Protect s guide for INJURY & ILLNESS INSURANCE

Transcription

1 Protect s guide for INJURY & ILLNESS INSURANCE

2 Protect administers Australia s leading personal injury and illness insurance cover for electrical workers. The insurance policy is held by the Electrical Trades Union Victorian Branch and is issued by ATC Insurance Solutions. Protect Injury and Illness Insurance including ETU Protect Extra Cover, is intended primarily to support members facing the challenge of non-work-related injury or illness. Workplace injuries and illnesses are covered by your State workers compensation scheme and, as such, no benefi ts are payable by Protect s insurers (except in the event of death or total and permanent disablement or if transport/workplace accident top-up benefi ts are payable). This brochure has been produced to assist workers in understanding the general benefi ts that apply under the cover administered by Protect and the circumstances under which those benefi ts are claimable. The Protect Injury and Illness Insurance cover will be reviewed by the policy holder in December The policy benefi ts detailed in this brochure are correct at the time of publication but may be updated or altered, in consultation with the policy holder, at any time. Workers and others should check with ATC Insurance Solutions to understand the full policy benefi ts, exclusions and limitations applicable at the date of the injury or illness. This brochure is intended to provide a general summary of ATC s policy wording. It does not purport to contain all information that may be relevant and is provided as a matter of general interest only. This is not the Insurance Policy wording. Conditions and exclusions apply to the benefits detailed in this brochure. Workers and others should check the accuracy, reliability and completeness of any information provided and, if necessary, obtain independent and specific advice relevant to their needs. Note: All claims are managed and processed by ATC Insurance Solutions. Protect administers and distributes the Protect Injury and Illness Insurance and ETU Protect Extra Cover products. For advice in relation to benefits and claims, you must contact ATC Insurance Solutions. ATC Insurance Solutions Level 2, 499 St Kilda Road Melbourne VIC 3004 Web Phone (03) Fax (03) Freecall

3 CONTENTS PROTECT INJURY & ILLNESS INSURANCE 6 What is covered? 7 Weekly income protection benefits 7 Transport accident/workplace injury claim top-up benefits 8 Lump sum death and injury (capital) benefits 10 Additional benefits 16 ETU PROTECT EXTRA COVER 18 Bigger lump sums 19 Extra claims support 20 Exclusive benefits 21 What is covered? 22 ETU MEMBER BENEFITS 28 Emergency transport cover 28 ETREC ETU contractor members 28 ETU rt health plan 29 Insurance notes 30 How to make a claim 30 What is NOT covered? 32 Limitations on what is covered 33 Protect Injury & Illness Insurance Handbook 3

4 ETU and Protect delivering for you and your family The ETU Victorian Branch campaigned and won Australia s best income protection and personal injury and illness insurance for electrical workers. More than 3,180 electrical workers, faced with the diffi culties or injury or illness, have benefi tted from Protect Injury and Illness Insurance and ETU Protect Extra Cover during the last ten years. During that time, more than $38 million in insurance benefi ts has been paid to Protect members. It s extremely rewarding to see that the Protect insurance has been of such great support to members and their families. And that s why the ETU Victorian Branch has regularly negotiated long and hard with Protect s insurers, ATC Insurance Solutions, to achieve even better insurance protection for both Protect members and for fi nancial members of the Union. ETU Directors of ElecNet (Aust) Pty Limited (as trustee for Protect): L-R Troy Gray (ETU Assistant Secretary); Dean Mighell (Chair and ETU Victorian Branch State Secretary); and Howard Worthing (ETU Assistant Secretary). 4 Protect Injury & Illness Insurance Handbook

5 If you are an ETU fi nancial member, and you are covered by Protect Injury and Illness Insurance, you ll automatically get higher benefi ts, broader cover and increased claims support through ETU Protect Extra Cover. In fact, for serious trauma injury claims, ETU Protect Extra Cover delivers you benefi ts that are generally seven and a half times higher than benefi ts available with other industry insurance schemes. And the Union has now employed ETU Member Welfare Offi cer, Pat Tutton, to assist Protect ETU members. The Welfare Offi cer can provide information on ETU Protect Extra Cover benefi ts, exclusions and limitations, or assist members in completing a claim form. For contact details, refer to the How to make a claim section in this handbook. ETU Protect Extra Cover benefi ts fi nancial members of the Union at no extra cost to your employer. It s just another way the ETU Victorian Branch is delivering for you and your family. $38 million in injury and illness insurance benefits was paid to Protect members during the past decade. Protect Illness Injury & Illness Injury Insurance Handbook 5

