2 Table of contents Table of contents 2 Special Notices 3 Policy wording 4 Introduction 4 How much we will pay 4 What we insure 4 1. Professional indemnity insurance cover Practice of your profession Legal defence costs 4 2. Legal fees and expenses cover Disciplinary and criminal investigations or inquiries Breaches of consumer protection legislation and defamation 5 3. Automatic extensions Practice entity and practice staff cover General optical council (UK) registration cover Retired members Members who temporarily cease membership Overseas charity or aid organisation cover Breaches of privacy Telehealth activities Continuous Cover Actions of others Contractual liability Advice on goods sold 7 4. Optional extension UK cover for practice of your profession 8 5. What we do not insure Asbestos or pollution Breach of registration, unregistered practise or lack of qualifications Contagious disease Contractual liability Defamation and intellectual property Dishonest, criminal or fraudulent acts Director, partner, officer or business owner disputes Discriminatory or sexual misconduct Employer, employee or collusion disputes Fines, penalties or punitive damages Indemnified practice Insured v insured Intoxication or under the influence Legal fees and other costs not incurred by us Liability of others Outside of Australia Outside the practice of your profession Prior or pending Product and public liability, property damage or workers compensation Radioactive materials Recovery of money or refund patient fees Retroactive date or outside policy period Conditions Loss prevention No Admission Subrogation and other insurance Risk management Fraud Disputes Payment of premium Payment of deductible You must notify us of a claim or incident Other matters of which you must notify us Conduct of claims, complaints or matters You must be reasonable in relation to settlement We may decide not to continue We will appoint the lawyer or other person Your duty to cooperate We are not liable if you do not cooperate The lawyer s or other person s account Appeals Appeals without our consent Our right to recover payment from you Claims acceptance Clinical records Cessation of specified clinical activities Cancellation Governing law Definition Claim Complaint Deductible Healthcare Professional Incident Lawyer Legal Defence Costs Legal Fees and Expenses OAA OAA Member Other Person Policy Period Policy Schedule Practice Entity Practice Staff Practice of Your Profession Premium Retroactive Date Telehealth Us, We, Our You, Your 16
3 Special Notices This is important and must be read by all persons applying for, renewing or varying an Avant Insurance Limited insurance policy. In these notices a reference to we us or our means Avant Insurance Limited ABN AFSL Your duty of disclosure Under the Insurance Contracts Act 1984 (Cth), before you enter a contract of insurance with us you have a duty to disclose every matter that you know, or could reasonably be expected to know that is relevant to our decision to accept the risk of the insurance and, if so, on what terms. Your duty of disclosure to us continues up to the time that the contract of insurance is entered into. You have the same duty to disclose those matters to us before you renew, extend or vary your insurance policy with us. Disclosure is not limited to matters applying to you under your insurance contract with us, but includes other past businesses or private insurances. However, you do not have to tell us about: a matter that diminishes the risk undertaken by us; or a matter that is considered to be common knowledge; or facts that we know or should know in the ordinary course of our business; or matters that we tell you we do not need to know. If in doubt you should disclose a matter to us. Non-disclosure If you fail to comply with your duty of disclosure, depending on the prejudice caused by your failure to comply, we may: reject your request for indemnity; or reduce our liability in respect of a Claim, complaint or matter; or cancel the policy. If your non-disclosure is fraudulent, we may avoid the policy entirely (that is, we may treat the policy as never being of any force or effect). The Professional Indemnity Insurance Policy is a claims made and notified contract. The policy covers compensation Claims (including Legal Defence Costs) made against You and notified in the Policy Period