The insurer will investigate the claim. Do not speak to an investigator without first consulting with your lawyer.
What happens after your claim has been received?
After your claim has been lodged and you’re given a claim number, the insurer will then investigate the claim.
As part of this investigation they will normally obtain a copy of the police accident report. You may also be required to speak to an investigator about your claim. If you are asked to speak to an investigator you should contact your Lawyer first to assist you in providing a statement to an investigator. Do not speak to an investigator without first consulting with your lawyer.
The insurer will then determine whether or not they will accept that the driver of the vehicle which you say caused the accident was at fault. The insurer must advise you in writing within 3 months of receiving the claim whether or not they will accept that their driver was at fault.
The letter advising you of the insurer’s decision is called a Section 81 Notice.
If the insurer accepts fault…
If fault is accepted the insurer will pay your reasonable and necessary medical, hospital, rehabilitation and travel expenses. The insurer will consider what medical treatment is reasonable and necessary and will pay your medical practitioners accordingly.
The maximum amount that an insurer has to pay for particular treatment is set out in the AMA list of medical services and fees. If your doctor charges over and above that set fee you may be responsible to cover the difference in cost.
To pay the medical practitioners, the insurer will require a copy of all accounts and/or receipts. You should ensure that you keep a copy of all of the original accounts and forward them to the insurer to request payment or reimbursement of expenses you have payed.
If the insurer denies fault…
If the insurer does not accept that their driver was at fault they will notify you in the Section 81 Notice. You should immediately contact your Lawyer to assist you in determining whether or not the insurer was correct in declining your claim.
The insurer will not pay for any medical treatment.
You will not need to refund any treatment paid for prior to this decision.
If the insurer makes no decision within 3 months…
On occasions the insurer will not make a decision within 3 months from the date of the accident. If this occurs the insurer will usually continue to pay your medical expenses up until the time that the insurer does make a determination in relation to liability.
The failure to deicide your claim is however taken to be a denial of liability and you should again consult your lawyer if this occurs.
What is early rehabilitation?
If your claim is accepted by the insurer then they will engage in early rehabilitation to assist you with treatment after the motor vehicle accident. Rehabilitation aims to return the injured person to a level of function and quality of life comparable to their pre injury level. To do this they usually appoint a rehabilitation provider. A rehabilitation provider is a company appointed by the CTP insurer to provide rehabilitation services which include Occupational Therapist, Rehabilitation Counsellors, Psychologist and Exercise Psychologists.
The rehabilitation provider’s role is to assist you to develop a plan and goals to assist in your recovery and return to work.
The rehabilitation provider will assist the insurer in determining what treatment is reasonable and necessary.
What other benefits are paid by the insurer?
The only benefit that is paid upfront by the insurer are medical expenses.
Occasionally if you are seriously injured an insurer will also pay for attendant care services. Attendant care services are services that provide assistance to people with everyday tasks and activities of daily living and can include personal assistance, nursing assistance, home maintenance and domestic services.
In the majority of claims however the insurer will only pay for the cost of medical treatment as it is incurred.
Your remaining entitlements to compensation are not payable until the conclusion of the claim and are payable as once off lump sum. These include:
- A lump sum for pain and suffering if you have an assessment of WPI greater than 10%
- Past and future medical expenses
- Past and future Wage loss
- Past and future Care
This amount is determined once all evidence to prove your claim has been obtained by your lawyer.
The insurer is the approached to see if an agreement can be reached as to how much compensation you are entitled to receive as a result of the injury sustained. This is usually done by meeting with the insurer for an informal discussion known as an informal settlement conference (ISC).
If we cannot reach agreement then this we will be determine through either an Arbitration system know as CARS ( if fault has been accepted) or by a Judge in Court ( where fault is denied).
It usually takes between 1 to 3 years for the date of an injury to finally resolve a claim, sometimes longer.
Should you have any questions please do not hesitate to contact us.
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