6 Protect Injury & Illness Insurance > 6 Protect Injury & Illness Insurance Handbook

7 What is covered? 1. Weekly income protection benefits NON-WORK-RELATED INJURY OR ILLNESS Protect Injury and Illness Insurance provides global income protection, 24 hours a day, 7 days a week, for members who are sick or injured and unable to work. PROTECT PREMIUM INCOME PROTECTION* Up to $1,200* per week for tradespersons Up to $750 per week for apprentices If you suffer an injury or illness and you become totally or partially disabled as a result, you will receive 100 per cent of your income (including all overtime and allowances) up to the applicable Protect maximum weekly income protection rate. EXAMPLE: If your average weekly income (before personal deductions and tax) as a tradesperson is $950, you will receive $950 per week. If your average weekly income is $1,400, you will receive the Protect maximum income protection rate of $1,200* per week. If you are only partially disabled and able to return to work in a reduced capacity, you will receive the weekly rate (as calculated above) less any income you receive from your employer. Unlike some other industry insurance schemes, you are generally not required to exhaust all of your available sick leave before making a Protect income protection claim. The Protect maximum weekly income protection rate is also signifi cantly higher than the maximum rate offered by other leading insurance schemes. *Note: Higher maximum income protection benefi t rates may apply at some major projects and with some participating employers; check with the Electrical Trades Union in your State. Protect Injury & Illness Insurance Handbook 7

8 A 14-day consecutive waiting period applies to each claim, generally commencing from the day after you seek medical treatment from a registered medical practitioner. Unlike some other industry insurance schemes, weekly income protection benefi ts are also payable if you are injured training or playing amateur sport. However, a reduced maximum benefi t period applies (refer limitations on cover). Income protection cover is for non-work-related injuries and illnesses only. Cover does not apply where you are entitled to benefits under any statutory workers compensation scheme or any statutory transport accident scheme (unless top-up benefits are payable). 2. Transport accident/workplace injury claim top-up benefits Protect Injury and Illness Insurance provides top-up weekly income benefi ts for members with an accepted statutory workplace injury or transport accident claim. If you suffer an injury or illness for which you are receiving weekly benefi ts from either a workers compensation or transport accident scheme insurer, you will receive a top-up benefi t from Protect s insurers. The top-up benefi t is equal to the difference between the amount you receive from the other insurer and your weekly income protection rate or 100 per cent of your pre-injury/illness income, whichever is the lesser. For example, if you are registered for the $1,200* maximum income protection rate with Protect and you are receiving $900 per week from a workers compensation insurer, Protect s insurer will pay you $300 per week. 8 Protect Injury & Illness Insurance Handbook

9 If your average weekly earnings prior to the injury or illness are less than $1,200*, you will receive the difference between the workers compensation payment and 100 per cent of your pre-injury/illness income. Top-up benefi ts are payable for up to two years of an eligible transport accident claim and from weeks 53 to 104 of a workplace injury insurance claim. Top-up benefi ts for the fi rst 52 weeks of a workplace injury claim are covered by your industrial Award, and are payable directly by your employer. Protect top-up weekly income benefits may cover up to 25 per cent of your pre-injury earnings, while you are receiving loss of income benefits from a workplace injury or transport accident insurer. The total benefi ts payable by Protect and the other insurer will not exceed your maximum weekly income protection rate or 100 per cent of your pre-injury/illness income, whichever is the lesser. Unlike some other industry insurance schemes, you are not required to exhaust all of your available sick leave before making a Protect income top-up benefi t claim. A 14-day consecutive waiting period applies to each claim, generally commencing from the day after you seek medical treatment from a registered medical practitioner. (A 52-week waiting period applies to workers compensation topup benefi ts; top-up benefi ts for the fi rst 52 weeks of a workplace injury claim are covered by your industrial Award, and are payable directly by your employer). Protect Injury & Illness Insurance Handbook 9

10 3. Lump sum death and injury (capital) benefits For many accidental injuries, Protect Injury and Illness Insurance provides lump sum payments that are more than double the capital benefi ts provided by similar schemes. And the ETU has negotiated even better serious trauma benefi ts for fi nancial members of the Union. The comprehensive ETU Protect Extra Cover provides Union members with an additional capital lump sum benefit of 50 per cent if they are a fi nancial ETU member at the time of their accident and when they make a claim. For example, if an ETU Protect member loses an arm or leg in an accident, he or she will receive the scheduled Protect capital benefi t of $50,000 plus an extra $25,000. The family of an ETU member killed as a result of an at-work injury would receive the Protect payable benefi t of $150,000 plus an extra $125,000 $275,000 in total. If you suffer an accident when you are covered by the policy and this directly results in one of the following events within 12 consecutive months, your nominated benefi ciaries will be eligible for a lump sum payment as follows: 10 Protect Injury & Illness Insurance Handbook