where the incident giving rise to the Claim occurred after the Retroactive Date. The policy covers Legal Fees and Expenses incurred in representing You provided that the matter or proceedings are commenced and notified to us in the Policy Period. This policy does not provide cover in relation to: Claims made against You arising from Incidents that occurred prior to the Retroactive Date; or Claims made against You or incidents notified to Us after the expiry of the Policy Period; or Claims made, threatened or intimated against You prior to the Policy Period; or Facts or circumstances of which You become aware prior to the Policy Period, and which You knew or ought reasonably to have known had the potential to give rise to a Claim or request for indemnity under this policy. Notification of facts which might give rise to a claim Pursuant to section 40(3) of the Insurance Contracts Act 1984 (Cth) where You give notice to Us in writing of facts that might give rise to a claim as soon as was reasonably practicable after You become aware of those facts but before the policy expires, You are covered for any claim made against You arising from those facts even if it is not made against you until after the Policy Period has expired. Privacy Statement Please refer to our website at to view our privacy statement. You may request a copy of our privacy statement free of charge by contacting Us. IMPORTANT: Professional indemnity insurance products available from Avant Mutual Group Limited ABN are issued by Avant Insurance Limited, ABN , AFSL The information provided here is general advice only. You should consider the appropriateness of the advice having regard to your own objectives, financial situation and needs before deciding to purchase or continuing to hold a policy with us. For full details including the terms, conditions, and exclusions that apply, please read and consider the policy wording and PDS, which is available at or by contacting us on
4 Policy wording Introduction In consideration of payment of the Premium by Optometrists Association Australia, We will cover You in accordance with the definitions, terms, conditions, limit of indemnity, sub-limit of indemnity, Deductibles, exclusions and endorsements, if any, of this policy. Some of the words used in this policy are specially defined. These words appear in Capital type and their meanings are explained in the Definitions section. How much we will pay (a) The most We will pay for any one Claim or request for indemnity under this policy, and in the aggregate for all Claims and requests for indemnity during the Policy Period is the limit of indemnity per OAA Member. (b) Any sub-limit of indemnity that applies to cover is the most We will pay against that cover in the aggregate for requests for indemnity during the Policy Period per OAA Member; and in such cases the sub-limit of indemnity applies in place of the limit of indemnity. (c) The limit of indemnity and sub-limit of indemnity are exclusive of the Deductible. (d) The limit of indemnity is inclusive of Legal Defence Costs. (e) Nothing in this policy operates to increase the limit of indemnity or sub-limit of indemnity. (f) All Claims or requests for indemnity under this policy which arise from, or are attributable to, a single act, error, omission, or occurrence or series of similar or related single acts, errors, omissions or occurrences will be treated under this policy as one Claim or one request for indemnity. Limit of indemnity Professional indemnity insurance cover Sub-limit of indemnity Disciplinary, coronial or criminal matters Consumer protection breaches & defamation Amount in the aggregate in the Policy Period per OAA Member $10 million Amount in the aggregate in the Policy Period per OAA Member $500,000 $100,000 What we insure 1. Professional indemnity insurance cover 1.1 Practice of your profession We will cover You for amounts You become legally liable to pay as compensation for civil liability in respect of Claims made against You in the Policy Period directly in connection with the Practice of Your Profession. 1.2 Legal defence costs We further agree to pay Legal Defence Costs that are necessarily and reasonably incurred by way of investigating, defending or settling a Claim. This is subject to the payment of the Deductible which is the first amount that is to be paid towards Legal Defence Costs.
