How to Make a Personal Injury Claim
For Football NSW
Option 1 – Complete Online
Submit your claim online.
Complete and submit all personal information and injury details relating to your claim online.
Following your online claim lodgement, JLT Sport will email you 3 separate Declarations that need to be completed and signed by your Club, your treating Physician and/or your Employer.
The Declarations can be printed and filled in manually or emailed straight to the relevant person for them to print, complete and return to the Insurer on your behalf.
If you have any questions about this process please contact JLT Sport on 1300 130 373.
Option 2 – Complete Manually
- Obtain and complete all relevant sections of the Personal Injury Claim Form
- Send your completed form to QBE Insurance within 90 days from the date of injury (earlier is preferable). QBE’s address for completed claim forms is:
QBE Insurance Australia
GPO Box 4108
Sydney NSW 2001
- QBE Insurance will confirm receipt of your claim and/or make contact with you should they require further information.
- Obtain and complete all relevant sections of the Futsal Personal Injury Claim Form
- Send your completed form to Football NSW Futsal Department within 90 days from the date of injury (earlier is preferable):
Football NSW Futsal Department
PO Box 6146
Baulkham Hills BC NSW 2153
- Football NSW will confirm receipt of your claim and/or make contact with you should they require further information.
The Health Insurance Act (Cth) 1973 does not permit the Insurer to contribute to any charges covered by Medicare (including the Medicare Gap).
|Examples of Non-Medicare Medical items||Examples of items covered by Medicare|
|Claimable as per the Policy Wording||Not claimable as per Health Insurance Act 1973|
|Private Hospital Accommodation||Anesthetist|
In addition, there will be no refund in respect of:
- Any expenses recoverable by You from any other insurance scheme or plan providing medical or similar coverage or from any other source except for the excess of the amount recoverable from such other policies/plans.
- Any expense to which the National Health Act (Cth) 1953 or any of the regulations made there under apply.