11 A. DEATH Accident type Death from an injury outside of work Death from an at-work injury* Protect $50,000 if you have dependants $25,000 if you have no dependants $150,000 if you have dependants $75,000 if you have no dependants ETU Protect Extra Cover $75,000 if you have dependants $37,500 if you have no dependants $275,000 if you have dependants $150,000 if you have no dependants *A statutory workers compensation benefi t is payable. Any lump sum benefi t payable will be reduced by any amount previously paid as a capital benefi t under the table of serious trauma benefi ts (for injuries arising from the same accident that directly results in your death within 12 months). A dependant means your: A. B. spouse/partner whose gross earnings are less than $16,000 per year in the 12 -month period immediately preceding the event, AND/OR unmarried, financially dependent children (or your spouse/partner s children) who live with you, up to 18 years of age (or up to 25 years of age if a full time student at an accredited institution of higher learning). Protect Injury & Illness Insurance Handbook 11

12 B. SERIOUS TRAUMA For most serious trauma injuries, Protect Injury and Illness Insurance provides lump sum payments that are more than double the capital benefi ts provided by similar schemes. Plus, the comprehensive ETU Protect Extra cover provides Union members with an additional capital lump sum benefit of 50 per cent if they are a fi nancial ETU member at the time of their accident and when they make a claim. If you suffer an accident when you are covered by the policy and this directly results in one of the following within 12 consecutive months, you will be eligible for a lump sum payment as follows: Accident type Total and permanent disablement from an at-work injury* Total and permanent disablement from an injury outside of work Protect ETU Protect Extra Cover $150,000 $275,000 $50,000 $75,000 Permanent paraplegia or quadriplegia $50,000 $75,000 Permanent total loss of sight of one or both eyes $50,000 $75,000 Permanent total loss of the lens of both eyes $50,000 $75,000 Permanent total loss of the lens of one eye $30,000 $45,000 Permanent and incurable insanity $50,000 $75,000 Permanent total loss of one or two limbs $50,000 $75,000 Permanent total loss of hearing in both ears $40,000 $60,000 Permanent total loss of hearing in one ear $10,000 $15,000 Third-degree burns and/or resultant disfi gurement of more than 40% of the entire body $25,000 $37,500 * A workers compensation benefi t has been paid for 24 consecutive months. Table continued next page 12 Protect Injury & Illness Insurance Handbook

13 Accident type Permanent total loss of: Protect ETU Protect Extra Cover four fi ngers and thumb of either hand $37,500 $56,250 four fi ngers of either hand $20,000 $30,000 one thumb, both joints $15,000 $22,500 one thumb, one joint $7,500 $11,250 a fi nger, three joints $5,000 $7,500 a fi nger, two joints $3,750 $5,625 a fi nger, one joint $2,500 $3,750 Permanent total loss of use of: all the toes of one foot $7,500 $11,250 great toe, both joints $2,500 $3,750 great toe, one joint $1,500 $2,500 other toe (each toe) $500 $750 Fractured leg or patella with established non-union Shortening of the leg by fi ve (or more) centimetres $5,000 $7,500 $3,750 $5,625 No serious trauma injury benefi t is payable if a death benefi t is also payable. If more than one serious trauma benefi t is applicable arising out of the same accident, the insurer will only pay a single lump sum benefi t for one accident type. The highest applicable benefi t will be paid. Protect Injury & Illness Insurance Handbook 13

14 C. BROKEN BONES NON-WORK-RELATED INJURY Protect also boasts the nation s leading industry insurance cover for broken bones and fractures. For fi nancial members of the Union, ETU Protect Extra Cover provides higher benefits than the cover provided by similar schemes. Accident type Protect ETU Protect Extra Cover Neck, skull or spine (full break) $5,000 $8,000 Skull or spine (hairline fracture) $1,500 $2,500 Hip $3,750 $6,250 Pelvis $2,500 $6,250 Ankle or knee (full break) $2,500 $4,000 Ankle or knee (hairline fracture) $1,000 $1,600 Leg (full break) $2,500 $4,000 Leg (hairline fracture) $1,000 $1,600 Shoulder blade $1,500 $4,000 Jaw $2,500 $4,000 Cheekbone $1,500 $2,500 Collarbone $1,000 $2,500 Foot or hand $375 $2,000 Nose $1,000 $1,600 Rib/s $500 $1,600 Arm, elbow or wrist $1,250 $2,000 Finger/s $250 $1,600 If more than one broken bones benefi t is applicable arising out of the same accident, the insurer will only pay a single lump sum benefi t for one accident type. The highest applicable benefi t will be paid. A broken bones lump sum benefi t will not be paid for a bone that was broken as a result of an injury while engaging in amateur sport or extreme sport/activity or as a result of an off-road motorcycling accident (refer Limitations on what is covered ). Further, a broken bone benefi t will not be paid for a work-related injury or for an injury suffered while you are unemployed. 14 Protect Injury & Illness Insurance Handbook