5 2. Legal fees and expenses cover You are covered for Legal Fees and Expenses in relation to the following matters directly arising from the Practice of Your Profession or research connected with the Practice of Your Profession when the matter or proceedings are commenced and notified to Us in writing in the Policy Period. 2.1 Disciplinary and criminal investigations or inquiries We cover Legal Fees and Expenses that We incur with the Lawyer in relation to: (a) defending a prosecution, responding to a commission, inquiry, inquest, investigation or Complaint brought by or before a registration board, professional body, tribunal or complaints unit; or (b) defending or responding to a criminal inquiry, investigation or proceeding; or (c) a coronial inquiry or inquest, (d) directly arising from the Practice of Your Profession or research connected with the Practice of Your Profession by You and commenced and notified to Us in writing in the Policy Period. We will also cover You for any legal costs You may be ordered to pay by a court or tribunal in relation to the above matters. 2.2 Breaches of consumer protection legislation and defamation We cover Legal Fees and Expenses that We incur with the Lawyer in relation to: (a) defending a Complaint that in the course of the Practice of Your Profession You breached or allegedly breached the provisions of Commonwealth consumer protection legislation or similar state or territory fair trading legislation; (b) pursuing or defending a Complaint where it is alleged that in the course of the Practice of Your Profession You were defamed or You defamed another person who is not a Healthcare Professional. 3. Automatic extensions The cover under clause 1.1 and clause 1.2 is extended to cover the following automatic extensions. These automatic extensions are subject to all of the definitions, terms, conditions, limit of indemnity, and any sub-limit of indemnity, Deductibles, exclusions and endorsements of this Policy, unless specifically expressed to the contrary. 3.1 Practice entity and practice staff cover We cover Your Practice Entity and Practice Staff for Claims made against them directly arising from the Practice of Your Profession provided that: (a) Practice Staff are acting under Your supervision or instruction; (b) the Practice Staff who are optometrists are OAA Members at the time of the Incident; (c) only applies if the Claim would be covered by the policy as if it had been made against You; and (d) requires Your Practice Entity and Practice Staff to do all of the things that You would have been required to do if the Claim had been made against You. 3.2 General optical council (UK) registration cover We cover You if You maintain General Optical Council (UK) registration but do not undertake the Practice of Your Profession in the United Kingdom (UK). If You plan to undertake the Practice of Your Profession in the UK then You will need to request UK cover for practice of your profession which is contained within the Optional extension section.
6 3.3 Retired members We cover OAA Members who: (a) retire from practice as an optometrist on or after 1 January 1992, but before the expiry of this policy; and (b) subsequently terminate their membership of the OAA. This cover will also apply to the estates of such former members in the event of their death. 3.4 Members who temporarily cease membership Where You cease Your OAA membership, We will continue to cover You where You notify Incidents or Claims to Us during the Policy Period, provided that: (a) the Incident occurred after the Retroactive Date and before You ceased to be an OAA Member; and (b) You notify Us of a Claim or Incident within 3 years of You ceasing OAA membership; and (c) You not having worked as an optometrist in Australia after Your OAA membership ceased; and (d) the OAA must confirm Your membership status for the purposes of this clause. 3.5 Overseas charity or aid organisation cover We cover You for the Practice of Your Profession outside of Australia, but only when: (a) the period You were outside of Australia was less than 120 days whether continuously or in aggregate in any Policy Period; and (b) You were practising within a recognised charity or aid organisation. Cover extended under this clause excludes Claims or requests for indemnity that arise as a result of the Practice of Your Profession in the United States of America ( the USA ). 3.6 Breaches of privacy We cover You in respect of Claims made against You in the Policy Period in relation to actual or alleged breaches of confidentiality or privacy legislation, provided the act, error or omission by You is unintentional and occurred directly in connection with the Practice of Your Profession. 3.7 Telehealth activities We cover You in respect of in respect of Claims made against You in the Policy Period in relation to providing Telehealth provided the act, error or omission by You occurred directly in connection with the Practice of Your Profession.
