The following procedure is to be followed by any insured player submitting sports injury claim.
1. Download a Claim Form. These forms are to be completed and returned within 90 days of the injury. (This forms part of the Terms and Conditions of the Policy). For more information, please refer to the JLT website.
2. Please fill out Section B and send to the club president via email here to fill out Club Representative and Association signatures, the form will be returned to you to send the completed form to JLT.
You will need the following details to complete the rest of the form
Did you register as a student
Club (i.e. Forest Killarney Football Club FC)
MWFA Player ID number (from your Registration card)
Type of injury
Date of injury
3. Upon Completion of the injury claim form if available also include supporting documentation such as (doctors/specialist reports, xrays and/or scans) then send to club President for endorsement. Note – claim form will also require endorsement of MWFA representative.
- If you are claiming Loss of Income Benefits, have your employer complete the relevant section on the reverse side of the claim form, regarding period of incapacity and employment details. Failure to fully complete this section may jeopardise the claim and will cause unnecessary delays in processing. Self employed persons must complete employment details onto a Statutory Declaration, and supply any other requested information relevant to the claim. If you register as a Student you are not entitled to claim Loss of Income Benefits.
- The physician’s statement is to be completed by your physician only (chiropractors and physiotherapists are not permitted to complete this form). All individuals must consult a doctor immediately after injury, to legitimise the claim. N.B. The policy only responds to paid receipts (no exceptions).
- Have the club’s VP, registrar or secretary complete the club’s section of the form and return the claim form and physician’s statement, together with any NON-MEDICARE RECEIPTS to the address on the form within 90 days. You do not need to have all your receipts to submit the form or to have stopped receiving treatment.
- On-going Loss of Income Benefits require new medical certificates every 14 days.
Note: If all receipts are not available within the 90 day period, please send the receipts in after the claim has been lodged. If you are in a private health fund, please present any accounts to your fund firstly and forward the rebate in for assessing. Following this procedure will ensure the maximum benefit and prompt response. Further information can be found on the MWFA website, look under the Insurance menu on the left. MEDICARE ITEMS AND MEDICARE GAP* ARE NOT COVERED BY THIS INSURANCE DUE TO FEDERAL LEGISLATION, i.e. GENERAL PRACTITIONER, X-RAY, ORTHOPAEDIC PRACTITIONER. DO NOT FORWARD MEDICARE RECEIPTS. *Medicare Gap is the difference between the Medicare rebate and the doctor’s or surgeon’s bill. Visit http://www.gowgatessport.com.au/football/nsw for more information.
- Insurance Summary Brochure is provided in Important Documents (PDF)
- Claims information
- Online injury claim form
- Download injury claim form (PDF)
- Football NSW Insurer web site
If a player, club official, match official or other person attending training or games suffers a serious or life threatening injury please notify FNSW so that additional support and insurance information can be provided.
Notify by email to firstname.lastname@example.org or phone 02 8814 4402.