Application for Membership of MDA National Limited

Proposal for Professional Indemnity Insurance

Welcome to MDA National’s online application service. 

When completing your application, you can at any time save it for completion at a later stage. An email will be sent to you with a link to your saved application which will remain valid for 14 days.

By completing an application, you are applying for Membership of MDA National Limited (MDA National) ABN 67 055 801 771 and Professional Indemnity Insurance Policy underwritten by MDA National Insurance Pty Ltd (MDA National Insurance) ABN 56 058 271 417, AFS Licence No. 238073.

In this form ‘we’ ‘our’ and ‘us' means MDA National and/or MDA National Insurance and 'you' and 'your' means the person seeking Membership and insurance.

It is important that you ensure that this application and insurance proposal is accurate and complete.  The information requested in this form is used by us for the purpose of considering you for Membership and deciding whether or not to insure you and, if so, on what terms.

If there is insufficient room on the application, please provide your answer on a separate attachment. Failure to disclose material information relevant to our decision to accept your Membership and the terms of insurance could invalidate the Membership and insurance contract. If you have any doubt as to whether any information is relevant it should be disclosed.

Important Notice

To have a thorough understanding of the cover provided under your policy please read the following information in conjunction with the current Professional Indemnity Insurance Combined Financial Services Guide, Product Disclosure Statement and Policy Wording and any applicable Supplementary PDS and Policy Wording.

Your duty of disclosure

Before you enter into an insurance contract, you have a duty, under the Insurance Contracts Act 1984 (Cth) to tell us anything that you know, or could reasonably be expected to know, may affect our decision to insure you and on what terms. You have this duty until we agree to insure you. You have the same duty before you renew, extend, vary or reinstate an insurance contract.


You do not need to tell us anything that:
  •  reduces the risk we insure you for; or
  •  is common knowledge; or
  •  we know or should know as an insurer; or
  •  we waive your duty to tell us about.

If you do not tell us something

If you do not tell us anything you are required to, we may cancel your contract or reduce the amount we will pay if you make a claim, or both.

If your failure to tell us is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed.

Claims made cover

The Professional Indemnity Insurance Policy is a claims made contract of insurance. This means that the policy responds to matters that have occurred on or after the retroactive date and that you first become aware of and notify to us in writing during the period of insurance.

Requirement to notify us

You must notify us in writing as soon as practicable of any material alteration of the risk during the period of insurance including any material change in:

  • your field of practice or the nature of the professional services provided by you, or
  • the risk category or billings bands you have previously declared. 
You must also notify us as soon as practicable after you become aware of:
  • any claim, investigation or inquiry;
  • any circumstance that might lead to a claim against you or to an investigation or inquiry involving you;
  • any other matter which might give rise to a claim for indemnity under this policy.

Rights under section 40(3) of the Insurance Contracts Act

If you have a policy with us and you notify us in writing of circumstances which may give rise to a claim during your period of cover, the fact that you do not give us written notice of a claim relating to those circumstances before your policy has expired will not, of itself, relieve us of liability in relation to the claim. However, you must notify us of a claim, investigation or inquiry as soon as you become aware of it.

Payments

All monies received will be paid into an Australian bank account and held in trust on your behalf until we agree to accept your proposal. If we do not accept your proposal, all monies will be refunded to you. 
 
MDA National is entitled to the interest earned on this bank account.

Privacy

Please note that any information you provide will be held and used by us and any companies, firms or individuals who assist us in providing services (including but not limited to reinsurers, medical specialists, solicitors and barristers) in accordance with the MDA National Group Privacy Policy.

Publications

Once you become a Member, our publications will be emailed to you. You may opt in to receive a hard copy via mail or opt out of receiving the publications altogether by unsubscribing. These publications are also available on the MDA National website at mdanational.com.au.