Service Providers Manual 2016-17
Participants in disability employment service programmes
DES Work Experience – Provider Insurance Manual
DoE Trim ID: D16/1131182
DSS ARC ID: D16/7233707
Table of Contents
Introduction ................................................................................................................................................................. 3
Contact details ............................................................................................................................................................ 9
Combined Liability ....................................................................................................................................................... 4
Limits of liability ....................................................................................................................................................................................... 5
Group Personal Accident ............................................................................................................................................ 6
Sum insured/capital benefits.................................................................................................................................................................... 7
Additional capital benefits ........................................................................................................................................................................ 9
Additional capital benefits ........................................................................................................................................................................ 9
Claims and Procedures ............................................................................................................................................. 10
Combined Liability – claim form ................................................................................................................................ 11
Personal Accident - claim form.................................................................................................................................. 12
2
Introduction
This insurance manual is a summary of the Liability and Group Personal Accident insurances arranged by Arthur J. Gallagher (AJG) on behalf
of the participants engaged in employment assistance programmes, employment and participation activities organised through the various
contracted providers and administered by the Department of Social Services (the Department).
This manual does not reflect all terms, conditions, exclusions and limitations of the actual insurance policies and it is only intended to represent
an outline of the coverage in force. Please refer to the policy documents for the actual terms and conditions, once these documents have been
provided to you by us.
You are strongly recommended to check all insurance policies arranged by AJG on your behalf and to let us know if, for any reason, you feel
that any particular insurance policy does not fully reflect your needs and requirements for cover.
AJG is responsible for:
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liaison, negotiation and placement of the insurances with appropriate insurers
administration of any claims reported under the policies
ensuring all claims have a reference which identifies the responsible Department
providing professional insurance advice to the Department of Social Services.
The Department is responsible for:
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ensuring that the information provided to AJG is current and correct
providing the employment service providers with copies of insurance documentation
provide policy advice to participants and service providers
ensuring any incidents that occur are appropriately and correctly reported AJG.
Employment Services Providers are responsible for:
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delivering Programmes that comply with all State and Federal legislation
providing all participants with a copy of the ‘Participants Insurance Manual’
providing assistance to participants in completing claim forms if required
ensuring any incidents that occur are appropriately and correctly reported to the Department as soon as practicable.
Combined Liability
Insurer
Pen Underwriting Pty Ltd
AFS Licence No. 290518
ABN 89 113 929 516
Policy number
GLS 13 0000003
Insured
Participants undertaking work experience in the Disability Employment Services Programme as administered by contracted employment
service providers on behalf of, or under funding arrangements administered by the Department of Social Services, or any department, agency
or authority of the Commonwealth which is responsible for administering each arrangement from time to time.
And/or its/their subsidiary and/or related bodies corporate, as defined in the Corporations Act 2001, (including those acquired or incorporated
during the period of insurance) for their respective rights and interests.
Period of insurance
From:
4.00 pm AEST on 30th June 2016
To:
4.00 pm AEST on 30th June 2017
Insured’s head office and any subsequent period for which the Insured shall pay or agree to pay and the insurer(s) shall agree to accept a
premium.
Business
Consisting principally but without limiting the generality, all activities of the insured:
a) now;
b) in the past including their predecessors in business and prior activities which have ceased or have been disposed of to the extent the
Insured retains a legal liability;
c) in the future; including:
i. farm and other activities related to Drought Force, and assistance with recovery from natural disasters.
ii. any activity where the Insured is deemed to have been the manufacturer of any Product;
iii. any other occupation incidental thereto, including the private work of every partner, officer, director, commissioner or employee;
iv. the provision of canteen, social and sporting clubs, child care facilities, welfare organisations, first aid, firefighting and ambulance
services.
v. any work performed, all other activities undertaken by or on behalf of the Insured and any occupation and/or business activity
incidental thereto.
4
Interested insured
The insured’s legal liability to third parties to pay compensation in respect of Personal Injury and/or Property Damage or Advertising Injury
occurring during the period of insurance within the territorial limits as a result of an occurrence and happening in connection with the business
or the insured’s products or any work performed by or on behalf of the insured, all as more specifically described in the policy.
Territorial limits
Anywhere in the world, except the United States of America and Canada.
