The University of Melbourne / Melbourne University Sport

The University of Melbourne / Melbourne University Sport
Personal Accident Insurance
Period: 31 October 2011-12
Claim Procedure
To proceed with a claim against the University’s Personal Accident Policy (No: 02.PO.012009) –
– please obtain, collate and post the following (original) documents
– to the University’s Insurer, “ACE Insurance Ltd” ( listed below ),
– with a brief covering letter:
1. Personal Accident Insurance – Report Form
● Please Note:
– The Policy Holder is The University of Melbourne
– The Policy Number is: 02.PO.012009
– The name of Broker is “MARSH (Melbourne)”
– “You” are the “The Claimant”
– Only Record “GST” details – “ if ”you are registered for GST
– The Medical Practitioner's Statement should only be completed by a qualified Doctor
● Where applicable, you will need to attach:
– If claiming for Weekly Benefits – provide Proof of Income (Salary)
– Receipts for Non-Medicare Medical Expenses & corresponding Private Health Fund Benefit Statements
2. Incident Report Form
– ( available from the Melbourne University Sport reception ) ( For completion by your University Club representative – to verify the occurrence of your injury – at a particular place and time.)
3. Letter from your Melbourne University Club
[ On their Original Club “Letterhead” – To confirm that you were a registered participant in their officially organized sports competition or training – at the time you were injured.)
4. Written ( Email / Letter ) Confirmation from Melbourne University Sport (Administration) # –
( To confirm that you were a “paid-up” and “financial” - Melbourne University club member – at the date that you were injured.)
# “MUS” contacts: Katie Duncan / Clubs & Sports Coordinator / e: /
OR Thomas Lutwyche p: (03) 8344 3945.
► Send the original copy of your claim documents (including tax invoices & receipts ) –
– AFTER lodgment with your private health insurance fund, if applicable
– DIRECT TO:
ACE Insurance Ltd
Claims Department
GPO BOX 4065
SYDNEY NSW 2001 / Ph: 1800 688 640 OR 02 9335 3355
Fax: 02 9231 3697
Email: A&
[ Please ensure that you retain a copy of all your documentation, for safe-keeping.]
[ Please contact the University Insurance Office at: - if you have any queries.]