Our Commitment to You
Thanks for taking out protection with us that looks after your interests. ROOBYX is here for the community who make up the gig economy. We understand that earning an income in the gig economy is different – it’s all about Earn-As-You-GO so we are all about developing products and services that are Pay-As-You-Go. Don’t pay for more than you have to, especially if your earnings are not consistent every week. Some of our services are free, which is even better for our community, so keep in contact.
Our commitment is to continuously provide you with relevant and informative products and services. We want to hear from you to help us develop and produce solutions in support of the way you choose to live your life.
Important Information You Need to Know
We want you to be informed, understand your rights and how we should work together. When you read these pages, you should:
- understand what you are covered for;
- how to make a claim or a complaint;
- what to expect from us;
- what we expect from you; and
- how to contact us.
When you read this document you will see that it’s in two parts.
The first part is a mandatory guide, known as a Product Disclosure Statement, PDS for short. In Australia, we are required to give this to you as it is designed to assist you make an informed decision on whether or not to purchase the insurance. It contains information about the policy coverage as well as important information about us, the insurer, the duty of disclosure, privacy, our claims service and our complaints handling requirements.
The second part of the document contains the actual Policy Wording. In this part, we outline the terms and conditions of your insurance policy.
Please read this PDS before applying for insurance so you understand what you are purchasing. We believe reading and understanding this document is in your best interest, therefore if you have any questions, please ask us and we will be happy to help you.
Like all insurance products we offer, if we accept your application for insurance, you will receive a Schedule that sets out details of the insurance you have taken out.
If you need more information about this PDS or your policy, please contact YourCover Pty Limited, trading as ROOBYX (YCR) on the contact details provided.
Product Disclosure Statement (PDS)
Who issues this policy
YourCover Pty Ltd (trading as ROOBYX) (YCR), ABN 35 169 038 466, AFS Licence No. 461299, is an Underwriting Agency and Lloyd’s Coverholder specifically created to provide innovative insurance solutions to groups and individuals.
If you have any queries about this policy, you should contact YCR. Our contact details are in this document.
The Insurer of the Policy is certain Underwriters at Lloyd’s. YCR is authorised by them, under a binding authority agreement with a Unique Market Reference B1216PRWW171000 to arrange, issue, vary and cancel these products on their behalf.
In this PDS
When it mentions ‘we’, ‘our’ or ‘us’ this means we are referring to certain Underwriters at Lloyd’s.
Where it says ‘you’, it means the person who is named in the policy Schedule as the insured for the insurance cover selected and for which the premium has been paid. The type of cover chosen will be shown on the policy Schedule.
Your policy is made up of two parts. They are:
- this Personal Accident Cover Policy Document which sets out details of your cover and its limitations, and
- a Schedule which states who is insured, the cover(s) selected, the Period of Insurance, the limits of liability, excesses and other important information. This is referred to as the Schedule or Table of Benefits in this policy document.
It’s important to carefully read the policy wording and schedule because together, they form the contract between you and us. Any new or replacement Schedule we may send you will become the current Schedule so you should also make sure that you read and keep these as well. Don’t forget, if you find an error in the schedule please tell us immediately.
To be eligible for this policy you must be:
- An Australian Resident or legally able to work in Australia;
- At least 18 years but less than 65 years of age; and
- A registered On-Demand Worker of a Nominated Platform on the start date of the Period of Insurance.
Our agreement with you
We will insure you for Injury resulting in one or more of the insured events shown in the policy document provided:
- The cover you selected and are paying or have paid for, is in force. You can find this on your current schedule.
- The information you gave us is true and correct. Understanding your Duty of Disclosure is very important because if you give us incorrect or untrue information we may be able to avoid paying you when a claim occurs. The full Duty of Disclosure and the consequences of non-disclosure, can be found on Page 6, “Your Duty of Disclosure” "Your Duty of Disclosure".
Summary of Personal Accident Cover
The following is a summary only of the types of cover provided for by this insurance, but please, look at the policy wording for a full explanation.
If you suffer an injury as a result of an accident during the period of insurance (shown on the schedule) we will pay you the benefit set out in your policy Schedule. The Injury suffered must:
- be one of the type set out in the wording, under the heading of Insured Events, and
- happen within twelve (12) calendar months from the date of the accident.
