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?*
For coverage details, please visit deliveroo.qover.com and select the relevant country.
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
ref_country
do_not_send_report
claim_language
claimhandler (not used)
TPA Id
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)

Cancelof
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
Your personal data will be collected and processed by Qover SA (hereinafter ‘Qover’) that is independent controller responsible for the processing of the personal data you are required to share when you submit your claim. The data will be processed only for the purpose of the use of the services provided by Qover, including risk assessment, insurance contract management, claims and complaints handling and crime prevention (such as fraud) as well as to allow Qover to fulfil its legal obligations. Qover may disclose personal data to the Risk Carrier, namely Zurich and third parties, such as service providers, subcontractors, or to our partners such as Deliveroo and Sedgwick, for the same purposes. Personal data may be transferred abroad, including to countries outside the European Economic Area and/or the UK. Such transfers are subject to appropriate safeguards, including contractual safeguards, in accordance with applicable European regulations and/or the UK ones. The persons concerned have certain rights relating to their personal data and in particular the rights of access, rectification, erasure or restriction of processing or to object to processing as well as the right to data portability. To exercise these rights, you may contact us at any time by writing Qover’s DPO at privacy@qover.com.

For further information about how Qover processes your data please visit our Privacy Policy - EN.

More information about how Zurich processes your personal data and the rights you have as a data subject, please consult the policy documentation
I hereby declare that:*

I provide my explicit consent to the processing of the personal data, including special categories of personal data, I submitted in this claim form.I have read and agree to the information provided and Qover Privacy Policy.I have answered the questions to the best of my knowledge, accurately, and truthfully and have not concealed any information related to this claim. I am aware of the stipulation that any right to benefit may lapse with an untrue 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