1800 931 129


Need to make a rugby league related personal accident claim? The below step-by-guide is here to help you through the claims process.

Option 2

Follow the below steps for a printable version of the claim form

  • Step 1

    Obtain a claims form from Gallagher by calling 1800 931 129 or download it below.

    Claim should be submitted within 30 days of incident.

    Download claims form

  • Step 2

    Arrange for your club’s President, Secretary, or Treasurer to complete the Club’s Declaration.

    This section must be completed on above claim form.

  • Step 3

    Arrange for your doctor to complete the Medical Statement.

    If possible provide with your claim form within 30 days. If unable to obtain prior, submit claim form and forward medical statement as soon as possible.

  • Step 4

    If claiming loss of income, have your employer complete the Member’s Employment Details section of the form.

    If possible provide with your claim form within 30 days. Otherwise as soon as reasonably possible.

    Forward to your claim form to your employer for completion.

    Note: This is only applicable if you have selected Loss of Income cover.

  • NOTE

    To ensure a quick response please submit your claim via email as soon as possible. The documents can be completed on the digital form however the medical form will need to be printed and signed by your treating Doctor. If you do not have access to a printer, ask your doctor if they can print it form you.

    If you are unable to scan any of the required documents or invoices, you can attach a photo of them.

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