15 D. ACCIDENTAL DENTAL INJURY Protect provides a maximum lump sum payment of $2,500 if members, dependant spouses (including de-facto and same-sex partners) or their dependant children suffer an accidental dental injury. Up to four claims per family are permitted each year. Protect members (and their dependants) who are also fi nancial members of the ETU at the time of their dental injury and lodgement of their claim, can claim a maximum lump sum payment of $3,750 per claim. Up to four claims per family are permitted each year. Accident type Protect ETU Protect Extra Cover Dental cover for singles $2,500 $3,750 Dental cover for family $2,500 $3,750 Fractured or broken tooth, per tooth $150 $225 Loss of teeth, per tooth $150 $225 Damaged denture/dental plate $150 $225 Chipping of teeth, per tooth $75 $ Loss of fi lling, per fi lling $75 $ For the purposes of this cover, a tooth includes dentures, implants and dental fi llings. However, no cover is provided for normal maintenance of dental health. Protect s insurers will pay a lump sum benefi t only for members and their dependants who suffer an injury resulting in damaged/ broken teeth. Dental invoices are not payable; these may be claimable with your private health insurer. EXAMPLE: If you chip a tooth and your dentist s bill is $60, you will receive $75. Unlike some other industry insurance schemes, any accidental dental injury benefi t which may be payable is not reduced by any claim you make with your private health insurer for costs arising from the same injury. The total amount payable in lump sum benefi ts for all damaged or lost teeth arising out of any one injury is $2,500 ($3,750 for ETU fi nancial members) and cover is subject to a maximum of four events per family (i.e. you and your dependants) each year. Protect Injury & Illness Insurance Handbook 15

16 Additional Benefi ts A. Return to work and rehabilitation assistance If you are receiving weekly benefi ts for an injury or illness, you may also be eligible for assistance of up to $20,000 to pay for vocational retraining, professional rehabilitation (including special equipment and/or modifi cations to your residence), family counselling and other assistance, as may be appropriate, to support your return to work and to help you regain your independence. Such assistance must be recommended by your medical practitioner and will be offered only at the election of the insurer. B. Extended between-jobs cover for injury If you cease work with your employer for reasons beyond your control, cover for weekly benefi ts will continue if you suffer an injury during the fi rst 39 weeks after your employment fi nishes and you were: continuously and actively seeking work in your usual occupation registered as unemployed with the ETU and/or Centrelink, and continuously unemployed. Weekly benefi ts will be paid for a maximum of 52 weeks. A lump sum death or injury benefi t is not payable for an injury suffered after your employment ceased. The actual weekly amount you will receive will depend on the number of working days for which your employer has paid premium contributions on your behalf in the previous 12 months. The weekly amount payable is calculated as follows: Number of days contributions paid Weekly injury benefit 0 to 64 Nil 65 to or more 75% of your maximum weekly rate or 75% of your income, whichever is the lesser Your maximum weekly rate or 100% of your income, whichever is the lesser 16 Protect Injury & Illness Insurance Handbook

17 C. Funeral expenses In the event that you die as a result of an injury, the policy will pay up to $5,000 for your burial or cremation. D. Emergency home help If you are receiving weekly benefi ts for an injury or illness and you are unable to perform your normal pre-injury/illness domestic duties, you are eligible to claim up to $250 per week (for a maximum of 26 weeks) as reimbursement for reasonable and necessary expenses that you paid for professional domestic assistance approved by your medical practitioner. This benefi t is only available to Protect ETU fi nancial members. Eligible members must be fi nancial ETU members at the time of their injury/illness and when they make a claim. E. Domestic duties assistance If your spouse or partner suffers an injury or illness and is medically certifi ed as unable to perform his or her full-time homemaker duties, you are eligible to claim up to $200 per week (for a maximum of 10 weeks) as reimbursement for reasonable and necessary expenses that you pay for domestic professional assistance while your spouse or partner recovers. This benefi t is only available to Protect ETU fi nancial members. Eligible members must be fi nancial ETU members at the time of their injury/illness and when they make a claim. F. Chauffeur plan If you are receiving weekly benefi ts for an injury or illness, you are eligible to claim reimbursement for hire costs of a taxi or chauffeurdriven car necessarily incurred to attend scheduled medical or rehabilitation appointments relating to your injury or illness, or to attend your place of work to perform work in a reduced capacity. Up to $1,000 per month reimbursement is claimable for a maximum of six months. Such assistance will be offered only at the election of the insurer. This benefi t is only available to Protect ETU fi nancial members. Eligible members must be fi nancial ETU members at the time of their injury/illness and when they make a claim. Protect Injury & Illness Insurance Handbook 17

18 ETU Protect Extra Cover > ETU fi nancial membership, delivering a better deal for you and your family. 18 Protect Injury & Illness Insurance Handbook

