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.

Will was playing rugby 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.  Will visited the specialist the next week who ordered an x-ray which revealed that a full knee re-construction was needed.  As Will 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.  Will was earning an average weekly wage of $600 per week.  For a period of 8 weeks following his injury he hired crutches from the local chemist.

Will completed a ‘Sports Injury 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 SLE who recorded the claim.  At the time of visiting the specialist Will had the ‘Attending Physicians’ section completed by him and this was sent off again to SLE together with ‘unfit for work’ certificates. Following payment of the medical expenses Will sent the receipts and additional ‘unfit for work’ certificates  to SLE.

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
Crutches Hire $150.00
Pharmaceuticals $110.00
Physiotherapy $40 per visit $600.00
Sub Total $3,020.00
Less Excess -$100.00
TOTAL NON MEDICARE EXPENSES PAID
$2,920.00
Loss of income  12 weeks @$300 per week
(28 days excess applied, $300 per week maximum applied)
$2,400.00
TOTAL CLAIM PAYMENT $5,320.00


Rugby Risk Management

Have you downloaded our Risk Management App?

Affiliated Clubs and Associations within the ARU Insurance Plan now have access to the Gow-Gates Sport iPhone app.

This app includes risk management resources that clubs can complete and store without the burden of having to make paperwork available for ground managers or storing completed documents.