Presentation on theme: "Equestrian Australia National Insurance Programme Presentation to EA 27 th May 2012."— Presentation transcript:
Equestrian Australia National Insurance Programme Presentation to EA 27 th May 2012
Brett Duprez Sports and Services Division Manager Kathryn Thomson EA Account Broker Gow-Gates Insurance Brokers
The following presentation is a summary based on the Equestrian Australia National Insurance Programme. Before acting on any information contained in this presentation you should refer to the full Product Disclosure Statement (PDS) and Policy Documents contained in the “2011-12 Equestrian Australia Insurance Manual”. This programme is designed to provide a uniform and basic level of cover for Personal Accident insurance for Equestrian in Australia. It is not designed to replace the need for Private Health Insurance and/or Income Protection. We encourage you to assess these policies in line with your own individual circumstances. Important Information
Overview Introduction Insurers EA Insurance Programme –Personal Accident –Public and Products Liability –Professional Indemnity –Management Liability Claims Process overview ‘Safe Equestrian’ & Risk Management Questions
Insurers Sportscover Australia Pty Ltd (Lloyds Syndicate 3334) –Personal Accident –General Liability & Professional Indemnity Chartis Insurance (American Home Assurance, formerly AIG) –Management Liability
EA National Insurance Programme Snapshot – The Insured and Insured Person(s) – Who is Covered ? Cover provided to the Insured and Insured Person(s) in the following classes; –Personal Accident –Public and Products Liability Insurance –Professional Indemnity Insurance –Club Management Liability
Who Is Covered ? The Insured : - Equestrian Australia Limited (EA), State Branches, direct members, coaches, officials, committees, subcommittees, affiliated associations and affiliated clubs Insured Persons : - All EA direct members, coaches, managers, administrators, voluntary workers, selectors, referees and other officials, medical officers, physiotherapists, masseurs and ambulance officers; and all directors, officers, employees, executive officers, office bearers and committees of the Insured
When Is Cover Provided ? Category 1 – EA Direct Members All direct members of EA, 24 hours a day 7 days a week whilst engaged in NON-INCOME earning equestrian activities Excluding travel to and from such activities
Category 2 – Coaches All EA Registered Coaches 24 hours a day 7 days a week whilst engaged in coaching Excluding travel to and from such activities When Is Cover Provided ?
Category 3 – All Other Insured Persons All other specified insured persons of EA, whilst engaged in EA or Affiliated Club organised activities (includes Administrators, Managers, Directors, Committee Members, Voluntary Workers, Officials, Judges, Course Builders, Selectors, Medical Officers) Excluding travel to and from such events Excluding Category 1 & Category 2 Insured activities When Is Cover Provided ?
Major benefits under the Personal Accident policy include; Capital / Lump Sum Benefits Non-Medicare Medical Benefits Weekly Benefits Additional Benefits Structure of Benefits
Personal Accident Capital Benefit This section provides a lump sum benefit to Insured’s that suffer permanent injury or death. The maximum sum insured under this section is $60,000 (Under 18 $25,000) Lump Sum Benefit for Permanent Injuries e.g. Paraplegia / Quadriplegia $60,000 Loss of Sight - One Eye $30,000 (50%) Loss of Use - One Arm $21,000 (35%) Loss of Use - One Finger $2,400 ( 4%) A complete list of percentages is available in the policy wording
Personal Accident Medical Expenses (Non-Medicare Medical Benefits) Important: National Health Act 1973 prevents insurance companies (apart from licensed Private Health Insurers) to cover Medicare items or the “GAP”. Benefit Payable:Maximum Claimable $3,500 85% of Non-Medicare Medical Expenses $100 Excess Claimable: Ambulance Physio / Chiro Dental Private Hospital Accommodation Not Claimable: Doctors & Surgeons Fees X-Rays Wholly or Partly Medicare
Weekly Benefits Loss of Income – 85% of Net Weekly Income Maximum Benefit $500/wk Excess Period 14 days Maximum Benefit Period 104 weeks Non-Income Earner – Domestic Help Benefit $200/wk Maximum Benefit Period 26 weeks Student Assistance – Tutor Benefit $200/wk Maximum Benefit Period 26 weeks Personal Accident
Additional Benefits Out of Pocket $1,000 Clothing$500 Emergency Accommodation $500 Overseas Medical $5,000 Funeral $5,000 A complete list of benefits and conditions applicable is available in the policy wording Personal Accident
Claims Example A parent volunteering at a Club rally day, slips over in the canteen Hospital via ambulance - Broken Leg Surgery Transferred to private hospital for 1 week Referred to a physio for ongoing treatment Unable to return to work for 6 weeks ($600 / week Net Income)
Claims Example Continued Private Practitioner Visit Scheduled amount covered by Medicare (*Gap not covered) Specialist Surgeon Scheduled amount covered by Medicare (*Gap not covered) X-Ray Scheduled amount covered by Medicare (*Gap not covered) Private Hospital accommodation 7 days @ $220 / Day $1,540.00 Theatre Costs$ 600.00 Ambulance Cost$ 300.00 Sub Total$2,440.00 Benefit payable 85%$2,074.00 Physiotherapy – 5 visits @ $40 per visit ($200)95% for each visit$190.00 Less excess$-100.00 TOTAL NON-MEDICARE EXPENSES PAID$ 2,264.00 Loss of income 6 weeks @ $600/week Salary (14 days excess applies, $500/week maximum applies) $2,000.00 TOTAL CLAIM PAYMENT$4,264.00
All Insurance policies contain exclusions. In the case of Sports Injury policies, some injuries are excluded; For example – -Riding of Mechanical Bulls/Horses -Being under the influence of alcohol or drugs -Engaging in or taking part in any Sport/s other than Equestrian -Any pre-existing defect, infirmity or sickness -Arising out of failure to seek or follow medical advice -Any medical or surgical procedure performed for any gradually developing Bodily deterioration whatever the cause of that deterioration. -Preventative measures rather than for the treatment of a Bodily Injury. Complete details of all exclusions are contained within the policy wording. Personal Accident – What is Not covered ?
