Student Care claim form

Important Information

You're about to begin a Student Care claim.

You'll find that your online claim is quicker if you have these details at hand:

Information about the incident, including the place and time, the type of damage, or any details of any other people or property involved.
You will also need to attach any medical or dental certificates applicable to the incident. Student Care claims cannot be processed without the relevant certificate for your claim.

Please note that CCI is prohibited from paying Medicare rebates, including the Medicare gap

Click here for more information

Please complete all the mandatory (*) areas of this claim form.

CCI handles your personal information with care and in accordance with the Privacy Act 1988 and the Australian Privacy Principles. For information about how to access and or correct the personal information we hold about you read our Privacy Policy or Complaints Policy.

General Insurance Code of Practice

The General Insurance Industry has developed the General Insurance Code of Practice (the Code) for use by insurers.

Catholic Church Insurance Limited (CCI) has adopted and enthusiastically supports the Code because it:

requires the provision of high standards of good practice and service
requires the provision of more relevant and useful information to consumers
promotes understanding of your rights and obligations under our insurance contracts
promotes informed and effective relationships between consumers, insurers and agents
provides a process for the resolution of disputes.

The Code sets out what we must do when dealing with you through all stages of our relationship with you - whether you’re taking out insurance, making a claim (including setting out timeframes for making a decision on your claim), or have a complaint. The Code also contains special provisions setting out how we must deal with claims resulting from catastrophes and disasters.

If you want more information about the Code, or to obtain a copy of the Code please contact us or visit the Insurance Council of Australia website at www.codeofpractice.com.au.

If we are unable to provide you with insurance cover, CCI will:

give you reasons for our decision;
refer you to another insurer, or the Insurance Council of Australia or NIBA for information about alternative insurance options (unless you already have someone acting on your behalf); and
if you are unhappy with our decision, make available information about our complaints handling procedures.

Alleged breaches of the Code can be reported to the Financial Ombudsman Service Limited (FOS), an independent organisation that resolves disputes between consumers and financial service providers.

Alternatively, there may be other external dispute resolution options available to you including:

State and Territory Review Tribunals (such as the Victorian Civil & Administrative Tribunal),
Mediation or Arbitration (where we both agree to use this option), and
Court proceedings.

To use this service, you have to agree to our terms of service and privacy policy, to agree please check the box.

I have read and understood CCI's Privacy Policy and procedures in handling and disclosing my personal information.

I have read and understand the Code of Practice procedures and will provide CCI with all information.

School Details

Please provide the School Name

Please provide the School State

School Name *

School State *

Please provide the School Address

Please provide the School Post Code

School Address *

School Post Code*

Please provide the School Suburb

School Suburb *

Please provide a valid School Email

School Email

Claimant's Details

Please provide a valid Mobile Number or Landline Number

Please provide the Claimant First Name

Please enter a valid Mobile Number

First Name *

Mobile Number *

Please provide the Claimant Surname

Please enter a valid Landline Number

Surname *

Phone Number *

Please provide a valid Email

Email *

Incident

Please select who the incident relates to

Who does the incident relate to? *

Parent / Guardian Details

School fee relief benefit

This benefit is payable when the parent or guardian who pays the school fees, dies as a result of an accident. We will pay the student’s school fees. In order to claim this benefit, we require a copy of the death certificate. Building fees, uniforms and book expenses are not eligible for reimbursement.

Please provide a death certificate

Please provide the deceased parents full name

Please attach a copy of the death certificate and school fee invoice *

Name of the deceased *

Add Attachment

Please provide the Legal Guardian First Name

Please provide the Legal Guardian Surname

Legal Guardian First Name *

Legal Guardian Surname *

Please provide the Legal Guardian Address

Please provide a valid Legal Guardian Email

Legal Guardian Address *

Legal Guardian Email

Please provide the Legal Guardian Contact Number

Legal Guardian Contact Number *

Please provide details of the enrolled students.

Student Date of birth

Student Full Name

Student Date of birth

Student Full Name

Add new row

Student Injury

Please indicate on the graphic where the injury occurred

Body Part

Injury Nature

Body Part

Injury Nature

Add new row

Please enter a brief description of the incident

Medical Certificate

Add Attachment

Summary

Please provide your Full Name

I declare that all the information contained in this claim is correct.

You are about to submit your claim. Please make sure you check all information carefully.

Once you submit your claim, you will receive an email with a PDF copy of your claim form.

A member of our claims team will then contact you within 3 business days to discuss your claim.

If you have any questions about the progress of your claim, please contact 1300 138 498.

Completed at 20/04/2018 8:49 AM

Use this page to add attachments to an item.
Name

Claims

You're about to begin a Student Care claim.

Please note that CCI is prohibited from paying Medicare rebates, including the Medicare gap

Please note that CCI is prohibited from paying Medicare rebates, including the Medicare gap