What is an Incident?
An incident is any matter where injury or damage is a result and may give rise to a claim on the policy. When the instructor becomes aware of an incident it should be recorded to assist in the preparation of the claim. The ideal situation is that before an after each class the instructor asks the students if any of them have an existing injury / don’t feel well / are feeling very tired / taking medication that might effect their balance or breathing or their ability to perform certain moves / exercises. Any incident or concern raised should be written in the incident book / dated and signed.
What should you do for the injured person?
At all time you should render assistance to the best of your ability, including providing first aid by a qualified first aid provider as there should be one available anytime during training. Offer the injured person a drink, make them comfortable, render the appropriate duty of care and even follow up with a telephone call. You should never admit liability for any injury or damage that may have occurred. Contact your insurance company and complete a report.
What you should advise the injured player?
If you are asked if any of the injury is covered by insurance, you should refer them to your insurance broker for coverage specifics. However, in every case the first response to any injury cost is Medicare, then private hospital cover should the injured person have private health insurance, and then subject to the policy terms and conditions, the player accident policy may provide some benefits for any excess costs.
When are claim forms issued?
You should issue a personal injury claim form following a request for one from the injured player, their parent or guardian. You should not provide any advice as to what is covered, or any enquires as to coverage, you should refer them to them to PSC Insurance.
School Owners failing to comply with their duty of disclosure may entitle the insurer to reduce his liability under the contract in respect of a claim or may cancel the contract. If your non-disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning. N.B. The disclosure is especially important in matters relating to the physical risk, past claims, cancellations of insurance covers, the imposition of increased premiums etc. and any matters that might affect the acceptance of the risk (such as insolvency or criminal convictions).
Your duty of disclosure must be taken seriously as it may affect your right to claim. Disclosure is not limited to matters applying to the insured named in the policy but includes other past businesses or private insurances.
Utmost Good Faith
Insurance contracts are subject to the doctrine of Utmost Good Faith and this is part of the Law. Both parties must strictly adhere to utmost Good Faith. If you fail to do so, you may prejudice any claim. For example if a school owner stated he had 100 students when in fact he had 200 then the person is really under insured by 50%. The insurer may choose to reduce the payout of a claim by 50% leaving the school owner to pay the balance to claimant.
Lodging and Making A Claim
Contact your broker / the person who sold the policy to you.
What is claimable?
Refer to policy wording document