If you are injured on the road in Queensland and you are not at-fault, you are entitled to make a claim for compensation against the ‘at-fault driver’s’ Compulsory Third Party (CTP) insurer. Once the claim is on foot, you may be entitled to funding for reasonable and appropriate rehabilitation expenses from the relevant insurer under the Motor Accident Insurance Act 1994 (Qld) (MAIA),
What does rehabilitation mean?
In Queensland, and in the context of a claim for compensation for a motor vehicle accident, rehabilitation is defined in section 4 of the MAIA. The MAIA defines rehabilitation as having two main functions:-
- to restore, as far as reasonably possible, physical or mental functions lost or impaired through personal injury; and
- to optimise, as far as reasonably possible, the quality of life of a person who suffers the loss or impairment of physical or mental functions through personal injury.
It outlines that rehabilitation through restoration of function and optimization of quality of life is to be through medical, psychological, physical, social, educational and vocational measures.
This definition creates a wide scope for injured people in Queensland to access rehabilitation when they sustain an injury in relation to a motor vehicle accident.
The Rehabilitation Standards and the Guideline for CTP insurers outlines what reasonable and appropriate rehabilitation encompasses (‘the Guidelines’).
Courts across Australia have previously found that the following treatments and services all fit within the Guidelines definition of rehabilitation:-
- GP appointments;
- Physiotherapy;
- Exercise physiology;
- Psychology treatment;
- Psychiatric treatment;
- Surgery;
- Home and vehicle modifications and at times, the purchase of a new home or vehicle;
- Taxi vouchers to travel in the community and to attend rehabilitation appointments;
- Wheelchairs, mobility scooters and other aids and equipment;
- Commercial domestic assistance (cleaning, gardening, etc.).
If it can be demonstrated that the rehabilitation you require is reasonable and appropriate, there is a legal obligation for the CTP insurer to fund it.
What is reasonable and appropriate rehabilitation?
As an example, Jane is injured in a motor vehicle accident and sustains bilateral shoulder injuries. Her GP refers her to a physiotherapist, who recommends an initial course of six sessions and submits a treatment plan to the CTP insurer. The insurer has 14 days to decide whether to fund the treatment.
Jane attends a local physiotherapist on the Sunshine Coast, which is considered reasonable given availability in her area. While she is free to choose her provider, the location and cost must also be reasonable. For example, travelling to Brisbane for the same service may not be reasonable if it is available locally, whereas travel from a remote area (e.g. Birdsville to Longreach) may be.
Her treatment must also be appropriate to her injury. Physiotherapy and clinically recommended exercise (such as Pilates for shoulder strength) are appropriate, while unrelated treatments would not be.
After completing her initial sessions, Jane’s physiotherapist recommends further treatment. The insurer initially declines, suggesting she move to a home program. Jane challenges this decision, relying on her provider’s recommendation and the definition of rehabilitation under the MAIA. The insurer ultimately approves the additional sessions.
Even if Jane’s injuries become “stable and stationary,” she may still be entitled to ongoing treatment to manage pain and symptoms, as this supports her quality of life.
Jane also seeks funding for fortnightly assistance with washing her hair due to her limited shoulder movements. Although initially declined, she explains that this support is necessary, particularly as her partner is not always available to assist, and that it improves her quality of life. The insurer agrees to fund this assistance temporarily.
Through this process, Jane accesses reasonable and appropriate rehabilitation aimed at restoring her function and improving her quality of life.
Understanding your right to access and undertake rehabilitation services is a critical part of the claims process when you have sustained an injury in a motor vehicle accident. Queenslanders are fortunate to have a strong and valuable CTP insurance scheme in Queensland. The MAIA is designed to ensure that injured people receive the support they need not only to recover, but to maintain their independence and quality of life. Knowing what is reasonable and appropriate, and being able to advocate for it when needed, can make a significant difference to your recovery journey.
