Once you have lodged a Personal Injury Claim Form with an insurer, the insurer will send you a letter saying your claim has been received. It will include a claim number that you must use when you write to the insurer about the claim and the name and phone number of the officer handling your claim.
The insurer will then investigate your claim. You may be required to give the insurer specific information (photos, documents, records etc) to help them with the investigation.
As part of the investigation, the insurer will normally get a copy of the police accident report. You may be required to speak to an investigator about your claim.
The insurer will investigate the accident and injury to find out whether liability for the claim will be accepted. By accepting liability the insurer agrees that the vehicle insured was at fault in the accident. The insurer must advise you within three months of receiving the claim whether they have accepted liability.
When an insurer makes a decision on your claim you will receive a 'Section 81 Notice'. This notice may make reference to an admission or denial of liability or an admission or denial that the insured driver had breached duty of care.
Green Slip insurers are bound by the MAA Claims Handling Guidelines (October 2008) (70kb). These guidelines ensure that claims are handled fairly and equitably. (The MAA monitors insurer compliance with the Claims Handling Guidelines).
Treatment and rehabilitation
You may require treatment after a motor vehicle accident. A health provider such as a hospital, doctor or a physiotherapist may provide this treatment.
Most people recover from their injuries after receiving initial treatment but some people need rehabilitation to help them recover. Rehabilitation aims to return the injured person to a level of function and quality of life comparable with their pre-injury level. When function cannot be restored, rehabilitation tries to help the injured person learn new skills, to adjust to any ongoing disability and to be as independent as possible.
If you are likely to have long term problems, it is important that you start a rehabilitation program as soon as possible. A rehabilitation program can form part of your compensation and your treating doctor or therapist will help you decide which is best for you. The insurer will be involved by approving payment for treatment.
Under the Scheme you must make every reasonable attempt to recover from your injuries by:
- having appropriate medical treatment
- participating in an appropriate rehabilitation program
- looking for alternative job opportunities
- returning to work when possible.
Whether the insurer pays for your treatment depends on the type of treatment expense, whether it is considered reasonable and necessary, and the insurer has admitted liability for the claim.
If the insurer accepts liability for your claim it will then pay for reasonable and necessary hospital, medical, rehabilitation and travel expenses. You do not have to wait until your claim is finalised for these expenses to be paid.
Insurers are only obliged to pay for reasonable and necessary expenses. The maximum amount the insurer is required to pay for a particular treatment is the amount set out in the Australian Medical Association List of Medical Services and Fees. Set fees may also apply for other services. You may be responsible for any costs over these set fees.
To be sure that the insurer will pay your accounts, you should obtain the approval of the insurer before you start your treatment or rehabilitation program.
Original accounts and receipts should be sent directly to the insurer. You should keep a record of all your expenses and a copy of any bills or receipts.
The insurer cannot be expected to pay accounts for continuing treatment unless improvement can be shown.
Most services provided by a public hospital are covered by an agreement between CTP insurers and the hospitals. You are not usually billed for public hospital care in New South Wales, but do not assume the services will always be free.
Payment for treatment by a doctor or therapist is not the insurer's responsibility unless the insurer has accepted liability for your claim. You may pay these expenses and be reimbursed by the insurer if liability is accepted later or the health provider may agree to wait for payment until the insurer decides liability. You will be personally liable for paying these accounts if the insurer later denies liability.
The insurer may be prepared to pay your medical, therapy and rehabilitation expenses without accepting liability. These are 'without prejudice' payments. Approval should be sought from the insurer before the services are provided.
If the insurance company denies liability on your claim you are responsible for your expenses. You may be able to claim part or all of your expenses from Medicare, private health insurance or from a personal accident insurance policy. You should notify these organisations that the expenses are for a CTP claim.
How your claim is settled
As part of the investigation of your claim, the insurer will need information regarding your medical condition. The insurer may get this from your treating doctor or by arranging for you to be assessed by another medical specialist. You must provide the insurer with full details of:
- your injuries
- your impairment and disabilities arising from these injuries
- your anticipated recovery if any of your injuries have not stabilised
- any economic or non-economic losses you are claiming.
You can settle your claim at any time. Once your injuries have stabilised and you have given the insurer full details of your claim the insurer should be in a position to make you an offer of settlement.
An offer of settlement is money (compensation) to cover the reasonable and necessary expenses and losses of income you have suffered as a result of your injuries. For people with more severe injuries the offer of settlement may also include an amount for non-economic loss. An offer made by an insurer should include a breakdown of all the components being paid. If you don't agree with the offer you should discuss it with the insurer or make a counter offer. You or your legal representative may negotiate with the insurer on settling your claim in a number of ways, including by letter and by settlement conference.
If you accept an offer of settlement from the insurer your claim is finalised.
If you do not agree with the insurer
A dispute can happen at any point along the way. A dispute may be about any aspect of your claim from payment for medical treatment provided, or to be provided, to the amount of the settlement.
For more information about how to resolve disputes with insurers, see: