Queensland Meals on Wheels Volunteers Personal Accident Policy - - PowerPoint PPT Presentation

Queensland Meals on Wheels

Volunteers Personal Accident Policy Presentation

26 March 2019

AGENDA

1. QMOW’s workforce and the risks 2. Medicare / Legislation 3. The Insurance cover 4. Overview of the policy limits 5. Medicare / Non Medicare Medical expenses 6. General exclusions 7. The claims process

Queensland Meals on Wheels as a community

• rganisation rely on the volunteers support on

the daily functions and operations of the

• rganisation.

It is important to ensure they are well protected in the event of an unexpected injury by implementing and promoting best practices and workplace safety.

1 WORKFORCE AND THE

RISKS

Queensland Meals on Wheels’ workforce is made up of paid position holders and volunteer team members. The average age of team members is more mature, with varying levels

• f physical conditioning.

Given the unique nature of your business activity, there are workplace risk factors specific to your organisation namely: ❑ 1. Environmental risks ❑ 2. Occupational risks ❑ 3. People risks

WORKFORCE AND THE RISKS

• 1. ENVIRONMENTAL RISKS

What are the environmental risks?

How is it created? What are you personal protective factors?

Varied terrain and client site conditions

Slippery surfaces & uneven terrain Wear enclosed shoes Don’t rush through tasks Plan your journey if walking on uneven terrain whilst carrying deliveries 3 points of contact

ENVIRONMENTAL RISKS (CONTINUE)

Exposure to the weather elements

Heat exposure during summer Hot vehicles Rainy conditions

Maintain hydration Wear a hat Apply sunscreen regularly Climate appropriate clothing Sunglasses Use of physical shade to block sun

Hot working conditions in the kitchens

Hot working surfaces Radiant sources of heat (ovens/stove tops)

Basic first aid for burns/first aid kit Use Fans & Heat extraction Regular rest breaks PPE and appropriate equipment Insulating hot work surfaces

• 2. OCCUPATIONAL RISKS

What are the

• ccupational risks?

How is it created? What are you personal protective factors?

Repetitive manual handling tasks

Performing the same physical tasks repetitively Food preparation Lifting of heavy cooking equipment Carrying deliveries Loading vehicles Be efficient with your personal energy Use mechanical aids that are available Follow manual handling guidelines Max 25kg lift per person

OCCUPATIONAL RISKS (CONTINUE)

Fatigue

Busy periods Multiple shifts Driver fatigue Take regular breaks Wear sunglasses when driving Eat regularly and stay hydrated Buddy up for long drives

Ergonomics

Prolonged standing in the kitchens Prolonged sitting in vehicles Repetitive tasks including food preparation

Wear enclosed and comfortable footwear Change posture frequently Check vehicle set up is appropriate for chair/steering wheel height Take regular breaks to stretch

• 3. PEOPLE RISKS

What are the people risks?

How is it created? What are you personal protective factors?

Working with members

• f the public

And people who are elderly, ill or disabled.

Exposure to communicable diseases Driver aggression Aggressive, psychologically unwell clients Clients with terminal illness Annual flu shots Carry hand sanitiser in the car Relaxation and mindfulness techniques Always carry your mobile Buddy system Debrief regularly/EAP

HEALTH BENEFITS OF GOOD WORK (CONTINUE)

“Loss of work has devastating effects on the individual, the family, and the community”.

Research shows that being out of work (paid or voluntary) for extended periods of time is bad for a person’s health. The longer someone spends away from work, the less likely they will ever return. If a person is off work for: 20 days, the chance of ever getting back to work is 70% 45 days, the chance of ever getting back to work is 50% 70 days, the chance of ever getting back to work is 35%

2 MEDICARE / LEGISLATION

Understand the Medicare legislation and what you are allowed to

claim

Know your Insurance Policy and what it does / does not cover

Be transparent with your volunteers regarding the gaps No organisation wants their volunteers to incur financial costs for their time volunteering or to have unrealistic expectations that the

• rganisation should pay for any gaps in medical expenses

Background:

When the government introduced Medicare and amended:

• the National Health Act (1953, Commonwealth), and
• the Health Insurance Act (1973, Commonwealth), and
• then later the Private Health Insurance Act (2007, Commonwealth),

an amendment to the Act was introduced that ensured that Insurers were locked out from providing full cover for any medical expenses that Medicare was to cover.

