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Despite a hard-fought union campaign, the NSW Workers Compensation Legislation Amendment Bill 2012 came into effect 19 June 2012. The Legislation effectively removed workers' compensation coverage for employees travelling to and from their place of employment, except in special circumstances.
The HSU provides Journey Personal Accident Insurance for all financial members of the union to ensure that no HSU member is exposed to a loss of income if injured on the journey to and from work.
This information is intended to be a guide only and does not supersede the policy issued by the underwriter, AIG. If you have any questions regarding specific cover, please contact the HSU to discuss.
Summary of Benefits for HSU Members
The HSU Journey Personal Accident Insurance will provide HSU financial members with:
Income support of up to 85% of a member’s weekly wage to a maximum of $1500 per week.
Weekly income includes all your regular allowances and penalties.
Benefit period of up to 104 weeks.
Death Benefits o $10,000.
Capital benefits up to $100,000.
A table that specifies certain injuries where the policy will pay out a fixed amount (such as the loss of an arm or an eye).
Members are not required to use their own leave entitlements except for the first 14 days following a journey accident.
Weekly benefits will be paid monthly or fortnightly in arrears directly to the claimant via EFT.
Terms and Conditions
The Journey Personal Accident Insurance policy does not cover any medical expenses and is purely for income support.
To be entitled to the benefits of the policy, you must be a current financial member of the HSU.
You must be a full member of the Union at the time of the accident to be covered under this policy. Pre-existing medical conditions are not insured.
The cover under the Journey Personal Accident Insurance policy is provided at HSU’s discretion and the terms and conditions of the policy may be subject to change without notice.
Claims are adjudicated by Corporate Services Network (CSN) on behalf of the insurer AIG. Below are their contact details:
When completing the claim form, please ensure you are completing all sections of the form to the best of your knowledge. Additionally, you must advise of any other insurance that covers the same risk that you are entitled to claim under or have access to.
Where do I send my claim form?
Please send your completed claim form and supporting documents to Marsh and the HSU:
Your claim will be assessed within 10 business days of receiving all required information. You will be contacted if further information is required to assess your claim.
You must also follow the advice of or undertake the recommended treatment by a Doctor for your Disability, which includes seeking specialist treatment or undergoing rehabilitation and failure to do so, may result in the suspension or cessation of your benefits.
All Medical Certificate(s) provided must state the medical condition that is causing your disablement along with the expected duration of your disablement.
For ongoing disablement you, and your treating Doctor, will be required to complete Progress Doctor’s Statement (PDS) on a monthly basis, throughout the duration of your claim.
You may be required by the insurer to be examined by an independent medical officer of their choice. If so, the insurer will pay the costs associated with this examination. However, if you fail to attend the examination for any reason you will be required to pay any costs incurred. Your failure to attend the independent medical examination may result in the suspension or cessation of your benefits.
Complaints and Disputes
Any complaints or disputes are to be reported to HSU immediately. We will engage Marsh and/or CSN as required, to resolve the complaint/dispute.
Detailed Benefits under the Policy
Subject to the Policy Terms and Conditions, when you are medically certified unable to work for more than 14 consecutive days because of an Injury giving rise to a claim for Temporary Total Disablement you may be entitled to receive 85% of your average weekly Salary up to a maximum of $1,500 per week.
A proportional benefit (Temporary Partial Disablement) may be paid if you can return to work in a partial capacity. Temporary Total Disablement or Temporary Partial Disablement must occur at or within 12 months from the date of Injury.
Benefits will cease when you are able to return to work in full capacity; or on your 75th birthday; or after the benefit payment period has been exhausted; or in the event of your accidental Death (whichever event occurs first).
Maximum period of time for which Weekly Benefits is paid under the policy:
Between the ages 16-65 years – Aggregate Period 104 weeks
Between the ages 66 to 70 years – Aggregate Period 52 Weeks
Between the agers 71 to 75 years – Aggregate Period 26 weeks
The amount of any benefit payable for Weekly Benefits will be reduced by the amount of:
Weekly or periodical disability benefits under any other policy of insurance; and/or
Weekly or periodical disability benefits under any Workcover or Workers Compensation Act or other statutory body having a similar effect, or under the Wrongs Act, or any Compulsory Third Party or Motor Vehicle Act, or Transcover or Transport Accident Act or other Statutory body having similar effect; and/or
Earned income from any other occupation
So that the total of all payments and/or Compensation does not exceed 85% of the average weekly income or $1,500, whichever is lesser.
If you receive a Lump Sum payment at a future date you may be required to reimburse the Insurer to ensure that the total benefits received do not exceed the total benefit entitlement.
Frequently Asked Questions:
What am I covered for?
