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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:
§
Sportscover Claims Hotline - 1300
134 956 (Australia
Only) or Marsh Sports Department on 1300 308 702; or
§
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 fax or post to the Sportscover
office nearest to you.
Step 3:
You will receive a claim number and internet access PIN.
Step 4:
To monitor the progress of your claim 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:
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Player A suffers a serious knee injury while playing tennis. The
injury is an anterior cruciate ligament rupture and requires surgery. No
private health insurance is held.
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He spends two days in a private hospital and incurs hospital
costs as follows:
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Room charge two nights at $450 per night
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$900.00
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Theatre fee
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$1,500.00
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Total
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$2,400.00
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Player A also requires 9 months of physiotherapy to assist in the
rehabilitation. $45 per visit. He attends 18 times. Total $810.00.
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The claim was settled as follows:
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Hospital cost
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$2,400.00
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@
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75%
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=
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$1,800.00
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Physiotherapy
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$810.00
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@
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75%
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=
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$607.50
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Sub Total
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=
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$2,407.50
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Less Excess
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$20.00
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Total payable by Sportscover for
medical benefits
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$2,387.50
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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.
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Player A is a self-employed tradesman and he is also unable to
work for 27 days. He holds no Private Income Protection Insurance. The
claim for loss of income would be calculated as follows:
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27 days less 7 days excess = 20 days
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$500.00 net per week or $71.43 per day.
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$71.43 X 20days = $1,428.60
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Total payable by Sportscover for
loss of income
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$1,428.60
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Total amount payable by Sportscover
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$3,816.10
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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).
- If you have private health
cover, you must claim on this first 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, that arise from the
conduct of your business, are regarded by insurance companies as extremely
serious.
If
this occurs , it is essential that under no circumstances should any
admission of liability or offer to pay, be given to the person
concerned. It is also important that you notify Marsh immediately on 1300 308 702 to ensure that your
interests are fully protected.
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