Insurance & Claims Manual

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Insurance & Claims Manual The Corporation of the Synod of the Diocese of Brisbane December 2016 Risk. Reinsurance. Human Resources. Contents Introduction... 1 Aon client promise... 2 Our promises
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Insurance & Claims Manual The Corporation of the Synod of the Diocese of Brisbane December 2016 Risk. Reinsurance. Human Resources. Contents Introduction... 1 Aon client promise... 2 Our promises to you... 2 Insurance program... 3 Program summary... 3 General information... 4 Excess Public & Products Liability... 5 Excess Directors & Officers Liability... 6 Excess Statutory Liability... 8 Marine Hull... 9 Personal Accident Stop Loss Corporate Protection Claims procedures General Industrial special risks General and products liability Claims Made policies Travel, personal accident, expatriate medical, baggage and motor vehicle claims procedure Corporate travel Personal accident Marine transit Workers compensation... 23 Introduction This Insurance and Claims Manual has been compiled by Aon Risk Services (Aon) to provide a broad outline of your Insurance Program and to offer general information and assistance in understanding the various insurances which have been arranged on your behalf and the steps and procedures to be followed in the event of claims arising under the program. Aon s role in the claims management process, as regards above deductible claims, is as follows: to submit, regularly follow up and negotiate settlement of above deductible claims, to assist in the resolution or conduct of difficult or contentious claims with underwriters and re-insurers where required, claims administration, including collection of insurance proceeds and proactive follow-up of outstanding claims until finalisation, provision of status reports on above deductible claims, and to maintain records of paid and outstanding claims for underwriting disclosure and inclusion in renewal submissions. However, there are a number of classes of insurance coverage where additional handling by Aon in the administration of claims can be counter-productive to the efficient, timely and cost effective resolution of claims. So, in order to ensure greater efficiency and improved service to clients, Aon has developed a process whereby simple, low value Travel, Personal Accident, Expatriate Medical, Baggage and Motor Vehicle claims will in future be directly reported to, and subsequently managed by, insurers. The Insurance Program section of the manual contains a brief description of individual insurances. It should not however be treated as a replacement for the relevant policy documents. Each policy should be carefully read and, in particular, note taken of the description in the policy of the coverage thereby provided as well as the exclusions and policy conditions these should not in any way be regarded as being fully or accurately described in the manual Aon client promise At Aon, we honour our commitments. Globally, we are united in our passion to provide you with a consistent, high-quality, high-value, and engaging experience with each interaction. Our colleagues are employed by Aon, but they work for you. At our core, we are problem-solvers and solution builders on the increasingly complex topics of risk and people. We bring a broad perspective and deep expertise. It all starts by listening to your biggest challenges and understanding your unique needs. This uncompromising commitment is the foundation of the Aon Client Promise. In its simplest terms, the Aon Client Promise defines the way we work together, what you can expect from us, and the value we will deliver. Behind the five promises is a simple but powerful process that tracks our progress and keeps our teams connected to ensure we deliver on your needs and to your expectations. We promise to be your best partners, offer expertise, design innovative solutions, deliver with excellence, and produce results. And you can hold us to that. Our promises to you 1. Partnership - Trusted advisors focused on your needs and priorities Our priority is to understand what value means to you. Our job is to know you, your business, and your people to anticipate your needs. Together, we will develop and execute on shared objectives to achieve your desired outcomes. Backed by the full power of Aon, we will serve as your advocate and engage in open, two-way dialogue founded on feedback and trust. 2. Expertise - Industry-leading experience and people you can trust In every situation, we bring you the best of Aon and promise to augment your teams with smart, talented professionals you can trust to act with integrity. We offer deep subject matter expertise both locally and globally through broad access to an expansive network of resources, markets, underwriting, capital, and capability in the risk and people industries. We are committed to attracting, retaining, engaging, and developing our talent to bring you unique insights, backed by powerful data and analytics. 