Public & Products Liability and Professional Indemnity
The Insured : - Equestrian Australia Limited (EA), State Branches, direct members, coaches, officials, committees, subcommittees, affiliated associations, affiliated clubs, members of affiliated associations and clubs Insured Persons : - All direct members, coaches, managers, administrators, voluntary workers, selectors, referees and other officials, medical officers, physiotherapists, masseurs and ambulance officers; and all directors, officers, employees, executive officers, office bearers and committees of the Insured. Who Is Covered ?
When Is Cover Provided ? 1) EA National Body, State Branches - At all times for activities ancillary to their occupation 2) EA Direct members - At all times whilst involved in non-income earning equestrian activities 3) EA Coaches - At all times whilst coaching (as an individual) The EA programme does not extend to coaches’ businesses 4) Affiliated associations and clubs - At all times for activities ancillary to their occupation 5) Other Insured Persons - whilst engaged in EA or affiliated club organised activities
This includes a Loss or Claim whilst participating in or administering Equestrian. This policy provides protection for all Insured’s for a Loss which a person or entity becomes legally obliged to pay on account of a Claim. The indemnity provided under the policy protects the Association, Club and/or Insured Persons for the legal liability to third parties for; –Personal Injury –Property Damage –Legal Defence Costs whilst defending a Claim under the policy Waivers still to be completed and signed Public and Products Liability
Limits of Liability : - $20,000,000 Public Liability - Any one occurrence - $20,000,000 Products Liability - Any one period of insurance - $100,000 Property in Care, Custody and Control Deductible : - $2,500 All claims Public & Products Liability Insurance
Claim Example During a cross country event, a rider is injured at the water jump due to a protruding object. The rider sues the host club for failing to provide a safe competition environment. The EA Insurance programme covers: - Defence costs for the club - Damages payable by the club
Claim Example A spectator purchases a sausage sandwich from the BBQ at a competition and contracts food poisoning, suing the manufacturer and the club. The EA Insurance programme covers: - Defence costs for the club - Damages payable by the club
When is Cover Not Provided ? Major exclusions include but are not limited to; Liabilities arising out of Claims or Incidents occurring in the USA or Canada. Asbestos Childcare or Childminding facilities Property undergoing construction, erection, addition or alteration – unless the total cost of the works is under $50,000. Solarium Use
Professional Indemnity This policy provides coverage for the Insured’s legal liability for a breach of professional duty in the sport of Equestrian by reason of an act, error or omission committed or alleged to have been committed in connection with the Insured’s Equestrian activities. Insured Persons are protected whilst administering, officiating, judging or coaching on behalf of the Association or Club. Important: ‘Claims Made Policy’ means that incidents and claims must be notified during the period of insurance.
Professional Indemnity Limits : - $20,000,000 Any one claim and in the Aggregate Deductible : - $2,500 All claims
Claim Example Direction is given for a rider to perform half pass during a dressage lesson. The horse misbehaves and the rider falls. The rider then sues the coach for giving instruction that was beyond the riders capabilities. The EA Insurance programme covers: - Defence costs for the coach - Damages payable by the coach
When is Cover Not Provided ? Major exclusions include but are not limited to; Known Circumstances that are not notified to the insurer during the policy period Actions prior to the Inception Date – The policy does not cover any claim arising from actual or alleged act, error, omission or conduct occurring prior to the inception date. Arising from non-medically prescribed drugs
Management Liability Covering the administration and management of your Equestrian Association or Club; Provides protection for the Club, it’s Directors, Officers and committee members as a result of any wrongful act whilst acting for and carrying out their duties on behalf of the club. The cover protects the Club against legal actions or civil proceedings made against the Club or it’s officials for any wrongful act, employment breach and/or employee fraud that is notified to the insurer during the period of insurance. Important: ‘Claims Made Policy’ means that incidents and claims must be notified during the period of insurance.
