Personal Accident
More detailed information on the policy benefits is detailed below.
The Sports Personal Injury policy has three main sections
- Capital Benefits
- Medical (Non Medicare) Benefits
- Weekly Benefits
Capital Benefits
This section provides a lump sum benefit to Insured Persons that suffer permanent injury or death.
The maximum sum insured under this section is $100,000
A detailed list of the percentages and limits is contained in the policy wording.
Medical Benefits
Non-Medicare Medical Benefits
This section provides reimbursement of Non-Medicare Medical Expenses, up to a maximum of $3,500 after any reimbursement from your Private Health fund. This is subject to a $100 excess (Nil excess if a member of a private health fund).
This benefit covers only expenses that are not covered by the Medicare Act 1983. i.e. expenses for which there is no full or partial Medicare rebate. Commonwealth Legislation prevents any programme of this kind from insuring the Medicare Gap.
Expenses that are claimable under this section are –
- Private Hospital Accommodation
- Ambulance Transport Cost
- Chiropractic
- Dental Services
- Orthotics, Splints and Prosthesis
Examples of expenses that are not claimable under this section include –
- Doctors fees
- Surgeon and anesthetists fees
- X-Ray costs
Physiotherapy Benefits
This section provides payment of Physiotherapy required and provided by a suitably qualified Physiotherapist as follows
Visits 1-5 – 95%
Visits 6-10 – 80%
All other visits – 75%
The maximum claimable for Medical Benefits (combining Non-Medicare Medical Expenses and Physiotherapy expenses) shall be $3,500
Weekly Benefits
A. Loss of Income Benefit – Income Earners
This section provides an income replacement to insured persons that suffer an injury and are temporarily totally disabled from performing their full time occupation.
The policy provides 85% of your average weekly income, up to a maximum of $500 per week.
The maximum benefit period is 104 weeks and is subject to a 14 day excess.
Your average weekly income which can be claimed under the policy is net of business expenses and excluding bonuses, commissions, overtime payments and other allowances.
Payments can only be made after the exhaustion of any sick leave entitlements.
It should be noted that proof of consistent work and pay entitlements will be requested.
Note: Tax may be withheld by the insurer from your Weekly Benefit. Please speak with your Accountant about your obligations to the ATO.
Additional Benefits
There are other additional benefits available under the Sports Personal Injury policy including:
- Student Benefit
- Domestic Benefit
- Parents Inconvenience Allowance
- Travel and Accommodation Expenses
- Rehabilitation Benefit
- Bed Care Benefit
- Dependant Children’s Allowance
- Home Renovation Benefit
- Funeral Expenses Benefit
- In Memoriam Benefit
- Kidnapping Benefit
- Membership Benefit
- Overseas Medical Expenses
For details of these additional benefits, please refer to the policy document or contact Gow-Gates.
What Injuries Are Not Covered ?
All Insurance policies contain exclusions. In the case of Sports Personal Injury policies, some injuries are excluded. This is not just for the EA National Insurance programme but is a standard practice amongst Sports Personal Injury policies.
The following list includes some key exclusions:
- being under the influence of alcohol or drugs
- engaging in or taking part in any Sport/s other than Equestrian
- any pre-existing defect, infirmity or sickness
- arising out of failure to seek or follow medical advice
- Any medical or surgical procedure performed for any gradually developing bodily deterioration whatever the cause of that deterioration.
- preventative measures rather than for the treatment of a Bodily Injury.
Complete details of all exclusions are contained within the policy wording.
