this certificate of insurance this notice contains ... · this 4th day of july, 2014 by...

Savannah Insurance Agency Pty Ltd is the Agent and not the Insurer under any Policy Contract and is acting as an Agent to the Principal. The Principal, who is the insurer under any Policy Contracts issued, is Certain Underwriters at Lloyd’s as shown in the Certificate

www.savannahgroup.com.au

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CANO01SII-0613

CERTIFICATE OF INSURANCE AND TAX INVOICE

Effected through: Savannah Insurance Agency Pty Ltd – GPO Box 4920, Sydney NSW 2001

(hereinafter called the Coverholder)

THIS CERTIFICATE OF INSURANCE confirms that in accordance with the authorisation granted under

Contract Binder Reference No: B0750RNMGT1306144 to the undersigned by certain Underwriters at Lloyd’s,

whose definitive numbers and the proportions underwritten by them, which will be supplied on application, can be ascertained by reference to the said Contract, and in consideration of payment of the Premium as shown in the Schedule, the said Underwriters are hereby bound, severally and not jointly, each for his own part and not one for another, their Executors and Administrators, have agreed to insure you, in accordance with the terms and conditions of the wording attached to this Certificate, or endorsed hereon.

‘PLEASE NOTE – This notice contains important information. PLEASE READ CAREFULLY

The liability of an insurer under this contract is several and not joint with other insurers party to this contract. An insurer is liable only for the proportion of liability it has underwritten. An insurer is not jointly liable for the proportion of liability underwritten by any other insurer. Nor is an insurer otherwise responsible for any liability of any other insurer that may underwrite this contract.

The proportion of liability under this contract underwritten by an insurer (or, in the case of a Lloyd’s syndicate, the total of the proportions underwritten by all the members of the syndicate taken together) is shown in this contract.

In the case of a Lloyd’s syndicate, each member of the syndicate (rather than the syndicate itself) is an insurer. Each member has underwritten a proportion of the total shown for the syndicate (that total itself being the total of the proportions underwritten by all the members of the syndicate taken together). The liability of each member of the syndicate is several and not joint with other members. A member is liable only for that member’s proportion. A member is not jointly liable for any other member’s proportion. Nor is any member otherwise responsible for any liability of any other insurer that may underwrite this contract. The identity of each member of a Lloyd’s syndicate and their respective proportion may be obtained by writing to Market Services, Lloyd’s, at the above address.

Although reference is made at various points in this clause to “this contract” in the singular, where the circumstances so require this should be read as a reference to contracts in the plural.’

In accepting this Insurance, the said Underwriters have relied on the information and statements that you have provided on the Proposal Form, or Declaration (which shall include your intermediary’s submission) the date of which is stated in the Schedule. You should read this Certificate carefully and if it is not correct contact the Coverholder. It is an important document and you should keep it in a safe place with all other papers relating to this Insurance.

This Certificate is Insurance Council of Australia’s General Insurance Code of Practice compliant, apart from any claims adjusted outside Australia. Underwriters at Lloyd’s proudly support the General Insurance Code of Practice. The purpose of the Code is to raise standards of practice and service in the general insurance industry.

Any enquiry or complaint relating to this Insurance should be referred to the Coverholder shown above in the first instance.

If this does not resolve the matter or you are not satisfied with the way a complaint has been dealt with, you should write

to:

Lloyd’s Underwriters’ General Representative in Australia

Suite 2, Level 21, Angel Place,

123 Pitt Street, Sydney, NSW 2000

Telephone Number: (02) 9223 1433 Facsimile Number: (02) 9223 1466



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Following receipt of your dispute, you will be advised whether your dispute will be handled by either Lloyd’s Australia or the Policyholder & Market Assistance Department at Lloyd’s in London:

Where you are a retail client and your dispute is eligible for referral to the Financial Ombudsman Service (FOS), your dispute will be reviewed by a person at Lloyd’s Australia with appropriate authority to deal with your dispute.

Where you are a retail client and your dispute is not eligible for referral to the Financial Ombudsman Service (FOS), or where you are a wholesale client, Lloyd’s Australia will refer your dispute to the Policyholder & Market Assistance Department at Lloyd’s, who will then liaise directly with you.

The Underwriters accepting this Insurance agree that:

(i) if a dispute arises under this Insurance, this Insurance will be subject to Australian law and practice and the Underwriters will submit to the jurisdiction of any competent Court in the Commonwealth of Australia;

(ii) any summons notice or process to be served upon the underwriters may be served upon:

Lloyd’s Underwriters’ General Representative in Australia

Suite 2, Level 21, Angel Place,

123 Pitt Street, Sydney, NSW 2000

who has authority to accept service and to appear on the Underwriters’ behalf;

(iii) if a suit is instituted against any of the Underwriters, all Underwriters participating in this Insurance will abide by the final decision of such Court or any competent Appellate Court.

(iv) In the event of a claim arising under this Insurance IMMEDIATE NOTICE should be given to:

Corporate Services Network (CSN)

Level 2, 280 George Street,

Sydney, NSW 2000, Australia

Contact CSN Assist

Phone +61 2 8256 1731 Fax +61 2 8256 1735

This Certificate is issued by the Coverholder shown above in accordance with the authority granted to them by certain Underwriters at Lloyd’s under the Contract numbers referred to in the Schedule.

You or your representative can obtain further details of the syndicate numbers and the proportions of this Insurance for which each of the said Underwriters at Lloyd’s is liable by requesting them from the Coverholder shown above. In the event of loss, each Underwriter (and their Executors and Administrators) is only liable for their own share of the loss.

IN WITNESS WHEREOF this Certificate has been signed at: Sydney, NSW

This 4th

day of July, 2014 by Coverholder.



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Sports Injury

Schedule of Insurance and Tax Invoice

Policy Number: CANO01SII-0613

Insured: Australian Canoeing Inc, Canoeing Clubs, the following State associations, SA, ACT, TAS, QLD, VIC, NT, NSW and WA and/or subsidiary and/or related Corporations as defined under Australian Corporations Law and/or financiers and all parties for whom the Insured undertakes to insure for their respective rights, interests and liabilities.

Insured Person(s): All registered members, non playing officials, instructors, coaches (including any business name and associated with an individual coaches canoe coaching activities), guides, observers, judges, office bearers, controlling bodies, apprentices, voluntary workers and work experience students, medical officers, announcers, appointed sub-committees, development officers, committee Members, Employees of the Insured

Period of Insurance: From 30 / 06 / 2014 to 30 / 06 / 2015 at 4pm Local Time

Broker for the Insured: V-Insurance as Authorised Rep for Willis Australia Ltd

Geographical Limit: Worldwide

Scope of Cover: Whilst participating in Australian Canoeing Inc activities including all club activities, games, competitions and training on behalf of the insured including journey to and from any club/sporting venue. For registered athletes, benefits are applicable to Injury occurring during any and all canoeing activities 24 hrs a day

Age Limit: 2 to 100 years

Limit of Liability:

We will pay the maximum Limit under the following Sections in respect of any one event:

Sections 1, 2 ,3 & 4 $2,000,000

Limit of Liability Charter / Unscheduled flights $500,000



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Lump Sum Benefits Sum Insured Per Insured Person

Insured Events

Injury resulting directly in an accident:

Sections

1 Personal Injury

Accidental Death & Lump Sum Benefits

Voluntary Workers & Officials: Permanant Total Disablement (via Endorsement)

- Under 18 years - Over 75 years but under 100 years - Between 18 and 75 years

All Other Insured Persons: Event 1


Events 4 - 13


Events 2 & 3 (Paraplegia/Quadriplegia)


$175,000 $175,000 $175,000

$20,000 $20,000

$100,000

$100,000 $20,000

$100,000

$175,000 $100,000 $175,000

Event 14 – Broken Bones


$3,000

NIL $3,000

2 Weekly Benefits – Injury

Insured Events – Temporary Total Disablement caused directly and solely by Injury

Voluntary Workers & Officials:

- Under 18 years - Over 75 years but under 100 years - Between 18 and 75 years - Between 91 years and 100 years

(During such Disablement, the weekly benefits as specified or 85% of Your Salary whichever is the lesser) All Other Insured Persons:

- Under 18 years - Over 75 years but under 90 years - Between 18 and 75 years - Between 91 years and 100 years

(During such Disablement, the weekly benefits as specified or 85% of Your Salary whichever is the lesser)

