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: katie.duncan@unimelb.edu.au /
                         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: ins-office@unimelb.edu.au - if you have any queries.]