equestrian australia national insurance programme presentation to ea 27 th may 2012
TRANSCRIPT
Equestrian AustraliaNational Insurance Programme
Presentation to EA
27th May 2012
Brett DuprezSports and Services
Division Manager
Kathryn ThomsonEA Account Broker
Gow-Gates Insurance Brokers
The following presentation is a summary based on the Equestrian Australia National Insurance Programme.
Before acting on any information contained in this presentation you should refer to the
full Product Disclosure Statement (PDS) and Policy Documents contained in the
“2011-12 Equestrian Australia Insurance Manual”.
This programme is designed to provide a uniform and basic level of cover for Personal Accident insurance for Equestrian in Australia.
It is not designed to replace the need for Private Health Insurance and/or
Income Protection. We encourage you to assess these policies in line with your own individual circumstances.
Important Information
Overview
• Introduction
• Insurers
• EA Insurance Programme– Personal Accident– Public and Products Liability– Professional Indemnity– Management Liability
• Claims Process overview
• ‘Safe Equestrian’ & Risk Management
• Questions
Insurers
• Sportscover Australia Pty Ltd (Lloyds Syndicate 3334)– Personal Accident
– General Liability & Professional Indemnity
• Chartis Insurance (American Home Assurance, formerly AIG)– Management Liability
QUALITY INSURANCE AT A SPORTING PRICE
EA National Insurance Programme
Snapshot –
• The Insured and Insured Person(s) – Who is Covered ?
Cover provided to the Insured and Insured Person(s) in the following classes;
– Personal Accident
– Public and Products Liability Insurance
– Professional Indemnity Insurance
– Club Management Liability
Personal Accident
Who Is Covered ?
• The Insured :
- Equestrian Australia Limited (EA), State Branches, direct members, coaches, officials, committees, subcommittees, affiliated associations and affiliated clubs
• Insured Persons :
- All EA direct members, coaches, managers, administrators, voluntary workers, selectors, referees and other officials, medical officers, physiotherapists, masseurs and ambulance officers; and all directors, officers, employees, executive officers, office bearers and committees of the Insured
When Is Cover Provided ?
• Category 1 – EA Direct Members
All direct members of EA, 24 hours a day 7 days a week whilst engaged in NON-INCOME earning equestrian activities
Excluding travel to and from such activities
• Category 2 – Coaches
All EA Registered Coaches 24 hours a day 7 days a week whilst engaged in coaching
Excluding travel to and from such activities
When Is Cover Provided ?
• Category 3 – All Other Insured Persons
All other specified insured persons of EA, whilst engaged in EA or Affiliated Club organised activities
(includes Administrators, Managers, Directors, Committee Members, Voluntary Workers, Officials, Judges, Course Builders, Selectors, Medical Officers)
Excluding travel to and from such events
Excluding Category 1 & Category 2 Insured activities
When Is Cover Provided ?
Major benefits under the Personal Accident policy include;
• Capital / Lump Sum Benefits
• Non-Medicare Medical Benefits
• Weekly Benefits
• Additional Benefits
Structure of Benefits
Personal Accident
Capital Benefit
This section provides a lump sum benefit to Insured’s that suffer permanent injuryor death.
The maximum sum insured under this section is $60,000 (Under 18 $25,000)
Lump Sum Benefit for Permanent Injuries
e.g. Paraplegia / Quadriplegia $60,000 Loss of Sight - One Eye $30,000 (50%) Loss of Use - One Arm $21,000 (35%) Loss of Use - One Finger $2,400 ( 4%)
A complete list of percentages is available in the policy wording
Personal Accident
Medical Expenses (Non-Medicare Medical Benefits)
Important: National Health Act 1973 prevents insurance companies (apart from licensed
Private Health Insurers) to cover Medicare items or the “GAP”.