$700 $700 $700

NIL

$500 $250 $500

NIL

Per Week for Income Earners only



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Benefit Period

104 weeks

Excluded Period of Claim 7 Days

3 Injury Assistance Benefits – Lump Sum Benefits

Insured Events

3.1 Non Medicare Medical Expenses Non Medicare Medical Expenses specifically relating to Ambulance: 100% of expenses incurred to a maximum limit of liability of

- Voluntary Workers & Officials - All other Insured Persons Excess NIL Each & Every loss

$5,000 $2,500

All Other Non Medicare Medical Expenses: 75% of expenses incurred to a maximum limit of liability of

- Voluntary Workers & Officials - All other Insured Persons Excess $ 50.00 Each & Every loss

$5,000 $2,500

3.2 Physiotherapy Benefits Excess $ 50.00 Each & Every loss

Included in total limits for Insured Events 3.1

3.3 Parents Inconvenience Benefit Not Insured

3.4 Rehabilitation Benefit

Not Insured

3.5 Dependant Children’s Allowance Not Insured

3.6 Home Renovation Benefit Not Insured

3.7 Funeral Expenses Benefit Not Insured

4 Injury Assistance Benefits – Weekly Benefits

4.1 Student Tutorial Benefits 100% of Expenses incurred to a maximum limit of liability of

$500

Per Week

Benefit Period 26 weeks


4.2 Domestic Help

100% of Expenses incurred to a maximum limit of liability of

$500

Per Week





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4.3 Student Allowance – Insured persons not in receipt of an Income


$500

Per Week



4.4 Domestic Home Help - Insured person not in receipt of an income


$500

Per Week



4.5 Bed Care 100% of Expenses incurred to a maximum limit of liability of

$500

Per Week



Policy Wording: Savannah’s Sports Injury Insurance Policy Wording

SIA – SII – LYDW – 011011v2

Endorsements:

(as per attached clauses)

Permanant & Total Disablement for Non-Participants

Swine Influenza A (H1N1) Exclusion Clause

Nuclear, Chemical, Biological Terrorism Exclusion Clause



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Endorsement: Permanant & Total Disablement for Non-Participants

This endorsement clause attaches to this insurance with effect from the inception date of the policy as shown in the Schedule.

It is hereby declared and agreed that Section 1 – Table of Lump Sum Benefits is extended to include the following

additional benefit:

Section 1 - Table of Lump Sum Benefits

INSURED EVENTS

THE BENEFITS

(being a percentage of the Lump Sum Insured shown in the Policy Certificate for each Insured Person(s))

Injury resulting directly in: 15. Permanant & Total Disablement for Non-Participants only 100 %

All other terms and conditions remain unchanged.

Endorsement: Nuclear / Chemical / Biological Terrorism Exclusion Clause

This exclusion clause attaches to this insurance with effect from the inception date of the policy as shown in the Schedule. Nuclear / Chemical / Biological Terrorism Exclusion Clause It is hereby declared and agreed that, regardless of any contributory cause(s), this insurance does not cover any claim(s) in any way caused or contributed to by an act of terrorism involving the use or release or the threat thereof of any nuclear weapon or device or chemical or biological agent. For the purpose of this exclusion an act of terrorism means an act, including but not limited to the use of force or violence and/or the threat thereof, of any person or group(s) of persons, whether acting alone or on behalf of or in connection with any organisation(s) or governments(s), committed for political, religious, ideological or ethnic purposes or reasons including the intention to influence any government and/or to put the public, or any section of the public, in fear. If the Underwriters allege that by reason of this exclusion any claim is not covered by this insurance the burden of proving the contrary shall be upon the Insured. All other terms and conditions remain unchanged.



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Endorsement: Swine Influenza A (H1N1) Exclusion Clause This exclusion clause attaches to this insurance with effect from the inception date of the policy as shown in the Schedule. Swine Influenza A (H1N1) Exclusion Clause It is hereby declared and agreed that this insurance excludes any loss directly or indirectly arising out of, contributed to by, or resulting from any;

A. Swine Influenza A (H1N1) virus with a minimum WHO level of influenza pandemic alert phase 3 (confirmed evidence of human-to-human transmission).

and/or

B. The Swine Influenza A (H1N1) virus leads to the imposition of quarantine or restriction in movement of

people or animals by any national or international body or agency and in respect of B) any fear or threat thereof (whether actual or perceived)

Swine Influenza Hours Clause

C. All losses arising out of Swine Influenza A (H1N1) virus with a minimum WHO level of influenza pandemic alert phase 3 (confirmed evidence of human-to-human transmission) shall be one loss occurrence provided that:

i) The losses arise from either:

a. the same virus; or b. related virus (which shall include, without limitation a disease which arises from another disease by

a mutation or re-assortment event); and

ii) The losses occur (whether in whole or in part), or arise out of events occurring within a period of 168 hours of the first such loss.

All other terms and conditions remain unchanged.

SIA-SII-LYDW-011011v2

Savannah Insurance Agency Pty Ltd

Sports Injury Insurance

Combined Product Disclosure Statement (PDS)

(including Policy Wording)

and

Financial Services Guide (FSG)

This Combined PDS & FSG is dated 1st September 2013.

Issued by Savannah Insurance Agency Pty Ltd (ABN 84 130 364 313), (Australian Financial Services

Licence No. 329631) (“Savannah”), acting under a binding authority arrangement which gives Savannah the authority to act as an Agent of Certain Underwriters at Lloyd’s.


This page has been deliberately left blank.


INDEX

Savannah Insurance Agency Pty Ltd

Sports Injury Insurance

Combined Product Disclosure Statement and Financial Services Guide

(including Policy Wording)

Part 1 – IMPORTANT INFORMATION ........................................................................................................................... 1

Part 2 – SPORTS INJURY INSURANCE POLICY WORDING ..................................................................................... 14

General Conditions and Limitations ......................................................................................................................... 15 Governing Law and Jurisdiction ............................................................................................................................... 17 Section 1 - Table of Lump Sum Benefits ................................................................................................................. 18 Section 2 - Weekly Benefits – Injury ....................................................................................................................... 19 Section 3 – Injury Assistance Benefits – Lump Sum Benefits ................................................................................. 19 Section 4 – Injury Assistance Benefits – Weekly Benefits ....................................................................................... 21

Part 3 – FINANCIAL SERVICES GUIDE (FSG) ................................................................. Error! Bookmark not defined.

Part 1 – IMPORTANT INFORMATION

SIA-SII-LYDW-011011v2 . 1


ABOUT OUR SPORTS INJURY INSURANCE

1. This Product Disclosure Statement (PDS)

This PDS is designed to assist You to make informed choices about Your insurance needs. It gives a summary of the benefits and risks associated with this insurance product. This document is divided into three sections. The first section (Part 1) includes general information about this insurance. The second section (Part 2) is the Policy wording that sets out the specific terms, conditions and exclusions of the cover that We will provide, which should be read carefully to ensure that it provides the cover You need. Parts 1-2 form the PDS. The third section (Part 3) is the Financial Services Guide designed to help You decide whether to use the services that Savannah provide, and other information that You should read carefully before entering into this Policy. Please keep this combined PDS and FSG, along with your policy documents, in a safe place for future reference. In this PDS:

We, Our or Us means Certain Underwriters at Lloyd’s.

You or Your means the Person(s) named in the Policy Certificate as the Insured and includes the Insured Person(s) in connection with:

(a) the circumstances in which entitlements to benefits arise (including the application of any

exclusions);

(b) the general conditions and limitations of cover;

(c) notification and disclosure obligations; and

(d) the obligation to pay the premium.

Insured Person(s) means any member of the Insured, or any other person actively engaged in and appropriately registered for the purpose of playing the Sport. This includes any officials and/or co-opted volunteers acting for and on behalf of the Insured. As the information in this PDS may change from time to time, You can obtain updated information simply:

by asking your intermediary (if applicable);

by visiting: www.savannahgroup.com.au;

by writing to the address shown below;

by emailing us: [email protected]

If the change to the information is materially adverse, We will issue a Supplementary PDS.

2. About Savannah Insurance Agency Pty Ltd

Savannah Insurance Agency Pty Ltd (ABN 84 130 364 313), (Australian Financial Services licence no.

