Off-Contract Claims

To make an off-contract claim, please complete the form below.

If you have questions or require help completing this form, please email us at occlaims@kent-athlone.com, someone will respond within 72 hours.

OC Claim Form

Section

Name of Hospital or Trust this claim is made for:

Contact Name

Contact Telephone Number

Contact Email Address

Name of product you are claiming for:

How many units did you originally order?

Strength

Quantity per pack

What date did you place your original order?

Have you already purchased this product off contract?

How many units do you intend to order?*

What is the proposed off-contract price per unit?

Who do you intend to purchase from?

What date did you purchase off-contract?

How many units did you purchase?

Who did you purchase from?

What off-contract price did you pay per unit?

Next steps

Once your form is submitted, we will review your claim.

If your claim meets the basic criteria for consideration, you will receive a claim reference number by email. We aim to respond within 1 working day but please bear with us if we take a little longer during busy periods.

We will also advise you of the necessary documentation required to support your claim. This must be received within 90 days of us sending you your claim reference.

Once we have received all documentation, please allow 90 days for your claim to be processed.

Disclaimer

Receipt of a reference number is not a guarantee of payment.

Each claim is subject to relevant checks before it is settled.

All requested documentation, must comply with the information submitted in this online form.

Failure to provide the requested documentation within 90 days of receipt of your reference number, will result in this claim being cancelled.

Queries

If you have any questions, please direct these to occlaims@kent-athlone.com.

Any claims sent directly to this inbox will not be actioned.

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