Cumann Luthchleas Gael
Droichead Na Banndan /
BANDON G.A.A. CLUB INJURIES POLICY 2015
It is the stated Policy of Bandon G.A.A. Hurling & Football Club that no player or their parents / guardians should be out of pocket as a result of any Injurysustained while playing for or training with the Club.
In order to implement and fully commit to this Policy it is essential that allMembers, Players, Parents / Guardians, are made, and kept, fully aware of our Club Policy in respect of Injury Claims.
Bandon GAA Club operates an Insurance Policy under the GAA Player Injury Scheme ( currently administered by Willis ). The guidelines for making Claims under the GAA Scheme are strict and it should be noted that processing and finalising Claims can take considerable time.
Bandon GAA Club can only make payments to players on foot of Claims after the GAA Insurance Scheme has reimbursed the Club in respect of those Medical Expenses.
This will mean that there will be a delay between the player / parent / guardian paying the medical bills arising and the re-imbursement of those expenses.This is totally out of the Club’s control and the delay in some instances can be several months.
Any player who wishes to make a Claim against the GAA Insurance Scheme and who also has Private Health Insurance ( VHI, LAYA,Aviva,Garda Medical Aid, etc. ) may do so, but in all cases you must first Apply under your own Private Health Policy.
If your Private Health Insurance Policy covers your Claim then there is no further action required.Should there be an Excess on the Private Policy which exceeds your Claim, then the GAA Injury Scheme will accept your Claim. A Statement of Account from your Private Health Insurers which sets out their position on the overall Claim will be required if you wish to further your Claim through the GAA Scheme.
Routine Physiotherapy is not covered through the GAA Player Injury Scheme.
GAA Players Injury Scheme
Hurling Claims are covered only if the injured Player is wearing an approved Helmet.This applies to Official Games, Challenge Matches, and Training Sessions.
From the 01st January 2014, all players in all Grades up to and including Senior will be required to wear a Helmetwith a Faceguard that meets the Standard set out in IS : 355 ( or other similar Standard ).
In Gaelic Football the use of Mouth-guards are compulsory for all grades since the 01st January 2014. Mouth-guards are mandatory in all Gaelic Football Practice Sessions and Games.Injured Players will not be covered under the Players Injury Scheme if they are not wearing a Mouth-guard.
No mouth-guard – no training – no game – no INSURANCE.
Please download and read a copy of the currentGAA Injury Claim Form here
There are important Points to note in relation to the Scheme and any potential Claims including :
The Insurers Willis must be sent at least the first 2 pages of the Claim Form to their Offices within 60days of the Date of the Injury occurring. Otherwise the Claim will be automatically declined.
All Claims to be eligible must be–Dated - Signed by Injured Party – Signed by the Treating Doctor / Dentist or Physio – May need to be Signed / stamped by Social Welfare, – May need to be Signed by Accountant -May need to be signed by Employer – May need a Referees Report – May need Letter on Club Paper - Has to be signed by Club Secretary – Has to be signed by County Board Secretary –Should be Reported to Insurers within 30 days of the Injury – Has to be reported within 60 days of Injury or the Claim fails
The initial Claim Forms to Willis can be hand delivered,posted, e-mailed, or faxed.
Injuries brought to the attention of the Club after the expiry of 60 days cannot be forwarded to the Insurance Company.
The Excess on the Scheme is currently set at €100.This Excess will be covered by the Club and the Player, Parent or Guardian will not be out of pocket.
The maximum amount claimable for Medical Expenses is currently set at €4,500.
Original Receipts only will be accepted.
A Referees Report is required if the injury occurred during an Official game or Challenge match and this must accompany the Claim. It is essential that the match Referee is notified of the Injury at the end of the game so that it is included in his Referees Report ( Team Managements please Note ).
If an incident is not reported to the match Referee then a Claim cannot be forwarded to the Insurance Company, and additionally the Club will not be held accountable for any Medical Expenses incurred on foot of the incident.
A Letter from the Club on headed notepaper is required if the Injuryoccurred during Club, Divisional, or County training.
Any Injuries requiring medical attention must be notified by team mentors to the Club within 24 hours
There is no cover for pre-operative Physiotherapy. The only Physiotherapy expenses that may be claimed are for treatments that are post-operative i.e. after a surgical procedure. They are then limited to €320 in total maxed at €40 for any one treatment. ( that is a total 8 treatments at €40 each). A Doctors Letter will be required referring the claimant for physiotherapy treatments.