329631) (“Savannah”), is an underwriting agency created to provide a range of insurance products including sports injury insurance. Savannah acts as an agent for and on behalf of Certain Underwriters at Lloyd’s. Savannah does not act on Your behalf. Savannah has full authority to quote contracts of insurance; issue contracts of insurance; collect premiums; and pay claims as an agent of Certain Underwriters at Lloyd’s. Savannah’s contact details are:

Savannah Insurance Agency Pty Ltd ABN 84 130 364 313; AFS Licence No: 329631 GPO Box 4920 Sydney NSW 2001

Telephone: (02) 8234 0416 Fax: (02) 8078 0162

Website: www.savannahgroup.com.au Email: [email protected]

http://www.savannahgroup.com.au/

mailto:[email protected]





3. About the Insurer

Lloyd’s underwriters are authorised by APRA pursuant to the Insurance Act 1973. Savannah is authorised by the Insurer to enter into contracts of insurance underwritten by Certain Underwriters at Lloyd’s and Savannah is authorised as agent of the insurer under a binding authority agreement as if it were the Insurer. We do not act on Your behalf.

4. Your Individual Requirements

When preparing this PDS, We and Savannah have not taken into account Your individual objectives, requirements or financial position. We generally distribute Our products through licensed insurance brokers or advisers (intermediaries). You should discuss with Your intermediary the type of risks You need to insure against and the appropriate amount of cover that You need. Further, if You have any questions about the appropriateness of this product for Your objectives, requirements or financial position, You should seek advice from Your intermediary. If You wish to contact Us about this PDS, please use the contact details given above. However, We can only provide You with factual information or general advice about this product and cannot advise You whether the product is appropriate for Your objectives, requirements or financial position. If Your circumstances, relevant to the risks We have agreed to insure, change after taking out this insurance You should notify Us (or ask Your intermediary to do so on Your behalf) as soon as possible.

5. Policy Definitions

Words that begin with a capital letter have a special meaning when used in the Policy. For the purpose of this Policy, the following important definitions apply: Accidental Death means death during the Period of Insurance resulting from an accident caused by sudden, violent, external and visible means and occurring solely and directly and independently of any other cause. It does not include any Pre-Existing Condition. It does not mean a sickness or disease.

Excluded Period of Claim means the period stated in the Policy Certificate during which no benefits are payable for Temporary, Total or Partial Disablement.

Guaranteed Income means Your Income that You can prove or substantiate to our satisfaction.

Income means the following:

1. If You are an employee, Income means Your gross weekly rate of pay excluding such things as bonuses, overtime or allowances; or

2. If You are not an employee, Income means any gross weekly Income which You have earned

by personal effort after deducting any expenses You had while earning the Income.

Injury means bodily injury resulting from an accident which is an external event that occurs fortuitously to the Insured Person(s) during the Period of Insurance and results solely, and independently of any other cause, 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:

(a) 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 or cancer;

(b) an aggravation of a pre-existing Injury;

(c) any other Pre-Existing Condition; or

(d) any degenerative condition.

Insured means the Insured as specified in the Policy Certificate.



Insured Person(s) means any member of the Insured, or any other person actively engaged in and appropriately registered for the purpose of playing the Sport. This includes any officials and/or co-opted volunteers acting for and on behalf of the Insured.

Insured Event means an event as defined and described in the Table of Benefits.

Insurer means Certain Underwriters at Lloyd’s.

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.

Normal Place of Residence means the place in which the Insured Person(s) lives at the time of the Insured Event and has been resident for the past three (3) consecutive months or intends to be resident for at least three (3) months.

Operation of Cover means:

1. Playing in official matches under the auspices of the Insured.

2. Engaging in organised training or practice (including practice matches) for the Sport(s).

3. Travelling directly to or from or between activities described in 1 or 2 above and the Insured Person(s) Normal Place of Residence or place of employment. Any amount payable under Section 1 – Table of Benefits shall be limited to 20% of the applicable benefit.

4. Staying away from the Insured Person(s) home district including overseas travel during a tour for the purpose of participating in representative matches and/or any other games duly authorised by the Insured.

5. Actually engaging in administrative or organised social activities of the Insured.

Paraplegia means total paralysis of both legs and part or whole of the lower half of the body.

Period of Insurance means the period stated in the Policy Certificate or such lesser period if this Policy is cancelled. In such circumstances, the Period of Insurance shall end at the effective date of cancellation.

Permanent in relation to disablement, means that the disablement has lasted twelve (12) consecutive months, and there is no hope of improvement. Pre-Existing Condition means a condition which the Insured Person(s) was aware of (whether diagnosed

or not) or has sought treatment for prior to the inception of this Policy.

Policy means this PDS and the Policy Certificate.

Policy Certificate includes any current schedule or renewal, variation or endorsement of this Policy.

Quadriplegia means total paralysis of both legs and both arms.

Salary means:

(a) Your Guaranteed Income for the twelve (12) months following the Injury.

(b) If You have no Guaranteed Income for the twelve (12) months following the Injury, then the average of Your Income for the preceding twelve (12) months or over such shorter period provided You have been continuously employed or engaged in Your occupation or business for a period of at least three (3) months.

(c) If You do not meet (a) or (b) above, then Your Salary shall be Nil.

Sport(s) means the sport(s) specified in the Policy Certificate.

Table of Benefits means the table referred to in Sections 1- 4 in Part 2 of this PDS.



Total Disablement means the Insured Person(s) inability to engage in their usual occupation or employment, or any other occupation or employment for which the Insured Person(s) is suited by reason of education, training, experience, or skill, or if not employed, from engaging in any and every occupation for the rest of the Insured Person(s) life.

Temporary Total Disablement means disablement which entirely prevents the Insured Person(s) from engaging in their usual occupation or employment for a period of time not exceeding twelve (12) months from the date the disablement commences.

We, Our, or Us means Certain Underwriters at Lloyd’s.

You or Your means the Person(s) named in the Policy Certificate as the Insured and includes the Insured Person(s) in connection with:

1. the circumstances in which entitlements to benefits arise (including the application of any exclusions);

2. the general conditions and limitations;

3. notification and disclosure obligations; and

4. the obligation to pay the premium.

6. Types of Cover

The Policy provides a choice of insurance cover. You may choose one of the following types of insurance cover, which are explained below. The type of insurance cover You choose will be set out on Your Policy Certificate. We will pay You the benefit set out in Your Policy Certificate if an Insured Person(s) during the Period of Insurance and whilst engaged in Sport during the Operation of Cover for You suffers an Injury resulting from an accident during the Period of Insurance. The Injury suffered must:

be an Insured Event as set out in the Table of Benefits; and

arise within twelve (12) calendar months from the date of the accident. We will insure You against Injury for:

Section 1 – Lump Sum Benefits

Defined events 1-13 in the Table of Benefits

Broken Bones event 14 in the Table of Benefits

Section 2 - Weekly Benefits Injury We will insure You for a maximum period of up to fifty-two (52) weeks where the Policy Certificate does not specify coverage as being for a lesser period. Section 3 – Injury Assistance Benefits – Lump Sum Benefits We will insure You for:

3.1 Non-Medicare Medical Expenses

3.2 Physiotherapy Benefits

3.3 Parents Inconvenience Benefit


3.5 Dependent Children’s Allowance

3.6 Home Renovation Benefit

3.7 Funeral Expenses Benefit



Section 4 – Injury Assistance Benefits – Weekly Benefits

4.1 Student Tutorial Benefits

4.2 Domestic Help

4.3 Student Allowance – Insured Person(s) not in receipt of an Income

4.4 Domestic Home Help – Insured Person(s) not in receipt on an Income

4.5 Bed Care We will insure You for a maximum period of up to fifty-two (52) weeks where the Policy Certificate does not specify coverage as being for a lesser period. Additional Benefits

1. Exposure

2. Disappearance

Further details and limits on cover are set out in Part 2 of this PDS.

7. Other Issues to Consider before Taking out this Insurance Like all insurance contracts, the Policy contains exclusions, terms and conditions, as well as limits and sub-limits that You should be aware of when considering whether to purchase this product.

8. Conditions As well as the conditions that appear in each section, the Policy also includes a number of general conditions that apply to all sections. These conditions are listed from page 12. In some circumstances, a breach of a condition may entitle Us to refuse to pay a claim or reduce the amount We are liable to pay.

9. Limit of Liability The most We will pay for all claims under this Policy during any Period of Insurance is set out under the limit of liability in the Policy Certificate. Once the limit of liability has been paid, You will need to pay Us a further premium to reinstate the Policy cover.

