How To Make A Claim

GROUP PERSONAL ACCIDENT

Non Medicare Medical Claims (e.g. Physio, Ambulance, Private Hospital Accommodation)

Step 1:
All claims must be notified to Sportscover within 30 days of the accident, injury or damage occurring. Please notify Sprortscover by obtaining the relevant claim form via:

Phone the Sportscover Claims Hotline - 1300 134 956 (Australia Only) or contact the Marsh Sports Department on 1300 306 383.
Complete an online claim form request http://www.sportscover.com/claim_request.asp

Step 2:
Complete the claim form, providing as much information as possible including supplying original receipts, and submit this to the Sportscover office nearest to you via fax or post.

Step 3:
You will then receive a claim number and Internet Access PIN.

Step 4:
To monitor the progress of your claim please visit http://www.sportscover.com/claims.asp by entering your claim number and Internet Access PIN.

Example of a Personal Accident Claim

An example is as follows:

Player A is injured playing football and suffers a serious knee injury. The injury is an anterior cruciate ligament rupture and requires surgery. No private health insurance is held.
He spends two days in a private hospital and incurs hospital costs as follows:
Room charge two nights at $450 per night	$900.00
Theatre fee	$500.00
Total	$1,400.00

Player A also requires 9 months of physiotherapy to assist in the rehabilitation. $45 per visit. He attended 18 times. Total $810.00.
The physiotherapist also recommended a two month gym program based on increasing the strength in the knee. Cost $200.00.

The claim was settled as follows:
Hospital cost	$1,400.00	@	80%	=	$1,120
Physiotherapy	$810.00	@	80%	=	$648
Gym program	$200.00	@	80%	=	$160
Sub Total				=	$1,928
Less Excess					$75

Total payable by Sportscover for medical benefits is:					$1,853

The fees of the surgeon and the anaesthetist were also incurred and totalled $2,200.00. Due to the provisions of the Health Insurance Act, these items are not claimable under the Sportscover policy, but they may be claimable via Medicare. Please refer to Medicare for further information.

Player A is a self-employed tradesman and he is also unable to work for 30 days. He holds no Private Income Protection Insurance. The claim for loss of income would be calculated as follows:
30 days less 10 day excess = 20 days
$200 per week or $28.49 per day
$42.86 X 20days = $569.86
Total payable by Sportscover for loss of income is					$569.86

Total amount payable by Sportscover is					$2,422.86

IMPORTANT INFORMATION

After $200 worth of treatment from an ancillary provider a referral from a legally qualified medical practitioner must be obtained.
Forward only original receipts (retaining a copy for your own records).
Claim on your Private Health Insurer FIRST if you have Private Health cover, and send their Statement of Payment with your claim.
Please do not send Doctors', Surgeons', Anaesthetists', X-Ray or MRI Scan accounts as they are covered by Medicare. The Health Insurance Act (Cth) 1973 does not permit the Trustee or the Insurer to pay any part of these accounts. Refer to Non Medicare Medical Expenses

PUBLIC LIABILITY & PROFESSIONAL INDEMNITY

Claims made against you by members of the general public for personal injury or damage to their property arising from the conduct of your business are regarded by Insurance Companies as extremely serious.

It is essential that Under No Circumstances should any admission of liability or offer to pay an amount be given to the person concerned and that you notify Marsh immediately on 1300 306 383 to ensure that your interests are fully protected.


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