Limits of Liability
General Liability $20,000,000 for any one claim or series of claims arising out of any one occurrence
Product Liability $20,000,000 for any one claim or series of claims arising out of any one occurrence and in the aggregate during any one
Period of Insurance.
Advertising Liability $20,000,000 for any one claim or series of claims arising out of any one occurrence.
Property in physical or legal control of the Insured $100,000 in respect of any one claim or series of claims arising out of any one
occurrence.
Deductible or Excess Nil
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Group Personal Accident
Insurer
QBE Insurance (Australia) Limited
ABN 78003191035
Policy number
AN A043966 PAD
Insured
Participants undertaking work experience in the Disability Employment Services Programme as administered by contracted employment
service providers on behalf of, or under funding arrangements administered by the Department of Social Services, or any department, agency
or authority of the Commonwealth which is responsible for administering each arrangement from time to time.
Period of insurance
From:
4.00 pm AEST on 30th June 2016
To:
4.00 pm AEST on 30th June 2017
Both local time at the insured’s head office and any subsequent period for which the insured shall pay or agree to pay and the insurer(s) shall
agree to accept a premium.
Business
Principally all work experience activities, and any other occupation incidental thereto, as administered by the contracted employment services
providers on behalf of the administering departments described in the insured above, or any department, agency or authority of the
Commonwealth which is responsible for administering each arrangement from time to time, and/or its/their subsidiary and/or related bodies
corporate, as defined in the Corporations Act 2001, (including those acquired or incorporated during the period of insurance) all for their
respective rights and interests.
Covering
Injury, including death, to Participants whilst engaged in the undertaking of any authorised work placements, as detailed above including direct
travel to and from such placements.
Territorial limits
Anywhere in the Commonwealth of Australia.
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Sum Insured/Capital Benefits
$250,000 and percentages thereof as per the following table.
Payable condition
Compensation payable
Death
100%
Permanent total disablement
100%
Permanent paraplegia
100%
Permanent quadriplegia
100%
Permanent unsound mind to the extent of legal incapacity
100%
Permanent and incurable paralysis of all limbs
100%
Permanent total loss of the entire sight of one or both eyes
100%
Permanent total loss of hearing in both ears
100%
Permanent total loss of use of both hands
100%
Permanent total loss of use of both arms
100%
Permanent total loss of use of both feet
100%
Permanent total loss of use of both legs
100%
Permanent total loss of use of one hand and one foot
100%
Permanent total loss of use of one hand and one arm
100%
Permanent total loss of use of one foot and one leg
100%
Permanent total loss of the lens of one eye
50%
Permanent total loss of the hearing in one ear
50%
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Sum Insured/Capital Benefits
Permanent total loss of use of four fingers and
thumb of either hand
75%
Permanent total loss of use of four fingers of either hand
40%
Permanent total loss of use of one thumb of
either hand, both joints
20%
Permanent total loss of use of one thumb of
either hand, one joint
15%
Permanent total loss of use of a finger, three joints
10%
Permanent total loss of use of a finger, two joints
8%
Permanent total loss of use of a finger, one joint
5%
Permanent total loss of use of all toes on one foot
15%
Permanent total loss of use of the great toe, both joints
5%
Permanent total loss of use of the great toe, one joint
3%
Permanent total loss of use of other toe, (each toe)
1%
Third degree burns and/or resultant disfigurement
which covers more than 40% of the entire external body
50%
Loss of at least 50% of all sound and natural teeth, including
capped or crowned teeth, but excluding first teeth and dentures
(to $10,000 in total for all teeth)
1%
Shortening of leg by at least 5cm
7.5%
Permanent Total Disablement not otherwise provided. The percentage we determine as being consistent with the Compensation provided in
this table but not exceeding 75%.
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Additional Capital Benefits
Sum Insured
Broken bones
$2,000 and percentages thereof as per the following list.
Payable condition
compensation payable
Neck, skull or spine
Hip
Jaw, pelvis, leg ankle or knee
Cheekbone or shoulder
Arm, elbow or wrist
Nose or collarbone
Foot or hand
In the case of an established non-union of any
of the above breaks, an additional
100%
75%
50%
30%
10%
20%
5%
Additional Capital Benefits
Sums Insured
Lifestyle modifications benefit
Disappearance capital benefits
Surviving spouse benefits
Dependent child benefit
Accidental HIV benefit
Out of pocket expenses
Domestic home help
Non-Medicare Medical Expenses
Deductible or excess Nil
$10,000
$250,000
$5,000
$5,000
$25,000
$200 per week / 52 weeks maximum
$200 per week / 52 weeks maximum
$20,000
5%
Aggregated limit $10,000,000 in respect of all claims arising during any one period of insurance except $2,000,000 in respect of all claims
arising from travel in any chartered or non-scheduled aircraft during any one period of insurance.