10. Limits on What We Will Pay If during the Period of Insurance and whilst engaged in activities during the Operation of Cover for You, as a result solely and directly of Injury, an Insured Person(s) suffers from Temporary Total Disablement or any of the following Insured Events set out in the Table of Benefits We will pay the corresponding benefits set out in that Table of Benefits. However, all Insured Events including disablement must occur within twelve (12) months of the Injury. 1. The maximum benefit

The maximum We will pay under this Policy is the Sum Insured set out in the Policy Certificate. We will pay for only one Insured Event, so if Your injuries could fall into more than one of the Insured Events listed in the Table of Benefits, We will pay You the Insured Event benefit which is the highest.

2. Temporary Total Disablement Payments

(a) The amount of any claim made under this Policy may be reduced where an Excluded Period of Claim applies. An Excluded Period of Claim is the number of days after medical treatment by a registered medical practitioner, for which We will not pay any benefits.

An Excluded Period of Claim will apply where You have chosen cover for Weekly Benefits – Injury Weekly Benefits (Section 2 and Section 4 – Injury Assistance Benefits 4.2 and 4.3 and 4.4) and will be stated in Your Policy Certificate.



(b) Any lump sum benefit payable shall be reduced by any amount of any other lump sum

benefit We have paid or are liable to pay in connection with the same Injury.

(c) If You receive any payments from any workers’ compensation or other statutory schemes for the Injury, then any weekly payments made under this Policy will be reduced by that amount.

(d) No payment will be made under Section 2 if You are already receiving sick leave payments from Your employer for the same Injury.

3. Persons Under nineteen (19) Years of Age

If You are under nineteen (19) years of age, We will only pay 20% of the amount listed in the Table of Benefits for Insured Events 1 - 13.

11. What We do not Pay

Claims may be excluded in certain circumstances under this Policy which means We may refuse to pay Your claim. We do not cover Injury that: 1. is deliberately self-inflicted or caused by You, including suicide or attempted suicide whether

sane, insane or under any mental distress; 2. 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;

3. Death occurring from natural causes; 4. results from You engaging in air travel except as a passenger in any properly licensed aircraft; 5. results from You engaging in or taking part in naval, military or air force service or operations; 6. results from You engaging in any professional sports or taking part in hazardous and/or

dangerous pursuits or pastimes; unless We have been informed of this/these sports or activities and have specifically included this/these into the Policy Certificate.

7. is attributable wholly or partly to childbirth or pregnancy or the complications of these; 8. 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;

9. an act of terrorism involving the use or release or the threat thereof of any nuclear weapon or

device or chemical or biological agent. 10. Expenses to which Section 118.1 of the Private Health Insurance Act 2007 (Cth) as amended, or

any of the regulations made thereunder apply; 11. is a sexually transmitted disease, or Acquired Immune Deficiency Syndrome (AIDS) disease or

Human Immunodeficiency Virus (HIV) infection contracted in any manner whatsoever (whether sexually transmitted or not). However, this does not apply to the extent cover is provided in Section 1 – Table of Lump Sum Benefits, Event 13;

12. results from a criminal or illegal act committed by You; 13. results from You being under the influence of alcohol or an illegal drug or where there is more

alcohol or drugs in Your blood than the law permits;



14. results from You directly or indirectly suffering from stress, depression, anxiety or any psychosomatic, psychological, psychotic, mental or nervous disorder;

15. results from any Pre-Existing Condition which is a condition You were aware of or sought

treatment for prior to the commencement of the Policy; 16. You receive sick leave payments for; 17. results from training for or participation in any sports other than the Sport/s as mentioned in the

Policy Certificate. 18. arises where You have attained the age of sixty-five (65), and there is no cover for Temporary

Total Disablement. Further details on what we do not pay are set out in Part 2 of this PDS. Please ensure that You read all Specific Exclusions and General Exclusions carefully.

12. Selecting a Sum Insured It is important that You ensure that You have selected a Sum Insured for each cover that provides You and the Insured Person(s) with sufficient protection for Your needs.

13. Sum Insured The Sum Insured is the amount We agree to insure You for when You take out the Policy as shown on Your Policy Certificate. If You suffer an Insured Event as a result of an Injury (Events 1-13) then We will pay You a percentage of the Sum Insured as set out in the Table of Benefits.

14. Basis of Settlement It is also important that You understand how We settle and pay Your claims. Each section details how claims are calculated for cover in respect of that section.

15. How to Apply for this Insurance and Our Contract with You You may need to complete an application form. We will use the information You supply in the application form to determine the terms of cover We will provide. The terms of cover are contained in the Policy and the most recent Policy Certificate that We issue to You. The Policy Certificate will contain important information about Your cover, including the Period of Insurance, the premium, the level of cover (and the insured amounts) You have chosen and whether any standard terms have been varied by way of endorsement to the Policy. You should keep all of the Policy documents in a safe place.

16. The Cost of this Insurance Policy The cost of Your Policy will be shown on the quotation provided, once all required information has been received. The cost of Your Policy is calculated based on a number of considerations including the age, occupation, claims experience, the number of persons covered and other information about persons covered under this Policy relevant to the particular risk. These factors, and the degree to which they affect Your premium, will depend on the information that You provide to Us. The cost of Your Policy is made up of premium, government taxes such as goods & services tax (GST) and stamp duty, where applicable. Please note that the cover We provide is subject to payment of the premium by the due date.



17. Your Duty of Disclosure – What You Must tell Us When You apply for insurance, You need to tell us certain information which would affect Our decision to insure You. If You do not give us this information, it may affect Your Policy. The duty of disclosure appears in full below. Please ensure You read this carefully. The duty of disclosure notice will also appear on Your renewal invitation and the duty of disclosure also applies to any endorsements or variations You request. Before You enter into a contract of general insurance with an insurer, You have a duty, under the Insurance Contracts Act 1984 (Cth) to disclose to Us every matter You know, or could reasonably be expected to know, that is relevant to Our decision whether to accept the risk of the insurance and, if so, on what terms. You have the same duty to disclose those matters to Us before You renew, extend, vary or reinstate a contract of general insurance. You do not have to tell Us about any matter that:

diminishes the risk to be undertaken by Us;

is of common knowledge;

We know or, in the ordinary course of Our business, ought to know; or

We say We do not need to know.

18. Who needs to disclose You are answering questions on behalf of Yourself and anyone else You want to be covered by this Policy. The duty of disclosure applies to You and everyone else insured by the Policy.

19. Non Disclosure If You fail to comply with Your duty of disclosure, We may be entitled to reduce Our liability under the Policy in respect of a claim, or We may cancel the Policy. If Your non-disclosure is fraudulent, We may also have the option of avoiding the Policy from its beginning.

20. Taxation Implications Depending upon You or Your company’s entitlement to claim input tax credits under this Policy, We may reduce the payment of Your claim by the amount of any input tax credit. A claim paid in respect of weekly disability benefits in this Policy, is subject to personal income tax and it is Your responsibility to declare such benefit when completing Your usual tax return. There may be other taxation implications affecting You depending upon Your own circumstances. We recommend that You seek professional advice.

21. Making a Claim If You need to make a claim, please send written notice of Your claim to Your insurance broker or adviser (intermediary) within thirty (30) days of the date of the incident occurring, or as soon as reasonably possible. Your insurance broker or adviser (intermediary) will send You a copy of Our 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 to Us. Any costs involved in the collection of information for the form are Your responsibility. At any time after a claim has been lodged, We may conduct enquiries into the circumstances of the claim. We may ask for medical examinations or, in the event of death, We may request an autopsy. This will be done at Our expense. Any payments under this Policy will be to You, or in the event of Your death, Your legal representative.



In the event of a claim arising under this Insurance IMMEDIATE NOTICE should be given to: Corporate Services Network (CSN)

Level 2, 280 George Street, Sydney , NSW 2000 Australia Contact ISN Assist Phone +61 2 8256 1731 Fax +61 2 8256 1735

Once a payment is made under this Policy, We may attempt to recover the amount We have paid to You if we find someone else is responsible for the loss or damage. We will do this in You or the Insured Person(s) name. We may also need to defend You, or the Insured Person(s), if someone else alleges You caused them loss or damage. You and the Insured Person(s) are required to cooperate with Us at all times.

22. Cooling-Off Period You have the right to cancel the Policy by notifying the Insurer in writing within twenty-one (21) days of

the date the Policy was issued to You (Cooling-Off Period). You are entitled, during the Cooling-Off Period, to a complete refund of the amount You have paid for the Policy. If You choose to cancel the policy during the Cooling-Off Period, We will treat the policy as never having existed. You are not entitled to a refund if, during the Cooling-Off Period, the Policy has already expired or if You have made a claim under the Policy.

