Transport Workers Union NSW Insurance FAQs The below Frequently Asked Questions is intended to provide general advice and summary explanations of the policy, coverage benefits and claims process only. It is important to note that the below information does not override the policy wording or policy schedule. The below information is provided as a summary only and at all times subject to the policy terms, conditions and exclusions. 1. What does the definition of Journey Injury Insurance cover mean? The definition of Journey is travel to and from a COVERED PERSON s place of residence to work and extended to include: DIRECT TRAVEL for the purpose of attending the COVERED PERSON s normal place of employment to the COVERED PERSON s normal place of residence; Including any minor deviations which in no way increases the risk of bodily injury that would have normally arisen had the insured person travelled directly provided no cover is granted by Workers' Compensation or the Traffic accidents act or equivalent. Journey also includes sanctioned and approved travel to yard visits, offsite learning or training organization as required during the course of the COVERED PERSON s employment with the POLICY HOLDER; Travel during meal breaks within business hours; Normal place of employment for truck drivers means the depot of the franchise/company they work under. 2. When am I covered? Cover commence from the time the financial member undertakes a journey to and from work and ceases upon arrival at either their normal residence or place of employment, whichever is their destination. 3. What am I covered for? The Journey Insurance policy will cover you for 85% of your weekly Salary, up to a maximum of $2,000 per week. (See point 15 for a definition of Salary) 4. Who is covered by the Journey Injury Insurance policy? Financial members of the Transport Workers Union NSW (TWU) and its Sub Branches at Sydney, Wollongong, Newcastle and ACT including owner drivers and TWU current employees. 5. What if I become un-financial with the TWU, am I still covered? No. 6. Why has the Transport Workers Union taken out this policy? In 2012, NSW WorkCover made a number of changes to the workers compensation system. Included in those changes was that Journey claims are no longer covered under workers compensation. The TWU wants to make sure that its members are covered by a minimum safety net that protects wages when travelling to and from work each day. 1 P age
7. Is there a death and capital benefit on the Journey Injury Insurance cover? No. 8. Is there an excess/waiting period? There is no journey insurance claim payable for the first 14 days. 9. Am I covered for any injury caused or contributed to by a pre-existing injury? No. 10. 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 intoxicating liquor 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. 11. Has travel during meal breaks within business hours been affected? No. It continues to be covered under the Workers Compensation legislation. 12. How are Owner Driver Members of the TWU classified? Owner Drivers are Contract Carriers as defined by section 309 of the Industrial Relations Act (NSW) 1996 13. Who pays for the Journey Injury insurance cover? The insurance policy premium will be paid by the Transport Workers Union of NSW. 14. Can I claim for any medical expenses? No medical expenses are covered. 15. What is included in the definition of SALARY? SALARY means in the case of an EMPLOYEE, their weekly pre-tax income or wage, excluding any commission and bonuses, but including overtime payments and allowances, averaged over the twelve (12) month period immediately preceding the commencement of the disablement or over any shorter period for which they have been employed. SALARY for self-employed COVERED PERSONS, including Lorry Owner Drivers, means, their total net income earned, averaged over the twelve (12) month period immediately preceding the commencement of the disablement or over any shorter period for which they have been employed. 16. I perform some regular overtime and also work weekend or night shifts. Will I be paid for these if I am off work from a journey injury and make a claim? Yes (See point 15). 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. 2 P age
17. 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 negotiate with your other insurance providers as to how the payments will be shared. Note that any payments received under this policy will be always limited to 85% of your salary. 18. How does, the Traffic Act and Workers Compensation Act affect a Journey claim process? Claims are reviewed on a case by case basis in relation to their likely acceptance under relevant Traffic Act (Compulsory Third Party (CTP))/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. 19. What should I do if I am injured on the way to or from work? You should put in a workers compensation claim through your employer in addition to completing a claim form (click here to download) for Journey insurance and submitting this to Arthur J. Gallagher. If the injury was the result of a motor vehicle accident which was not your fault, you may be able to receive compensation under the Third Party Compensation (CTP) scheme. Alternatively you could contact the Transport Workers Union Membership Service Section for advice. 20. If I make a claim, when will I be paid? If you make a claim and your doctor verifies that you are expected to remain off work for longer than two weeks, then your income benefits under this Policy will be paid to you fortnightly in advance. Assuming all required paperwork is provided and the claim has been successfully approved, the first payment would be made 14 days after the date of the injury. 21. How are payments made to members? Income benefits (based on weekly salary) are paid fortnightly in advance directly to the member making the claim. 22. 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 provided your claim has been accepted and approved. However an employer may be able to terminate employees on leave without pay in circumstances where they are absent for over 3 months and not on sick leave (sec 352 Fair Work Act and regulation 3.01 of the Fair Work Regulation) 3 P age