We will insure you against Injury for:
- defined events 1-18 in the Schedule
- defined events 20-28 in the Schedule
- a weekly accident benefit (temporary disablement Event 19)
The Most We Will Pay
There are cover limits in each section of this insurance. This is the maximum amount we will pay out in respect of any one claim under that section. You should review these before you purchase any insurance cover.
Conditions and Exclusions
As with any insurance, there are certain conditions with which you must comply when we agree to cover you and in order for us to pay a claim. For example:
- As soon as possible after you have any Injury you must obtain and follow medical advice from a legally qualified medical practitioner.
- You must immediately notify us in writing if you take out any other insurance with any Insurer providing for weekly compensation of a similar kind which, together with this insurance, will exceed your income.
There are also certain events that will not be covered by this insurance. For example, we will not pay any claim directly or indirectly arising from:
- Any Pre-Existing Condition
- You committing a criminal or illegal act
- Illness, sickness or disease
- Certain occupations and activities which we deem hazardous, as detailed under ‘Exclusions’
These are just a few examples and you should read the full insurance wording to make yourself aware of all the conditions and exclusions that apply. If you do not comply with the policy terms and conditions we may refuse to pay or reduce any claim payment and cancel the policy, to the extent permitted by law.
Pre-Existing Conditions – Please read this section carefully
This insurance is designed to cover you for sudden and unforeseen events occurring during the period of insurance. Conditions that exist at the time the policy is issued are not covered.
What is a Pre-Existing Condition? - Please read this section carefully
A ‘Pre-Existing Condition’ is a defined term under this policy and means any medical condition, injury or defect which you were aware of (whether diagnosed or not) or had sought treatment for the condition or the symptoms of the condition in the twelve months prior to the inception of your Policy.
The cost of your policy
The total cost of the policy is made up of premium, government taxes such as Goods & Services Tax (GST) and Stamp Duty, and any administration fee where applicable.
The Premium payable by you will be shown on Your Schedule. The premium is calculated taking into consideration a number of risk factors including the Waiting Period chosen, your age, your Occupation(s), Nominated Platforms and the sums insured.
Your Duty of Disclosure
Before you enter into an insurance contract with us, the Insurance Contracts Act 1984 requires you to provide us with the information we need to enable us to decide whether and on what terms your proposed insurance is acceptable and to calculate how much premium is required for your insurance.
The Act imposes a different duty the first time you enter into the policy with us and also applies when you vary, renew, extend, reinstate or replace your policy. We set these two duties out below.
When you apply and enter into this policy with us for the first time you will asked various questions. Under your Duty of Disclosure, you must, when answering these question:
- give us honest and complete answers,
- tell us everything you know, and
- tell us everything that a reasonable person in the circumstances could be expected to tell us.
Your Duty of Disclosure at the time or before you renew, vary, extend, reinstate or replace your policy is to tell us every matter which:
- you know, or
- a reasonable person in the circumstances could be expected to know, is relevant to our decision whether to insure you and whether any special conditions need to apply to your policy.
There are some things you do you do not need to tell us under either duty. These are matters:
- that diminish our risk,
- that are of common knowledge,
- that we know or should know as an Insurer, or
- that we tell you we do not need to know.
The above duties apply to everyone who is insured under the policy. If you or they do not comply with either duty, we may cancel the policy or reduce the amount we pay if you make a claim. If fraud is involved, we may treat the policy as if it never existed and pay nothing.
Before this policy expires, which is the date shown on the schedule, we will normally offer renewal by sending a renewal invitation. The invitation will set out the premium rate payable to renew this policy. We will also tell you if there have been any changes to the policy benefits, terms, conditions, exclusions and limitations. It is important that you check the information shown before renewing each year to satisfy yourself that the details are correct and acceptable to you.
A claim paid for Nominated Platform or self-employed weekly disability benefits is subject to personal Income tax and it is your responsibility to declare such benefit when completing your usual tax return.
A claim paid for employee weekly disability benefits is taxable income and attracts Pay As You Go (PAYG) Withholding tax, the same as salary and wages. PAYG Withholding tax will be deducted from the benefit payment before it’s paid, and then forwarded to the Australian Taxation Office. If you receive employee weekly disability benefits you will be asked to provide your Tax File Number (TFN) to us. If you don’t provide your TFN, tax will be deducted at the highest PAYG withholding tax rate.
