| PLAYER BENEFIT PROGRAM |
| PUBLIC LIABILITY
Southpine Touch is covered by Policy 1: Public & Products Liability. Limit of Liability (Indemnity) Public Liability $5,000,000: Product Liability $5,000,000 Policy 2: Professional Indemnity. Limit of Liability: Any one incident/claim $1,000,000 & total any one period of insurance $1,000,000 PLAYER BENEFIT PROGRAM Southpine Touch operates a no fault sports benefit program for player injuries. This is as follows: Medical cover only (loss of income is not applicable) Provides for an injured player to receive 85% of any injury claim up to a maximum of $2,000 for NON MEDICARE expenses. If you have Private Health cover you must claim this first, the player benefit program then covers 75% of the gap for NON MEDICARE items Players must report the injury to the referee ON THE NIGHT the injury happened, and submit Claim Forms to Sportcover within 120 days of the injury occurring. HOW TO CLAIM 1. Obtain claim forms from the Sportscover by phoning 03 97214700 or from the Sportscover Web Site at www.sportscover.com 2. Have the claim forms fully completed (according to the instructions on the claim form) and have them signed by your team captain and returned to the Sportscover within 120 days of injury. The address for this is as follows: Claims Department 271 -273 Wellington Road MULGRAVE, VIC 3170 Medical Expenses Claim 1. Claims for treatment given by a chiropractor, masseur, naturopath, osteopath or physiotherapist must be accompanied by a referral from a registered medical doctor. 2. Complete ALL sections on the front of the Sports Injury Claim Form. 3. Have your appointed President andTeam Captain fully complete the club declaration. 4. When you are satisfied everything is completed correctly, please sign and date the Claim Form at the bottom of the second page. 5. Have your attending doctor complete the Medical Statement including period of your incapacity. 6. If you are a member of a Private Health Fund, please claim from them first and then forward your rebate statement, account and receipt to us when you completely finish treatment. Important 1. Please send your completed Sports Injury Claim Form to Sportscover within 120 days of your injury. 2. Please wait until you completely finish treatment before sending your medical accounts to our Sportscover. DO NOT forward them, as you receive them. 3. Please note that it is a policy condition that we only pay for treatment that takes place within 365 days of the date of the event that caused the injury unless the delay is on the advice of a registered medical doctor or dentist. Should you have any further enquiries please contact the Southpine Touch President on Mob: 0410317578 during business hours. |