19 Financial members get a better deal If you are an ETU fi nancial member, and you are covered by Protect Injury and Illness Insurance, you ll automatically get higher benefi ts and broader cover through ETU Protect Extra Cover. In fact, for serious trauma injury claims, ETU Protect Extra Cover delivers you benefi ts that are generally three times higher or more than with other industry insurers. That s better cover for you and your family, at a time when you need it most. How does ETU Protect Extra Cover work? If you are covered for income protection insurance by an ETU Enterprise Agreement, you are already protected by Australia s leading industry injury and illness insurance cover. And, as long as you are a fi nancial ETU member at the time of your accident and when you make your claim, you re now also covered by the superior benefi ts of ETU Protect Extra Cover. And that better deal ETU Protect Extra Cover is just another way your Union is delivering for you and your family. Bigger lump sums ETU Protect Extra Cover provides higher lump sum payments across four of Protect s range of insurance benefi ts to members who suffer an accidental injury: 1. LUMP SUM DEATH (CAPITAL) BENEFITS Up to $75,000 death benefi t for an accidental injury outside of work Up to $275,000 death benefi t for an accidental injury at work 2. LUMP SUM INJURY (CAPITAL) BENEFITS Up to $75,000 total and permanent disablement benefi t for an accidental injury outside of work Up to $275,000 total and permanent disablement benefi t for an accidental injury at work Up to $75,000 serious trauma benefi t for an accidental injury outside of work Protect Injury & Illness Insurance Handbook 19

20 3. BROKEN BONES LUMP SUM BENEFITS FOR AN INJURY OUTSIDE OF WORK Up to $8,000 broken bones benefi t for an accidental injury outside of work 4. ACCIDENTAL DENTAL INJURY LUMP SUM BENEFITS Up to $3,750 accidental dental cover for members and their dependants. Up to four claims per family, each year. Further information on Protect s complete range of insurance benefits, exclusions and limitations is available in this handbook or from Protect s website at Extra claims support Protect Injury and Illness Insurance claim forms (also covers ETU Protect Extra Cover claims) are available via a link from Protect s website or at ETU Member Welfare Officer Union members can contact the ETU Member Welfare Offi cer for information on Protect Injury and Illness Insurance benefi ts, exclusions and limitations or for assistance in completing a Protect claim form contact: Pat Tutton ETU Member Welfare Officer 200 Arden Street North Melbourne VIC 3051 Web Phone (03) Fax (03) Mobile Protect Injury & Illness Insurance Handbook

21 Exclusive benefits ETU Protect Extra Cover also provides additional insurance benefi ts exclusive to ETU fi nancial members. 1. Emergency home help Up to $250 per week, for up to 26 weeks, reimbursement for reasonable and necessary professional domestic assistance expenses. You are eligible if you are receiving Protect weekly income protection benefi ts, you are unable to perform your normal pre-injury or illness domestic duties and professional domestic assistance is approved by your medical practitioner. 2. Domestic duties assistance Up to $200 per week, for up to 10 weeks, reimbursement for reasonable and necessary professional domestic assistance expenses. You are eligible if your spouse or partner suffers an injury or illness and is medically certifi ed as unable to perform his/her full-time homemaker duties. 3. Chauffeur plan Up to $1000 per month, for up to six months, reimbursement for necessary hire costs of a taxi or chauffeur driven car to attend scheduled medical or rehabilitation appointments. You may be eligible if you are receiving Protect weekly income protection benefi ts. Chauffer plan assistance will only be offered at the election of the insurer. Protect Injury & Illness Insurance Handbook 21

22 What is covered? Lump sum death (capital) benefits ETU Protect Extra Cover provides lump sum payments of up to $275,000, if you are killed as the result of an accident. For fi nancial members of the Union and their families, lump sum death benefi ts can be three times higher or more than the cover provided by other industry schemes. If you suffer an accident when you are covered by ETU Protect Extra Cover, and this directly results in one of the following events within 12 consecutive months, your dependants or other nominated benefi ciaries will be eligible for a lump sum payment as follows: A. DEATH Accident type Death from an injury outside of work Death from an at-work injury* Protect $50,000 if you have dependants $25,000 if you have no dependants $150,000 if you have dependants $75,000 if you have no dependants ETU Protect Extra Cover $75,000 if you have dependants $37,500 if you have no dependants $275,000 if you have dependants $150,000 if you have no dependants *A statutory workers compensation benefi t is payable. Any lump sum benefi t payable will be reduced by any amount previously paid as a capital benefi t under the table of serious trauma benefi ts (for injuries arising from the same accident that directly results in your death within 12 months). 22 Protect Injury & Illness Insurance Handbook