23. Cancellation You may cancel the Policy by notifying Us in writing. The cancellation will take effect on the day We receive such notice in writing. We will refund the premium for the unexpired Period of Insurance. If more than one person, company or firm is named on the Policy as an Insured Person(s), We will only cancel the Policy if a written agreement to cancel the Policy is received by Us from all parties named as an Insured Person(s). We may cancel the Policy in any of the circumstances set out in, and in the manner allowed by, the Insurance Contracts Act 1984 (Cth). We will advise You in writing if the Policy is cancelled by Us. If We cancel the Policy We will refund the premium for the unexpired Period of Insurance.



24. Dispute Resolution We and Savannah will do everything possible to provide a quality service to You. However, We recognise that occasionally there may be an aspect of Our or Savannah’s service or a decision We or Savannah have made that You wish to query or draw to Our or Savannah’s attention. Savannah has complaints and dispute resolution procedures which undertake to answer Your queries or complaints within fifteen (15) working days. If You have any queries or complaints, please contact Savannah, Savannah’s staff are always available to listen to You and to help where they can. If You wish to make a complaint or access Savannah’s internal dispute resolution service, please contact Savannah and ask to speak to Savannah’s dispute resolution manager. The contact details of Savannah’s dispute resolution manager are as follows: Savannah Dispute Resolution Manager GPO Box 4920, Sydney, NSW 2001 Tel: (02) 8234 0416 Fax: (02) 8078 0162 If You are unhappy with Savannah’s response, or Savannah has taken more than fifteen (15) working days to respond, You should contact the Compliance Officer at:

Lloyd’s Australia Limited Suite 2, Level 21 Angel Place 123 Pitt Street, Sydney NSW 2000 Telephone: (02) 9223 1433 Facsimile: (02) 9223 1466

Email: [email protected] When You lodge Your dispute with Us, We will Usually require the following information:

Name, address and telephone number of the policyholder

The type of insurance policy involved

Details of the policy concerned (policy and/or claim reference numbers, etc)

Name and address of the insurance intermediary through whom the policy was obtained Details of the reasons for lodging the dispute

Copies of any supporting documentation You believe may assist Us in addressing Your dispute appropriately.

Following receipt of Your dispute, You will be advised whether Your dispute will be handled by either Lloyd’s Australia or the Policyholder & Market Assistance Department at Lloyd’s in London: If You are unhappy with this response, You may take Your complaint to the Financial Ombudsman Service (FOS), an Australian Securities & Investments Commission (ASIC) approved external dispute body. The FOS resolves certain insurance disputes between consumers and insurers and will provide an independent review at no cost to You. We and Savannah are bound by any determination made by the FOS but the determination is not binding on You. The contact details of the FOS are as follows. GPO Box 3, Melbourne VIC 3001 Freecall: 1300 78 08 08 Fax: (03) 9613 6399 Email: [email protected] Web: www.fos.org.au

If FOS has no jurisdiction or if you are unhappy with its determination then the following

Lloyd’s Australian Alternative Dispute Resolution Procedure is available.


http://www.fos.org.au/



In the event that a dispute arises between us and you out of or otherwise in relation to this agreement, then:

(a) Any party to the dispute shall, without prejudice to any other right or entitlement they may have, give written notice to the other party (the “Dispute Notice”) requiring them within seven (7) days of this notice to negotiate (whether in a face to face meeting or by teleconference) in good faith as to how the dispute can be resolved;

(b) If a dispute is not resolved within ten (10) days of the Dispute Notice, either party can request the other party within a further ten (10) days to agree on either:

1. a process for resolving the dispute through means other than litigation or arbitration, such as further negotiation, mediation, or any other alternative dispute resolution technique. The rules governing any such technique shall be agreed as between the parties and where no such agreement as to the process and or guidelines is reached within ten (10) days, then it shall be by mediation by a mediator selected by the Chairperson for the time being of Lawyers Engaged in Alternative Dispute Resolution (LEADR) (or other appropriate professional body as agreed by the parties); or

2. referral of the matters in dispute to an independent expert for an expert determination. The parties agree that they will not be bound by the determination of the expert. The expert:

i) will be a person agreed between the parties within ten (10) days of the dispute being referred to expert determination or failing this, the expert will be a person appointed by the Australian Insurance Law Institute (or other appropriate professional body as agreed by the parties);

ii) will act as an expert and not as an arbitrator;

will proceed in such a manner as he or she thinks fit without being bound to observe the rules of natural justice or the rules of evidence;

iii) will take into consideration all documents, information and other written and oral material that the parties place before him or her including documents, information and material relating to the facts in dispute and to arguments and submissions upon the matters in dispute; and will act with expedition to provide the parties with a determination in writing within thirty-five (35) days of the referral to him or her of the matters in dispute.

Both parties must use their best endeavours to achieve resolution by the selected process and further agree that neither party will initiate litigation (as set out in clause (c) below) without first pursuing such informal resolution techniques in good faith; In the event that the dispute is not resolved by such informal process within thirty-five (35) days of the Dispute Notice (or such other period as agreed in writing between the parties) the dispute shall be referred to litigation. (c) Following either a mediation or an expert determination pursuant to clause (b) of this provision,

either party may then initiate proceedings in any competent Court in the Commonwealth of Australia in relation to the matters in dispute.

Such proceedings may only be commenced on 14 days written notice to the other party and shall be determined in accordance with the law and practice applicable in such Court: Any summons, notice or process to be served upon Underwriters may be served upon:

Lloyd's Underwriters' General Representative in Australia Suite 2, Level 21, Angel Place

123 Pitt Street, Sydney NSW 2000, Australia

who has authority to accept service and to appear on Underwriters’ behalf.



If proceedings are instituted against any one of the Underwriters, all Underwriters participating in this insurance will abide by the final decision of such Court or any competent Appellate Court. (d) Except where the dispute renders it impossible to do so, the parties will continue performing

their respective obligations under the Policy while the dispute is being resolved, unless and until such obligations are terminated or expire in accordance with this agreement.

(e) Each party must use its reasonable endeavours to ensure that where a dispute is reasonably

foreseeable, it is dealt with at a sufficiently early stage to ensure that there is a minimal effect on the ability of either party to perform its obligations under the Policy.

(f) Notwithstanding anything in this schedule, either party may at any time commence Court

proceedings in relation to any dispute or claim arising under, or in connection with the Policy where the party seeks urgent interlocutory relief.

25. Service of Suit Clause (Australia)

The Underwriters hereon agree that: (i) In the event of a dispute arising under this Policy, Underwriters at the request of the insured (or

reinsured) 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.

(ii) Any summons notice or process to be served upon the Underwriters may be served upon:

Lloyd’s Australia Limited Suite 2, Level 21 Angel Place

123 Pitt Street, Sydney NSW 2000 Telephone: (02) 9223 1433 Facsimile: (02) 9223 1466

who has authority to accept service and to enter an appearance on Underwriters' behalf, and who is directed at the request of the insured (or reinsured) to give a written undertaking to the insured (or reinsured) that he will enter an appearanceon Underwriters' behalf.

(iii) If a suit is instituted against any one of the Underwriters all Underwriters hereon will abide by the

final decision of such Court or any competent Appellate Court.

26. Privacy We are committed to protecting Your privacy. We Use the information You provide Us to quote on Your application for a Policy, to provide the insurance, administer the Policy and asses and manage any claims. We only provide personal information to Our underwriters and reinsurers (and their representatives) and those We appoint to assist Us with claims under Your Policy. If You do not provide Us with full information, We cannot properly quote for Your insurance and We cannot insure You. You can check the personal information We hold about You at any time. Such application should be directed to Savannah, in writing, where it will be considered by its internal privacy disputes department. If You provide Us with personal information about anyone else, We rely on You to have obtained their consent and to have informed them:

to whom We may provide their personal information;

the purposes for which We will Use their personal information; and

how they can access that information. If the information is sensitive, We rely on You to have obtained their consent on these matters. For more information about Our privacy policy, please visit Our Website.



27. Code of Practice

This Policy is Insurance Council of Australia’s General Insurance Code of Practice compliant, apart from any claims adjusted outside Australia. Underwriters at Lloyd’s proudly support the General Insurance Code of Practice. The purpose of the Code is to raise standards of practice and service in the general insurance industry. When You lodge a claim Savannah will tell You in plain language what information Savannah needs and how You should go about making Your claim. Savannah will respond promptly to any requests You make for assistance with Your claim and it will be considered and assessed promptly.