3. Innovation - Comprehensive and tailored solutions that anticipate your needs We are committed to continuous investment in creative ideas, fact-based solutions, and pragmatic research that anticipates your needs and solves your current and future business challenges. We will help you translate macroeconomic risk and people trends, our own market-leading research and analytics, into actionable insights and comprehensive risk and people solutions that help you achieve real results. Working together, we will cultivate and execute on the ideas that will shape the risk and people industries. 4. Excellence - Distinctive service every day You can trust us to deliver accurate, secure, and reliable analysis, solutions, and service. Backed by solution- oriented benchmarking and relevant analytics, we offer insightful, useful advice you can trust. We promise a consistent, engaging experience for you and your people as we instil in our own colleagues a professional standard of excellence and a commitment to distinctive client service and value. Above all, we execute with excellence. 5. Results - Superior client value delivered We promise measurable results on the risk and people outcomes that matter to you. Through a comprehensive understanding of the total cost of your risk, we are committed to help you produce stronger returns on your risk and people investments. You can count on us to add distinctive, long-term value through the work we do Insurance program Program summary Class of Insurance Underwriter Policy Limit(s) Deductible(s) Excess Liability ($30m x $120m) Excess Management Liability ($15m x $15m) Excess Statutory Liability ($2m x $2m) QBE Insurance (Australia) Limited $30,000,000 any one Occurrence and in the aggregate in respect of Products Liability in excess of underlying $120,000,000 any one Occurrence and in the aggregate in respect of Products Liability Vero Insurance Limited $15,000,000 excess of $15,000,000 (except Insuring Clause 3.3 Entity Liability where it is $15,000,000 excess of $10,000,000) Specialist Underwriting Agencies $2,000,000 any one Claim, subject to the Aggregate Limit of Liability in excess of Other / Overlying Insurance. Marine Hull CGU Insurance Limited $2,656,256 as per agreed value noted in Schedule of Vessels $1,000 All Claims Personal Accident Stop Loss Chubb Insurance Limited Various as per the policy schedule 7 Days Corporate Protection Hiscox Underwriting $10,000,000 per insured event Waiting Period: 6 hours Nil Nil Nil General information The Named Insured and Business Description form part of your insurance contracts. It is therefore important that you advise of any alterations that may arise during the course of the year as these may prejudice your insurance cover. To eliminate unnecessary repetition, unless otherwise stated within the Insurance and Claims Manual, the following information is common to all policies: Insured Business Description Period of Insurance The Corporation of the Synod of the Diocese of Brisbane including associated bodies of the Anglican church in the Diocese of Brisbane whether Incorporated or unincorporated &/or affiliated thereto Principally Religious Institution, Charitable, Property Owners/Occupiers, Nursing, Child & Aged Care Services, Educational and Welfare Organisation and all other activities incidental thereto. From: 4.00 PM on 31 October 2016 Local Standard Time To: 4.00 PM on 31 October 2017 Local Standard Time Excess Management Liability & Excess Statutory Liability From: 4.00 PM on 31 October 2016 Local Standard Time To: 4.00 PM on 31 October 2017 Local Standard Time Corporate Protection From: 4.00 PM on 31 October 2015 Local Standard Time To: 4.00 PM on 31 October 2018 Local Standard Time Personal Accident -Stop Loss From: 4.00 PM on 31 December 2016 Local Standard Time To: 4.00 PM on 31 December 2017 Local Standard Time Excess Public & Products Liability Underwriter Policy Number Limit of Liability Wording QBE Insurance (Australia) Limited AQE001649EXL $30,000,000 any one Occurrence and in the aggregate in respect of Products Liability in excess of underlying $120,000,000 any one Occurrence and in the aggregate in respect of Products Liability. QM 2399 Excess Liability wording subject to the following endorsements: Molestation Exclusion Excess Directors & Officers Liability Underwriter Policy Number Limit of Liability Wording AAI Limited ABN trading as Vero Insurance Limited LPX $15,000,000 Excess of $15,000,000 (Except Insuring Clause 3.3 Entity Liability where it is $15,000,000 excess of $10,000,000). Vero Excess Insurance Policy V /11 Follow form of Ansvar Insurance ANIP Management Liability Insurance Policy Underlying Insurance Class Insurer Policy Number Limit of Liability Management Liability Directors and Officers Liability only Ansvar Insurance Ltd $15,000,000 Endorsements Non Follow Form Coverage Sections: Insuring Clause Employment Practices Liability Insurance Insuring Clause Trustees Liability Insurance Insuring Clause Statutory Liability Insurance Insuring Clause Internet Liability Insurance Insuring Clause Entity