LEGISLATION – THE HEALTH INSURANCE ACT

3 THE COVER EXPLAINED

WHAT IS A VOLUNTARY PERSONAL ACCIDENT POLICY?

A Voluntary Workers Personal Accident policy provides cover for defined out of pocket and non-Medicare medical expenses incurred in the event of an incident that results in all income earning voluntary workers and all non-income earning voluntary workers’:-

• Death, or
• Injury

The incident must have occurred :

• While the volunteer performed authorised work on behalf of Queensland Meals on

Wheels' duties, and/ or

• While they were travelling to and from work

WorkCover Queensland Your WorkCover QLD accident insurance policy covers any workers you employ and does not relate to the Insurances arranged by JLT.

4 POLICY LIMITS

POLICY LIMITS– PERSONAL ACCIDENT & SICKNESS

Policy limits:

▪ Part A Lump Sum Benefit $250,000

(outlined on next on next slide)

▪ Part B Bodily Injury Weekly Benefits $800 x 156 weeks

(up to 85% of salary for working volunteers)

▪ Part D Fractured Bones - Lump Sum Benefit - $3,000 ▪ Part E (1) Loss of Teeth or Dental Procedures - Limit per tooth - $250 ▪ Part E (2) Loss of Teeth or Dental Procedures - Lump Sum Benefit - $3,000 ▪ Other Non–Medicare Medical Expenses - Lump Sum - $20,000

POLICY LIMITS– PERSONAL ACCIDENT & SICKNESS

Lump Sum Benefit $250,000

Cover for an ‘Event’ under this Part applies only if an amount for that Event is shown in the Schedule against Part A - Lump Sum Benefits

Events Benefits Note: the following Event(s) must occur at or within twelve (12) months from the date of the Bodily Injury The percentage of the amount shown in the Schedule against Part A - Lump Sum Benefits (per covered person) Accidental Death 100% Permanent Total Disablement 100% Paraplegia or Quadriplegia 100% Loss of sight 100% Loss of use of one (1) or more Limbs 100% Permanent and incurable insanity 100% Permanent Loss of hearing 100% Permanent Loss of use fingers (4 fingers + thumb) 80% Burns- 3rd degree 50% Burns - 2nd degree 25% Fractured leg or patella with established non-union 10% Shortening of leg by at least 5 cm 7.5% Loss of at least fifty percent (50%) of all sound and natural teeth, including capped or crowned teeth, but excluding first teeth and dentures 1% to a max of $10k in total

PERSONAL ACCIDENT & SICKNESS - ADDITIONAL BENEFITS

Additional Benefits explained:

• Out of Pocket Expenses

For the Insureds unforeseen expenses for Medical Aids, local transportation – (other than in an ambulance), for the purpose of seeking medical treatment, and other non- medical expenses such as clothing and non-medical equipment

• Rehabilitation and Return to Work Assistance Benefit - $25,000

Targeted at improving the physical, psychological and emotional wellbeing of the Insured to support return to work

• Funeral expenses Benefit - $10,000

If the Insured suffers accidental death – cover for reasonable funeral, burial or cremation / associated expenses

PERSONAL ACCIDENT & SICKNESS - ADDITIONAL BENEFITS (CONTINUE)

• Emergency home help Benefit - $500 per week (max 26) weeks

If the Insured suffered from bodily injury which results in the inability to carry out domestic duties – reasonable cost to assist with home help

• Bed care Benefit - $500 per week (max 26) weeks

If the Insured is confined to a bed in excess of 48 hours the ongoing costs where the bed confinement continues

• Accommodation and Transport expenses Benefit - $10,000

Where the Insured is admitted as an in-patient of a hospital, which is more than 100km from usual place of residence – the reasonable cost incurred for transport and accommodation for their spouse/partner or dependant children

