1. Temporary Total Disablement only applies to people in full-time gainful employment and only covers their loss of actual earnings. In the event of a claim being made the Insurance Company will deduct any payments from the employer,Social Welfare and any other source and will pay the balance to bring the player to his/her average weekly wage, leaving the player in an equal ( not better ) situation so that the accident has not actually affected his/her earnings. Average weekly wage will be defined as the net wage for the six weeks prior to the date of the accident.
2. Medical Expenses claims are subject to an excess of €100 and also includes physiotherapy certified by a doctor up to a limit of €250 per player per year. Medical Expenses are payable for 12 months from the date of the first treatment and are irrecoverable expenses only, therefore if a player holds VHI,BUPA or similar health insurance then they must pursue a claim under that policy first.
3. Cover for emergency dental treatment to a limit of €500. Emergency dental treatment must take place the same date as the injury. An excess of €100 applies.
4. Managers,coaches and officials connected with the team are covered for team benefits. All claims must be notified within 30 days. Any notification to the Insurance Company after 30 days will require a written explanation from the club/player giving a reason for the delay. Please note however that any claims more than 60 days from the date of the injury will render the claim void.
5. Temporary Total Disablement is payable for 26 weeks immediately after the excess period. The excess period which applies to Everton is 2 weeks. The excess period starts immediately after the date of the accident.
Making A Personal Accident Insurance Claim
a. No claim will be processed by the club unless membership is paid in full.
b. Report the incident to Eric Fitzgerald or Gerry Stanton within 30 days. The incident will then be reported to the Insurance Company and your claim will be registered. No claim can be registered with the Insurance Company after 30 days and no compensation will be paid by either the club or the Insurance Company.
c. A claim form will be sent to the club which must be fully completed by you. The medical certificate must be completed by your doctor and the fully completed form should then be returned to Eric Fitzgerald to be counter signed before being returned to the Insurance Company ( please note that if any questions on the claim form are left unanswered the Insurance Company will be unable to process the claim).
d. If you are claiming for medical expenses you must send all original invoices to the Insurance Company with your claim form. If your treatment is ongoing you may send in additional invoices as your treatment continues. However if you hold private medical insurance your claim must be submitted to your private health insurer first. Any amounts not covered by that policy can then be claimed through the club’s personal accident insurance subject to written confirmation from VHI,Quinn,Bupa etc of the payments made and/or declined.
e. If you are claiming for physiotherapy/chiropractic treatment this must be certified by a registered medical practitioner and is limited to €250 per player per insurance year. An excess of €100 applies.
f. If you go to a private clinic for treatment to an injury there is an excess of €100 on the policy which the club will refund to you. Any additional claims will have to be claimed from the Insurance Company.
g. If you are intending to claim for loss of earnings you must send in the following documentation with your claim form:
1. 6 payslips for the 6-week period immediately prior to the date of the injury showing your net weekly wage. If you are self employed a letter from your accountant on company headed paper will be required to confirm your net weekly earnings for the same 6-week period.
2. A photocopy of your most recent P60.
3. A signed letter from your employer on company headed paper detailing your entitlement to receive sick pay whilst absent from work (The Insurance Company reserve the right to contact your employer to verify the authenticity of this letter).
4. Confirmation from Social Welfare of your entitlement to receive illness benefit whilst unable to work as a direct result of your injury. If you are not entitled to receive this benefit you must obtain a letter from Social Welfare specifically stating that you do not qualify for illness benefit.
5. The Insurance Company will also request regular medical reports from your doctor giving an indication of the date you are expected to be fit to return to work.
6. Once all documentation has been received by the Insurance Company claims are usually processed within 3 working days. All correspondence including the issue of cheques will be sent via the club. Once your claim for loss of earnings has been processed and approved the Insurance Company will endeavour to issue payments on a fortnightly basis.
The Insurance Company or the club will be unable to process your loss of earnings claim or medical claim unless all of the relevant documentation has been received.