Contact Details
Mail:
Department of Social Services
Comcover Insurance Team
GPO BOX 7576 | Canberra ACT 2601
Phone: 1300 653 227
Email: [email protected]
Web: www.dss.gov.au
9
Claims and Procedures
What to do in the event of a claim
If you are a contracted services provider or host organisation engaged in delivering work experience programmes, you must report all claims
as soon as possible using the appropriate claim form provided in this manual, ensuring that all relevant questions are answered and attach
any relevant documents you may have.
When a participant is injured, you must
1. Provide assistance to the participant and notify any emergency services, if appropriate to do so.
2. Advise the participant to seek medical advice from a legally qualified and registered medical practitioner as soon as possible after
sustaining an injury.
3. Advise the participant that this is NOT a workers compensation claim and that they are not eligible for workers’ compensation benefits.
4. Advise the participant that they must claim the costs of any visits to a doctor and/or medical facility through Medicare. If possible,
participants should be referred to a bulk billing doctor to limit their out of pocket expenses.
5. Assist the participant to complete the personal accident claim form and forward to your relevant Departments’ liaison officer with any
supporting documentation e.g. doctors report, etc including any non-Medicare medical expenses incurred eg, physiotherapy, dental etc.
The Department will then provide this information to Arthur J Gallagher.
When a third party is injured or has their property damaged, you must
1. Provide assistance to the injured person and notify any emergency services, if appropriate to do so.
2. Take all reasonable steps, following an accident or loss, to protect any person or property from any further injury, loss or damage.
3. Never admit liability verbally or in writing, or make any statement implying fault or accepting responsibility. To do otherwise may
prejudice your claim with the insurers. The insurer has undertaken to accept the risks you have insured against, so it is their
responsibility to accept or reject liability.
4. Immediately record all details of:
(a) the incident.
(b) any third party who has, or may have, sustained injury, loss or damage.
(c) any witnesses to the accident or loss.
5. Complete the combined liability claim form and forward to your relevant Departments’ liaison officer with any supporting
documentation e.g. doctors report, etc including any non-Medicare medical expenses incurred eg, physiotherapy, dental etc. The
Department will then provide this information to Arthur J Gallagher.
6. Immediately forward any summons, writ or other legal demand to your relevant Departments’ liaison officer. The Department will then
provide this information to Arthur J Gallagher.
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Combined Liability – claim form
(This form is to be used when a third party alleges a Participant has been negligent and caused
injury or property damage)
REMEMBER: Under No Circumstances should you admit Liability or enter into any discussion or
correspondence in connection with any incident that could result in a claim being made against your
policy.
Name of Participant involved in the incident
Address of Participant involved in the incident
Email
Telephone Number
Please advise details of the Programme/Activity being undertaken
Date and time of the incident
Where did the incident occur?
Describe what happened
Was there any property damage? – if so please describe
Were there any witnesses? – if so please detail names, addresses and telephone numbers
Name and address of the Service Provider including details of Team Supervisor
DECLARATION
All the information that I/We have given in this Claim Form/Incident Report is true and complete
Signature of Participant
Date
Signature of Service Provider
Date
DES Work Experience – Provider Insurance Manual
DoE Trim ID: D16/1131182
DSS ARC ID: D16/7233707
Personal Accident - claim form
(If the claim is for permanent or partial disablement, the Insurers may require an additional form to be
completed)
Name of injured Participant
Address of injured Participant
Date of Birth
Email
Telephone Number
Please advise details of the Programme/Activity being undertaken
How did the accident happen?
Date and time of the accident
Where did the accident occur?
What were the injuries?
Name, address and telephone number of Medical Practitioner attending the Participant:
Has the participant previously suffered from this type (or similar) injury? YES/NO If yes, provide details
Provide details of any witnesses
Name and address of the Service Provider including details of Team Supervisor
DECLARATION
All the information that I/We have given in this Claim Form/Incident Report is true and complete
Signature of Participant
Date
Signature of Service Provider
Date
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