28. Age Limits There are certain age limits that apply to this Policy. There is no cover for any person over the age of sixty-five (65) years.

Part 2 – SPORTS INJURY INSURANCE POLICY WORDING



IMPORTANT INFORMATION

Savannah gives notice that this contract has been effected under an authority, given to Savannah by Certain Underwriters at Lloyd’s. Savannah has entered into this contract as an agent of Certain Underwriters at Lloyd’s and not as Your agent or an agent of any Insured Person(s). All cover under this Policy is subject to: 1. the Payment of premium;

2. the terms and conditions contained in this Policy and in the Policy Certificate; and

3. the limits of liability referred to in this Policy. Subject to the terms, conditions, exclusions and limitations contained in this Policy, this Policy provides cover for disablement caused by Injury only – it does not cover You for Death arising from natural causes. Benefits are payable in the circumstances set out in this Policy. The particular cover which applies to You and which You selected when You applied for this insurance is referred to in the Policy Certificate. If You are not entirely satisfied with this Policy, and provided the Policy has not already expired, or You have not made any claim upon it You may cancel it by returning it to Us within twenty one (21) days of the date the Policy was issued to You. We will refund Your premium and the Policy will be treated as though it never existed.

What We will pay

If during the Period of Insurance and whilst engaged in Sport during the Operation of Cover for You, as a result solely and directly of Injury, an Insured Person(s) suffers from any of the following Insured Events set out in the Table of Benefits We will pay the corresponding benefits set out in that Table of Benefits. However, all Insured Events including disablement must occur within twelve (12) months of the Injury.

What We will not Pay

Claims may be excluded in certain circumstances under this Policy which means We may refuse to pay Your claim. We do not cover Injury that: 1. is deliberately self-inflicted or caused by You, including suicide or attempted suicide whether sane,

insane or under any mental distress; 2. 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;

3. Death occurring from natural causes; 4. results from You engaging in air travel except as a passenger in any properly licensed aircraft;

5. results from You engaging in or taking part in naval, military or air force service or operations;

6. results from You engaging in any professional sports or taking part in hazardous and/or dangerous pursuits or pastimes; unless We have been informed of this/these sports or activities and have specifically included this/these into the Policy Certificate.

7. is attributable wholly or partly to childbirth or pregnancy or the complications of these;



8. 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;

9. an act of terrorism involving the use or release or the threat thereof of any nuclear weapon or

device or chemical or biological agent. 10. Expenses to which Section 118.1 of the Private Health Insurance Act 2007 (Cth) as amended, or

any of the regulations made thereunder apply; 11. is a sexually transmitted disease, or Acquired Immune Deficiency Syndrome (AIDS) disease or

Human Immunodeficiency Virus (HIV) infection contracted in any manner whatsoever (whether sexually transmitted or not). However, this does not apply to the extent cover is provided in Section 1 – Table of Lump Sum Benefits, Event 13;

12. results from a criminal or illegal act committed by You;

13. results from You being under the influence of alcohol or an illegal drug or where there is more alcohol or drugs in Your blood than the law permits;

14. results from You directly or indirectly suffering from stress, depression, anxiety or any psychosomatic, psychological, psychotic, mental or nervous disorder;

15. results from any Pre-Existing Condition which is a condition You were aware of or sought treatment for prior to the commencement of the Policy;

16. You receive sick leave payments for; 17. results from training for or participation in any sports other than the Sport/s as mentioned in the

Policy Certificate.

18. arises where You have attained the age of sixty-five (65), and there is no cover for Temporary Total Disablement.

General Conditions and Limitations

1. A benefit shall not be payable for more than one of the Insured Events 1-13 in respect of the same

Injury, in which case the highest benefit will be payable. 2. Any benefit payable for Insured Events 1-13 shall be reduced by any sum already paid for Insured

under sections 2, 3 or 4 in respect of the same Injury. 3. No benefits will be payable for death that occurs through natural causes. 4. A benefit payable to Insured Person(s) under nineteen (19) years of age for Insured Events 1-13

shall be 20% of the minimum Sum Insured stated in the Policy Certificate unless otherwise specified.

5. Weekly benefits for Temporary Total Disablement shall be limited to the Sum Insured stated in the

Policy Certificate or 80% of Your Salary, whichever is the lesser. If You receive benefits or Income from any other source, Our payments will be reduced by that amount and We will pay the difference up to 80% of Your Salary. If You redeem or commute or settle Your entitlement to benefits or Income from any other source, Our payments under this Policy will immediately cease.

6. We will pay one-seventh (1/7) of the weekly benefits for each day of disablement where

disablement lasts for less than a week. 7. No benefits shall be payable for any expense to which Section 118.1 of the Private Health

Insurance Act 2007 (Cth) as amended or any of the regulations made thereunder apply



8. The weekly benefit payable for Temporary Total Disablement shall be reduced by the amount of any workers' compensation entitlement or any other payment which You are entitled to receive from any insurance policy.

9. No Weekly benefits shall be payable for disablement during the deferral period shown in the Policy Certificate.

10. No further benefit will be payable under this Policy and all cover under this Policy will cease if:

10.1 You become entitled to the payment of a Sum Insured being 100% of the Sum Insured stated in the Policy Certificate.

10.2 You become entitled to the payment of weekly benefits for the maximum period stated in the

Policy Certificate. The maximum period is fifty-two (52) weeks from the date You first become -entitled to the payment of weekly benefits except for persons sixty (60) years and over where the benefit period is twenty-six (26) weeks. Should You become entitled to weekly benefits at the age of fifty-nine (59) Your benefit period ceases when You turn sixty-one (61). The benefit period ceases at the expiration of the maximum period. The maximum period commences from the time You first sought medical attention following an Injury.

10.3 You become entitled to both a Sum Insured as stated in the Policy Certificate and weekly

benefits and You are paid 100% of the Sum Insured stated in the Policy Certificate and weekly benefits for the total period stated in the Policy Certificate.

11. No benefits are payable unless, as soon as possible after the happening of any Injury, You obtain

and follow medical advice from a legally qualified medical practitioner. Your benefit commences from the time You first sought medical attention following Your Injury.

12. You must give Us immediate written notice if You take out any other insurance with any insurer

providing for weekly benefits of a similar kind which, together with this insurance, will exceed Your Salary.

13. 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. 14. 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.

15. The benefits of this Policy depend on You or any person covered by this Policy giving Us any reasonable information and help We require. This includes giving Us written statements of documents We consider relevant. We may also require You or any person covered by this Policy 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.

16. 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.

17. We may request a progressive claim form be completed by Your attending physician or specialist. 18. No action at law or equity shall be brought or maintainable unless and until the parties have first

participated in a formal mediation process before a mediator appointed by agreement or failing that by the president of the law society of that state the claimant ordinarily resides. The costs of any mediator shall be borne equally by the parties.

19. No action at law shall be brought to recover on this Policy prior to the expiration of sixty (60) days

after Our reasonable requirements in connection with a claim have been met. No such action shall be brought after the expiration of three (3) years after the date of the Injury giving rise to the claim.



20. You may cancel the Policy by notifying Us in writing. The cancellation will take effect on the day We receive such notice in writing. We will refund the premium for the unexpired Period of Insurance. If more than one person, company or firm is named on the Policy as an Insured Person(s), We will only cancel the Policy if a written agreement to cancel the Policy is received by Us from all parties named as an Insured Person(s). We may cancel the Policy in any of the circumstances set out in, and in the manner allowed by, the Insurance Contracts Act 1984 (Cth). We will advise You in writing if the Policy is cancelled by Us. We will refund the premium for the unexpired Period of Insurance.

21. All cover under this Policy shall cease upon Your attaining the age of sixty-five (65) years unless

otherwise indicated on the Policy Certificate. 22. All weekly benefits shall be paid monthly in arrears. 23. All benefits shall be paid to You, or in the case of Your death, to Your legal personal representative. 24. If a sum is shown in the Policy Certificate as being the aggregate limit of liability, We shall not be

liable to pay benefits under this Policy totalling in all more than the aggregate limit of liability Sum Insured for all claims arising under this Policy during the Period of Insurance shown in the Policy Certificate, including any current Policy Certificate.