7 3.8 Continuous Cover Notwithstanding clause 5.18, We will cover You where: (a) You failed to tell Us about an Incident which You knew about or a person in Your position should reasonably have known might result in a Claim; and (b) We were Your professional indemnity insurer at the time You first knew or ought to have known of the Incident; and (c) We continued without interruption to be Your professional indemnity insurer from the time You knew or ought to have known of the Incident to the date of actual notification to Us; and (d) the Incident is notified to Us by You under this policy and the Incident is covered under this policy; and (e) had We been notified by You of the Incident when You first knew of it, You would have been covered under the policy in force at that time; and (f) the Incident has not been previously notified to Us. Our liability under this automatic extension for any one occurrence and in the aggregate for all Claims under this extension shall not exceed the lesser of the limit of indemnity under this policy, or the limit of indemnity under the previous policy under which the Incident should have been notified. We may reduce Our liability to the extent of any prejudice We may suffer in connection with Your failure to notify Us as soon as practicable after You first knew of the Claim or circumstance. 3.9 Actions of others We cover You in respect of Claims made against You in the Policy Period in relation to any liability incurred by You to the extent of Your liability, arising as a result of any care, treatment, advice, services or goods provided in respect of the Practice of Your Profession by a consultant, contractor or any other person or entity. This clause does not operate to indemnify any such consultant, contractor or any other person or entity. This clause is subject to You ensuring within the Policy Period, that any contractor who is a Healthcare Professional: a) holds the requisite qualifications, registration, authorisations, licences; and b) holds current professional indemnity insurance covering the types of healthcare they provide. You must maintain accurate records and obtain copies of such qualifications, registrations, authorisations, licences and insurances mentioned above in the Policy Period and retain these records and copies for at least 7 years from the expiry date of this policy Contractual liability We cover You in respect of Claims made against You in the Policy Period in relation to contractual liability directly in connection with the Practice of Your Profession. This clause does not operate to indemnify any liability assumed by contract, waiver, guarantee or warranty, unless liability would have attached in the absence of such contract, waiver, guarantee or warranty Advice on goods sold We cover You in respect of Claims made against You in the Policy Period in relation to negligent advice provided by You during the sale of any goods or products provided the act, error or omission by You occurred directly in connection with the Practice of Your Profession.
8 4. Optional extension 4.1 UK cover for practice of your profession If You require this optional extension You must make a request to Us in writing. We will assess Your request for cover and if We agree to extend cover to include this optional extension it will be noted on Your Policy Schedule and will be subject to an additional premium determined by Us. This additional premium is payable by You and not the OAA. If You have this optional extension noted in Your Policy Schedule cover under clause 1.1 and 1.2 is extended to cover You if maintain General Optical Council (UK) registration and undertake the Practice of Your Profession in the United Kingdom. 5. What we do not insure There is no cover under this policy for any Claim, Complaint, matter or request for indemnity which arises out of or in connection with: 5.1 Asbestos or pollution any asbestos or pollution except where the Claim arises from the treatment of a patient in relation to asbestos or pollution related disease or condition. 5.2 Breach of registration, unregistered practise or lack of qualifications the Practice of Your Profession where You: (a) are in breach of terms, conditions, undertakings or limitations on Your registration as an optometrist; or (b) were not registered as an optometrist and were required to be registered; or (c) have not completed the recognised training or lack the qualification to practise. 5.3 Contagious disease the transmission of a contagious disease or virus by You to any person if You knew or should have reasonably known or suspected that You were carrying the disease or virus. 5.4 Contractual liability any liability that You assumed by contract, waiver, guarantee or warranty, except as provide by clause Defamation and intellectual property defamation (except as provided by clause 2.2) or the infringement of any type of intellectual property. 5.6 Dishonest, criminal or fraudulent acts any: (a) actual or alleged dishonest, criminal or fraudulent act, error or omission; or (b) wilful breach of any statute, contract or duty of care. (c) If You are requesting cover under clauses 2.1 You will only be excluded for a criminal act, error or omission once You have been found guilty or admitted guilt in a criminal prosecution.
9 5.7 Director, partner, officer or business owner disputes any: (a) action taken against You in Your capacity as a director, officer, principal, trustee, associate, shareholder; or (b) any action taken against You by Your former or current partners, associates, shareholders or directors; or (c) action in relation to the sale of Your practice or business. 5.8 Discriminatory or sexual misconduct any sexual harassment, sexual misconduct or any form of discriminatory conduct (except as provided by clauses 2.1). 5.9 Employer, employee or collusion disputes any dispute or matter between: (a) You and Your former, current or proposed employer; or (b) You and Your former, current or proposed employee; or (c) that results from Your collusion with someone else Fines, penalties or punitive damages any punitive, aggravated or exemplary damages, fines or civil penalties Indemnified practice the Practice of Your Profession for which You are entitled to indemnity by Your employer or where You are entitled to indemnity under another policy of professional indemnity insurance Insured v insured a Claim or matter initiated by an OAA Member or any entity owned, operated or controlled by an OAA Member against You, except for a: (a) cross claim or a third party claim otherwise insured under this policy; or (b) Claim by an OAA Member in their capacity as a patient of Yours Intoxication or under the influence the Practice of Your Profession while You are under the influence of an intoxicant, narcotic or other drugs affecting or which may affect neuro-cognitive competence Legal fees and other costs not incurred by us any Legal Defence Costs or Legal Fees and Expense that We do not incur. We also do not cover You for any personal expenses You incur, attending court, hearings, meetings and conferences Liability of others any liability of any person or entity not insured under this policy including: (a) any corporate entity, practice, association or partnership (except as provided by clause 3.1); or (b) the Practice of Your Profession by another optometrist, or any Claims made against You as a result of any association or arrangement with another optometrist (except as provided by clause 3.1); or (c) contractors, Practice Staff or a Practice Entity (except as provided by clause 3.1).