Crisis Insurance Molestation Exclusion Royal Commission Exclusion Endorsement Special Comments Claims Made Wording This Policy is issued on a claims made basis. This means that the Policy responds to: (a) Claims first made against you during the policy period and notified to the underwriter during that policy period, provided that you were not aware at any time prior to the policy inception of circumstances which would have put a reasonable person in your position on notice that a claim may be made against him/her; and (b) Facts, pursuant to Section 40(3) of the Insurance Contracts Act 1984, which states: where the insured gave notice in writing to the underwriter of facts that might give rise to a claim against the insured as soon as was reasonably practicable after the insured became aware of those facts but before the insurance cover provided by the contract expired, the underwriter is not relieved of liability under the contract in respect of the claim when made by reason only that it was made after the expiration of the period of insurance cover provided by the contract When the policy expires, no new notifications can be made on the expired policy even though the event giving rise to the claim against you may have occurred during the policy period Excess Statutory Liability Underwriter Policy Number Territorial Limits Aggregate Limit of Liability Deductible Specialist Underwriting Agencies Pty Ltd CPP Anywhere in Australia $2,000,000 in the aggregate for all Claims and/or Losses during any one Policy Period in Excess of Other/Overlying Insurance The maximum Deductible any one Claim and/or Loss shall not exceed the Deductible for the Named Organisation. The maximum Deductible any one event will not exceed the highest applicable Deductible any one Claims and/or Loss. Limit of Liability Retroactive Date $2,000,000 any one Claim, subject to the Aggregate Limit of Liability in excess of Other/Overlying Insurance. Unlimited (excluding known Claims and/or Circumstances). Prior & Pending Date 19 May 2016 Underlying Primary Insurance Class Insurer Policy Number Limit of Liability Management Liability Statutory Liability section only Ansvar Insurance Ltd $2,000,000 Special Comments Claims Made Wording This Policy is issued on a claims made basis. This means that the Policy responds to: (a) Claims first made against you during the policy period and notified to the underwriter during that policy period, provided that you were not aware at any time prior to the policy inception of circumstances which would have put a reasonable person in your position on notice that a claim may be made against him/her; and (b) Facts, pursuant to Section 40(3) of the Insurance Contracts Act 1984, which states: where the insured gave notice in writing to the underwriter of facts that might give rise to a claim against the insured as soon as was reasonably practicable after the insured became aware of those facts but before the insurance cover provided by the contract expired, the underwriter is not relieved of liability under the contract in respect of the claim when made by reason only that it was made after the expiration of the period of insurance cover provided by the contract. When the policy expires, no new notifications can be made on the expired policy even though the event giving rise to the claim against you may have occurred during the policy period Marine Hull Underwriter CGU Insurance Limited Policy Number 39C Insured Interest Insured The Corporation of the Synod of the Diocese of Brisbane including associated bodies of the Anglican church in the Diocese of Brisbane whether Incorporated or unincorporated &/or affiliated thereto As per Schedule of Vessels provided Description of Vessels Rowing Sculls, sailing boats, power boats, canoes, kayaks, surf skis and boards and accessories Basis of Settlement Use & Navigations Limits Limit(s) of Liability Deductible Conditions Noted Agreed Value Anywhere within the Commonwealth of Australia or its Inland and Coastal Waters up to 400kms off the Australian Coast. as per agreed value noted in Schedule of Vessels $1,000 all claims, any one accident any one occurrence. Subject to the under mentioned Clauses Institute Yacht Clauses 1/11/85 Clause 11 Excluded Institute War and Strikes Clauses Yachts 1/11/85 Institute Yacht Clauses Transit Clause amended to Australia Wide Institute Yacht Clauses Racing risks Extension Clause 1/11/85 Institute Radioactive Contamination, Chemical, Biological, Bio-chemical and Electromagnetic Weapons Exclusion Clause Terrorism Exclusion Clause Marine Asbestos Exclusion Clause Institute Cyber Attack Exclusion Clause 10/11/03 Lumley Hull Standard Wordings (01/04) LGW33901 Goods Experience Discount (GED) Clause (20/70) Liability Excluded Absolutely Automatic Inclusion Clause This policy is extended to cover any watercraft purchased, hired, leased, loaned or borrowed during the currency of the policy and not listed in the policy schedule, provided that: a) the sum insured will be the purchase price or market value where there is no purchase price, but