Group Personal Accident: Instructions on lodging a claim

Group Personal Accident: Instructions on lodging a claim

Introduction

As described in QBSI 5.6.6, Scouts Queensland maintains a Personal Accident Insurance Policy. This policy provides a level of coverage for all members, and volunteers, providing support as part of an approved scouting activity. While not a replacement for private health insurance, this policy is intended to provide a level of assistance to families/individuals who may be out of pocket as a result of a severe injury.

The level of coverage is subject to the policy conditions, and policy limits. For more information and details of what can be claimed please see QBSI 5.6.6 or contact a member of the Facility and Risk Support team on 07 3870 7000 or at risk@scoutsqld.com.au

Please submit claim with supporting documents within 12 months of the reported incident date and do note that insurer may take up to 10 business days to acknowledge/process the completed claim submission.

Claim Procedure

To ensure that your claim is dealt with as quickly as possible, it is important to follow a few simple steps:
  1. Please fully complete all sections of the claim form and ensure you sign the privacy declaration (Section 6).  Please provide responses and supporting document to all of the information required in order to avoid delays with your claim as we cannot proceed with the claim without this information.
  2. Pay all medical and other accounts as the insurer will not pay those on your behalf.
  3. Make your Medicare Claim.
  4. The Scouts Insurance includes coverage for non-Medicare medical expenses.
  5. Any portion of any expense for which a Medicare benefit is paid or payable, including the balance of monies you have to bear after deduction of any Medicare benefit or rebate from the actual expense incurred (commonly known as the ‘Medicare gap’) and any invoices listed under Medicare Benefits Scheme, is unable to be reimbursed under this or any other general insurance due to Australian Federal Legislation.  It is in fact a breach of the Health Insurance Act to reimburse such costs.
  6. Make Private Health Insurance claims, as the insurer’s obligation is only for any portion not fully covered by Private Health – please provide a copy of your Health Fund Benefit Statement (if applicable).
  7. YOUR EMPLOYER fully completes Section 8 of the claim form. Should you have more than one employer, please complete the section separately for each employee. Attach a copy of your 12 month pay slips immediately preceding the date of your injury.
  8. YOUR DOCTOR fully completes the two-page Section 7 - Medical Practitioner's Statement to Company. Attach any relevant letter, referral, report and scans.
  9. Scan and email to risk@scoutsqld.com.au the completed form with relevant supporting documents (medical letter/referral/reports/scans/payslip/etc) along with any account statements and tax invoice/receipts for out-of-pocket expenses claim.
  10. If the personal injury claim is approved, further claim for out-of pocket expenses relevant to the treatment and/or support for the injury may be submitted within 12 months of the reported incident date.



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