Terms & Conditions

1. Purpose

This policy defines the criteria and documentation requirements used to determine whether a client’s medical circumstances qualify as a medical emergency for the purposes of refund assessments.

2. Definition of Medical Emergency

A medical emergency is a sudden, severe, and unforeseen medical condition that:

• Requires immediate medical intervention, and
• Directly prevents the client from participating in or continuing the program.

3. Eligibility Criteria

A medical emergency must meet at least one of the following conditions:

• A life-threatening medical condition requiring urgent or emergency medical care.
• A medically certified condition that explicitly restricts physical activity or participation in the program.
• A medical condition that renders the client physically incapable of continuing the program for an indeterminate period, supported by appropriate medical documentation.

4. Documentation Requirements

All medical emergency claims must be supported by valid, clear, and verifiable medical documentation. Acceptable documentation includes, but is not limited to:

• Hospital admission and/or discharge summaries
• Diagnostic reports or imaging results
• Doctor-issued medical certificates or specialist letters

Documentation must clearly indicate:

• The diagnosis or nature of the medical condition
• The treatment period or hospitalization dates
• Any recommended activity restrictions or limitations
• The expected duration of incapacity, where available

Incomplete, unclear, or unverifiable documentation may result in the claim being denied or delayed.

5. Examples of Qualifying Medical Emergencies

Medical emergencies that may qualify under this policy include, but are not limited to:

• Emergency hospitalization due to:
  • Cardiac events
  • Stroke
  • Organ failure or cancer
• Major accidents resulting in:
  • Fractures
  • Surgical intervention
  • Prolonged immobility or rehabilitation
• Acute medical conditions requiring urgent or emergency surgery

6. Non-Qualifying Scenarios

The following situations do not qualify as medical emergencies under this policy:

• General illnesses, mild infections, or temporary medical conditions
• Conditions causing short-term discomfort without sustained incapacity
• Medical situations involving brief hospitalization without long-term restrictions on program participation
• Preventive, elective, or pre-existing medical treatments, unless complications meet the eligibility criteria outlined in Section 3

7. Assessment and Decision Authority

• All claims are assessed on a case-by-case basis.
• Approval is contingent upon compliance with this policy and the adequacy of supporting documentation.
• The organization reserves the right to:
  • Request additional medical information
  • Verify the authenticity of submitted medical documentation
  • Deny claims that do not meet the policy criteria

This policy forms part of the organization’s Terms and Conditions and is binding upon all participants.