Mosman Football Club Summary of Football NSW – Player Personal Injury Insurance
(March 2015)
Note that the following is NOT to be considered legal advice and players should refer to the
insurer’s full policy for details and make their own assessment of the risks.
Part A - Summary
1.
Summary
1.1
Football NSW has in place a personal injury insurance policy, provided by JLT Sport and
underwritten by QBE Insurance Australia for the benefit of its registered players, coaches and
match officials for personal injury sustained in official sanctioned games and events (Insurance
Policy).
1.2
The Insurance Policy broadly provides three types of insurance cover for the benefit of the
Covered Persons injured in a Covered Event, which are all subject to the Exclusions:
(a)
Non-Medicare medical expenses to a maximum limit of $5,000 (Medical Expenses);
(b)
Permanent disability to a maximum limit of $100,000 (Capital Benefits); and
(c)
Income protection benefits to a maximum benefit of $13,000 (Income Loss),
(Types of Cover).
1.3
The benefits payable and claim limits in respect of each of the Types of Cover are more fully
described in Table 1 below.
1.4
There are a significant number of exclusions and limitations to the compensation payable under
the Insurance Policy (see paragraph 4 and Table 1 below), including:
(a)
where the medical treatment obtained is listed on the Medicare Benefits Scheme (for
example surgeon’s fees, doctor’s fees, MRI scans);
(b)
$350 limit for physiotherapy, osteo etc;
(c)
where a child is injured whilst playing competitively with parent’s;
(d)
complications relating to pregnancy and childbirth;
(e)
where the expense was incurred 12 months after the date of the Claimable Event;
(f)
where a claim is submitted later than 90 days after the Claimable Event.
2.
Recommendations
2.1
To ensure adequate insurance cover, the Club recommends that players consider taking out
their own:
2.2
2.3
(a)
private health insurance (hospital and extras);
(b)
income protection insurance; and
(c)
life and permanent disability insurance.
If injured whilst playing, a player should:
(a)
ensure claims are submitted within 90 days of the Covered Event;
(b)
to the extent possible, ensure medical treatment is obtained and all rehabilitation
concluded within 12 months of the Covered Event;
The Club further recommends that:
(a)
Pregnant women not play or play at their own risk because any injuries sustained to
pregnant women whilst playing that results in pregnancy or childbirth complications will
not be covered;
(b)
Parents and adults should not ‘play’ with the children during official club training or
games because any child injured in such ‘games’ will not be covered by insurance.
Part B - Definitions
3.
Covered persons
The Insurance Policy covers all registered:
(a)
Players
(b)
Referees
(c)
Coaches
(d)
officials
(e)
volunteers,
(Covered Persons).
4.
Covered Events
4.1
Subject to the Exclusions, an injury sustained by a Covered Person:
(a)
During an ‘official’ match or training sessions (hence trial matches and non-club
sanctioned training sessions are excluded);
(b)
Travelling to and from official club activity
(c)
Participation in an official club function
(d)
Tours or representative matches,
(Covered Events)
5.
Exclusions
Compensation for injuries sustained during a Covered Event will be reduced or excluded
where:
(a)
The medical treatment obtained is listed on the Medicare Benefits Scheme
(b)
The injury or illness is a pre-existing medical conditions
(c)
The injury is a football related ‘wear and tear’ injury
(d)
Injured whilst playing against medical advice
(e)
Under the influence of drugs or alcohol
(f)
Injury sustained whilst involved in a criminal act,
(g)
Social matches
(h)
Social events, such as end of season trips
(i)
Pregnancy & childbirth and related complications
(j)
activities involving parent/child competition
(k)
Contributory negligence (claim reduced by the % of the individuals contribution to the
injury),
(l)
claimable expense was incurred 12 months after the date of the Covered Event. That is
the treatment must occur within 12 months of the Covered Event – eg, date of surgery,
physio etc must be within 12 months of the injury event to be claimable;
(m)
where a claim is submitted later than 90 days after the Claimable Event
(Exclusions).
Table 1: Types of Cover, benefits and claim limits
Category
Description
Benefit
Permanent total
disability
100% capped at 5
times annual predisability earnings
Death
100% but capped at
$10,000 for persons
without dependent
children
Paraplegia,
quadriplegia,
permanent paralysis
100%
Loss of use of 2 limbs
100%
Loss of 1 eye, hearing,
use of 1 limb
50%
Loss of a thumb down
to … loss of a toe
30% - 1%
Osteo, physio,
massage, chiro, but
only where referred by
a doctor
Max $350
Limit
Capital Benefits
Injury resulting in:
Max $100,000
Medical Expenses
Non-Medicare medical
expenses
Post-operative
treatment prescribed a
an orthopaedic
surgeon
Max benefit of $5,000
per Claim
$50 excess
Private hospital bed fee
Theatre fee
Dental
Ambulance
Exclusions
Medical Services
covered by Medicare1
Doctor’s Fees
$0
Surgeon’s Fees
Anaethetist’s Fees
X-rays
MRI scans
Injury prevention
1
S126 of the Health Insurance Act 1973 does not permit an insurer to reimburse above the Medicare schedule fee
devices (e.g. guards)
Breakage of dentures,
glasses
Expenses incurred
more than 12 months
after injury
Where Covered Person
is covered by Private
Health insurance
Income Insurance
Loss of income
Max $250 per week for
52 weeks
$13,000