The Journey Personal Insurance policy will cover you for 85% of your weekly wage, up to a maximum of $1500 per week. The Policy also provides a death benefit of $10,000 and a ‘table of maims’ where you may receive one off payments for specific injuries up to $100,000.
Is there an excess period/waiting period?
There is no journey insurance claim payable for the first 14 days of being off work resulting from a journey accident. This is the excess period and you will need to use any sick leave or other leave entitlements to cover this period off work.
What is the Age Limitation?
The age limit is between 16 years to 75 years of age.
Will my fees go up for this insurance?
No. The Journey Personal Accident Insurance Policy is paid out of existing membership revenue.
What if I become unfinancial with the Union, am I still covered?
No. If you become unfinancial you will not be covered any longer by the Journey Personal Accident Insurance Policy. If you have an ongoing claim it will cease if you become unfinancial.
Is there a wait period to be covered?
No, the policy is available to members as soon as they join and have made their membership payment.
When am I covered?
Cover commences from the time the financial member undertakes direct travel to and from work and ceases upon arrival at either their normal residence or place of employment, whichever is their destination. Once the member crosses the boundary of their property the journey is considered to have started or finished.
What if I stopped on the way to or from home and work?
Any injury that is sustained before, during, or after, any substantial interruption of, or substantial deviation from the journey, made for any reason unconnected with the employment is excluded by this policy.
How are payments made to members?
Weekly Benefits are paid directly to the member making the claim via EFT. Death benefits are paid into the estate of the member.
Am I required to take all my sick leave or any other leave before I can claim?
You are only required to use your own sick leave for the first 14 days after a journey accident. Following the first 14 days period, income benefits will be paid to you. Following the expiry of the elimination period of 14 days, you can only receive weekly benefits under the Policy if you are not receiving any sick leave payments. You are unable to be paid both at the same time. However, if you have taken sick leave before the claim is accepted your insurer will reimburse you via your employer for the Sick Leave in excess of the Elimination Period of 14 days subject to:
a) Written confirmation from your employer that the Sick Leave has been re-credited; and
b) You gaining approval from your employer to accept payment and providing the payment details of your employer.
If you cannot secure the agreement of your employer then the insurer will not pay the benefit.
Can I claim for medical expenses?
No. Medical expenses coverage or rehabilitation costs benefits are not payable under this policy.
I perform some regular overtime and work weekend or night shifts. Will I be paid for these if I am from a journey accident policy and make a claim?
Yes. Your weekly income benefit under this Policy includes an average of all your penalties, overtime and allowances that you earned over the previous twelve (12) months.
I have an income protection policy; can I receive benefits from both my income protection policy and the Journey Insurance?
You are not entitled to get paid twice for the same loss of income. The Insurer will share the costs with your other income protection policy provider.
How does the Traffic Act and Workers Compensation Act affect a Journey Accident claim process?
Claims are reviewed on a case by case basis in relation to their likely acceptance under relevant Traffic Act and Workers Compensation Law. Whilst there is an obligation for the insured to pursue a claim via these routes, the insurer will consider providing benefits to an insured, whilst they proceed with these claims against any Traffic Act or Workers Compensation Act, if it is believed that there is a possibility that this claim would not be successful.
If the insurer has paid a benefit to a member who is subsequently successful with their claim against any Traffic Act (CTP green slip)/Workers Compensation, the funds received via their claim would be used to reimburse the insurer for payments made to the insured against this policy.
What happens if I have an accident after I have consumed alcohol?
The journey cover policy shall not apply to any event directly or indirectly arising out of you being under the influence of alcohol or having a blood alcohol content over the prescribed legal limit or being under the influence of any drug other than a drug taken or administered by, or in accordance with the advice of a legally qualified practicing medical practitioner.
If I am only getting 85% of my weekly wage under this policy, can I top up my weekly wage payments with some additional sick leave?
If you do, it will reduce the benefit payable to you under this policy. For example, if an Insured person uses up 2 days of their sick leave, then the Insurer will only pay 85% of the remaining 3 days income that you would have earned, had you remained at work.
How will the insurance company calculate the Journey Accident Insurance payments?
Your income will be averaged over the previous twelve (12) months period and divided by 52 weeks prior to the injury which takes into account any paid and/or unpaid leave over that period. This means that a period of no income will be counted in the 52 week calculation.
What happens in the event of a 'Relapse of Injury?'
You will be covered for a maximum of 104 weeks (or as per the aggregate period) from the date of the original injury.
Would the personal information I provide be kept confidential?
Yes. The information provided will be kept confidential in accordance with the Privacy Act 1988 cth.
Is tax deducted from Journey claim payments?
Yes. Members must provide a tax file declaration at the time of the claim to enable tax to be paid to the ATO on behalf of the claimant.