When should I make a Motor Accidents claim?
In order to ensure your claim is dealt with promptly, making a claim under the motor accidents scheme, should be done within 28 days of the accident and the accident must be reported to the Police.
Types of Motor Vehicle Accident claims
There are two types of claims that can be made if you have an injury due to a motor vehicle accident:
- A Statutory Benefits Claim – which includes payment of medical expenses, care and income payments for time of work.
- A Common Law Claim for Damages – this is a claim for pain and suffering, past and future loss of income and loss of superannuation.
We provide the following step by step outline to making a claim for compensation because of a motor vehicle accident, in circumstances where you have sustained personal injury and require treatment and wage reimbursement.
How To Make A Statutory Benefits Claim
Step 1 – Complete Application for Person Injury Benefits form
You need to make a claim for statutory benefits under the NSW Motor Accident CTP Scheme within 28 days of your initial accident. To make a claim for compensation for injuries sustained in a motor vehicle accident, you first need to complete an Application for Person Injury Benefits form. This form can be found on SIRA.
This is a no fault scheme and anyone injured in an accident can obtain benefits for up to 52 weeks (for accidents post 1 April 2023) or 26 weeks (for accidents occurring between 1 December 2017 and 31 March 2023)
Step 2 – Prior To Lodgement
Prior to lodgement of the form, you need the following information to support your claim:
- A NSW Police Event Number – this is a number that you obtain from the NSW Police Service upon making a report of the motor vehicle accident to which you are involved. The Police will give you an event number or a number starting with a “E” with a series of numbers after which will correlate with the report to NSW Police.
- A medical certificate from your General Practitioner/Specialist outlining your injuries and your fitness for work.
- Evidence of your income prior to the accident – if you are claiming loss of income associated with your injuries you need to provide records to show your earnings and loss of such earning due to the accident.
- Accounts/receipts for reimbursement of medical treatment you have incurred
Step 3 – Identify The Name Of The CTP Insurer
Lodge your claim documents with the relevant CTP Insurer of the vehicle that caused the accident (if only a one vehicle accident make a claim against that vehicle). Upon lodgement of your claim, the insurer should contact you within three (3) days after you have lodged the claim. They will confirm that they have received your application and will outline the next steps in the process. They should provide you with a claim number, a case manager, and their contact details. If you need immediate medical treatment, ask the Insurer what you should do next and how you go about obtaining immediate medical care.You need to identify the name of the CTP insurer for the vehicle you believe to be most at fault. If you did not obtain these details as part of the accident process, then you can contact the State Insurance Regulatory Authority (SIRA) who maintains a registry of all CTP insured vehicles in NSW.
CTP Assist or CTP Connect will take some initial details from you and provide you with the right insurer for the vehicle most at fault. They will also forward your details to the relevant CTP Insurer who will then contact you and assist you further with the claims process.
Step 4. Lodge Documents With The CTP Provider
Lodge your claim documents with the relevant CTP Insurer of the vehicle that caused the accident (In cases involving only one vehicle, file a claim against that specific vehicle). Upon lodgement of your claim, the insurer should contact you within three (3) days after you have lodged the claim. They will confirm that they have received your application and will outline the next steps in the process. They should provide you with a claim number, a case manager, and their contact details. If you need immediate medical treatment, ask the Insurer what you should do next and how you go about obtaining immediate medical care.
Step 5: Claim Investigation
Upon lodgement the Insurer will investigate your claim and shortly after let you know if they are accepting your claim. Once acceptance is received, they should start making payment towards your loss of income, medical expenses, and care.
Statutory Benefits Claim FAQ’s
Who Can Apply For a Statutory Benefits Claim?
Anyone who is injured in a motor vehicle accident in NSW can apply. This includes:
- Drivers and passengers
- Riders and pillion passengers
The injury sustained must either be physical or psychological.
What are the time periods for a Statutory Benefits Claim?
To receive back payment of wages flowing directly to the accident, the CTP Insurer needs to receive a claim for compensation within 28 days of the date of accident.
If the claim is made on the Insurer after 28 days, then you will need to explain your delay in lodging the claim to be considered eligible to receive weekly payments of statutory benefits from the day of the date of accident.
For claims made outside the first 28 days, weekly payments of statutory benefits will only begin from when the day the claim is made and will not be backdated.
You can still submit a claim up to three (3) months after the accident, but it is best to submit a claim as soon as possible and within 28 days if you want payments to start directly from the day of the accident.
Can I receive Wage Compensation in a Statutory Benefits Claim?
In respect of compensation, you are entitled to receive income support payments under the statutory scheme where you have lost income because of your injury.
If you are off work, these payments will help you pay the bills so you can focus on getting better.
For the first 12 months (for injuries post 1 April 2023 or six months for accidents occurring between 1 December 2017 and 31 March 2023) of statutory payments, you will receive the following percentage of your pre accident earnings:
- For the first 13 weeks the maximum is 95%
- After 14 weeks the maximum is 85% (depending on whether you have total or partial loss of earning capacity)
After 52 weeks income and medical payments end if:
- You were “wholly or predominantly” at fault or;
- Your injuries are assessed as a minor injury and do not meet the “threshold injury” as defined by the legislation.