Benefit Payable: Maximum Claimable $3,500
85% of Non-Medicare Medical Expenses$100 Excess
Claimable: Ambulance Physio / Chiro Dental Private Hospital Accommodation
Not Claimable: Doctors & Surgeons Fees X-Rays Wholly or Partly Medicare
Weekly Benefits
• Loss of Income –85% of Net Weekly IncomeMaximum Benefit $500/wk Excess Period 14 daysMaximum Benefit Period 104 weeks
• Non-Income Earner –Domestic Help Benefit $200/wk Maximum Benefit Period 26 weeks
• Student Assistance –Tutor Benefit $200/wk Maximum Benefit Period 26 weeks
Personal Accident
Additional Benefits
• Out of Pocket $1,000
• Clothing $500
• Emergency Accommodation $500
• Overseas Medical $5,000
• Funeral $5,000
A complete list of benefits and conditions applicable is available in the policy wording
Personal Accident
Claims Example
• A parent volunteering at a Club rally day, slips over in the canteen
• Hospital via ambulance - Broken Leg
• Surgery
• Transferred to private hospital for 1 week
• Referred to a physio for ongoing treatment
• Unable to return to work for 6 weeks ($600 / week Net Income)
Claims Example Continued
Private Practitioner Visit Scheduled amount covered by Medicare
(*Gap not covered)
Specialist SurgeonScheduled amount covered by Medicare
(*Gap not covered)
X-RayScheduled amount covered by Medicare
(*Gap not covered)
Private Hospital accommodation 7 days @ $220 / Day
$1,540.00
Theatre Costs $ 600.00
Ambulance Cost $ 300.00
Sub Total $2,440.00
Benefit payable 85% $2,074.00
Physiotherapy – 5 visits @ $40 per visit ($200) 95% for each visit $190.00
Less excess $-100.00
TOTAL NON-MEDICARE EXPENSES PAID $ 2,264.00
Loss of income 6 weeks @ $600/week Salary(14 days excess applies, $500/week maximum
applies)$2,000.00
TOTAL CLAIM PAYMENT $4,264.00
All Insurance policies contain exclusions. In the case of Sports Injurypolicies, some injuries are excluded;
For example –
- Riding of Mechanical Bulls/Horses- Being under the influence of alcohol or drugs- Engaging in or taking part in any Sport/s other than Equestrian- Any pre-existing defect, infirmity or sickness- Arising out of failure to seek or follow medical advice- Any medical or surgical procedure performed for any gradually developing
Bodily deterioration whatever the cause of that deterioration.- Preventative measures rather than for the treatment of a Bodily Injury.
Complete details of all exclusions are contained within the policy wording.
Personal Accident – What is Not covered ?
Public & Products Liabilityand
Professional Indemnity
• The Insured :
- Equestrian Australia Limited (EA), State Branches, direct members, coaches, officials, committees, subcommittees, affiliated associations, affiliated clubs, members of affiliated associations and clubs
• Insured Persons :
- All direct members, coaches, managers, administrators, voluntary workers, selectors, referees and other officials, medical officers, physiotherapists, masseurs and ambulance officers; and all directors, officers, employees, executive officers, office bearers
and committees of the Insured.
Who Is Covered ?
When Is Cover Provided ?
• 1) EA National Body, State Branches- At all times for activities ancillary to their occupation
• 2) EA Direct members - At all times whilst involved in non-income earning equestrian activities
• 3) EA Coaches- At all times whilst coaching (as an individual)
The EA programme does not extend to coaches’ businesses
• 4) Affiliated associations and clubs- At all times for activities ancillary to their occupation
• 5) Other Insured Persons- whilst engaged in EA or affiliated club organised
activities
• This includes a Loss or Claim whilst participating in or administering Equestrian.
• This policy provides protection for all Insured’s for a Loss which a person or entity becomes legally obliged to pay on account of a Claim.
• The indemnity provided under the policy protects the Association, Club and/or Insured Persons for the legal liability to third parties for;
– Personal Injury– Property Damage– Legal Defence Costs whilst defending a Claim under the policy
Waivers still to be completed and signed
Public and Products Liability
• Limits of Liability :
- $20,000,000 Public Liability - Any one occurrence
- $20,000,000 Products Liability - Any one period of insurance
- $100,000 Property in Care, Custody and Control
• Deductible :
- $2,500 All claims
Public & Products Liability Insurance
Claim Example
• During a cross country event, a rider is injured at the water jump due to a protruding object. The rider sues the host club for failing to provide a safe competition environment.
