Gow-Gates Insurance Brokers

Presented by Anton Gelbart

Gow-Gates Insurance Brokers

Presented by Anton Gelbart

AUSTRALIAN RUGBY UNIONInsurance Scheme

AUSTRALIAN RUGBY UNIONInsurance Scheme

Presentation to Queensland Rugby UnionPresentation to Queensland Rugby Union

• Gow-Gates have been the brokers to the ARU since 1996

• Structured the ARU Funded Deductible

• Covers Personal Accident, Sports Public and Products Liability and Sports Professional Indemnity

• Renewal Date is 1st March 2004

BackgroundBackground

ARU Insurance Policy ARU Insurance Policy

• Covers all players and officials involved in Rugby Union throughout Australia, when affiliated with the ARU

• The plan is held by the ARU and extends to include various affiliated unions, clubs, players and officials

The ARU Funded DeductibleThe ARU Funded Deductible

• Different to conventional insurance

• Obtain cost savings

• Proportion of the Sports Injury insurance is set up under a self-insurance type fund

• The Fund pays all Personal Injury claims up to $1,600,000

• QBE Insurance Company administer fund

• Claims are paid on the same basis as the insurance policy.

Insurance Levy PaymentsInsurance Levy Payments

• All clubs affiliated with the ARU and/or various state unions are automatically covered

• An insurance Levy based on team numbers is payable by all clubs

• An invoice based on the previous years team numbers is sent to each club

• The insurance levy is payable by 30th June 2004

• There are premium funding options available to make payments in 7 installments

Who Is Covered? Who Is Covered?

• Australian Rugby Union Limited and its members and affiliate members, including member clubs and associations of the various State members

• All players, coaches, trainers, managers, administrators, voluntary workers, selectors, referees, touch judges, ball boys, medical officers, physiotherapists and ambulance workers, and all directors, officers, employees, executive officers, office bearers, members and committees of the Insured

Those Not Covered Those Not Covered

• School teams not playing in ARU Junior competitions

• Golden Oldies

• Social Teams not playing in ARU or underlying Union sanctioned competition

• Age limitation for the Personal Accident Policy

• 4-65 years increased to 75 for Administrators

When Is Cover Provided? When Is Cover Provided?

• Engaging/playing in official club matches/activities

• Engaging in organised training or practice

• Traveling directly between matches/activities and the Person’s residence or place of employment

• Staying away from the Insured’s home during a tour

• Engaging in administrative or organised social activities of the Insured

• Liabilities arising out of the Insured’s Sporting Activities

• Definition of Sporting Activities:A club, association, or other entity playing or administrating Rugby Union and includes all official activities connected with the Sport including club social and fund raising activities.

• A clubhouse or Sports pavilion with a liquor license used by members and guests will be covered

• Presentation nights, annual balls, dinners, fund raising are covered if organised by the club for the benefit of the club

Liability Coverage Liability Coverage

• Activities relating to a Licensed Club

• Property Owners liability where premises are hired out for non-rugby functions or activities

Liabilities Excluded Liabilities Excluded

Sports Injury – provides coverage for injuries incurred accidentally whilst playing, training, officiating and administering rugby

Section A: Death and Permanent Disability

Section B: Weekly Benefits (Loss of Income)

Section C: Non-Medicare Medical Expenses

What Benefits are Covered? What Benefits are Covered?

Death and Permanent Disability

This section provides a lump sum benefit to insured’s who suffer permanent injury or death

Maximum sum insured is $300,000Death cover is limited to $100,000Death cover is limited to $10,000 if under 18

There are percentages payable for various levels of disability

Section ASection A

Section B Section B

Weekly Benefits (Loss of Income)• Benefit of $250 per week, with a 28 day excess

• Income Earner - 80% of average weekly income up to a maximum of $250 per week. 28 day excess, 52 week benefit period

• Non-Income Earner - 80% of domestic help which has been certified as necessary by a medical practitioner up to a maximum of $250 per week. 14 day excess, 52 week benefit period

• Full Time Student - 80% of the actual cost of a home tutor which has been certified as necessary by a medical practitioner up to a maximum of $250 per week. 14 day excess, 52 week benefit period

• Parents Inconvenience Allowance – Reimbursement of parents expenses incurred in visiting a hospitalised injured person who is a full time student or is under the age of 25 years. The benefit payable is $100 per day up to a maximum of $2,000. No benefit is payable for the first two days of hospitalisation.

Section C Section C

Non-Medicare Medical ExpensesLimit $2,000, with a $250 excess

This section provides payment of 80% of non-Medicare medical expenses after any reimbursement from a health fund.

Non-Medicare medical expenses are those medical expenses that are not subject to any full or partial Medicare Rebate.