5

NON-MEDICARE/ MEDICAL EXPENSES EXPLAINED

Non-Medicare Medical Expenses means: Expenses:- (a) incurred within twelve (12) months of sustaining a Bodily Injury: and (b) paid by a Covered Person or by the Policyholder for Doctor, physician, surgeon, nurse, physiotherapist, chiropractor, osteopath, hospital and/or ambulance services for the following treatments: ✓ Medical ✓ Surgical ✓ X-ray ✓ Chiropractor ✓ Osteopathic ✓ Physiotherapy ✓ Hospital (where Medicare does not apply) ✓ Nursing Treatment

DEFINITIONS UNDER NON-MEDICARE MEDICAL EXPENSES

Conditions applying to Non-Medicare Medical Expenses

• The benefit payable is less any recovery made from any private health insurance

fund with respect to the expense

• No benefit is payable in respect of the Medicare gap - Being the difference

between the payment made by Medicare and the Medicare Benefits Schedule fee for the expense Example: Volunteer Joe Blogs sustained a minor injury in the kitchen that required professional

• ut of hospital medical treatment:

➢ GP Consultation charge (no bulk billing) - Bill $100 ➢ Medicare Benefits Scheduled Fee - $80 ➢ Medicare Rebates - $68 ➢ Insurance Policy - $NIL ➢ Joe Blogs' ‘out of pocket’ / gap - $32

DEFINITIONS UNDER NON-MEDICARE MEDICAL EXPENSES (CONTINUE)

6 GENERAL POLICY

EXCLUSIONS

This Volunteers Personal Accident Insurance policy will not pay any benefits in the respect to the following:

• No cover is provided for students or work experience placements
• A Volunteer participating and or training of any professional sport
• Flying or engaging in aerial activities
• Results from any intentional self-injury, suicide, reckless misconduct
• Illegal or criminal acts
• Results from stress or psychiatric conditions (incl. depression, anxiety, neurosis,

psychosis mental or emotional stress, physical fatigue, mental disease or associated disorders)

• Any benefits covered by Medicare, Workers Compensation, Transport Accident

legislation, common law entitlement, any government sponsored fund, plan

• r medical benefit scheme or any other insurance policy required to be

effected by or under law

GENERAL INSURANCE POLICY EXCLUSIONS

• Any claims resulted directly or indirectly from a covered person being under the

influence of Drugs and Alcohol

• Any claims that results out of Temporary Total Disablement, Temporary Partial

Disablement, due to childbirth or pregnancy (except for unexpected medical complications of emergencies arising therefrom)

• Any claims that would results from a Pre-Existing Medical Condition (except illness
• r disease resulting directly from medical or surgical treatment rendered necessary

by any Bodily Injury)

• Results from War or Civil War in Australia
• Any claims that would result in contravening the Health Insurance Act 1973

(Cth), the Private Health Insurance Act 2007 (Cth), Private Health Insurance (Health Insurance Business) Rules as updated from time to time, or the National Health Act 1953 (Cth) or any amendment to, or consolidation or re-enactment of, those Acts.

GENERAL POLICY EXCLUSIONS (CONTINUE)

7 CLAIMS PROCESS

CLAIMS PROCESS

CLOSING

• 1. Risk management is crucial within the organisation and each Member Service
• 2. Implementing and promoting workplace safety is best practise to avoid harm to

volunteers, workers and members of the public

• 3. The gap in the market and the Medicare coverage affects anyone and everyone

who engages volunteers

• 4. Understand the Insurance covers available to you
• 5. Be transparent with your volunteers – prevent unrealistic financial expectations

whilst they are volunteering at Queensland Meals on Wheels

• 6. Understand that the Queensland Meals on Wheels Voluntary Workers Insurance

policy arranged by JLT fully complies with legislation which limits the benefits Health Funds (and others) are legally allowed to insure

• 7. Don’t hesitate. Contact JLT if you don’t fully understand your Insurance Policy,

we are here to assist you with your risk management needs.

THANK YOU

CONTACT

Sandra van Zyl Account Manager | Corporate Risks QLD DD: + 61 (0) 7 3246 7537 Mob: + 61 (0) 412 696 137 Fax: + 61 (0) 7 3246 7590 Email: sandra.vanzyl@jlta.com.au Website: www.jlta.com.au