MRI Scans can be claimed maxed at €300per Scan.There are however severalMedical Centres offering MRI Scans well below this price.A Doctors referral is currently not required for an MRI Scan, for the purposes of the Scheme.
If the claimant has Private Health Insurance (VHI, Quinn, Aviva etc. ) then they must claim from these primary Insurers first.
It is important to note that the Scheme covers:
Members performing designated duties underrequest/instruction of an authorised ClubOfficer, ina strictly voluntary capacity, on GAA property or onproperty under the exclusive use of the GAA.
Players on a team registered with the Scheme whoincur accidental injury while playing Hurling, GaelicFootball, Handball, or Rounders only, either:
(a) in the course of an official competitive game or achallenge game or
(b) in the course of an official and supervised teamtraining session.
Match Officials, i.e. referees, linesmen or umpires,injured whilst officiating at an official game ofHurling, Handball, Gaelic Football or Rounders asspecified in Rule 1.1.
Voluntary coaches, team managers, selectors andmembers of official team parties injured duringgames or training as specified in Rule 1.1
The GAA Scheme is NOT an Insurance Scheme.It is a Benefit Scheme for the purpose of giving an injured player a "dig out" if they have no other recourse for their medical expenses.Payments from this Scheme come directly from GAA funds, there is no Insurer or Underwriter involved with the Scheme. It is important to note that Willis act as the Scheme Claims Assessors and Administrators ONLY and do not underwrite the Scheme.
Any treatment being claimed must have been paid prior to claiming with the Scheme. This does not mean that you must wait for your treatment to be completed before submitting a Claim. It means the Scheme will only assess receipts and not Invoices or unpaid Bills.
Loss of wages can be claimed for up to 52 weeks provided the claimant is declared medically unfit to work by doctor/consultant or surgeon. The claimant must be in full-time employment (16 hours or more per week). Loss of earnings will not apply to Students.
The Policy Excess for a loss of Wages Claim is the first week of the Claim.
Payment is calculated by taking the claimants average weekly net wage minus social welfare payment (Illness Benefit which the Claimant must make a Claim for, and provide written evidence from his local Social Welfare Office stating how much he is receiving, or alternatively why he is not entitled to receive any payment) or sick pay entitlements from his employer etc.
The Scheme then follows the below limits on the remainder:
Week 1 - excess (no payment)
Week 2 - 4up to € 200
Week 5- 52up to € 400
There is scope in the Scheme to claim if the claimant has suffered a Permanent total or partial disability (loss of finger etc). However each case is taken on its own merits and the medical information is assessed by an Independent Medical Advisor. The decision is made directly by CLG and they will agree the relevant Claim figure.
A claimant can claim for a stay in hospital provided they are an in-patient for a minimum of 10 consecutive days and they can claim for a maximum of 15 days. € 400 per day is claimable. This is separate to any hospital charges as these can be claimed under medical expenses.
Please be aware that there are administration delays involved in processing Claims and it may take several weeks or even months to fully process Injury Claims. To avoid even further delays it is essential that Forms are Signed, Stamped if necessary, and Completed correctly. Also that Receipts and other documentation are forwarded to Willis as soon as possible after the injury occurs.
Physio
Physiotherapy is costing the Club far too much each year and the Costs that wereonce covered by Insurance have now been burdened on the Club.Many players cost the Club nothing in Physio year after year.
Each year the Club pays about €7,000 for Player Insurance to the GAA.Players membership levied does not even match that amount. The Club cannot sustain the current level of Physio costs and it is affecting the Development work we want to complete in the Club.
There will be a new Club Policy in place for Physiotherapy in 2015, and until further Notice :
There will no longer be a Club Account operated with any Club Physio.All Physio treatments must be paid for by the injured party and the receipts produced to the Club Treasurer or other Officerto obtain a refund.
The Club will now only cover the cost of the first 2 Physio treatment sessions.
There are three main reasons for the change
1) The existing system is open to abuse.
2) Existing Private Medical Insurance Policies are not being used to reduce the cost per visit to the Club.
3) The Club cannot get the cost of the annual Physio bill down year on year.
Your Physiotherapy costs may be covered by your personal Insurance Policy:
Currently with VHI Health Plus Plans you can get an allowance of €13 per visit for up to 5 Physio visits.
Currently the Aviva Value Focus Policy allows 8 Physio visits twice a year with a once off Excess fee of €50.