10 5.16 Outside of Australia the Practice of Your Profession outside of Australia or any court or disciplinary proceedings, inquiry or inquest outside of Australia, or any proceeding brought in any court or tribunal which is applying the law of a country other than Australia, except as provided by clause 3.2 and Outside the practice of your profession any act, error or omission (except for any act, error or omission in emergency situations) that is not normally associated with the Practice of Your Profession Prior or pending any Claim, circumstance or matter which You: (a) knew about or a reasonable person in Your position would have thought might result in a Claim or matter covered under this policy and which You failed to notify Us of prior to the commencement of this policy; or (b) any circumstances or matter to which the policy would otherwise respond which You notified to Us or to another insurer before the Policy Period commenced Product and public liability, property damage or workers compensation (a) the design, manufacture, distribution or sale of any goods or products (except as provided by clause 3.11); or (b) any physical loss of, or damage to property or any loss or damage which results from that loss or damage; or (c) any personal injury or property damage suffered by Your employees; or (d) the ownership, use or occupation or state of premises, or the contents of such premises or anything done or omitted to be done in respect of the state of any premises owned, leased or occupied by You or the contents of such premises Radioactive materials radioactive materials of any type Recovery of money or refund patient fees any action in relation to the recovery of money; or a request by a patient to refund fees they have paid to You, or to waive fees due to You Retroactive date or outside policy period (a) the Practice of Your Profession outside of the Policy Period or before the Retroactive Date specified in the Policy Schedule; or (b) any Claim, Complaint or matter notified to Us outside the Policy Period; or (c) any Claim, Complaint or matter notified to Us after You cease to be an OAA Member (except as provided by clause 3.3 and 3.4).
11 6. Conditions These conditions apply to Your policy unless otherwise stated. 6.1 Loss prevention You must not do anything recklessly or wilfully that might give rise to a Claim, Complaint or matter under this policy. You must take all reasonable care to avoid or reduce the chance of any Claim, Complaint or matter being made against You. You must not do, or fail to do anything which You know or should reasonably be expected to know will result in any Claim, Complaint, or matter being made against You. 6.2 No admission You must not make any admission of liability, offer or compromise in relation to any Claim, Complaint or matter covered by this policy without Our prior written consent. 6.3 Subrogation and other insurance If We make a payment under this policy We are subrogated to all Your rights of contribution, indemnity or recovery without the need for Your consent. You agree not to surrender any right to, or settle any claim for, contribution, indemnity or recovery without Our prior written consent. You must notify Us in writing when making a Claim or requesting indemnity if You have any other insurance policies or entitlement to indemnity which may also cover You in respect of anything covered by this policy. To the extent allowed by law, We will not pay under this policy any part of a liability in relation to which You are entitled to be indemnified under another policy of insurance. 6.4 Risk management We are entitled to undertake a practice audit, peer review, risk analysis or other investigation of Your practice when, in Our reasonable opinion, such action is required. Your cooperation in any such action is a condition of Your policy. If You do not cooperate in such action We may cancel Your policy by giving You seven (7) business days notice in writing. 6.5 Fraud We may reject Your fraudulent request for indemnity or any part of Your request for indemnity that is fraudulent or is supported by fraudulent or exaggerated evidence. 6.6 Disputes Any dispute which arises under this policy may be addressed, at Your request, by reference to Our internal dispute resolution procedure. This will not include access to our external dispute resolution provider, unless We agree to such a step. 6.7 Payment of premium You will not be covered for any period for which the OAA does not pay the Premium. 6.8 Payment of deductible When a Deductible applies to Your request for indemnity the following applies: (a) You shall bear the amount of the Deductible at Your own risk; (b) where We have paid all or any part of any Deductible in respect of a request for indemnity on Your behalf, You must reimburse Us all or any part of the Deductible You owe Us within 14 days from the date We request payment from You; (c) in the event that You fail to reimburse Us in response to a request under (b) above, the sum requested shall, at the expiration of 14 days after the request, become a debt due and payable by You to Us; (d) in the event that You fail to reimburse Us in response to a request under (b) above, and if such failure leads an increase in costs or liability, Our liability under the policy shall not exceed the amount for which the Claim or matter could have been settled up to the date of Your failure or refusal to reimburse all or part of the Deductible.
