"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: firstname.lastname@example.org / 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 Ph: 1800 688 640 OR 02 9335 3355 GPO BOX 4065 Fax: 02 9231 3697 SYDNEY NSW 2001 Email: A&HClaims.AU@acegroup.com [ Please ensure that you retain a copy of all your documentation, for safe-keeping.] [ Please contact the University Insurance Office at: email@example.com - if you have any queries.]