INSURANCE INFORMATION

Claims Procedure & Incident Report Form

Please Read

This page contains information relating to insurance claims procedures and incident reporting.

000

For all MEDICAL EMERGENCIES, on & off the field, DIAL TRIPLE ZERO (000) and ask for an ambulance.

Visit our Health & Safety page for full details.

Dial 000 (use for medical emergency only)

Injuries & Accidents

For all medical emergencies dial triple zero (000) and ask for an ambulance.

For Club sports related injury claims on or off the field, contact the Insurance company. Scroll down this page for information on the Club's insurance policies and claims procedures. Take care to select the correct insurance company and procedure.

Please complete the Incident Report Form so that the Club has a record.

Incident Report Form

Please complete and submit your incident report within 72 hours of the incident occurring.

This form is for reporting all on-field and off-field incidents relating to Greystanes FC only and is sent directly to the Club secretary for review by the Club Executive.

If you would like assistance with reporting an incident contact our Club MPIO.

Incident Report Form | Greystanes FC

Please complete and submit your incident report within 72 hours of the incident occurring. This form is for reporting all on-field and off-field incidents relating to Greystanes FC only and is sent directly to the Club secretary for review by the Club executive. If you need assistance with reporting an incident please contact our Club MPIO. More about our MPIO

Your Details

The Reporter

First name *

Last name *

FFA number

Email address *

Telephone 1 *

Telephone 2

About your Relationship to Greystanes FC *

parent

guardian

senior player

junior player

coach

manager

supporter

game official

other club member / supporter ** (please provide details below).

other ** (please provide details below).

Select one

** other details

The Incident Details

Date of Incident *

Enter the date of the incident. (format = day.month.year)

Time of Incident *

Enter the time of the incident using 24 hr clock; (12am, midnight = 00:00, 12pm, midday = 12:00).

Are you seeking insurance coverage (claim) for this incident, which may be classified as either a sports-related injury or accident?

Yes

If yes, then you must complete your insurance claim with the insurance company. Policies cover players and officials. Details on this page.

Description of Incident *

Witnesses

Please ensure you have permission from witnesses to share their personal information, beforehand.

W1 First name *

W1 Last name *

W1 Email address *

W1 Telephone

W2 First name *

W2 Last name *

W2 Email address *

W2 Telephone *

Form submission at 00:55 on 27.4.2024 from address 18.118.30.253 with id e17c07eeae9e0897

Information in the completed form will be transmitted by email over the internet.

Website

Insurance Claims

Procedures Information

GDSFA / Phoenix League Insurance

GDSFA is insured under the Football NSW insurance program
with Gow-Gates Insurance Brokers.

Follow this procedure if you're registered to play in games sanctioned by
GDSFA, Phoenix League and Football NSW.

Claims Procedure

Visit the Gow-Gates Football Insurance Website.

Select your relevant Association i.e. Football NSW.

Navigate to the ‘Claims’ section and follow the link to lodge your claim online.

The standard documentation you will be required to upload during the claims portal submission are:

Club Declaration (to be completed and signed by an Authorised Representative of your Club e.g. President, Vice President, Secretary, Treasurer)
Physician’s Report (to be completed by a GP, specialist, surgeon or dentist)

If you are claiming for Loss of Income, in addition to the Club Declaration and Physician’s Report you will also be required to upload:

Employment Statement (to be completed by your employer)
Incapacity to Work Statement Page 3 of the Physician’s Report (to be completed by a GP, specialist or surgeon)

You will be prompted to download blank copies of the relevant documentation in Step 4 of the claims portal process. The claim submission is an 8 Step procedure and will save your progress as you complete each Step.

Complete the Incident Report Form and send to Greystanes FC for our records.

All Insured Persons must be registered with Football NSW for coverage by this insurance program.
Only injuries which occur during the policy period are covered.

No cover is provided for:

Any pre-existing defect, infirmity or sickness the insured person suffered from at the time of the accident
Self-infliction
War and terrorism
Aerial activities
Being under the influence of Drugs or alcohol
Criminal acts
Psychiatric or psychological disorder
Contamination by radioactivity
Sickness, disease or disorder of any kind
Injuries which occur outside the policy period
Pregnancy or related complications.
It is recommended that all Insured Persons take out separate Private Health Insurance and/or Personal Income Protection, Life Insurance and Trauma cover.

When you register to play with a Football Club, you are reminded that Football is a body contact sport. Potential, notwithstanding all safety guards, exists for a player to sustain injury. Players are therefore reminded of their obligation to prepare themselves for training and matchday sessions, by engaging sufficiently in warm up activities and maintain an adequate level of fitness.

As a measure of your club and Football NSW’s support to all Insured Persons, they have arranged insurance cover as set out in this document and for your benefit and risk protection.

In addition to these policies all Insured Persons are encouraged to take out private health insurance and life insurance cover over and above that is outlined on the previous page to ensure individual needs and circumstances are met.

For any advice or additional insurance cover that you may require please contact Gow-Gates.

CFA Sydney Insurance

CFA Sydney competitions are insured
with Sportscover.

Follow this procedure if you are registered to play in games sanctioned by CFA Sydney.

Claims Procedure

All claims must be notified to Sportscover within 30 days of the accident, injury or damage occurring.

A Claim Form can be obtained via either of the following three methods:

Request a claim form
Calling the Sportscover Claims Hotline – 1300 134 956 (Australia Only) or
Calling your Insurance Broker
If you have been injured, then you require a Personal Accident Claim Form
If your insured property has suffered damage or loss, then you require a Property Claim Form
If an incident has occurred that you believe may result in legal action against you, then you require a Liability Claim Form

Complete the claim form providing as much information as possible and submit this to the Sportscover Asia Pacific Claims Department.

Monitor the progress of your claim by entering your Claim Number and Internet Access PIN in the Claims Progress Login.

You should have received claim number and Internet Access PIN, if you have not please Contact us.

Complete the Incident Report Form and send to Greystanes FC for our records.

All Insured Persons must be registered with CFA Sydney for coverage by this insurance program.
Only injuries which occur during the policy period are covered.

No cover is provided for certain items.

It is recommended that all Insured Persons check with the Insurer for exclusions.
It is recommended that all Insured Persons take out separate Private Health Insurance and/or Personal Income Protection, Life Insurance and Trauma cover.

As a measure of your club and Sportcover’s support to all Insured Persons, they have arranged insurance cover as set out in this document and for your benefit and risk protection.

For any advice or additional insurance cover that you may require please contact Sportcover.

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