12 6.9 You must notify us of a claim or incident You must notify Us in writing as soon as practicable of any Incident or Claim including, but not limited to: (a) a patient suffering a major complication; or (b) there is an error made, causing harm; or (c) an adverse outcome results in significant anger in Your patient or their family; or (d) You receive a letter from a solicitor indicating dissatisfaction or requesting a patient record; or (e) You are concerned that an Incident has occurred (including a Complaint, investigation or inquiry) which You think may lead to a Claim. If You do not notify Us of an Incident or Claim as soon as practicable, You may not be covered under this policy and Your right to indemnity may be significantly reduced by Us. To report an Incident or Claim You must notify Us in writing to: Avant Insurance Limited PO Box 746, Queen Victoria Building NSW Your notification must include Your details, the details of the Incident or Claim including the date of the Incident giving rise to the Claim, the patient s name and the details of any Claim Other matters of which you must notify us You must notify Us in writing as soon as practicable of any matter that will lead You to request indemnity under this policy including (but not limited to) any prosecution, inquiry, inquest, investigation or Complaint, judgment, appeal, dispute that may be covered by this policy which directly relates to Your practice as an optometrist. If You do not notify Us of the matters set out above as soon as practicable, You may not be covered under the policy and Your right to indemnity may be significantly reduced by Us Conduct of claims, complaints or matters You agree that We have the conduct of a Claim, Complaint or matter covered under this policy including its investigation, pursuit, defence, avoidance, reduction or settlement and We may do so in Your name. We may defend or settle a Claim, Complaint or matter as We think fit You must be reasonable in relation to settlement You must not act unreasonably in rejecting a settlement or an offer of settlement, which We or the Lawyer recommend to You. You may defend any Claim, Complaint or matter which We believe should be settled but We will not pay any more in relation to that Claim, Complaint or matter than We would have been required to pay if it had been settled or resolved as We believed it could or should have been We may decide not to continue We may decide not to incur any further Legal Fees and Expenses for pursuing, defending or responding to a Complaint, matter or prosecution if We believe that there are no reasonable grounds for pursuing, defending or responding to the Complaint, matter or prosecution. We will take account of the Lawyer s advice in making that decision. If We do that, We will notify You in writing. We will pay the Legal Fees and Expenses incurred prior to the date on which We write to You notifying You of Our decision. You may continue pursuing, defending or responding to the Complaint, matter or prosecution at Your own cost. If We subsequently decide to assist You We will appoint the Lawyer to act on Our behalf. After We cease paying the Legal Fees and Expenses, We will only pay You thereafter for Legal Fees and Expenses (not including the GST component if You are registered for GST) that You have incurred if You are successful in pursuing, defending or responding to a Complaint, matter or prosecution.