not greater than the market value of $100,000 whichever is the lesser amount. b) The insured notifies Underwriters of any additional vessels within 30 days with additional premium payable at the agreed rate. It is noted and allowed that TSS Watercraft are used as safety boats and Coast Guard Regattas Personal Accident Stop Loss Underwriter Policy Number Insured Person(s) Scope of Cover Age Limit Geographical Limits Policy Wording Chubb Insurance Limited 04PO Clergy (including School Chaplains), Lay Workers and Casual Employees of the Anglican Church of Australia Diocese of Brisbane 24 hours per day, 365 days per year Age Limit is increased to 75 in lieu of 70 as agreed. Anywhere in the world Anglican Group Personal Accident & Sickness Insurance Policy Wording & PDS Schedule of Benefits Sum insured each Covered Person All limits are in the same currency as the premium and taxes displayed SECTION 1: Personal Accident & Sickness Category Table of Events Part A Lump Sum Benefits 1 Event 1 Accidental Death 0 Events Category Part B Bodily Injury Resulting in Surgery Benefits Part C Sickness Resulting in Surgery Benefits Category Part B - Weekly Benefits - Bodily Injury % of Salary - Part B Excess Period (Days) Part B 1 $1,484 x 52 weeks Category Part C - Weekly Benefits - Sickness % of Salary - Part C Excess Period (Days) Part C 1 $1,484 x 52 weeks Category Part D - Fractured Bones Lump Sum Benefits Part E - Loss of Teeth or Dental Procedures - Lump Sum Benefits Aggregate Limit of Liability: Any one (1) Period of Insurance (A): $1,000,000 Non-Scheduled Aircraft (B): $500,000 Endorsements Age Limit Extension It is hereby noted and agreed that the maximum age limit under this Policy is extended to seventy-five (75) years of age. Notwithstanding anything contained in the Policy to the contrary the following conditions shall apply to this endorsement: There is no cover under this Policy with respect to any Covered Person who is aged seventy-five (75) years or more and all cover with respect to a Covered Person shall cease upon their attaining that age. This will not prejudice any entitlement to claim benefits which has arisen before a Covered Person has attained the age of seventy-five (75) years. Annual Aggregate Stop Loss: This Policy is subject to an Annual Stop Loss claims limit of $90,000, whereby We will only pay the benefits set out in the Table of Events if claims under the Anglican Church of Australia - Diocese of Brisbane - Accident & Sickness scheme, during the Period of Insurance exceeds $90,000. Provided that such claims have been admissible under the Terms and Conditions of this Policy. Weekly Benefit: With regards to the Weekly Benefit and Supplementary Allowance the cover is as follows: A Combined Limit of the Covered Person's Salary and Supplementary Allowance for any one (1) week will not exceed a total of $1577. The Benefit Period will be 55 weeks and an excess period of seven (7) days will apply. Supplementary Allowance: means the Table of Conditions is extended to incorporate Supplementary Allowance . We will pay additional expenses of the ministry that have been incurred when replacement ministry is required. For example, travel costs, housing and superannuation. It is hereby noted and agreed that in respect to: Section 1, Part A - Weekly Benefits - Injury, Event 2. Temporary Partial Disablement; and Section 1, Part B - Weekly Benefits - Sickness, Event 4. Temporary Partial Disablement the benefits 25% of the amount payable for Event 1 and 25% payable for Event 4 respectively is deleted and replaced by: We will pay an amount per week not exceeding the percent of disablement x 1/52 part of the annual minimum rate of Stipend for Parish Priest as provided under the Parish's regulation canon up to the maximum amount shown on the Policy Schedule Should a claim be payable under Part A or Part B of the policy, in addition to the percentage of disablement benefit payable under Part A or Part B, the Policyholder shall be entitled to claim a minimum of 30% and up to the sum insured stated in the Schedule for Part A - Weekly Benefits - Injury and Part B - Weekly Benefits - Sickness, for costs associated and/or incurred to engage workers to replace ministers and/or employees, including where costs have not been incurred by the parish. Benefit Period It is hereby noted and agreed that the Benefit Period is amended as follows: Full Time Employees - General Conditions - Condition 3(a) is amended to fifty-five (55) weeks Casual Employees - General Conditions - Condition 3(a) is amended to twenty-six (26) weeks Corporate Protection Underwriter Policy Number Covered Persons Insured Events Hiscox Underwriting London KN All Directors, Officers and Employees of including Clergy and all full time and part time Students under care custody and control of the Assured. This also includes chaperones or volunteers or alumnae travelling with the Covered Person on school sponsored trips or programmes as agreed by Underwriters. As per Hiscox Corporate Protection /1
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