23 Lump sum injury (capital) benefits For serious trauma injury claims, ETU Protect Extra Cover delivers you and your family benefi ts that are generally three times higher or more than with other industry insurers. If you suffer an accident when you are covered by ETU Protect Extra Cover, and this directly results in one of the following events within 12 consecutive months, you will be eligible for a lump sum payment as follows: Accident type Total and permanent disablement from an at-work injury* Total and permanent disablement from an injury outside of work Protect ETU Protect Extra Cover $150,000 $275,000 $50,000 $75,000 Permanent paraplegia or quadriplegia $50,000 $75,000 Permanent total loss of sight of one or both eyes $50,000 $75,000 Permanent total loss of the lens of both eyes $50,000 $75,000 Permanent total loss of the lens of one eye $30,000 $45,000 Permanent and incurable insanity $50,000 $75,000 Permanent total loss of one or two limbs $50,000 $75,000 Permanent total loss of hearing in both ears $40,000 $60,000 Permanent total loss of hearing in one ear $10,000 $15,000 Third-degree burns and/or resultant disfi gurement of more than 40% of the entire body $25,000 $37,500 Permanent total loss of: four fi ngers and thumb of either hand $37,500 $56,250 four fi ngers of either hand $20,000 $30,000 one thumb, both joints $15,000 $22,500 one thumb, one joint $7,500 $11,250 a fi nger, three joints $5,000 $7,500 a fi nger, two joints $3,750 $5,625 a fi nger, one joint $2,500 $3,750 * A workers compensation benefi t has been paid for 24 consecutive months. Table continued overleaf Protect Injury & Illness Insurance Handbook 23

24 Accident type Permanent total loss of use of: Protect ETU Protect Extra Cover all the toes of one foot $7,500 $11,250 great toe, both joints $2,500 $3,750 great toe, one joint $1,500 $2,500 other toe (each toe) $500 $750 Fractured leg or patella with established non-union Shortening of the leg by fi ve (or more) centimetres $5,000 $7,500 $3,750 $5,625 No serious trauma injury benefi t is payable if a death benefi t is also payable. If more than one serious trauma benefi t is applicable arising out of the same accident, the insurer will only pay a single lump sum benefi t for one accident type. The highest applicable benefi t will be paid. BROKEN BONES NON-WORK-RELATED INJURY ETU Protect Extra Cover provides higher broken bones benefits than other industry insurers. Accident type Protect ETU Protect Extra Cover Neck, skull or spine (full break) $5,000 $8,000 Skull or spine (hairline fracture) $1,500 $2,500 Hip $3,750 $6,250 Pelvis $2,500 $6,250 Ankle or knee (full break) $2,500 $4,000 Ankle or knee (hairline fracture) $1,000 $1,600 Leg (full break) $2,500 $4,000 Leg (hairline fracture) $1,000 $1,600 Shoulder blade $1,500 $4,000 Jaw $2,500 $4,000 Table continued next page 24 Protect Injury & Illness Insurance Handbook

25 Accident type Protect ETU Protect Extra Cover Cheekbone $1,500 $2,500 Collarbone $1,000 $2,500 Foot or hand $375 $2,000 Nose $1,000 $1,600 Rib/s $500 $1,600 Arm, elbow or wrist $1,250 $2,000 Finger/s $250 $1,600 A broken bones lump sum benefi t will not be paid for a bone that was broken as a result of an injury while engaging in amateur sport* or extreme sport/activity** or as a result of an off-road motorcycling accident.*** Members who engage in these activities are encouraged to review their insurance cover. Further, a broken bone benefi t cannot be claimed for a workrelated injury or for an injury suffered while you are unemployed. * Amateur Sport: An amateur sport means training for or playing in any non-professional sport or activity organised by any sporting organisation, authority, club or centre. ** Extreme Sport/Activity An extreme sport/activity means: being in charge of or operating a recreation motorcycle of any description (including, but not limited to, dirt bikes, trail bikes, motocross bikes, quad bikes, and beach buggies); BMX or mountain bike riding; snowboarding; snow skiing; jet skiing; water skiing; surfi ng; martial arts or boxing (or any similar combative sport or activity); BASE jumping; parachuting; skateboarding; wake boarding; go karting; taking part in any racing and/or time trials of any kind (other than on foot); mountain climbing; roller skating; abseiling; and/or gliding of any description (including paragliding, hang gliding or any similar activity, whether in tandem or otherwise). *** Off-Road Motorcycling Accident An off-road motorcycling accident means an accident when you are in charge of or operating a motorcycle of any description (including, but not limited to, road bikes, dirt bikes, trail bikes, motocross bikes, quad bikes and beach buggies) either on private land (unless the motorcycle was registered and you were licensed to be in charge of that motorcycle when the accident occurs) or not on a public road. Refer to Limitations on what is covered, on page 33, for more information. Protect Injury & Illness Insurance Handbook 25

26 ACCIDENTAL DENTAL INJURY BENEFITS ETU Protect Extra Cover provides a maximum lump sum payment of $3,750 for fi nancial members of the Union and their dependants who suffer an injury resulting in damaged/broken teeth. Up to four claims per family, are permitted each year. Dental invoices are not payable, these may be claimable with your private health insurer. Unlike some other industry insurance schemes, any accidental dental injury benefi t which may be payable is not reduced by any claim you make with your health insurer. Accident type Protect ETU Protect Extra Cover Dental cover for singles $2,500 $3,750 Dental cover for family $2,500 $3,750 Fractured or broken tooth, per tooth $150 $225 Loss of teeth, per tooth $150 $225 Damaged denture/dental plate $150 $225 Chipping of teeth, per tooth $75 $ Loss of fi lling, per fi lling $75 $ Protect Injury & Illness Insurance Handbook