13 6.14 We will appoint the lawyer or other person We will appoint the Lawyer or Other Person. When We appoint the Lawyer or Other Person, We do so in Our own capacity and not as an agent for You. The Lawyer or Other Person appointed by Us supplies services to Us and not to You for the purposes of the Goods and Services Tax (GST). We are entitled to claim a GST input tax credit on services supplied by the Lawyer or the Other Person Your duty to cooperate You must cooperate with the Lawyer in resolving the matter in a satisfactory, timely and cost-effective way. In particular, You must: (a) give the Lawyer a full and truthful account of the relevant facts; (b) give the Lawyer any relevant information or documents in Your possession that they ask for; (c) obtain any other relevant information or documents that You can; (d) execute any documents the Lawyer reasonably asks You to execute; and (e) attend any meetings the Lawyer reasonably asks You to attend. You agree at Your expense to give Us, Our investigators and the Lawyer all information, documents and assistance We reasonably require; and cooperate fully with Us, Our investigators and the Lawyer. You further agree to waive any claim for legal professional privilege or confidentiality to the extent only that the privilege or confidentiality would otherwise prevent the Lawyer from disclosing information to Us. The Lawyer will keep Us properly informed on all relevant matters We are not liable if you do not cooperate We will not be liable for Legal Fees and Expenses if You do not give Us or the Lawyer adequate instructions, or You do not follow the advice of the Lawyer or You cause a delay which, in Our or the Lawyer s reasonable opinion, prejudices the outcome of the case The lawyer s or other person s account The Lawyer or Other Person will provide Us with an account for fees, charges, expenses and disbursements reasonably incurred. We will pay the account subject to the limit of Our liability set out in the Policy Schedule and subject to payment by You of any Deductible Appeals If You are dissatisfied with any decision made in a Claim, Complaint or matter against You by a court or other decision making body and wish to appeal against that decision, You must seek Our consent to the appeal within seven (7) business days after the date of the decision, or such shorter period as may be reasonable having regard to the time limit for an appeal. The application must be in writing and must fully set out the reasons for bringing an appeal. We will inform You in writing if We consent to the appeal. If We do not consent to the bringing of an appeal, You may conduct the appeal at Your own expense. If We wish to appeal against any decision made in a Claim, Complaint or matter against You by a court or other decision making body, You must reasonably cooperate with Us in the bringing of such an appeal Appeals without our consent If You appeal from a decision in a Claim, Complaint or matter without Our consent: (a) after We cease paying the Legal Defence Costs and Legal Fees and Expenses, We will only pay You thereafter for Legal Defence Costs and Legal Fees and Expenses (not including the GST component if You are registered for GST) that You have incurred if You are successful in the appeal; and (b) if the appeal is successful and You are entitled to a refund of any money that We paid to the claimant, then We are entitled to recover that amount after deduction of the costs You have incurred.
14 6.20 Our right to recover payment from you If We have made any payment under this policy and the Claim, Complaint or matter is later found to involve a fraudulent, criminal or dishonest act or omission by You, We are entitled to recover this payment from You Claims acceptance The acceptance of a Claim, Complaint, matter or indemnity by Us under this policy can be subsequently withdrawn if facts come to Our attention that trigger or satisfy a policy exclusion or the policy does not cover the Claim, Complaint or matter Clinical records You must maintain clinical records for the Practice of Your Profession that: (a) are of a standard expected of a competent optometrist; (b) are prepared and updated on or reasonably proximate to each occasion of the provision of Your professional care; and (c) if computerised, the integrity of the records can be verified by reference to the security features of the software Cessation of specified clinical activities You must stop providing or conducting a particular procedure, treatment or clinical activity if: (a) We consider that the procedure or clinical activity poses an unreasonable risk of negligence or injury, illness or disability to patients; or (b) a registration board places a condition on Your registration that You must not perform a specified procedure, or that You cannot perform a procedure in a particular way. We will provide a minimum of fourteen (14) business days notice requiring You to cease carrying out any such procedure, treatment or clinical activity. If You do not do so We may cancel Your policy by giving You seven (7) business days notice in writing Cancellation The OAA may cancel this policy at any time by notice in writing in which case We will refund the Premium on a pro rata basis less two (2) months Premium (does not include government charges or levies). If the OAA and/or its affected members have notified an Incident or a Claim during the Policy Period there will be no pro rata refund. We may cancel this policy at any time by giving the OAA seven (7) business days notice in writing: (a) if the OAA has not paid the Premium within thirty(30) business days of the Policy Period commencing; or (b) if the OAA and/or its affected members are in breach of any of the conditions of this policy; or (c) for any other reason available to Us under the Insurance Contracts Act 1984 (Cth). If We give notice to cancel the policy then We must give that notice to the OAA personally, or send it by certified mail at the last address of which the OAA notified Us. Unless the OAA proves otherwise, it will be treated as if the OAA received the notice when it would have arrived in the ordinary course of the post.