Making A Claim and Your Excess (Waiting Period)
A Waiting Period may apply if you make a claim under this policy. The Waiting Period will have been selected by you and will be shown on your policy Schedule. A Waiting Period is the time immediately after you become disabled and seek medical treatment where no benefits will be paid for Temporary Total Disablement.
If you need to make a claim please contact YCR by phone, email or website within thirty (30) days of the date of the Injury occurring and you will be sent a claim form which will need to be fully completed. We will not be responsible for any payments under the policy unless this form is fully completed and returned. Any costs involved in the collection of information for the form are your responsibility.
You need to ensure that you have seen a qualified medical practitioner as soon as possible after the Injury as your benefits will only be paid from the date you first seek medical attention and are certified Temporary Totally Disabled.
At any time after a claim has been lodged we may, at our expense:
- request you to undergo medical or related examinations;
- in the event of death, we may require an autopsy;
- conduct enquiries into the circumstances of the claim;
- request your attending doctor or specialist provide a progress report.
Any payments under this policy will be to you or, in the event of your death, to your legal representative.
If you decide that you do not want the policy, there is a cooling off period of fourteen (14) days from the start of the policy. You must tell us in writing that you wish to cancel the policy and we will repay the full amount of the premium to you. If you choose to use the cooling-off period, then we will treat the policy as never having existed.
You cannot use this cooling-off period if the policy has already expired or if you have made a claim under it.
You may cancel your policy by giving YCR written notice. On receiving the written notice, after deducting an amount for the period of cover you have had, we will refund to you the balance of any premium paid by you provided that no claims have been made.
We may cancel your policy only when the Insurance Contracts Act 1984 (Cth) allows us to do so. For example, if you breach your duty of disclosure, make a misrepresentation to us, act fraudulently or breach a term and/or condition of the policy. We will give you a written notice and after deducting premium for the period of insurance up to the date of cancellation, we will refund to you the balance of any premium paid by you.
You may not be entitled to make a claim unless your premium is paid within 30 days of the due date. We may also be entitled to cancel your insurance if your premium not is paid within 30 days of the due date.
Whilst we will do everything possible to provide you with good service, we know that sometimes you may not be totally happy. If you have any concerns or a complaint contact us YCR we are always available to listen to you and to help where they can.
If, after talking to us, you wish to take the matter further, we have an Internal Disputes Resolution (IDR) review process to help resolve the issue. Our commitment is to provide a final decision within fifteen (15) working days of contacting us.
If you are not satisfied with our IDR response to your complaint you can refer the matter to the Lloyd’s General Representative in Australia for consideration under their dispute resolution process.
If you’re not happy with the final decision, you may take your complaint to the Financial Ombudsman Service Limited (FOS), an independent and external dispute resolution body. They will advise you if the complaint falls within their terms of reference. Access to the FOS process is free of charge to you.
Contact details for each of the above mentioned bodies are included this document.
We may need to collect personal information (and sometimes sensitive information such as health information) about you. YCR need this personal information in order to properly address your insurance needs. We will collect this information directly from you where possible, but there may be occasions when we collect this information from someone else.
We only use your information for the purposes for which it was collected, other related purposes and as permitted or required by law. You may choose not to give us your information, but this may affect our ability to provide you with insurance cover.
We may share this information with other companies within our group and third parties who provide services to us or on our behalf, some of which may be located outside of Australia. Lloyd’s is regulated by United Kingdom data protection laws which offer similar protection to the Privacy Act and Lloyd’s has agreed to handle information for Australian policyholders in accordance with the Privacy Act. If a recipient is not regulated by laws which protect your information in a way that is similar to the Privacy Act, YCR will seek Your consent before disclosing your information to them.
Updating the PDS
Information in the PDS may need to be updated from time to time. You can obtain a paper copy of any updated information without charge by calling us on the contact details provided in this policy document. If the update is to correct a misleading or deceptive statement or an omission, that is materially adverse from the point of view of a reasonable person deciding whether to acquire this policy, we will provide you with a new PDS or a supplementary PDS.