• The EA Insurance programme covers:
- Defence costs for the club
- Damages payable by the club
Claim Example
• A spectator purchases a sausage sandwich from the BBQ at a competition and contracts food poisoning, suing the manufacturer and the club.
• The EA Insurance programme covers:
- Defence costs for the club
- Damages payable by the club
When is Cover Not Provided ?
Major exclusions include but are not limited to;
• Liabilities arising out of Claims or Incidents occurring in the USA or Canada.
• Asbestos
• Childcare or Childminding facilities
• Property undergoing construction, erection, addition or alteration – unless the total cost of the works is under $50,000.
• Solarium Use
Professional Indemnity
• This policy provides coverage for the Insured’s legal liability for a breach of professional duty in the sport of Equestrian by reason of an act, error or omission committed or alleged to have been committed in connection with the Insured’s Equestrian activities.
• Insured Persons are protected whilst administering, officiating, judging or coaching on behalf of the Association or Club.
Important:• ‘Claims Made Policy’ means that incidents and claims must be
notified during the period of insurance.
Professional Indemnity
• Limits :
- $20,000,000 Any one claim and in the Aggregate
• Deductible :
- $2,500 All claims
Claim Example
• Direction is given for a rider to perform half pass during a dressage lesson. The horse misbehaves and the rider falls. The rider then sues the coach for giving instruction that was beyond the riders capabilities.
• The EA Insurance programme covers:
- Defence costs for the coach
- Damages payable by the coach
When is Cover Not Provided ?
Major exclusions include but are not limited to;
• Known Circumstances that are not notified to the insurer during the policy period
• Actions prior to the Inception Date – The policy does not cover any claim arising from actual or alleged act, error, omission or conduct occurring prior to the inception date.
• Arising from non-medically prescribed drugs
Management Liability(Directors & Officers)
Management Liability
Covering the administration and management of your EquestrianAssociation or Club;
• Provides protection for the Club, it’s Directors, Officers and committee members as a result of any wrongful act whilst acting for and carrying out their duties on behalf of the club.
• The cover protects the Club against legal actions or civil proceedings made against the Club or it’s officials for any wrongful act, employment breach and/or employee fraud that is notified to the insurer during the period of insurance.
Important:• ‘Claims Made Policy’ means that incidents and claims must be notified during the
period of insurance.
Management Liability
• Limits & Deductibles :
- Management Liability $20,000,000 (Nil excess)
- Corporate Liability $20,000,000 ($2,000 excess)
- Employment Practices Liability $20,000,000 ($2,000
excess)
- Crime Protection (Fidelity) $250,000 ($2,000 excess)
- Superannuation Trustees Liability $500,000 ($2,000 excess)
- Statutory Liability $1,000,000 ($2,000
excess)
Claim Example
• An employee is sacked by a State Branch. The employee alleges wrongful dismissal and takes action against the State Branch.
• The EA Insurance programme covers:
- Defence costs for the State Branch
- Damages payable by the State Branch
- Up to $100,000 for Public Relations to protect the reputation of the branch
- Costs of investigating the claim
When is Cover Not Provided ?
Major exclusions include but are not limited to;
• Liability arising from Bodily Injury or Property Damage
• Prior and pending litigation - The policy excludes claims arising from any circumstance prior to the commencement of the insurance that you were aware of that may eventuate in a claim under the policy.
Important:• ‘Claims Made Policy’ means that incidents and claims must be notified during
the period of insurance.