If you do satisfy theses requirements, then income payments continue for up to after 2 years if you have an ongoing loss of earning capacity. Medical expenses and care are payable for life. If you then make Common Law claim for damages income support payment can be extended up to a maximum of 5 years.
What is considered a minor injury in a motor vehicle accident?
There will be significant argument as to whether an injured motorist has suffered a “minor injury” in accordance with the definition contained in the Act.A “minor injury” is defined as any of the following:
- A soft tissue injury; or
- A minor psychological or psychiatric injury.
A soft tissue injury is defined as an injury to the tissue that connects, supports or surrounds or structures or organs of the injury (E.g. muscles, tendons, ligaments, meniscus, cartilage, fascia, fibrous tissue, fat, blood vessels and synovial membranes), but not an injury to nerves or a complete or partial rupture of tendons, ligaments, meniscus or cartilage.
A minor psychological injury is defined as a psychological or psychiatric injury that is not a recognised psychiatric illness.
If the insurer decides that you have sustained a “minor injury” and you disagree you should contact your Lawyer immediately for assistance.
If you accept the insurer’s decision that you have a “minor injury” then statutory benefits of weekly compensation and medical expenses will cease after 26 weeks.
Do I have to pay for the medical expenses?
You should be aware that you do not need to lodge a formal claim to receive early treatment. Once you have notified the relevant insurer, they can approve a GP visit and 2 treatment sessions such as physiotherapy without further documents. You can use the online accident notification system through CTP Connect or CTP Assist to lodge an early notification to the relevant CTP insurer.
If you will require more than 1 GP visit and 2 treatment sessions, it is important to submit an Application for Person Injury benefits.
The Insurer may pay for all reasonable and necessary expenses for injury resulting from the accident. This includes:
- Medical, dental and pharmaceutical expenses
- Rehabilitation and treatment expenses (such as physiotherapy)
- The cost of travelling to and from appointments
- In some cases, support services (such as personal care and domestic assistance)
Common Law Damages Claim
If the car accident was not your fault and your injuries are serious (and meet the threshold injury definition of “non minor”), you may be eligible to make a common law claim for damages and receive lump sum compensation associated with your accident.
Common law damages for lump sum compensation are limited to people who:
- Have more than a minor injury; and
- Were not wholly at fault for causing their injury or their accident.
When Should I Apply For Common Law Damages?
A claim for common law damages must be made within 3 years from the date of the motor vehicle accident. If you are making a claim for common law damages more than 3 years after the motor vehicle accident, you will need to provide a full and satisfactory explanation for the delay in making the claim.
A common law claim for damages is usually made at about 1 year following and accident.
The benefits of making a lump sum claim for common law damages is that you can claim damages for economic loss and damages for non-economic loss (if the degree of permanent impairment of the injured person is greater than 10%).
Non-economic loss is an amount of money to compensation for pain and suffering and loss of enjoyment of life. You need to be assessed as having more than 10% whole person impairment to be entitled to any compensation for pain and suffering. You will need a lawyer’s assistance to make a common law claim and have the WPI assessed.
What is the lump sump that can be awarded?
The lump sum amount payable for pain and suffering is usually in the range of $200,000 to $400,000.00.
You also claim for economic loss, that is loss of past and future income due to the injuries sustained as well of loss of superannuation. This can be a significant amount if the injuries prevent you from undertaking your usual employment.
The amount payable varies in each claim and you will need the consult an Accredited Specialist in Personal Injury law to ensure you have the right lawyer who has the experience to get the best result for your case.
Is there a time limit for making a motor vehicle accidents claim?
The Application for Personal Injury Benefits Form should be completed within 28 days from the date of the motor vehicle accident. This will ensure that you receive weekly payments from the date you were unable to work.
You can complete the Application for Personal Injury Benefits Form within three months from the date of the motor vehicle accident however weekly payments will only be commenced from the date you submit the form. The insurer will also commence payment of medical expenses once you submit the form.
You then have a period of three years from the date of the accident to commence a claim for damages if you are eligible.
These time limits are very important and should be diarised to ensure that you and your lawyer comply with the time limits.
What if I disagree with the insurer’s decision?
If you disagree with the insurer’s decision you need to request an internal review from the insurer.This paperwork will be provided to you with the decision declining your claim.
This will require another person within the insurer (who was not involved in the original decision) to review the matter and make a new decision.
If you are still not satisfied with that outcome you can make an application with SIRA through the Dispute Resolution Service who will appoint an independent person to review the decision on your behalf. There are limited situations in which legal assistance can be provided.
If you have been injured in a motor vehicle accident and need the assistance of an expert in person injury law, contact Garling and Co lawyers. Our lawyers are accredited specialists in personal injury law and available to assist you with your claim. Contact us today on (02) 8329 9500 or complete a free case assessment today.
You might also be interested in…BACK TO BLOG
A guide for people injured in a motor vehicle accident on or after 1 December 2017
If you have been injured in a motor vehicle accident on or after 1 December 2017 you can make a clai...READ POST