Underwriters at Lloyd’s pay remuneration to insurance intermediaries when we issue, renew or vary a policy the intermediary has arranged or referred to us. The type and amount of remuneration varies and may include commission and other payments. If you require more information about remuneration we may pay your intermediary, you should ask your intermediary.
Code of Practice
The Insurance Council of Australia Limited has developed the General Insurance Code of Practice (the Code) which is a self-regulatory code for adoption by insurers. YCR and Lloyd’s support the Code and embrace its objectives of raising the standards of practice and service in the insurance industry.
Details can be found on the website www.codeofpractice.com.au
Service of Suit Clause
The insurers (being certain underwriters at Lloyd’s) agree that:
In the event of a dispute arising under this insurance, the insurers at the request of the Insured will submit to the jurisdiction of any competent Court in the Commonwealth of Australia. Such dispute shall be determined in accordance with the law and practice applicable in such Court.
Any summons notice or process to be served upon the insurers may be served upon Lloyd’s General Representative in Australia who has authority to accept service and to enter an appearance on the insurers’ behalf, and who is directed at the request of the Insured to give a written undertaking to the Insured that he will enter an appearance on the insurers’ behalf.
If a suit is instituted against any one of the underwriters, all underwriters hereon will abide by the final decision of any such Court or any competent Appellate Court.
Contact details for the Lloyd’s General Representative are included later in this document.
Several Liability Notice LSW1001
The subscribing underwriters’ obligations under contracts of insurance to which they subscribe are several and not joint and are limited solely to the extent of their individual subscriptions. The subscribing underwriters are not responsible for the subscriptions of any co-subscribing underwriter who for any reason does not satisfy all or part of its obligations.
This Product Disclosure Statement was prepared on 15 March 2018. YCR are authorised to distribute this Product Disclosure Statement.
|YourCover Pty Limited – trading as ROOBYX (YCR) ABN 35 169 038 66 AFS Licence No: 461299|
|Phone||1800 ROOBYX (1800 766 299) or 07 3010 9746
(Monday to Friday from 8.30am to 5.30pm, Brisbane time, except public holidays)
Fax: 07 3010 9001
|[email protected] (Website – www.roobyx.com)|
|Post||GPO Box 111, Brisbane QLD 4001|
|Lloyd’s General Representative in Australia|
|Phone||02 8298 0700|
|Post||Lloyd’s Australia Limited
Level 9, 1 O’Connell Street, Sydney NSW 2000, Australia
|Financial Ombudsman Service (FOS Australia)|
|Phone||1300 780 808|
|[email protected] (Website – www.fos.org.au)|
|Post||GPO Box 3, Melbourne VIC 3001|
|Office of the Australian Information Commissioner (OAIC)|
|Phone||1300 363 922
(Monday to Friday from 9am to 5pm, Sydney time, except on public holidays)
|[email protected] (Website – www.oaic.gov.au)|
|Post||GPO Box 5218, Sydney NSW 2001|
YourCover Pty Ltd trading as ROOBYX (YCR) gives notice that this contract has been effected under a binding authority agreement, given to YCR by certain Underwriters at Lloyd’s. YCR has entered into the binding authority agreement as an agent of the Underwriters and not an agent of the Insured. A commission is payable by Underwriters to YCR for arranging the insurance.
All cover under this Policy is subject to:
- The payment of premium;
- The terms and conditions contained in this Policy Document and in the Schedule;
- The limits of liability referred to in the Policy.
Subject to the terms, conditions, exclusions and limitations contained in this Policy, this Policy provides cover for Disablement caused by Injury only and Benefits are payable in the circumstances set out in the Policy. The particular cover which applies to you and which you selected when you applied for this insurance is referred to in the Schedule and forms part of this Policy.
If you are not entirely satisfied with this Policy, you may cancel it by returning it to us within fourteen (14) days of the start of the policy. We will refund your premium and the Policy will be treated as though it never existed.
This policy has important definitions which apply:
ACCIDENT means a sudden, unexpected, unusual, specific, external event which occurs at an identifiable time and place during the Period of Insurance.
COMPLETE FRACTURE means a fracture in which the bone is broken completely across and no connection is left between the pieces.
EMPLOYEE means an individual who works part-time or full-time under a contract of employment, whether oral or written, express or implied, and has recognised rights and duties.
