It is vital that sport and recreation organisations protect their assets and personnel with adequate insurance. Sport insurance policies are designed to cover players, clubs, groups and associations. The types of policies for a sport cover;
- Public Liability covers a range of financial risks such as your club’s legal costs or other costs associated with legal action
- Club Management Liability covers a range of financial risks for your club’s directors and officers such as costs associated with legal action if sued for: Negligence, libel, slander, defamation, discrimination, etc.
- Personal Injury Cover provides financial assistance in three key areas: Non-Medicare Medical Benefits, Loss of Income Benefits, Capital Benefits
It is only when you are injured that you begin to understand and appreciate its importance. It is only when you are injured and you go through the process of making a claim can you understand the good bad and ugly of player insurance. The purpose of this article is look at the sport insurance which is in place for hockey players and club/associations in Australia from insight gained as an injured player who used player insurance for the first time.
As a hockey player for over 50 years I never gave it much thought to player insurance only knowing part of our hockey fees paid for insurance. I never knew who I was insured with or what was covered or how the claim process worked. Following an early season collision on the field which resulted in being whisked in ambulance to spend the next five days in hospital with five broken ribs and punctured lung I was to first hand come face to face with the claim process of player insurance. The costs of the injury included ambulance, hospitalisation and treatment, post hospital pharmaceutical costs, and post hospital treatment/rehabilitation costs. Fortunately or unfortunately I was in a non-work period so claims on income loss were not part of the equation. It is estimated the total cost for the injury from beginning to end was $10,000.00.
The first part of the process for making a player insurance claim with trying to understand what player insurance I had. Upon investigation I found Hockey Australia has joined the likes of AFL, Swimming Australia, and Cricket Australia in utilising the sport insurance services of JLT Sport. JLT Sport have over 30 years of experience in this field in designing, developing and implementing insurance, risk solutions and risk management programmes for sporting communities. JLT Sport is the insurers but the claims are handled by the Innovation Group. The innovation group handle the claims I found out. They provide personal injury claims management, ensuring your customers’ claims are processed in a timely and cost-effective way, according to their own claim which through the whole experience found this to be the case. They communicated regularly and personally.
Now I knew who I was dealing with what could I claim and trying to understand some of that fine print policy stuff. Hockey Australia to their credit has made that clearly accessible. To find this information you go via Hockey Australia website page http://www.hockey.org.au/Playing/Registration-Insurance to the go to https://hockey.jltsport.com.au/products_pi.aspx . Here you can find the information you need to ‘wade’ through to get understanding. What constitutes player insurance? Personal Accident insurance provides coverage for injuries sustained whilst participating in an activity under the following circumstances;
- An official match or training session
- Travelling to and from an official club activity
- Participation in an official club function
- Tours or representative matches
The second part of the process for making a player insurance claim was in understanding how to make a claim. This was relatively straightforward as JLT Sport has spelled out the process, i.e.
- Step 1 – access a current claim form from the JLT Sport website
- Step 2 – complete all relevant sections of the claim form
- Step 3 – send your claim form to your nominated claims advisor as soon as possible*
- Step 4 – your claims advisor will confirm receipt of your claim and begin process
* Please note – most policies have a time limit in which to submit your claim form. For more detail https://hockey.jltsport.com.au/claim_pi.aspx
My advice here before making a claim is that you clearly document the injury as to when it occurred, what happened and what you did as a consequence of the injury. Ensure both club and association are informed asap and complete appropriate accident report. In my case the first aid officer present filled out an accident report.
So with understanding I now tackled what is claimable through JLT Sport. As a synopsis this is what was found.
- NB: The Health Insurance Act (Cth) 1973 does not permit the Insurer to contribute to any charges covered by Medicare (including the Medicare Gap).
|Examples of Non-Medicare Medical items.||Examples of items covered by Medicare.|
|Claimable as per the Policy Wording.||You are not reimbursed for these costs.|
|Private Hospital Accommodation||Anaesthetist|
|MRI Scans*||MRI Scans*|
- MRI scans are generally claimable through Medicare, however sometimes the referrer and/or provider are not registered with Medicare. Please check with your treating physician prior to lodging your claim.
- In addition, there will no refund in respect of: Any expenses recoverable by you from any other insurance scheme or plan providing medical or similar coverage or from any other source except for the excess of the amount recoverable from such other policies/plans.
Number 3 was interesting which certainly constituted what I found as the ‘bad and ugly’ about the process.
Having private health insurance is a personal choice, and these days a huge cost. As you may or may not be aware depending on your private health insurance cover you get an allocated amount you can claim annually, e.g., physiotherapy, chiropractic etc. Once you use it up you pay the full or almost full amount to the health service you need to use. Therefore it is handy to have this health insurance benefit up your sleeve when you need it. So what is my point? In the rehabilitation of the injury sustained I had to attend the physiotherapist regularly, which I thought initially would be covered by JLT Sport insurance. However to my dismay I had to use my own private health insurance then as a result of what my private cover did not pay as a claim for the treatment JLT Sport then would reimburse me75% of the difference which was not much. What I was left with as a result was that I used up for the year my own private insurance allocated amount for this service. The irony is that if I did not have private health insurance JLT Sport would have paid the 75% of the physiotherapist treatment costs. It is apparent JLT Sport must love claims where a person has private health insurance as they ‘piggy back’ what a person is already paying.
It is obvious but critical that you collect your collect and file your medical receipts as there is a paper work trail that needs to be conducted in the claim process.
In the end JLT Sport made a 75% Policy reimbursement of $171.41 which was for what I could claim under the policy for physiotherapist costs and some pharmaceutical cost for pain killers. Thank goodness for Medicare and private health insurance who paid for the other estimated cost of $9,820.00 which was associated with the injury. Then what is there to complain about as the cost of player insurance was $25 for the 2017 season. The information for making the claim and what you can expect is clearly available for review. The dealings with the appointed Innovation Group claim officer were cordial. The whole process was time consuming for the actual return. Thank goodness for Medicare and private health insurance.
Source: Hockey Australia / JLT Sport