Endorsements
Endorsements are specific changes made to the base policy wording. The impact of the LCIS endorsements attaching to this policy wording are to broaden the cover for most community groups but there are still activities or circumstances which are beyond the bounds of insurability or better covered by a different type of insurance.
While the endorsements are amendments which tailor the standard wording to reflect the risks of most community groups and give a winder scope of operation to the base policy there are still exclusions that apply to the cover. Contrary to popular belief the exclusions are not there because insurers try to avoid paying claims. Exclusions apply because the activity or risk excluded is either beyond the bounds of insurability (intentional injury, suicide, war, terrorism), against the public interest (being under the influence of alcohol or illicit drugs); better covered by a specialised insurance policy (flying or other aerial activity in an unlicenced aircraft). What is important is the policy does largely cover the activities of volunteers working on behalf of most community groups. The endorsements to this policy are shown in the section headed Policy Extensions, the standard policy exclusions are listed under the heading Exclusions further down this page.
Read our Volunteer Workers Personal Accident Insurance policy wording.
Policy Benefits
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Payment of 100% of income up to the amount shown on the policy Schedule and for up to 104 weeks.
No waiting period applies to this section.
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No lower age limit cutoff.
No upper age limit cutoff but the Capital Benefit sum insured for any person aged over 85 years is reduced to $10,000.
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Out of pocket expenses related to the injury of up to $10,000. This includes Non-Medicare Medical Expenses* with reimbursement of 100% of all non-Medicare medical expenses incurred as a result of personal injury.
*NOTE: The Non-Medicare Medical Expenses benefit may not be payable to all injured volunteers. Cover in this area is regulated by the [Commonwealth] Private Health Insurance Act 2007 and the Rules attaching to the Act.
- This policy covers volunteers anywhere in Australia
Endorsements to the policy wording
Page 6.
Definition “Pre-disability earnings” is amended to read as follows:
“Pre-disability earnings” – If an insured person is self employed:
- gross weekly income from personal exertion after allowing for costs and expenses incurred in deriving that income averaged over the 12 months prior to injury or any shorter period that they have been engaged in their occupation.
If an insured person is an employee:
- basic weekly base rate of pay inclusive of overtime payments, bonuses, commission or allowances averaged over the 12 months prior to the injury.
Definition “Voluntary work” is amended to read as follows:
“Voluntary Work” – voluntary work performed on behalf of you and includes necessary direct travel to from and during such voluntary work and where the performance of voluntary work does not receive any remuneration. The reimbursement of reasonable expenses incurred whilst performing voluntary work does not constitute remuneration.
Page 7
Section A – Capital Benefits
The first paragraph is amended to read
If you have chosen this cover it will be shown on your Policy Schedule. The amount shown as the Capital Benefit will reduce to $10,000 for any injured person who is over 85 years of age.
Page 9
Section D – Injury Assistance Benefits is amended to read as follows:
Delete the paragraph headed Injury assistance – injury
Delete the table headed Compensation Table – Injury Assistance Benefits
Include the following
OUT OF POCKET AND NON MEDICARE MEDICAL EXPENSES BENEFIT
(APPLIES TO PERSONS ACTING IN A VOLUNTARY CAPACITY ONLY)
Should an Insured Person suffer Injury We will reimburse 100% of Out of Pocket including Non Medicare Medical Expenses incurred to a maximum of $10,000.
Any payable condition claimed must occur within 12 months of the date of injury.
This policy only pays Non Medicare Medical benefits as permitted by Private Health Insurance Act 2007 and the Rules attaching to the Act.
“Non Medicare Medical Expenses” means expenses paid by an Insured Person occurring within twelve (12) calendar months of the date a claim is accepted for:
Relevant Health Services as defined under the Private Health Insurance 2007 Act Rules at Part 4; Section 13 (2)
Out of Pocket Expenses are defined as: All Costs incurred by an Insured Person following personal injury which are not recoverable from any other source including but not limited to Non Medicare Costs, Non Medical Costs, Home Help, Travelling Costs and the like.
In the event of an Insured Person becoming entitled to a refund or all or part of such expenses from any other source We will only be liable for the excess of the amount recoverable from such other source.
We shall not be liable for any payment in respect of the rendering of a professional service for which Medicare benefit is, or would be payable in accordance with the Health Insurance Act 1973.
Page 10
Additional Exclusions applying to this policy
Delete: paragraph at end of point 7
We will not pay for any claim under any section of the Policy if:
- The Insured Person is over 80 years of age.
- The Insured Person is under 12 years of age.
Replaced by:
We will not pay for any claim under Section B of the Policy if:
- The Insured Person is over 85 years of age.
Exclusions
- War; Terrorism; Radioactivity
- Being under the influence of intoxicating liquor or drugs unless prescribed by a medical practitioner;
- Alcoholism, drug addiction
- Whilst training or participating in any professional sport;
- Flying other than as a fare paying customer of a recognised airline;
- Intentional self-injury, Suicide;
- Psychotic or psychoneurotic disorders
- The insured person’s criminal or illegal act
The above statements are issued as a matter of information only and for full terms and conditions you should refer to the policy wording.