25. Any claim or benefit paid under this Policy will be paid in the same currency as premium quoted.

Governing Law and Jurisdiction This Policy is governed by the Laws of the Australian State or Territory it was issued in and any dispute or action in connection therewith shall be conducted and determined in Australia.

Additional Benefits

1. Exposure

If, as a result of an Injury occurring during the Period of Insurance and whilst engaged in Sport during the Operation of Cover for You, an Insured Person(s) is exposed to the elements and suffers from any of the Insured Events set out in the Table of Benefits as a direct result of that exposure, We will pay the corresponding benefit accordingly. 2. Disappearance If an Insured Person(s) disappears during the Period of Insurance and whilst engaged in Sport during the Operation of Cover for You, following the disappearance, sinking or wrecking of a conveyance in which the Insured Person(s) was travelling and the Insured Person(s) body has not been found within one (1) year after the date of disappearance, We will pay a benefit on the assumption that the Insured Person(s) died as a result of an Injury at the time of the disappearance, sinking or wrecking of the conveyance.



Section 1 - Table of Lump Sum Benefits

INSURED EVENTS THE BENEFITS

(being a percentage of the Lump

Sum Insured shown in the Policy

Certificate for each Insured

Person(s))

Injury resulting directly in: 1. Accidental Death 100 % 2. Permanent Quadriplegia 100 % 3. Permanent Paraplegia 100 % 4. Permanent total loss of sight of both eyes 100 % Permanent total loss of sight of one eye 50 % 5. Permanent total loss of hearing two ears 75 % Permanent total loss of hearing one ear 25 % 6. Permanent total Loss of Use of two arms 75 % Permanent total Loss of Use of one arm 35 % 7. Permanent total Loss of Use of two legs 75 % Permanent total Loss of Use of one leg 35 % 8. Permanent total Loss of Use of two+ fingers 40 % Permanent total Loss of Use of two fingers 14 % Permanent total Loss of Use of one finger 4 % Permanent total Loss of Use of one thumb 5 % 9. Permanent total Loss of Use of two+ toes 40 % Permanent total Loss of Use of two toes 14 % Permanent total Loss of Use of one toe 4 % 10. Permanent total loss of two kidneys 75 % Permanent total loss of one kidney 30 % Permanent total loss of spleen 25 % Permanent total loss of liver 70 % Permanent total loss of two testicles 40 % Permanent total loss of one testicle 6 % Permanent total loss of sexual function 45 % 11. Permanent total disfigurement Up to 45 % Permanent total shortening of leg by at least 5cm 7.5 % 12. Permanent Total Disablement or permanent total Loss of Use of

any body part not shown above will be compensated at a percentage of the lump sum benefit as determined at Our absolute discretion. Such determination will not be inconsistent with the benefits provided under Insured Events 1-11 inclusive.

Up to 90 %

13. Becoming HIV positive but cover for this Insured Event is only provided if the infection was as a direct result of playing or participating in the Sport.

10 %

14. Broken bone benefits caused directly and solely by Injury a. Neck or spine (full break) b. Hip, pelvis c. Skull, shoulder blade d. Collar bone, upper leg e. Upper arm, kneecap, elbow f. Lower leg, jaw, wrist, cheek, ankle, hand , foot g. Ribs h. Finger, thumb, toe Limit of liability any one accident

$ $ $ $ $ $ $ $ $

5,000

500 200 200 150 100 100 50

5,000



Section 2 - Weekly Benefits – Injury

2.1 Temporary Total Disablement caused directly and solely by Injury

During such disablement, the weekly benefits as specified or 80% of Your salary as defined whichever is the lesser.

Maximum Benefit Period: We will insure You for a maximum period of up to fifty-two (52) weeks from the date the Insured Person(s) first becomes entitled to the payment of weekly compensation where the Policy Certificate does not specify coverage as being for a lesser period

Section 3 – Injury Assistance Benefits – Lump Sum Benefits

3.1 Non – Medicare Medical Expenses

We will pay the cost of the following expenses, provided they are incurred within twelve (12) months of the Injury, being expenses paid to a legally qualified medical practitioner, nurse, hospital or ambulance service for medical, surgical, x-ray, hospital or nursing treatment, including the cost of medical supplies and ambulance hire, but excluding the cost of dental treatment unless such treatment is necessarily incurred to teeth (excluding dentures) and is caused by Injury, provided that We shall not be liable to make any refund in respect of: a. any expenses recoverable by the Insured Person(s) from any other source except for the excess of the amount recoverable from such other source. b. the rendering in Australia of a professional service for which Medicare benefit is, or would but for subsection 18(4) of the Private Health Insurance Act 2007 (Cth), be payable. c. any expenses to which the Private Health Insurance Act 2007 (Cth) and its regulations applies.

The benefits payable for non-Medicare medical expenses shall be limited to 80% of expenses incurred to a limit of liability of $2,000 per claim.

If an insured Person(s) suffers an Injury more than 200 kilometres from their Normal Place of Residence and are hospitalised for three (3) days or more at that location We will pay up to $2,000 toward the cost of repatriation to a medical facility of the Insured Person(s) choice within 20 kilometres of their Normal Place of Residence in addition to expenses incurred under Section 3.1 Non-Medicare Medical Expenses.

3.2 Physiotherapy Benefits

If an Insured Person(s) suffers an Injury which within twelve (12) calendar months results in physiotherapy treatment required and provided by a suitable qualified physiotherapist We will pay the following:

Visits 1 to 5 Visits 6 to 10 All other visits

95% (of the fee charged less rebates from other sources) 80% (of the fee charged less rebates from other sources) 75% (of the fee charged less rebates from other sources)

The benefits payable for Physiotherapy Benefit shall be limited to $2,000 per claim.

Provided that We shall not be liable to make any refund in respect of:

a. Any expenses recoverable by the Insured Person(s) from any other source except for the excess of the amount recoverable from such other source.

b. The rendering in Australia of a professional service for which Medicare benefit is, or would but for subsection 18(4) of the Private Health Insurance Act 2007 (Cth), be payable.

c. Any expenses to which the Private Health Insurance Act (Cth) and its regulations applies.



3.3 Parents Inconvenience Benefit

We will reimburse an Insured Person(s) for non medical expenses incurred directly relating to Injury. For the purposes of 3.3 only, non medical expenses includes items such as transportation and accommodation costs certified as necessary by the Insured Person(s) medical practitioner. Non medical expenses does not include wages lost by any Insured Person(s). No compensation shall be payable in respect of 3.3 should there be any amount payable under Section 2 – Weekly Benefits – Injury.

The benefits payable for Parents Inconvenience Benefit shall be limited to $2,000 per claim.


We will pay all reasonable costs incurred for the rehabilitation of an Injury which have been incurred following a referral from a medical practitioner to a rehabilitation provider including but not limited to a gymnasium, pilates studio or physical trainer. In addition to this We will pay the expenses incurred for tuition or advice from a licensed vocational school provided such tuition is undertaken with the Company’s prior written agreement and deemed required by the Insured Person(s) regular medical practitioner.

The benefits payable for Rehabilitation Benefit shall be limited to $1,000 per claim. The annual aggregate limit of liability We shall pay is $3,000.

3.5 Dependent Children’s Allowance

We will pay all reasonable costs incurred by the Dependent Children of an Insured Person(s) as a direct result of an Injury to the Insured Person whilst the Insured Person(s) is undergoing treatment for an Injury covered under this Policy. Dependent Children means the unmarried children under the age of (nineteen) 19 who are still living at home, or under twenty-five (25) years of age and engaged as a full time student at an accredited institution of higher learning, and are entirely dependent on the Insured Person(s) at the time of the loss. Dependent Children extends to include step or legally adopted children.

The benefits payable for Dependent Children’s Allowance shall be limited to $500 per claim.

3.6 Home Renovation Benefit

If, as a direct result of an Injury, an Insured Person(s) has a valid claim under Events 2 to 7 of Section 1 – Lump Sum Benefits, and the Insured Person(s) is required to renovate his or her Normal Place of Residence, for the purpose of normal daily living (ie washing, cooking, bathing and dressing) We will pay 80% of costs incurred for the installation of necessary items including but not limited to ramps, guide rails, alarm systems and similar household aids.

The benefits payable for Home Renovation Benefit shall be limited to $10,000 per claim.

3.7 Funeral Expenses Benefit

If, as a direct result of Injury, an Insured Person(s) suffers Event 1 of Section 1 – Lump Sum Benefits, We will pay the Insured Person(s) funeral expenses.