Claim Example An employee is sacked by a State Branch. The employee alleges wrongful dismissal and takes action against the State Branch. The EA Insurance programme covers: - Defence costs for the State Branch - Damages payable by the State Branch - Up to $100,000 for Public Relations to protect the reputation of the branch - Costs of investigating the claim
When is Cover Not Provided ? Major exclusions include but are not limited to; Liability arising from Bodily Injury or Property Damage Prior and pending litigation - The policy excludes claims arising from any circumstance prior to the commencement of the insurance that you were aware of that may eventuate in a claim under the policy. Important: ‘Claims Made Policy’ means that incidents and claims must be notified during the period of insurance.
Claims Procedure Personal Accident Claims Contact Gow-Gates via phone, email or via the Gow-Gates Equestrian Insurance Website Complete the online claim notification on our website (pre-filled claim form will be sent by Sportscover) Obtain and complete a claim form available from Gow-Gates (or the Gow-Gates Equestrian Insurance Website) Lodge the claim form with Sportscover Submit additional paperwork as requested
Online Claims Gow-Gates have recently developed an EA specific website, which includes policy information, online claim lodgment and claim tracking – Online Claim Forms
Claims Procedures – Other Risks Public & Products Liability Claims Professional Indemnity Claims Management Liability Claims Contact Gow-Gates immediately to notify of any potential claim DO NOT admit liability under any circumstances Early notification and early intervention is critical
Continuation & Maintenance of Club Activities Legal Responsibility Social Responsibility i.e. Competitor & Organiser Safety Spectator Safety Protect Good Reputation Why ?
Statutes OH&S Legislation Environmental Health Regulations Animal Welfare Common Law Duty of Care Standard of Care Foreseeable Legal Responsibility
“Risk”: The chance of something happening that will have an impact upon operations. It is measured in terms of consequence and likelihood. What is Risk ?
“Risk Management”: The SYSTEMATIC APPLICATION of management policies, procedures & practices to the activities and facilities. What is Risk Management ?
Risk Assessment: What can go wrong? Risk Control What can we do about it? Management of Risk
What can we do about it? Prevention is about reducing(elimination) of risk to the lowest reasonable (manageable) level Protection to control circumstances by reducing hazard or potential severity Risk Control
The interaction of a person with the hazard or environment by: UNSAFE BEHAVIOUR Competency Level Inexperience Stress/Fatigue Time UNSAFE CONDITIONS Unsuitable equipment & layout Inadequate maintenance Poor housekeeping Contributing Factors
Where are the clubs at ? The application of; Guidelines for the Development of Risk Management Policies and Plans EA Risk Management Guide EVENT RISK MANAGEMENT PLAN / MANUAL Risk Management & Control Schedule Event Risk Management Checklist Where are Clubs at ?
Risk Management Policy & Plan including: Responsible Officers Event Set Up & Inspections ArenasVenue & Parking Areas Horse FloatsHorse & Rider Assessment WaiversAccreditation First aid Emergency Services What is Covered ?
Event typical entry points; Risk Improvement Area Do you have appropriate signage at entry points to the event and restricted areas? Limited signage & No Conditions of Entry
SAMPLE –SAMPLE – Conditions of Entry Sign Improvement
Electrical Cables; Risk Improvement Area Risk Improvement – Electrical Cables should be installed & used to appropriate standards
Spectator Stands; Risk Improvement Area Risk Improvement – Stands to be installed & maintained to appropriate standards
No Signage Standards; Risk Improvement Area Risk Improvement – Review Signage Standards
Event typical entry points; Risk Improvement Area Risk Improvement – Use of Plastic Posts Steel Posts Timber Posts
Uncapped Steel Posts; Risk Improvement Area Risk Improvement – Develop standard for Star Posts Uncapped Steel Star Posts Capped Steel Star Posts
Review Standards for Event Operations Develop Method Statements for Condition of Entry Spectator Control Signage Standards Contractor Controls Develop a Safety Alert System for Clubs Where to from here ?
References Equestrian Australia Risk Management Guides Guidelines for Managing Risk in Sport & Recreation (HB 246) AS/ 4360:1999 Risk Management Code of Practice for the Horse Industry - AIHC Links www.equestrian.org.au www.horsesport.org Risk Improvement Area
For further information regarding the EA National Insurance Programme or additional coverage, please contact www.gowgatessport.com.au/equestrian firstname.lastname@example.org 02 8267 9999 or 1800 811 371 Thank You! Contact Details