FINGERS, THUMBS OR TOES mean the digits of a Hand or Foot.
FOOT means the entire foot below the ankle.
GIG ECONOMY a way of working based on having temporary jobs and/or doing separate pieces of work, each paid separately, as an Independent Contractor and not an Employee via a platform that is an established and registered entity under the Corporations Act in Australia.
HAIRLINE FRACTURE means mere cracks in the bone.
HAND means the entire hand below the wrist.
INCOME means your weekly taxable income earned through personal exertion in the course of your Occupation(s) calculated after the deduction of expenses incurred in producing that income and before the deduction of income tax.
INDEPENDENT CONTRACTOR means a person who contracts to do work for another person according to his or her own processes and methods; the contractor is not subject to another's control except for what is specified in a mutually binding agreement for a specific job.
INJURY means bodily Injury to the Insured Person resulting from an Accident during the Operative Time while this policy is in force which, solely and independently of any other cause (except illness directly resulting from, or medical or surgical treatment rendered necessary by such injury) results in any of the Insured Events specified in the Table of Benefits within twelve (12) calendar months from the date thereof. Injury does not include:
- Any consequences of an Injury which are ordinarily described as being a disease, including but not limited to any congenital condition, heart condition, stroke or any form of cancer;
- A Pre-Existing Condition;
- Any degenerative or gradual onset condition.
INSURER means certain Underwriters at Lloyd’s.
LONG DISTANCE OR HEAVY HAULAGE DELIVERY means to a delivery destination outside a 250 kilometre radius from home base or which requires an overnight stay and/or where the vehicle requires a HR, HC or MC class licence.
LOSS OF SIGHT means the permanent and total loss of sight which we will consider as having happened:
- in both eyes, if your name is added to the Register of Blind Persons on the authority of a fully-qualified ophthalmic specialist; or
- in one eye if, after correction, the degree of sight you have left is 3/60 or less on the Snellen scale.
LOSS OF USE means loss of, by physical severance, or total and Permanent loss of the effective use of the part of the body referred to in the Table of Benefits.
MEDICAL PRACTITIONER means a person legally qualified and registered to practice medicine in Australia and who is a person other than the Insured, their relatives, business partners, shareholders or employees. Chiropractors, Physiotherapists and alternative therapy providers are not regarded as a Medical Practitioner.
NOMINATED PLATFORM(S) means your Gig Economy partner(s) providing on-demand work which you have declared to us and agreed to pay premium for this insurance on activities performed and is an established and registered entity under the Corporations Act in Australia. The Nominated Platform(s) selected by you are stated in the Schedule
OCCUPATION(S) means the occupations declared to us and stated on your schedule as covered occupations from which you earn Income.
ON-DEMAND WORKER means an individual person who derives any Income through personal exertion whilst working as an Independent Contractor and not an Employee in the Gig Economy within Australia.
OPERATIVE TIME means one of the following options selected by you and stated in the Schedule:
- While You Work Cover which provides cover for Injury only while performing duties directly allocated to you by your Nominated Platform, including direct travel to and from your home and the location of the work, and for which premium is paid; or
- 24/7 Cover which provides cover 24 hours a day, but excluding you engaging in any form of work or employment outside of Australia.
OTHER FRACTURE means any fracture other than a Complete Fracture, Hairline Fracture or Simple Fracture.
PARAPLEGIA means the permanent and total paralysis of the two lower limbs, bladder and rectum.
PERIOD OF INSURANCE means the period stated in the Schedule.
PERMANENT TOTAL DISABLEMENT means disablement lasting at least twelve (12) consecutive months, and at the end of that time being beyond hope of improvement which entirely prevents you from engaging in any occupation or employment for which you are suited by reason of education, training, experience, or skill.
PRE-DISABILITY INCOME means:
- If you have linked your bank account and/or invoicing software to the Roobyx Platform the calculation of the average amount of weekly Income during the period of 10 consecutive weeks immediately prior to the date of any Disablement giving rise to a claim under this insurance verified by credit amounts received into your bank account or invoices for Income paid to you; or
- If you have not linked your bank account or invoicing software to the Roobyx Platform the average amount of weekly Income during the period of 12 consecutive months immediately prior to the date of any Disablement giving rise to a claim under this insurance verified in the form of tax returns or employer issued payslips.