27 ETU PROTECT EXTRA COVER PAYS OFF Only one week into a dream holiday, John was hiking deep in a Thailand jungle when he stumbled on uneven ground and broke his ankle. Believing it was only a bad sprain and determined to continue his trip, the ETU member gritted his teeth and continued to hobble around for the next three weeks. On his return to Australia, an x-ray confi rmed his ankle was broken with a prognosis of a long and diffi cult recovery. John ended up needing six months off work from his job. As an ETU member for 19 years, John was covered by Protect s global income protection insurance, 24 hours a day, 7 days a week. John s full leg break entitled him to a lump sum benefi t. And as a fi nancial ETU member at the time, ETU Protect Extra Cover delivered John a benefi t payment that was nearly twice the claim entitlement available with other industry based insurance schemes. The ETU is great, and Protect cover is fantastic, said John. There are defi nitely a lot of extra benefi ts available to Union members, such as ambulance cover etc. Protect Injury & Illness Insurance Handbook 27

28 ETU member benefi ts Emergency transport cover ETU membership covers members and their families with free emergency transport. To receive this benefi t, members need to ensure their membership is continuously fi nancial - members must be fi nancial at the time of use. Call the ETU on or visit and log in to the member area for details. New benefits for ETU contractor members Discounted Trades Pack Insurance Public Liability Tools of Trade Illness and Income Protection Work Vehicle Legal Support Powering up contractors Free basic Terms of Trade Free Variations to Contract template Set Price Accounting with FREE BAS lodgement Training and materials on setting up your OHS Management Plan Debt Management and Collection Free basic Terms of Trade Free Variations to Contract template Your own website at huge discounts And more... For more information call ETREC on or visit 28 Protect Injury & Illness Insurance Handbook

29 Protect Injury & Illness Insurance Handbook 29

30 Insurance notes How to make a claim Protect s insurers, ATC Insurance Solutions, try to take the stress out of making a claim. ATC has a dedicated and experienced claims team who will manage your claim from start to finish. Protect Injury and Illness Insurance claim forms are available via a link from Protect s website or at There are five easy steps to completing the Protect claim form: 1. You fully complete Section A of the claim form, including either the Injury statement or the Sickness statement 2. Your medical practitioner fully completes Section B of the claim form OR Your dentist completes Section C of the claim form 3. Your employer fully completes Section D of the claim form 4 If you went to hospital following an injury, attach a copy of. the hospital admission notes. If you have a broken bone, attach a copy of your radiology report. (Note: dental invoices are not payable by the insurer; only a lump sum benefi t will be paid refer accidental dental injury benefi t in this brochure.) 30 Protect Injury & Illness Insurance Handbook

31 5. Check all questions have been answered and each section has been signed and dated. Send the claim form to: ATC Insurance Solutions Level 2, 499 St Kilda Road Melbourne VIC 3004 Web Phone (03) Fax (03) Freecall You should retain a copy of the completed claim form and attachment for your records. Insurance benefi ts payments will be delayed if the insurer needs to return the claim form to you because it is incomplete. If you need assistance completing the claim form, contact ATC Insurance Solutions. ETU Member Welfare Officer Union members can contact the ETU Member Welfare Offi cer for information on Protect Injury and Illness Insurance benefi ts, exclusions and limitations or for assistance in completing a Protect claim form contact: Pat Tutton ETU Member Welfare Officer 200 Arden Street North Melbourne VIC 3051 Web Phone (03) Fax (03) Mobile Protect Injury & Illness Insurance Handbook 31

32 What is NOT covered? Like all insurance policies, the Protect Injury and Illness policy (including ETU Protect Extra Cover) has a number of general exclusions which state when benefi ts will not be payable. In summary, benefi ts will not be payable for any disablement or other insured event if they are caused by or arise from: 1. war or terrorism 2. ionising radiation or contamination by radioactivity from any nuclear material 3. an accident when you are in charge of or operating a motor vehicle (including a motorcycle) or powered watercraft under the influence of intoxicating liquor or of a drug as defined in the motor vehicle or other laws applicable where the accident occurs 4. an accident when you are in charge of or operating a motor vehicle (including a motorcycle) or powered watercraft that wasn t properly registered or you weren t appropriately licensed to be in charge of, or operate that motor vehicle or watercraft, according to the applicable registration and/or licensing laws 5. intentional self-inflicted injury or sickness, suicide or attempt at it 6. being a pilot or crew member of any aircraft or engaging in any aerial activity except as a passenger in a properly licensed aircraft 7. pregnancy, childbirth or miscarriage other than a complication arising from any of those conditions which requires hospitalisation in the first 33 weeks of pregnancy 8. engaging in or taking part in or training for sports as a professional (where the majority of your income is derived directly or indirectly from the sport) 9. a criminal act committed by you or a beneficiary of your benefits 10. any stress-related condition or psychiatric-related condition (whether or not as a result of an injury or a sickness), including, but not limited to, depression, neurosis, psychosis, stress or anxiety, unless you are in receipt of workers compensation benefits for that condition 11. Acquired Immune Deficiency Syndrome (A.I.D.S.) Disease or Human Immunodeficiency Virus (H.I.V.) infection 12. Chronic Fatigue Syndrome, or 13. any pre-existing condition. 32 Protect Injury & Illness Insurance Handbook