The benefits payable for Funeral Expenses Benefit shall be limited to $5,000 per claim.



Section 4 – Injury Assistance Benefits – Weekly Benefits Where an Insured Person(s) has suffered an Insured Event in sections 1 or 2, above and is entitled to benefits provided in sections 1 to 3, above, the Insured Person(s) may be entitled to the following additional Injury Assistance Benefits (where applicable). Benefits will only be payable under one of the sub-sections within section 4 for each Insured Event. All benefits payable under this section are subject to the Maximum Benefit Period noted in the Policy Certificate.

4.1 Student Tutorial Benefits

It is hereby declared and agreed that a student who is an Insured Person(s) not in receipt of pre-disability earnings is entitled to reimbursement of student tutorial fees under Temporary Total Disablement Event section 2 provided that: a. such fees are paid to a professionally qualified tutor who continues teaching

the student during the period in disability; and b. such fees are certified by a legally qualified medical practitioner.

The benefits payable for Student Tutorial Benefits shall be limited to $600 per week payable for an aggregate period of twenty-six (26) weeks.

4.2 Domestic Help It is hereby declared and agreed that any Insured Person(s) not in receipt of pre-disability earnings will be paid under Temporary Total Disablement Event section 2 for the cost of hiring domestic help and/or child-minding services reasonably and necessarily incurred provided that: a. such child-minding services and domestic help are carried out by persons other than members of the Insured Person(s) family or other relatives or person’s permanently living with the Insured Person(s); and b. such child-minding services and domestic help is certified by a legally qualified

medical practitioner as being necessary for the recovery of the Insured Person(s). An Insured Person(s) entitlement to benefits under this section does not commence until after the expiry of the Excluded Period of Claim specified in the Policy Certificate.

The benefits payable for emergency Domestic Help shall be limited to $500 per week payable for an aggregate period of twenty-six (26) weeks.

4.3 Student Allowance - Insured Person(s) not in receipt of an Income If an Insured Person(s), who does not earn an Income but is a full time student at an accredited institution of higher learning, suffers an Injury, We will pay up to 80% of the actual cost of home tutorial expenses certified as necessary by the attending medical practitioner.

Subject to a maximum of $200 per week for each week of Temporary Total Disablement. An Insured Person(s) entitlement to benefits under this Section does not commence until after the expiry of the Excluded Period of Claim specified in the Policy Certificate.

4.4 Domestic Home Help – Insured Person(s) not in Receipt of an Income If an Insured Person(s) who does not earn an Income suffers an Injury We will pay up to 80% of the actual costs of domestic home help certified as necessary by the attending medical practitioner.

Subject to a maximum of $200 per week for each week of Temporary Total Disablement. An Insured Person(s) entitlement to benefits under this section does not commence until after the expiry of the Excluded Period of Claim specified in the Policy Certificate.

4.5 Bed Care In the event an Insured Person(s) is necessarily confined to a bed after an Injury and their confinement is certified as necessary by their attending medical practitioner and they require the continuous care of a registered nurse, who is not related to the Insured Person(s) or a member of the Insured Peron’s family We will pay the costs incurred in relation to hiring the registered nurse. For the purposes of this Benefit We will not pay for any claim whereby the Insured Person(s) is confined to a bed in any institution used as a nursing or convalescent home, a place of rest, a geriatric ward, a mental institution, a rehabilitation or extended care facility or a place for the care of alcohol or drug addicts.

The benefit payable for Bed Care benefit shall be limited to $300 per week for an aggregate period of fifty-two (52) weeks after the expiry of the Excluded Period of Claim specified in the Policy Certificate.

Maximum Benefit Period: We will insure You for a maximum period of up to fifty-two (52) weeks from the date the Insured

Person(s) first becomes entitled to the payment of weekly compensation where the Policy Certificate does not specify coverage as being for a lesser period

Part 3 – FINANCIAL SERVICES GUIDE (FSG)



Date of Preparation: 1st September 2013

Distribution of this FSG has been authorised by Savannah Insurance Agency Pty Ltd (Savannah).

This FSG contains important information about Savannah. This FSG is designed to help You decide whether to Use the services Savannah provide, how they are remunerated and how any complaints You may have are dealt with.

If You decide to acquire insurance, You will be given a Product Disclosure Statement (PDS) before or at the time You acquire the insurance. The PDS is designed to assist You to make informed choices about Your insurance needs. It gives a summary of the benefits and risks associated with, including general information about, the insurance as Well as a policy wording (that sets out the specific terms, conditions and exclusions of the cover provided).

Please keep this FSG along with Your policy documents in a safe place for future reference.

1. About Savannah

Savannah is an underwriting agency acting under a binding authority which means Savannah acts as an agent of the Insurer. Savannah does not act on Your behalf. Savannah acts on behalf of, and as agent of the Insurer.

2. Savannah’s Services

Savannah is authorised under its Australian Financial Services Licence (No. 329631) to provide general financial product advice (but not personal advice) on, and issue, general insurance including but not limited to the following insurance cover; Public Liability, Professional Indemnity, Management Liability, Commercial Motor, Crime & Fidelity Guarantee, Tax Audit and Personal Accident.

3. How Savannah is Remunerated

Savannah will receive a percentage of the gross premium (including taxes and charges) each time You buy a policy (including renewals) and for some variations. This does not increase the amount of premium paid by You. Savannah retains all the commission it receives from the Insurer as well as any fee it may receive for policy issuing and administration or back office services.

Savannah may also receive a profit share commission calculated as a percentage of the gross premium (including taxes and charges) from the Insurer based on the profit they earn on the portfolios underwritten by Savannah on their behalf.

Savannah may also charge You an administration fee when You first enter into a policy and on any variation, renewal or cancellation. This amount is payable in addition to Your premium.

Savannah’s staff are paid a salary. They may receive bonuses or other incentives and rewards depending on their performance relating to certain specific business criteria.

For details of Savannah’s remuneration, please contact Savannah within a reasonable time after receiving this FSG and before Savannah provide any insurance services to You.

4. What happens if You have a complaint?

Savannah has established formal internal dispute procedures to ensure that all enquiries and complaints are fairly and properly considered and dealt with. If You have an enquiry or complaint about Our services or the services of Savannah please phone Our Complaints Manager on (02) 8234 0416.

If Your complaint remains unresolved, please contact:

Savannah Dispute Resolution Manager



GPO Box 4920, Sydney NSW 2001 Tel: (02) 8234 0416 Fax: (02) 8078 0162 Email: [email protected]

If You are unhappy with Savannah’s response, or Savannah has taken more than fifteen (15) working days to respond, You should contact the Compliance Officer at: Lloyd’s Australia Limited

Suite 2, Level 21 Angel Place 123 Pitt Street, Sydney NSW 2000 Telephone: (02) 9223 1433 Facsimile: (02) 9223 1466 Email: [email protected]

If You are not satisfied with the outcome of either Savannah or Lloyd’s Australia Limited’s dispute resolution process You may lodge a written complaint with the Financial Ombudsman Service Limited (FOS) which can be contacted at:

GPO Box 3, Melbourne VIC 3001

Freecall: 1300 78 08 08 Fax: (03) 9613 6399 Email: [email protected] Web: www.fos.org.au

This service is offered to You free of charge and their decisions are binding on Savannah but not You.

5. Professional Indemnity Insurance

Savannah has professional indemnity insurance in place which covers Savannah and their employees for any errors or mistakes relating to their insurance services. This insurance meets the requirements of the Corporations Act and meets claims relating to an employee even after they cease to be an employee, provided that the Insurer is notified of the claim when it arises and this is done within the relevant policy period.

6. Privacy

Savannah are committed to protecting Your privacy. Information supplied to them by You (or Your intermediary) will only be Used to arrange the insurance product(s) with the Insurer. Savannah do not trade, rent or sell Your information and You can check the information they hold about You at any time. Savannah’s complete Privacy Policy can be accessed on Our Website www.savannahgroup.com.au or by writing to Savannah at the address shown in this FSG.

7. Contact details

If You need further information about Savannah’s products or services, or should You have any queries please contact Savannah or visit Our Website: www.savannahgroup.com.au

Savannah Insurance Agency Pty Ltd ABN 84 130 364 313 AFSL # 329631

GPO Box 4920, Sydney, NSW 2001

Tel (02) 8234 0416

Fax (02) 8078 0162




http://www.fos.org.au/



this certificate of insurance this notice contains ... · this 4th day of july, 2014 by...

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