Gow-Gates Insurance Brokers

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Presentation to Queensland Rugby Union
AUSTRALIAN RUGBY UNION Insurance Scheme
Gow-Gates Insurance Brokers Presented by Anton
Gelbart
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Background

• 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

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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

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The 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.

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Insurance 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

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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

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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

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When Is Cover Provided?

• Engaging/playing in official club
  matches/activities
• Engaging in organised training or practice
• Traveling directly between matches/activities and
  the Persons residence or place of employment
• Staying away from the Insureds home during a
  tour
• Engaging in administrative or organised social
  activities of the Insured

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Liability Coverage

• Liabilities arising out of the Insureds
  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

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Liabilities Excluded

• Activities relating to a Licensed Club
• Property Owners liability where premises are
  hired out for non-rugby functions or activities

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What Benefits are Covered?
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
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Section A
Death and Permanent Disability This section
provides a lump sum benefit to insureds who
suffer permanent injury or death Maximum sum
insured is 300,000 Death cover is limited to
100,000 Death cover is limited to 10,000 if
under 18 There are percentages payable for
various levels of disability
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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.

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Section C
Non-Medicare Medical Expenses Limit 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).
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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).

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Claimable

• 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

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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

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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

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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.
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Sports Professional Indemnity
Limit of Liability 10,000,000 Excess 1,000 Th
is section provides coverage for the Insureds
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.
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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 Robins PO Box 1438 PARRAMATTA NSW
2150 Claim forms are to be sent to GAB Robins
within 30 Days of the injury occurring.
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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

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2004 Levy Cost Per Team

• Seniors 2,000
• Juniors 175
• Womens 10s 900

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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

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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

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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

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Contacts at Gow-Gates
Telephone [phone] Fax [phone] Anton
Gelbart agelbart_at_gowgates.com.au Robert
Lawson rlawson_at_gowgates.com.au Evelyn
Shih eshih_at_gowgates.com.au Rebecca
Fleming rfleming_at_gowgates.com.au Vicki
Baker vbaker_at_gowgates.com.au Prashant Anand
panand_at_gowgates.com.au
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