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Sports Injury Claims Example

Below is  a basic example of the benefits that can be claimed under the policy and the process in order to claim.

Shaun was playing football for his club when tackled by an opposing player, suffering an injury to his left knee.  An ambulance was called and he was transported to the local hospital where he was given something for his pain and sent home.  After being in extreme discomfort that night he visited his local GP the next morning who gave him some pain relief, a certificate stating he was not fit to work for one week and referred him to a specialist orthopaedic surgeon.  Shaun visited the specialist the next week who ordered an X-Ray which revealed that a full knee re-construction was needed.  As Shaun was unable to work due to his injury he arranged for the surgery to be performed the following Thursday.  The specialist provided an unfit for work certificate for an additional 4  weeks.  His operation was successful and he started on a course of physiotherapy and was able to return to work 12 weeks after the injury.  Shaun was earning an average weekly wage of $600 per week.

Shaun completed a ‘Sporting Accident Claim Form’ two days after his injury, had his employer complete the employers sections, his club secretary complete the club’s section, and sent the claim form off to Gow-Gates who recorded the claim.  At the time of visiting the specialist Shaun had the ‘Medical Report’ section completed by him and this was sent off again to Gow-Gates together with ‘unfit for work’ certificates. Following payment of the medical expenses Shaun sent the receipts and additional ‘unfit for work’ certificates  to Gow-Gates.

The claim was settled by the Insurer as follows -

Private Practitioner Visit Scheduled amount covered by Medicare
(*Gap not covered)
Specialist Surgeon Scheduled amount covered by Medicare
(*Gap not covered)
X-Ray Scheduled amount covered by Medicare
(*Gap not covered)
Anaesthetist Scheduled amount covered by Medicare
(*Gap not covered)
Private Hospital accommodation 3 days @ $420 $1,260.00
Theatre Costs $ 600.00
Ambulance Cost $ 300.00
Physiotherapy – 5 visits @ $40 per visit $200.00
Sub Total $2,360.00
Less Excess $50.00
Plus Weekly Benefit
Loss of income  11 weeks @$250 per week (7 days excess applies, $250 per week maximum applies) $2,750.00