Whenever you suffer an injury, the most important step you take is always to get medical or other treatment. Doctors always say that early rehabilitation is the best. But, the cost of medical and allied health treatment can be expensive, especially with rising interest rates and cost of living, the poor coverage by private health insurance, and on top of all that when you can’t work because you are injured.
In this blog, we will explain the process involved in getting funding from a Compulsory Third Party (CTP) insurer to pay for treatment and rehabilitation for an injury you might suffer in a car accident.
Step 1: Notice of Accident Claim Form
The first step is to actually start a claim against the CTP insurer of the vehicle at fault for the accident. This is called a personal injury claim or compensation claim for a car accident. The claim is commenced by lodging a Notice of Accident Claim Form with the relevant CTP insurer. The CTP insurer will always be the insurer of the vehicle at fault.
If you are a passenger in a vehicle and the driver is at fault, then the relevant CTP insurer will be the CTP insurer for the vehicle in which you are a passenger.
The CTP scheme in Queensland provides coverage for people injured in a range of accidents, including pedestrians, scooter riders, bicycle riders, motorbike riders and pillion passengers, passengers in a car, by-standers and so on.
It is very important to get legal advice as soon as possible after any accident so that you understand what your rights are and because there are some strict procedural requirements and time limits within which a claim must be started.
Step 2: Beware of Time
There are strict time limits to start a personal injury claim for a motor vehicle accident. You must get legal advice about time limits, or you risk losing your right to claim.
Step 3: Medical Certificate
Before any CTP insurer will agree to pay for treatment for you, they will want to see a medical certificate and a referral from your doctor for that treatment. The medical certificate is a specific form in the Notice of Accident Claim form. This must be completed before your claim is accepted by the CTP insurer. It is very important that you consult with your GP as soon as possible after a motor vehicle accident and ask your GP to give you the following:-
- The Medical Certificate; and
- A referral for any treatment you require.
The referral for treatment must be specific. In other words, if you need to see an Orthopaedic Surgeon or other specialist, a Physiotherapist, an Occupational Therapist or your GP recommends a gym exercise program, then it is important for your GP to give you those specific referrals.
Step 4: Requesting Funding from the CTP Insurer
A CTP insurer has certain obligations to provide funding for reasonable and appropriate treatment and rehabilitation. Once you have a medical certificate and referral for treatment, then a request can be made to the CTP insurer to fund such recommended treatment and rehabilitation. Please bear in mind that it can sometimes take up to two weeks in order to get approval from an insurer to fund such treatment.
If you pay for treatment out of your pocket in the meantime, you can seek reimbursement from the CTP insurer.
Also, sometimes insurers will try to argue that the treatment is not reasonable or appropriate. If this happens, you should consult your GP or treatment provider and lawyer about what steps can be taken to encourage the CTP insurer to pay for your treatment as a result of personal injuries sustained in the motor vehicle accident. Sometimes the refusal by the CTP insurer stems from their misunderstanding or misreading of medical documents. This may be an easy issue to fix. However, it is essential that it is dealt with quickly for your own personal benefit.
Step 5: Starting Treatment for your Injuries
Once the CTP insurer has approved funding for treatment for your injuries from the motor vehicle accident, they will communicate directly with your treatment provider to confirm this. It will then be a very simple matter of you contacting your treatment provider and making the first available appointment.
At the first appointment you can expect your treatment provider to discuss with you how the accident occurred, what pain you are experiencing and what your expectations are for your recovery. It is very important to think in detail about all of the injuries and symptoms you are experiencing. This is because this information is recorded and can be used in your claim as evidence later down the track.
Your treatment provider will then prepare a treatment plan which will be submitted to the CTP insurer to approve.
Final Important Note
The most important advice Travis Schultz & Partners can provide you is: never delay.
If you suffer an injury from a motor vehicle accident, you should immediately consult your doctor about it. You should also seek legal advice early, so that you are informed of your rights and time limits, and you can make the best decision for yourself about whether to commence a claim.
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