33 Limitations on what is covered Over 65 The policy does not cover persons over 65 years of age, and all benefi ts being paid will cease when a person turns 65. Waiting period A 14-day consecutive waiting period applies to each claim, generally commencing from the day after you seek medical treatment from a registered medical practitioner. A 52-week waiting period applies to workers compensation top-up claims. Top-up benefi ts for the fi rst 52 weeks of a workplace injury claim are covered by your industrial Award, and are payable directly by your employer. Maximum benefit period In most cases, weekly income protection benefi ts will be paid for a maximum of 104 weeks after the waiting period expires. Workers compensation top-up benefi ts will only be paid for a maximum of 52 weeks following the 52-week waiting period. Top-up benefi ts for the fi rst 52 weeks of a workplace injury claim are covered by your industrial Award, and are payable directly by your employer. If you injure yourself after ceasing employment, the maximum benefi t period is also limited to 52 weeks. A different benefi t period also applies in the following cases: A. AMATEUR SPORT If you suffer an injury as a result of participating in an amateur sport, weekly income protection benefi ts will be paid for a maximum of 13 weeks after the waiting period. An amateur sport means training for or playing in any nonprofessional sport or activity organised by any sporting organisation, authority, club or centre. Protect Injury & Illness Insurance Handbook 33

34 B. EXTREME SPORT/ACTIVITY If you suffer an injury as a result of participating in any extreme sport/activity, weekly benefi ts will be paid for a maximum of 13 weeks after the waiting period. An extreme sport/activity means: being in charge of or operating a recreation motorcycle of any description (including, but not limited to, dirt bikes, trail bikes, motocross bikes, quad bikes, and beach buggies); BMX or mountain bike riding; snowboarding; snow skiing; jet skiing; water skiing; surfi ng; martial arts or boxing (or any similar combative sport or activity); BASE jumping; parachuting; skateboarding; wake boarding; go karting; taking part in any racing and/or time trials of any kind (other than on foot); mountain climbing; roller skating; abseiling; and/or gliding of any description (including paragliding, hang gliding or any similar activity, whether in tandem or otherwise). C. OFF-ROAD MOTORCYCLING ACCIDENT If you suffer an injury as a result of an off road motorcycling accident, weekly benefi ts will be paid for a maximum of 13 weeks after the waiting period. An off-road motorcycling accident means an accident when you are in charge of or operating a motorcycle of any description (including, but not limited to, road bikes, dirt bikes, trail bikes, motocross bikes, quad bikes and beach buggies) either on private land (unless the motorcycle was registered and you were licensed to be in charge of that motorcycle when the accident occurs) or not on a public road. Private land means any land (whether publicly or privately owned) that members of the public may not enter or remain on without permission. A public road means an area that is open to or used by the public and is developed for, or has one of its main uses, the driving or riding of motor vehicles with at least four wheels (including parking areas), but does not include: any dirt or other unsealed track or trail intended for use by vehicles with less than four wheels, or any undefi ned path; or any motocross track, motorcycle park or other circuit or area specifi cally built or intended for recreation, including, but not limited to, racing, competing, testing, or time trials. 34 Protect Injury & Illness Insurance Handbook

35 D. DEGENERATIVE CONDITIONS Weekly benefi ts will be paid for a maximum of 26 weeks if you are disabled by a degenerative condition (including any condition that has gradually developed over time) affecting your musculoskeletal system (muscles, bones, ligaments and joints, including vertebral discs). Further, benefi ts will only commence after all available sick leave has been exhausted (this requirement does not apply to any other type of claim). Broken bones A broken bones lump sum benefi t will not be paid for a bone that was broken as a result of an injury while engaging in amateur sport or extreme sport/activity or as a result of an off-road motorcycling accident. Further, a broken bone benefi t will not be paid for a work-related injury or for an injury suffered while you are unemployed. Protect Injury & Illness Insurance Handbook 35

36 For all enquiries regarding information in this brochure, or for a Protect claim form, contact: ATC Insurance Solutions Level 2, 499 St Kilda Road Melbourne VIC 3004 Web or Phone (03) Freecall Fax (03) Want to know more? For more information on ETU Protect Extra Cover, contact the ETU Member Welfare Officer on (03) or For more information on ETU membership benefits, contact the ETU Victorian Branch on (03) or visit the website at PROT INSURANCE SOLUTIONS