Deliveroo claim

Deliveroo claim
Please note the following before filing your claim
- This insurance does not cover the damages to your possessions, for example your bicycle or your phone are not covered by this insurance.
- If you have an insurance for your vehicle and your vehicle was damaged, do not forget to let your insurance company know about the accident.
Select your country*
What type of claim do you wish to submit?*
What type of claim do you wish to submit?*
What type of claim do you wish to submit?*
To claim for your own medical costs and/or temporary incapacity as a result of an accident, while you were working for Deliveroo.
If you’re incapacitated to work due to a sickness (not related to any road accident while delivering for Deliveroo).

if your incapacity to work is due an accident linked with a Deliveroo order please select accident.

Be careful:

- You must have completed at least 30 orders over the last 8 weeks before.

- Your incapacity to work must be certified by a doctor (medical certificate required).
If you’d like to receive compensation for a newborn child, adopted child or still birth.

Attention point: you must have been collaborating for Deliveroo at least for 6 months and you have completed at least 30 orders in the 8 weeks prior to the event date or at least 60 orders in the last 6 months prior to the event date if you are the natural mother.
You have been selected for a jury and this prevents you from doing deliveries? Fill in this form to be eligible for a compensation.
We are sorry that you had an accident.

As of the 1st of February 2020, Inail is responsible for Personal injury insurance coverage for Deliveroo Riders.

● Any medical expenses following an accident during your trips for Deliveroo and the incapacity for work will be covered by Inail.

For the correct reporting procedure and for further information, please click here.

What does Qover free rider insurance cover me for?

● Public Liability: Material damage and/or medical costs of an involved third party will be handled by Qover

If you are responsible for an incident, or have caused damages to other people (or their property) while working for Deliveroo, please report your incident at the following link.
Qover will provide you with the necessary insurance support!
If you are not a Deliveroo Rider but you were involved in an accident with a Deliveroo Rider, please contact SATEC via this link or call this number +33 1 42 80 15 03

Or if you are a Deliveroo Rider and the only damage is caused to a third party, use this link to declare the claim to SATEC or call this number +33 1 42 80 15 03
Insurer
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do_not_send_report
claim_language
claimhandler
fromEmail
deliveroo_email
example@example.com
replyTo
example@example.com

Rider information

Please provide us the following details of the Deliveroo rider
Name*

First NameLast Name
Birthday*

DayMonthYear
Date
Email*
example@example.com
Phone Number*
Rider's address

Please provide us the following details of the Deliveroo rider's address
Street of the rider*
Street number of the rider*
Postal code of the rider*
City of the rider*
claimant_address_country*
claimantEntityType
Deliveroo rider account number*
claim_type
claim_subtype
Deliveroo rider's IBAN*
Provide here your bank account number in IBAN format

Incident information
When did the incident take place?*

DayMonthYear
Date
Hour Minutes
Street of the incident*
Street number of the incident*
Postal code of the incident*
City of the incident*
Country of the incident*
Describe the incident*
Provide a detailed description of the incident
Vehicle you used at time of incident*
At what moment of the delivery did the accident happen?*
Are you injured ?*
Any medical expenses following an accident during your trips for Deliveroo and the incapacity for work will be covered by Inail.

For the correct reporting procedure and for further information, please click here.
Please describe your injuries as a result of this accident*
A condition is added on the next question "Was a third party involved in the accident". If that question is filled with an answer (and it will since it's a mandatory question), it will skip all next pages until the last one. This is how we handle the multi coverage apsect of this form
Was a third party involved in the accident?*
ThirdParty EntityType
Third party's firstname*
Third party's lastname*
Third party's street
Third party's postal code
Third party's street number
Third party's city
Third party's phone number
Third party's email
Third party's country
Describe the damage and/or injury of the third party*
Please keep all your medical documents, they will be requested by our claim handler later. You don't need to include any details or medical reports in this form.
Upload any relevant file regarding the third party (optional)

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Are there any witnesses ?*
witness_entity_type
Witness's firstname*
Witness's lastname*
Witness's street
Witness's street number
Witness's postal code
Witness's city
Witness's phone
Witness's email
Witness's country

Sickness information
If you’re incapacitated to work due to a sickness (not related to any road accident while delivering for Deliveroo).

Be careful:

- You must have completed at least 30 orders over the last 8 weeks before.

- Your incapacity to work must be certified by a doctor (medical certificate required).
What is the start date of your sickness period stated in the doctor's certificate? *

DayMonthYear
What is the end date of your sickness period stated in the doctor's certificate?*

DayMonthYear

Attendance on a jury
You have been selected for a jury and this prevents you from doing deliveries?

Fill in this form to be eligible for a compensation.
When was the jury duty ?*

DayMonthYear
Please send us a copy of your court summons

Cancelof

Parent expenses
You can benefit from this coverage if you have been collaborating for Deliveroo at least for 6 months and you have completed at least 30 orders in the 8 weeks prior to the event date or at least 60 orders in the last 6 months prior to the event date if you are the natural mother.

Please note that you must submit your claim after the event date (certificate required).
Event date*

DayMonthYear
(e.g. birth date or adoption date)

Data Protection, Fraud Prevention and Detection & Medical information

In order to administer your claim, this information will be used by Qover, the claim adjuster and the insurer. It may be held on computer and or in manual files for administration and risk assessment purposes.
incident_date

DayMonthYear
Date
Hour Minutes
By returning this form, you consent to our processing of your sensitive personal data for the above purposes. You also consent to our transferring of your information to countries which do not provide the same level of data protection as France, if necessary for the above purposes. If we do make such a transfer we will, if appropriate, put a contract in place to ensure your information is protected. Where you have provided information about another person, you confirm that they have appointed you to act for them, to consent to the processing of their personal data, including sensitive data, to the transfer of their information abroad and to receive on their behalf any data protection notices.*

I agree with the Privacy Statement
Should be Empty:

Deliveroo claim

Rider information

Incident information

Sickness information

Attendance on a jury

Parent expenses

Data Protection, Fraud Prevention and Detection & Medical information