The ARU strongly recommend that separate Private Health Insurance be taken out,

The Australian Health Act prevents insurers (other than Private Health Insurers) to provide cover for any medical expense covered or partly covered by Medicare (Doctors and X-rays).

Not Claimable Not Claimable

• Doctors Fees

• Surgeon and Anaesthetists fees

• X-ray costs

The Australian Health Act prevents insurers (other than Private Health Insurers) to provide cover for any medical expense covered or partly covered by Medicare (Doctors and X-rays).

ClaimableClaimable

• Private hospital accommodation fees, theatre costs, including drips and pins

• Physiotherapy and chiropractic (referred by doctor)

• Pharmacy

• Ambulance

• Dental

• Hiring of artificial aids such as crutches

Conditions to Non-Medicare Expenses Conditions to Non-Medicare Expenses

• Expenses incurred after 12 months from the date of the injury are not covered

• Expenses covered under this section must be certified necessary by a legally qualified medical practitioner

• Reimbursement must first be sought from any applicable Health Fund provider and/or other insurance scheme/plan

• Expenses incurred after the injured person resume playing rugby are not claimable – including physio

What Injuries Are Not Insured?What Injuries Are Not Insured?

• Injuries which occur outside the policy period

• Injuries arising out of pre-existing injuries

• Injuries arising out of AIDS, HIV, childbirth or pregnancy

• Injuries arising out of the insured person engaging in air travel except as passenger in any properly licensed aircraft

• Deliberately self-inflicted injury or suicide

• Injuries arising out of War, invasion, acts of foreign enemies

• Injury caused as a result of any Heat-stroke, sickness or disease and/or Cardiac or Pulmonary or Cerebrovascular incident

notwithstanding that such incident may have been caused by or induced by or accelerated by Injury

Sports Public and Products Liability Sports Public and Products Liability

Limit of Liability $10,000,000

Excess: $1,000

Certificates of Currency are available for all clubs.

- Interested parties can not be noted on the certificate

Excludes claims arising from actual participation by a person in Rugby or

training for Rugby where the injury or damage is caused or allegedly caused by

another participant.

Sports Professional Indemnity Sports Professional Indemnity

Limit of Liability $10,000,000

Excess $1,000

This section provides coverage for the Insured’s legal liability for breach of

professional duty in sport by reason of an act, error or omission committed by

or on behalf of the Insured.

This policy excludes claims arising from a Player against a Player, however,

persons coaching, refereeing, officiating or supervising Rugby or training for

Rugby are afforded cover under this section for actions taken against them by

Players.

Claims Procedures Claims Procedures

As a loss control procedure, clubs/players are required to phone our office to request claim forms. We can either post or email these directly.

Claims are administered by GAB Robins and all claim forms are to be sent directly to them.

GAB RobinsPO Box 1438PARRAMATTA NSW 2150

Claim forms are to be sent to GAB Robins within 30 Days of the injury occurring.

Claims Cont. Claims Cont.

• Club Secretary to obtain original ARU Sports injury report form

• The player is to fully complete the claim form and return to Secretary

• Club Secretary is to sign and verify details of claim and ensure full completion

• Club Secretary to send the claim form to GAB Robins

• Player to submit paid accounts and Health Fund rebate statements

• Loss of Income claims to include:• Employee completing section of the form• Doctors certificate certifying the period of disability• Fully completed Attending Physician Statement• If player self employed, proof of earnings such as tax return

2004 Levy Cost Per Team 2004 Levy Cost Per Team

• Seniors $2,000

• Juniors $175

• Women’s 10s $900

One-Off Covers One-Off Covers

• A request for a one-off match, carnival or short competition

• Cover is available subject to:

• The event is sanctioned by the QRU

• Most players are existing ARU registered players

• The game is controlled by an accredited referee

• The game is played under ARU rules

Agreement from the Insurers is required prior to event being covered

Top-Up Cover Top-Up Cover

• Top-up Cover can be arranged on a team or individual basis for

weekly benefits and medical expenses cover.

• Capital benefits cannot be topped up

• Excesses cannot be varied

Gow-Gates Insurance Brokers Pty Ltd Gow-Gates Insurance Brokers Pty Ltd

• Formed in 1963

• One of the largest Australian owned insurance brokers employing in excess of 70 people

• Totally independent

• Licensed to operate in Australia and Lloyds

• NIBA member

• NSW Metropolitan Broker of the Year 2000

• Zurich Broker of the Year 2003

Contacts at Gow-GatesContacts at Gow-Gates

Telephone: 02 9267 3199 Fax: 02 9261 3755

Anton Gelbart agelbart@gowgates.com.au

Robert Lawson rlawson@gowgates.com.au

Evelyn Shih eshih@gowgates.com.au

Rebecca Fleming rfleming@gowgates.com.au

Vicki Baker vbaker@gowgates.com.au

Prashant Anand panand@gowgates.com.au