PRE-EXISTING CONDITION means a medical condition, injury or defect which you were aware of (whether diagnosed or not) or had sought treatment for the condition or the symptoms of the condition in the twelve months prior to the inception of your Policy.
QUADRIPLEGIA means the permanent and entire paralysis of both legs and both arms.
ROOBYX PLATFORM means the online platform at www.roobyx.com where this insurance is marketed and administered.
SCHEDULE includes any current Schedule or renewal or variation of this Policy.
SIMPLE FRACTURE means a fracture in which there is a basic and uncomplicated break in the bone and which in the opinion of a Medical Practitioner requires minimal and uncomplicated medical treatment.
TEMPORARY TOTAL DISABLEMENT means disablement as a result of an Injury which entirely prevents you from performing all the usual duties of your Occupation(s) necessary to produce Income and any other gainful occupation for which you are suited by reason of education, training, experience, or skill and which results in a loss of Income.
WAITING PERIOD is the period stated in the Schedule during which no Benefits are payable for Temporary Total Disablement.
YCR means YourCover Pty Ltd trading as ROOBYX, ABN 35 169 038 466, AFS Licence No. 461299; Level 5, 320 Adelaide Street, Brisbane, QLD 4000, Australia.
YOU/YOUR/INSURED PERSON is the person named in the Schedule.
WE/OUR/US means certain Underwriters at Lloyd’s.
Extent of Cover
If, as a result solely and directly of Injury, you suffer from Temporary Total Disablement or any of the Insured Events set out in the Table of Benefits we will pay you the compensation set out in that Table. However, all Insured Events including disablement must occur within twelve (12) months of the Injury.
Table of Benefits
The percentage shown against Item 1 is of your chosen Accidental Death Benefit shown in the Schedule.
The percentage shown against Items 2 to 18 are of your chosen Accidental Permanent Disablement Benefit shown in the Schedule.
The compensation being a percentage of the Sum Insured stated in the Schedule. Injury resulting directly in:
|Insured Event||Schedule #||Percentage|
|Permanent Total Disablement||2.||100%|
|Permanent and incurable paralysis of all limbs||3.||100%|
|Permanent Total Loss of Sight of both eyes||4.||100%|
|Permanent Total Loss of Sight of one eye||5.||100%|
|Permanent Total Loss of Use of two limbs||6.||100%|
|Permanent Total Loss of Use of one limb||7.||100%|
|Permanent and incurable insanity||8.||100%|
|Permanent Total Loss of hearing in|
|a. both ears||9a.||80%|
|b. one ear||9b.||20%|
|Permanent Total Loss of four fingers and thumb of either hand||10.||80%|
|Permanent Total Loss of the lens of one eye||11.||60%|
|Permanent Total Loss of Use of four fingers of either hand||12.||50%|
|Third degree burns and/or resultant disfigurement which covers more than 40% of the entire external body||13.||50%|
|Permanent Total Loss of Use of one thumb of either hand|
|a. both joints||14a.||30%|
|b. one joint||14b.||15%|
|Permanent Total Loss of Use of fingers of either hand|
|a. three joints||15a.||10%|
|b. two joints||15b.||7.5%|
|c. one joint||15c.||5%|
|Permanent Total Loss of Use of toes of either foot|
|a. all - one foot||16a.||15%|
|b. great - both joints||16b.||5%|
|c. great - one joint||16c.||3%|
|d. other than great, each toe||16d.||1%|
|Fractured leg or patella with established non-union||17.||10%|
|Shortening of leg by at least 5cm||18.||7.5%|
|Temporary Total Disablement caused directly and solely by Injury||19. During such disablement, the percentage of Your Earnings as specified in the Schedule .|
If as a result of an Injury occurring during the Operative Time within the Period of Insurance you are exposed to the elements and suffer from any of the Insured Events set out in the Table of Benefits as a direct result of that exposure, we will pay compensations accordingly.
If you disappear following the disappearance, sinking or wrecking during the Operative Time within the Period of Insurance of a conveyance in which you were then travelling and your body has not been found within one (1) year after the date of disappearance, we will pay a compensation on the assumption that you died as a result of an Injury at the time of the disappearance, sinking or wrecking of the conveyance provided that the person or persons to whom such sum is paid shall sign an undertaking to refund such sum to us if you are subsequently found to be living.
