information we collect and how it is used.

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