Journey Accident Insurance FAQs

 

What is the Association’s Journey Accident Insurance?

This insurance is a scheme to provide assistance to members who are injured travelling to or from work and who, but for the O’Farrell Government’s changes to the Workers Compensation Act effective from 19 June 2012, would have been entitled to Workers Compensation.

Who is covered by Journey Accident Insurance?

If you are a financial member of the New South Wales Nurses & Midwives’ Association at the time of your accident travelling to or from work, you are entitled to claim under the scheme.

What does the cover provide?

The Journey Accident Insurance cover provides members who are financial at the time of the accident with:

  • A Weekly Accident benefit up to 85% of average gross weekly salary for a period of up to 104 weeks (after a 7-day waiting period)
  • Rehabilitation costs up to $20,000 per claim period (non-Medicare medical expenses such as physiotherapy) per claim period.
  • Home / Car Modification Benefit up to a maximum of $20,000 per claim period.
  • Funeral expenses up to a maximum of $5000.
Claims reporting process

What should I do if I have an accident travelling to or from work?

  1. Lodge a Workers Compensation claim, as uncertainty remains about the interpretation of the laws;
  2. If your Workers Compensation claim is denied you should contact the Association;
  3. Be aware that you may be entitled to a Third Party claim (CTP claim) under the provisions of the Motor Accidents Compensation Act 1999.

How do I make a claim?

Please contact the Association and a Journey Accident claim form will be forwarded to you

The form will need to include:

  • Claimant’s personal information
  • Details of the accident
  • Doctor’s assessment of the injury (including an estimated duration that the claimant will be unfit to work)
  • Income details from the employer to enable calculation of average gross weekly salary.

Once you have completed the claim form, submit it to the Association along with a copy of any letter advising you that your Workers Compensation claim has been denied.

What will the Association do?

Upon receiving your Journey Accident Claim form, the Association will:

  • Confirm that you were a financial member at the time of the accident;
  • Check that the form is fully completed and ready to be submitted to our Insurers for review and processing;
  • Forward it on your behalf to our Insurers for assessment; and
  • Refer you to our solicitors for advice about:

– Your Workers Compensation claim; and
– Other legal entitlements eg. Third Party/Personal Injury claim.

The Association will liaise on your behalf with our Insurers and we will continually advise you of the progress of your claim.

What is the process I should expect when making a claim?

Upon receipt of your completed Journey Accident Claim form, the Association will forward it to our Insurers for review and processing. Our Insurers will assess and respond to the claim within 5 business days. Should further information be required, this will be requested via the Association and once received by our Insurer will be assessed within a further 5 business days.

Once the initial payment has been approved, a remittance advice will be forwarded to the Association and you will be advised by email (or mail if you do not have access to email).For claims that are assessed to be more long term you will be requested to provide the following over the life of the claim:

  • Every three months a progressive claim form will need to be completed by your treating physician which will give a detailed update on your condition;
  • At approximately six months after the accident has occurred, a loss assessor will be appointed to interview you. This is to provide our Insurer a clear understanding of your current condition, the progress of your recovery and the outlook of your claim;
  • Throughout the life of the claim an independent medical review may be requested in order to determine the progress of your injuries and ensure the correct treatment is being received.

Frequently asked questions

Q: When am I covered?

A: When travelling directly between the boundaries of your place of residence and place of work (nursing related activities only) for the purposes of starting or ending your day’s work or whilst travelling during recess breaks.

Q: How are payments made to members?

A: Benefits are paid directly to the member’s nominated bank account. Initial payment will be made to the member within 5 business days of our Insurer receiving claim form. Further payments will then be paid directly to the member on a monthly basis for the life of the claim.

Q: Will I automatically be paid?

A:  No. The insurance policy has a 7-day waiting period which means that if you are off work for less than a week as a result of your accident, you are not entitled to any payment.

However, you should still submit a claim as an injury arising from your accident may mean that you have time off work at some future date.

Q: How long will payments last?

A: Payments will continue until you are fit to return to work, but are limited to a maximum of 104 weeks from the date of your injury.

Q: Can I use my sick leave and then have it re-credited?

A: Yes, provided your employer agrees.

Where a member has received paid leave during their time off work as a result of their injuries, there is the option to elect for the insurance benefit to be paid directly to their employer to ‘buy back’ (re-credit) a portion of their leave entitlement. In this case the amount payable to the employer is the same as that which is payable to the member i.e. up to 85% of salary (excluding leave loading).

  • In addition to the usual claim information required to submit a claim, a member who is electing to have payment made direct to the employer, we will also require the following:
  • Written confirmation advising the employer’s agreement to re-credit the member’s leave;
  • Payment details for the employer.

Please inform us if you are seeking to have your leave re-credited as there is an additional form that will be required to be completed.