15 6.25 Governing law Any interpretation of this policy relating to its construction, validity or operation shall be made in accordance with the laws of the Australian state or territory in which it is issued. The parties to this policy will submit to the exclusive jurisdiction of the courts of that state or territory. A reference in this policy to a statute, regulation, code or other law or a provision of any of them or a professional body or organisation includes any amendment or replacement of it and/or another regulation or other statutory instrument made under it, or made under it as amended or replaced. 7. Definitions 7.1 Claim A demand for or an assertion of a right to compensation or damages or an intimation of an intention to seek compensation or damages in relation to an Incident. 7.2 Complaint An allegation of unlawful or actionable conduct or an allegation of misconduct or unsatisfactory conduct. 7.3 Deductible Is the amount set out in the Policy Schedule which is the amount that You shall bear at Your own risk in respect of each Claim or request for indemnity under the policy. The limit of indemnity and sub-limit of indemnity only apply after the Deductible has been exhausted. 7.4 Healthcare Professional A person who provides healthcare who is a medical or dental practitioner or is registered to provide healthcare in accordance with the laws of the Commonwealth or the State or Territory legislation in Australia. 7.5 Incident Any act, error or omission by You which adversely affects a patient; or an unexpected complication or injury occurring to a patient under Your care as a result of the Practice of Your Profession. 7.6 Lawyer The legal practitioner or Other Person instructed by Us to provide services to it. 7.7 Legal Defence Costs The necessary and reasonable costs of investigating, defending or settling a Claim made against You and covered by this policy. 7.8 Legal Fees and Expenses The necessary and reasonable fees and expenses incurred in the defence, pursuit, conduct of or response to matters covered by clause 2.1 and OAA The Optometrists Association Australia OAA Member An optometrist who is a member of a State division of Optometrists Association Australia Other Person A person including but not limited to: an accountant, an actuary, an expert witness, a witness as to fact, or any person required to assist Us in any matter covered under this policy Policy Period The period specified in the Policy Schedule.
16 7.13 Policy Schedule The current schedule to this policy Practice Entity Any corporate entity that is in the business of providing optometry services which is wholly controlled or wholly owned by OAA Members or a partnership in which all partners who are practising optometrists are OAA Members Practice Staff An employee working in Your practice, other than a medical practitioner, who is supervised or instructed in their activities by You or an optometrist employed by You, subject to that optometrists being OAA Members or holding their own professional indemnity insurance at the time of the Incident Practice of Your Profession The provision by You of professional treatment, advice and services to patients in the course of Your profession as an optometrist Premium The amount the OAA is required to pay for insurance cover under this policy for the Policy Period specified in the Policy Schedule. Where the context requires, this includes government taxes and levies. The Premium is specified on the tax invoice Retroactive Date The date specified in the Policy Schedule as the Retroactive Date. There may be more than one Retroactive Date. The Retroactive Date is the date after which an Incident must have occurred to constitute a valid Claim or request for indemnity under the policy Telehealth Services provided in the Practice of Your Profession to, or in respect of a patient who is not in the same place, that uses any form of technology, to enable it to be provided, including video-conferencing, internet and telephone Us, We, Our Avant Insurance Limited ABN and AFS Licence You, Your A qualified optometrist who is a member of a State Division of the OAA. Avant Insurance Limited ABN AFSL Registered Office Level 28 HSBC Centre 580 George Street Sydney NSW 2000 PO Box 746 Queen Victoria Building Sydney NSW 1230 DX Sydney Downtown Website Telephone Facsimile Free call Free fax A subsidiary of Avant Mutual Group Limited ABN V February 2011
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