3. Injury Resulting in Fractured Bones
The following Event(s) which have been diagnosed within 3 months from the date of the Accident
The compensation being a percentage of the Sum Insured stated in the Schedule. Injury resulting directly in: -
|The Events||Benefit Amount|
|20. Complete Fracture of neck, spine or skull||100%|
|22. Other Fracture of jaw, pelvis, leg, ankle or knee||50%|
|23. Cheekbone, shoulder or Hairline Fracture of neck, skull or spine||40%|
|24. Other Fracture of arm, elbow, wrist or ribs (per rib)||30%|
|25. Simple Fracture of jaw, pelvis, leg, ankle or knee||25%|
|26. Nose or collarbone||25%|
|27. Simple Fracture of arm, elbow, wrist or ribs (per rib)||25%|
|28. Finger (per Finger), Thumb (per Thumb), Foot, Hand or Toe (per Toe)||10%|
General Conditions & Limitations
- Compensation shall not be payable for more than one of the Insured Events 1-18 in respect of the same Injury, in which case the highest compensations will be payable.
- Any compensation payable for Insured Events 1-18 shall be reduced by any sum already paid for Insured Event 19 in respect of the same Injury.
- Weekly compensation for Temporary Total Disablement shall be limited to the chosen percentage of your Income stated in the Schedule. If you receive benefits/sick leave pay/Income from any other source as compensation for the same lost income covered under this Policy our payments will be reduced by that amount and we will pay the difference up to the chosen percentage of your Income stated in the Schedule. If you redeem or commute or settle your entitlement to benefits/Income from any other source, our payments under this Policy will immediately cease.
- We will pay one-seventh (1/7th) of the weekly compensation for each day of disablement where disablement lasts for less than a week after the end of the Waiting Period.
- No weekly compensation shall be payable for disablement during the Waiting Period.
- The maximum benefit payable for any one (1) Injury resulting in fractured bones under Insured Events 20--28 shall be the amount shown in the Schedule.
- No further compensation will be payable under this Policy and all cover under this Policy will cease if:
- You become entitled under this Policy to the payment of a Sum Insured being 100% of the Sum Insured stated in the Schedule.
- You become entitled to both a Sum Insured as stated in the Schedule and weekly compensations and you are paid 100% of the Sum Insured stated in the Schedule and weekly compensations for the total period stated in the Schedule.
- No compensations are payable unless as soon as possible after the happening of any Injury you obtain and follow medical advice from a Medical Practitioner. Your benefit commences from the later of the start of your Temporary Total Disablement and the time you first sought medical attention following your Injury.
- You must give us immediate written notice if you take out any other insurance with any Insurer providing for weekly compensations of a similar kind which, together with this insurance, will exceed your Income.
- Written notice of claim must be given to us within thirty (30) days after the occurrence of any circumstances giving rise to a claim or as soon thereafter as is reasonably possible.
- Upon receipt of a notice of claim, we shall submit our usual claim form for completion. We shall not be liable to make any payment under this Policy unless the claim form is properly completed and all information reasonably required by us has been furnished at your expense.
- Weekly compensation for Temporary Total Disablement shall be dependent upon you giving us proof of Your Pre-Disability Income. The benefit payable will in all cases be based on the lesser of your verified Pre-Disability Income or the Pre-Disability Income amount upon which your premiums were based and paid.
- The benefits of this policy depend on you giving us any reasonable information and help We require. This includes giving us written statements or documents we consider relevant. We may also require you to attend Court to give evidence. You must help us even when we have paid your claim. If you do not co-operate your payments may be suspended.
- We may at our own expense conduct any medical examination or examinations or arrange for an autopsy to be carried out. We may also at any time during your claim ask for further information or appoint a person to conduct further enquiries into the nature and circumstances of the claim.
- We may request a progressive claim form be completed by your attending physician or specialist.
- This Policy may be cancelled by you at any time by giving us written notice. We may cancel this Policy in accordance with the provisions of the Insurance Contracts Act. Upon cancellation by us, we shall refund a proportion of the premium paid calculated by reference to the unexpired Period of Insurance.
- All cover under this Policy shall cease upon your attaining the age of sixty-five (65) unless otherwise indicated on the Schedule.
