The information shown on this website (apart from the actual policy documents) is prepared as a guide only and in no way affects, alters or overrides the Terms, Conditions and Limitations of the Policies that set out the basis of the Insurance. For full details of cover, terms and conditions refer to the policy documents or contact Gow-Gates Insurance Brokers directly.
Personal Accident Insurance
What is covered under the Personal Accident policy?
Personal Accident insurance covers EA members, coaches, officials and volunteers for an accident or injury sustained whilst participating in an EA endorsed activity, subject to the terms and conditions of the policy. Cover is provided for injuries occurring during the period of insurance, from 4pm local standard time 30 June, 2011 to 4pm local standard time 30 June, 2012.
Compensation includes capital benefits for death or permanent disablement, weekly benefits for temporary disablement, and various other expenses.
SCOPE OF COVER
Class of Insurance:
Personal Accident Insurance
Equestrian Australia Limited, State Branches, direct members, coaches, officials, committees, subcommittees, affiliated associations, affiliated clubs, members of affiliated associations and clubs.
All direct members, coaches, trainers, managers, administrators, voluntary workers, selectors, referees and other officials, medical officers, physiotherapists, masseurs and ambulance officers; and all directors, officers, employees, executive officers, office bearers, members and committees of the Insured.
To provide protection to all direct members of the EA, 24 hours a day 7 days a week in respect of all hazards which a member is exposed to whilst engaged in non-income earning equestrian activities but excluding travel to and from such activities
To provide protection to all coaches of the EA, 24 hours a day 7 days a week in respect of all hazards which a coach is exposed to whilst engaged in coaching under the EA coaching environment but excluding travel to and from such activities
(c) All other Insured Persons
To provide protection to the specified insured persons of the EA, in respect of all hazards to which they are exposed whilst engaged in endorsed activities of EA or affiliate clubs but excluding travel to and from such activities
What Benefits are Covered ?
This section provides a lump sum benefit to insured’s that suffer permanent injury or death.
The maximum sum insured under this section is $60,000, or $25,000 if under 18 years old.
There are percentages payable for various levels of disability for example;
Permanent Quadriplegia or Paraplegia 100%
Permanent Total Loss of sight of one eye 50%
Permanent Total Loss of Use of Hearing - One Ear 25%
Permanent Total Loss of the use of one arm 35%
Death cover is limited to $60,000 (or $25,000 for under 18 year olds).
A detailed list of the percentages is contained in the policy wording.
1. Income earner: This section provides an income replacement to insured persons that suffer an injury and are temporarily totally disabled from performing an occupation. The benefit is 85% of your average net weekly income or $500 per week, whichever is the lesser. No benefit is payable for the first 14 days from injury. The benefit is payable for up to 104 weeks from the date of the injury. Cover is only provided if the Insured Person was engaged full time in their Occupation up to the time of the Bodily Injury.
2. Domestic Home Help for Non-income earners: If an Insured Person who does not earn income suffers Bodily Injury, benefits are payable of up to $200 per week for authorized domestic help for each week of Temporary Total Disablement. The benefit is payable for up to 26 weeks from the date of the injury.
3. Student Allowance - Non-income earner: If an Insured Person who is a full time student suffers Bodily Injury, benefits are payable of up to $200 per week for each week of Temporary Total Disablement. The benefit payable is for up to 26 weeks from the date of the injury.
Non-Medicare Medical Expenses
The section provides payment of non-Medicare medical expenses incurred up to a maximum of $3,500, after any reimbursement from your Private Health fund. A $100 excess applies to each and every claim, but no excess is applicable for Private Health Fund members.
Non-Medicare medical expenses are those medical expenses that are not subject to any full or partial Medicare rebate.
Examples of expenses that are not claimable under this section include -
· Doctors fees
· Surgeon and anaesthetists fees
· X-Ray costs
Examples of expenses that are generally claimable under this section are -
○ Private hospital accommodation
○ Theatre fees in private hospital (where Medicare does not apply)
○ Chiropractic treatment (must be referred by a doctor)
○ Ambulance transport cost
○ Dental (to sound whole teeth only)
○ Orthotics, Splints and Prosthesis where an Insured Person’s Medical Practitioner considers them medically necessary for the treatment of the Bodily Injury
For Private Health Fund members, the above examples of claimable expenses only apply to the difference between any private health insurance rebate to which an Insured Person may be entitled and the actual cost incurred by the Insured Person.
Section 126 of the Health Insurance Act 1973 does not permit the Insurer to contribute to any Medical Expenses covered (whether fully or partly) by Medicare (“The Medicare Gap”).
Further Benefits available are detailed within the policy wording, but an outline of some of those benefits are as follows:-
OUT OF POCKET EXPENSES
Reimbursement for reasonable out of pocket expenses incurred as a result of an Injury to an Insured Person up to $1,000.
EMERGENCY TRANSPORT COSTS
Costs up to $3,000 for emergency transport or other mode of transport of an Insured Person where an ambulance would ordinarily be required.
EMERGENCY ACCOMMODATION BENEFIT
$50 per day up to a maximum of $500 will be paid for one Family Member accompanying an Insured Person and which results in the need for accommodation in a location more than 100kms from their normal place of residence.
OVERSEAS MEDICAL EXPENSES
$5,000 (maximum) will be paid for the cost of emergency medical treatment of an Insured Person who suffers an injury as a result of an accident whilst outside the territorial limits of Australia
What Injures are not insured ?
The Sports Injury policy is designed to provide coverage for injuries incurred
accidentally whilst engaged in EA endorsed activities. In keeping with this philosophy the policy contains some exclusions that clarify this intention. A
summary of the exclusions contained in the full policy wording are as follows –
- War and terrorism
- Aerial activities
- Being under the influence of drugs or alcohol
- Criminal acts
- Psychiatric or psychological disorder
- Contamination by radioactivity
- Pre-existing conditions
- Injuries which occur outside the policy period
How do I make a Claim ?
When making a claim for an injury, you must:
1. Advise your authorised club office bearer that you wish to make a claim.
2. Obtain from your authorised club office bearer or the Gow-Gates Equestrian Insurance Website.
• “Sporting Accident Claim Form” to be completed by you, and
• “Medical Report” to be completed by your treating doctor.
3. Send the completed claim form directly to the insurer, Sportscover Australia within 30 days from the date of injury;
SPORTSCOVER AUSTRALIA PTY LTD
Locked Bag 6003
WHEELERS HILL VICTORIA 3150
4. Claims must be advised as above within 30 days of injury.
5. When completing the claim form, ensure that you provide as
much information as possible. This may include documents,
records or even photographs for identification.
6. You must attend any medical examinations or other assessment
organised by Sportscover Australia Pty Ltd.
7. You must take all reasonable steps to recover from any
8. If you require an update on the status of your claim, please refer to the following sources;
Gow-Gates Equestrian Insurance Website
Sportscover’s Claims Hotline – 1300 134 956
This insurance does not seek to replace the need for Private Health Insurance, Income Protection Insurance and/or Life Insurance. EA and Gow-Gates recommend
that ALL EA members consider individual coverage as required for their particular