23. Why is there an agreed excess 14 day waiting period before a claim under Journey Injury Insurance can be lodged? First the application has to be lodged with Work Cover to determine the nature of the claim whether it is covered under Workers Compensation or Journey Cover. The Workers Compensation has seven (7) days to either accept or refuse the claim. If declined the first 14 days can be made up by using annual or sick leave. 24. If I am only getting 85% of my weekly wage under this policy, can I top up my weekly payments with some additional sick leave? No. Any payments received via sick leave benefits will reduce the payments received under this policy. Whilst on claim, the total benefits payable (including any sick leave or other insurance entitlements) under this policy will be to 85% of your pre-injury salary. For example, if you claim a day s salary via sick leave, you would not receive that day s pay via the insurance policy. 25. I work in the ACT where we still have journey claims under the workers compensation system. Am I covered under this policy? All members in the ACT are insured for, as not all ACT workers will be covered by the workers compensation system there. Some workers under Commcare will still require protection under this insurance policy. If a member makes a claim under this policy, then a claim should still be made under the workers compensation system. 26. Why do I need to also put a workers compensation claim in if I am claiming under this journey insurance policy? There are aspects of the workers compensation system which are unclear. Some cases may still be covered by workers compensation and therefore in the first instance, an attempt must be made to gain coverage under workers compensation. 27. If I have to make a workers compensation claim at the same time as making a claim under this policy, will this delay receiving any benefits? If all the paperwork is submitted properly, it is not expected this will delay a claim. A workers compensation claim must be determined within 7 days and the Journey Insurance claim will take a few more days after that. All this is expected to occur within the first 14 days of the excess period. 28. What documents do I need to submit when lodging a claim? A completed claim form is required, in addition to a copy of your most recent pay slip. Download the form here. Note for self-employed members, additional information may be required such as copies of tax returns, financial reports and bank statements. The insurer will advise what is required on a case by case basis. For example, Owner Drivers (Lorry Owner Driver s) are required to provide details of the gross remuneration received by way of Tax Receipts from their Principal Contractor or Bank statements for the immediate 12 months (52 weeks) period prior to their injury or disablement. 4 P age
29. How will the Insurance company calculate the Journey Injury 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. 30. What happens in the event of a Relapse of Injury? You will be covered for a maximum of 104 weeks or two years from the date of the original injury. 31. What happens if I am unable to return to work? The Journey Injury insurance cover provides you with financial security for up to 104 weeks or two years from the date of original injury. However unlike workers compensation if you are off work for more than 3 months the employer does not have to keep your job open for you. Therefore if you are unable to return to work with 10 weeks of the injury, you should contact the Transport Workers Union Membership Service section for advice. 32. Would the personal information I provide be kept confidential? Yes the information provided will be kept confidential in accordance with the Privacy Act 1988 (Cwth). 33. Are there any additional benefits covered under this policy? Yes refer to the below table for a summary and the policy wording and policy schedule for full details: Additional s Sum Insured Explanation of Rehabilitation Return to work $25,000 To assist in being able to return to work sooner, the insurer may elect to pay for rehabilitation training at vocational schools or counselling, on agreement with the injured person s doctor. $25,000 To assist in being able to return to work sooner, the insurer may elect to pay for professional assistance to improve the injured person s mental wellbeing or pay for home or work modifications to assist in the return to work process. Dependant, Child Assistance Maximum $ 45,000 In the event of the death of the injured person the original injury, lump sum payments are made to the estate where the deceased member had dependent children. Surviving Spouse/partner $15,000 In the event of the death of the injured person the original injury, lump sum payments are made to the spouse of the deceased member. 5 P age
Partner retraining Unexpired membership $25,000 In the event of the death of the injured person the original injury, the insurer may elect to pay for the deceased s partner to undergo retraining to assist in finding employment. $1,000 If a member is off work for greater than 26 weeks, the insurer will reimburse the member for the un-used portion of an industry or professional association membership, including their membership to the Transport Workers Union. Funeral Expenses Maximum $10,000 In the event of the death of the injured person the original injury, the insurer will pay the funeral expenses for the deceased. The above Frequently Asked Questions is intended to provide general advice and summary explanations of the policy, coverage benefits and claims process only. It is important to note that the below information does not override the policy wording or policy schedule. The above information is provided as a summary only and at all times subject to the policy terms, conditions and exclusions. If you have any questions with regards to the above, please don t hesitate to contact Arthur J. Gallagher s broking team for the Transport Workers Union of NSW. 6 P age