Claim Process Overview
Claims Procedure
Personal Accident Claims
• Contact Gow-Gates via phone, email or via the Gow-Gates Equestrian Insurance Website
• Complete the online claim notification on our website (pre-filled claim form will be sent by Sportscover)
• Obtain and complete a claim form available from Gow-Gates (or the Gow-Gates Equestrian Insurance Website)
• Lodge the claim form with Sportscover
• Submit additional paperwork as requested
Online Claims Gow-Gates have recently developed an EA specific website, which includes
policy information, online claim lodgment and claim tracking –
• Online Claim Forms
Claims Procedures – Other Risks
Public & Products Liability Claims
Professional Indemnity Claims
Management Liability Claims
• Contact Gow-Gates immediately to notify of any potential claim
• DO NOT admit liability under any circumstances
• Early notification and early intervention is critical
Risk Management and Risk Control
Risk Management Consultants
Continuation & Maintenance of Club Activities
Legal Responsibility
Social Responsibility
i.e. Competitor & Organiser Safety
Spectator Safety
Protect Good Reputation
Why ?
• Statutes
OH&S Legislation
Environmental
Health Regulations
Animal Welfare• Common Law
Duty of Care
Standard of Care
Foreseeable
Legal Responsibility
“Risk”:
The chance of something happening that will have an impact upon operations. It is measured in terms of consequence and likelihood.
What is Risk ?
“Risk Management”:
The SYSTEMATIC APPLICATION of management policies, procedures & practices to the activities and facilities.
What is Risk Management ?
Risk Assessment:
What can go wrong?
Risk Control
What can we do about it?
Management of Risk
• What can we do about it?
Prevention
• is about reducing(elimination) of risk to the lowest reasonable (manageable) level
Protection• to control circumstances by reducing hazard or
potential severity
Risk Control
The interaction of a person with the hazard or environment by:
UNSAFE BEHAVIOUR
Competency Level
Inexperience
Stress/Fatigue
TimeUNSAFE CONDITIONS
Unsuitable equipment & layout
Inadequate maintenance
Poor housekeeping
Contributing Factors
Where are the clubs at ?
The application of; • Guidelines for the Development of Risk Management
Policies and Plans
• EA Risk Management Guide
• EVENT RISK MANAGEMENT PLAN / MANUAL
• Risk Management & Control Schedule
• Event Risk Management Checklist
Where are Clubs at ?
Risk Management Policy & Plan including:
Responsible Officers Event Set Up & Inspections
Arenas Venue & Parking Areas
Horse Floats Horse & Rider Assessment
Waivers Accreditation
First aid Emergency Services
What is Covered ?
• Event typical entry points;
Risk Improvement Area
Do you have appropriate signage at entry points to the event and restricted areas? Limited signage & No Conditions of Entry
• SAMPLE – SAMPLE –
Conditions of Entry SignConditions of Entry Sign
Improvement
• Electrical Cables;
Risk Improvement Area
Risk Improvement – Electrical Cables should be installed & used to appropriate standards
• Spectator Stands;
Risk Improvement Area
Risk Improvement – Stands to be installed & maintained to appropriate standards
• No Signage Standards;
Risk Improvement Area
Risk Improvement – Review Signage Standards
• Event typical entry points;
Risk Improvement Area
Risk Improvement – Use of Plastic Posts
Steel Posts
Timber Posts
• Uncapped Steel Posts;
Risk Improvement Area
Risk Improvement – Develop standard for Star Posts
Uncapped Steel
Star Posts
Capped Steel Star Posts
Review Standards for Event Operations
Develop Method Statements for
Condition of EntrySpectator Control
Signage StandardsContractor Controls
Develop a Safety Alert System for Clubs
Where to from here ?
References
Equestrian Australia Risk Management Guides
Guidelines for Managing Risk in Sport & Recreation(HB 246)
AS/ 4360:1999 Risk Management
Code of Practice for the Horse Industry - AIHC
Linkswww.equestrian.org.au www.horsesport.org
Risk Improvement Area
Questrians ?
For further information regarding the EA National Insurance Programme or additional coverage, please contact
www.gowgatessport.com.au/equestrian
02 8267 9999 or 1800 811 371
Thank You!
Contact Details