Currently Garda Medical Aid will pay 60 % of the cost of a prescribed Physio to a maximum of €34 per visit and 10 visits in a calendar year
Currently with Laya Enhanced Everyday Cover you can get a €20 per visit Physio allowance with no limits.
You can also claim 20 % (Standard rate tax relief) of all your Medical Expenses against your Income tax each year by completing a Form Med 1. There are plenty accountants in the Club who can assist you with your claim free of charge.
The Pupil Accident Policy may be operated by Primary and Secondary Schools, and offers cover to students attending those Schools.Injury claims appear to be dealt with very efficiently through those Schemes and it may be more convenient to Claim under such a Policy. There is evidence of Medical Care Costs being refunded within two weeks of Claims being submitted.
In addition the School Policy covers attendance at Swift Care Clinics.
Parents interested in knowing more about the School Policy should contact their child’s school and establish if they have 24 Hour Cover in place. This would mean accidents occurring while playing for Bandon Club would be covered.
The Club will not process Claims, or be held accountable for medical expenses incurred where the player presents at a Private Emergency Department or Private Clinic. If a player or his parent / guardian wish to be treated in a Private Clinic in respect of an Injury, then it will be the Club’s understanding that a Claim for any medical expenses arising will not be submitted to the Club’s Insurer’s, but will instead be claimed by the player / parent / guardian under an alternative Policy such as Private Medical Cover or the Pupil Accident Policy.
Under no circumstances will the Club any longer pay for treatments or operations on Injuries that have not been officially reported or notified to the Club, or notified to the GAA Injury Scheme. Such treatments and procedures which can cost several thousand Euros have to be authorised in advance by the Club to ensure that the Club and the individual can have adequate Insurance Cover in place.
If you have any questions or comments regarding any of the above please do not hesitate to contact any Club Officer.
Synopsis Of Current 2015 GAA Injury Scheme Policy Document and Cover
Lifetime Disability Benefit (Payable in addition to any other benefit) €300,000
A single identifiable occurrence on the field of play resulting in permanent total physical paralysis such that the Insured Person is confined to a wheelchair for life.
Capital Benefits
Permanent Total Disablementfrom gainful employment €100,000
Loss of Sight €100,000
Permanent Partial Loss of Sight Up to €100,000
Loss of Limb(s) €100,000
Complete and incurable paralysis €100,000
All above benefits Less any Loss of Wages Benefit claimed
Permanent Partial Disablement ("Continental Scale")
A scale of benefits providing for benefits to a maximum of€50,000 for specified disabilities applies.
Details are available on request.
(ii) Death Benefit
Adult (or Married Youth) €50,000
Youth €25,000
(iii) Medical
Otherwise unrecoverable medical expenses up toamaximum of €4,500. The first €100 of each andevery claim is not covered.
(iv) Dental
Otherwise unrecoverable dental expenses up to amaximum of €4,500. The first €100 of each andevery Claim is not covered.
(v) Supplementary Hospital Benefit
€400 per day's stay in hospital. Benefit only payableif stay is a minimum of 10 consecutive days up to amaximum of 15 days
(vi) Loss of Wages
(Applicable (a) to Adults and (b) toYouths who are in full-time employments at thedate of injury)
Otherwise unrecoverable loss of basic nett wages
(i.e. excluding overtime, bonuses, unsociableworking hours etc.) payable up to 52 weeks but excluding the first week
Social Welfare/Income Protection and/or other entitlements will be considered as recoverable income and will be deducted from the basic nett wage figure.
Benefit is payable for full weeks only and the maximum benefit payable per week is as follows :
WEEK 1 NIL
WEEKS 2-4 UP TO €200
WEEKS 5-52 UP TO €400
(vii) Benefits/Conditions and Team Subscriptions may be altered from time to time at the discretion of C.L.G.
NOTE:
The Injury Scheme is funded entirely from Club and GAAfunds with no outside (e.g.Insurance) involvement. There isno legal obligation on the GAA to provide such a scheme.Risk is an inherentfactor in sport, as in life. When membersvoluntarily take part in Club Activities, they accept the risksthat such participation may bring. Legal representation isnot required and there is strictly no Legal Expenses Coveramongst the benefits provided.
This document is for Information purposes only. It does not form any Contract and does not purport to deal with all aspects ofthe GAA Injury Scheme.The Scheme may be amended or altered from time to time and any updates or alterations will appear on the GAA Injury Claim Form or on the GAA web-site.