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 Sportscover
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 |
|
|
|
|
$50.00 |
| |
| Total payable by Sportscover for medical benefits is:
|
$1,878.00 |
| |
| The fees of the surgeon and the anaesthetist were also
incurred. 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. |
| |
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 Insurance 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 you should notify Marsh immediately on 1300
306 383 to ensure that your interests are fully protected.
|