- All weekly compensations shall be paid monthly in arrears.
- All compensations shall be paid to you, or in the case of your death, to your legal personal representative.
- Any claim or benefit paid under this policy will be paid in the same currency as premium quoted.
- The Benefits under this Policy may be increased or decreased by you at any time, other than while a claim is ongoing, by giving us written notice. The Waiting Period and Benefit Period may also be amended by you at any time, other than while a claim is ongoing, by giving us written notice. You will be advised at the time of making the change request the effect it will have on your Premium payments and whether the change will have immediate effect or will take effect at a later date.
- If you choose to increase the Table of Benefits Items 1 to 18 or the percentage of earnings covered on Item 19 or decrease the Waiting Period under this Policy the Pre-Existing Condition Exclusion will be re-applied effective from the date of change to the amount of the increased benefit and/ or to the period of decreased Waiting Period.
No compensations are payable under this Policy for any loss, claim or event:
- Which results from any Pre-Existing Condition (as defined);
- Which results from illness, sickness or disease.
- Resulting from Injury which is deliberately self-inflicted or caused by you, including suicide or attempted suicide whether sane, insane or under any mental distress;
- Which results from you engaging in:
- air travel except as a passenger in any properly licensed aircraft;
- or taking part in or training for professional sports of any kind or for any code of football;
- racing and/or time trials of any form, other than on foot;
- tasks as a bicycle courier, Long Distance or Heavy Haulage Delivery, mining activities either above or below ground, security guard either armed or unarmed;
- any activity which requires a licence, permit, qualification or formal training if such authorities have not been obtained or are not current;
- any activities at exposed heights above 5 metres;
- any activities at exposed depths below 10 metres whether underground or underwater;
- any activities involving the use of firearms, explosives, hazardous or classified dangerous chemicals or asbestos;
- Which results from a criminal or illegal act committed by you;
- Which results from you being under the influence of an illegal drug or there is more alcohol or drugs in your blood than the law permits for the activity you are carrying out in the state where the Injury occurs;
- Which is attributable wholly or partly to childbirth or pregnancy or the complications of these;
- Which results from a sexually transmitted disease, or Acquired Immune Deficiency Syndrome (AIDS) disease or Human Immunodeficiency Virus (HIV) infection;
- Which results from you engaging in or taking part in naval, military or air force service or operations;
- Which occurs as a result of war, invasion, acts of foreign enemies, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power or confiscation or nationalisation or requisition or destruction of or damage to property by or under the order of any Government or Public or Local Authority;
- Which occurs as a result of the use, existence or escape of nuclear weapons material or ionising radiation from or contamination by radioactivity from any nuclear fuel or nuclear waste from the combustion of nuclear fuel;
- Which results from losses arising from nuclear, chemical or biological terrorism. Terrorism includes, but is not limited to, any act, preparation in respect of action or threat of action, designed to:
- influence a government or any political division within it for any purpose, and/or
- influence or intimidate the public or any section of the public with the intention of advancing a political, religious, ideological or similar purpose;
Sanction Limitation and Exclusion Clause LMA3100
No (re)insurer shall be deemed to provide cover and no (re)insurer shall be liable to pay any claim or provide any benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose that (re)insurer to any sanction, prohibition or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of the European Union, United Kingdom or United States of America.
Governing Law & Jurisdiction
This policy shall be governed and construed in accordance with the laws of Australia. Any dispute under this policy shall be resolved in accordance with the laws of Australia.
If we make any payments under the Policy to you, then, to the extent you may have a cause of action for loss or damage against any third party in respect of the facts, matters and circumstances which gave rise to the payments being made under the Policy, then we have a right of subrogation and repayment including any claim for interest by way of an action which may be brought in the name of you against such third party. You must provide reasonable cooperation to us in pursuing any such right.
If you bring a claim for loss or damage in their own name against a third party in respect of the facts, matters and circumstances which gave rise to the payments being made under this Policy, then you must include in your claim any payments which may be recoverable from the third party including a claim for interest (recoverable payments) and should you recover damages against the third party either by way of settlement or judgment then you must repay to us out of any such damages the recoverable payments which you received under this Policy. We will provide reasonable cooperation to you and your legal advisers in bringing any such action.