More detailed information on the policy benefits is detailed below.
The Sports Personal Injury policy has three main sections
- Capital Benefits
- Medical (Non Medicare and Physio) Benefits
- Weekly 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 (increased to $600,000 for Paraplegia/Quadriplegia) (Death cover is limited to $20,000 for persons under 18 years)
A detailed list of the percentages and limits is contained in the policy wording.
Non-Medicare Medical Benefits
This section provides an 85% payment of Non-Medicare Medical Expenses after any reimbursement from your Private Health Fund up to a maximum of $2,500. A $50 excess applies to each claim.
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
- Dental Services
- Orthotics, Splints and Prosthesis
Examples of expenses that are not claimable under this section include –
- Doctors fees
- Surgeon and anaesthetists fees
- X-Ray costs
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.
85% of your average weekly income up to a maximum of $250 per week for 52 weeks. No benefit is payable for the 1st 14 days.
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.
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
- Others as per policy
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 FFA 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 Football
- 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.