20 August 2020

CTP claimants left short changed

Leading Queensland compensation lawyer, Travis Schultz, is calling on the RACQ to end its consultation cost fixing strategy for allied health professionals treating patients under Compulsory Third Party (CTP) insurance claims as a matter of urgency.

Mr Schultz said he has serious concerns for patient welfare and the viability of small allied health providers who are being told by RACQ to fit their service fees into the price range set by their new strategy to reduce claim costs.

“As a lawyer practicing in the field of personal injury litigation for most of my career, I have significant concerns for those health practitioners – podiatrists, physiotherapists and psychologists – who have been refused payment by the RACQ for their ‘normal’ rehabilitation services,” Mr Schultz said.

“This is untenable for small, often sole practitioners who now face a deplorable choice: to maintain patient welfare and absorb the gap in service fee, or object to the unfair pricing, risk being ‘blacklisted’ by the RACQ and, ultimately, compromise the patient’s outcomes due to lack of access or longer waiting times for local treatment.”

Redlands mum Jessie Green is a recent victim of RACQ’s claim cost reduction strategy. She was pushing a pram with her baby daughter outside the Redlands Hospital when a driver lost control of their car and struck her and the pram, causing injuries to both she and her baby girl. She and her daughter have both had to undergo comprehensive rehabilitation treatment, including a number of appointments with allied health professionals.

Ms Green said having to battle with RACQ every time you need to have treatment funded just adds another layer of stress to what is already a traumatic situation.

“RACQ make it so hard to have everything approved that eventually you feel that you have no option but to give up,” Ms Green said.

“It is embarrassing seeking treatment from health care professionals who are not being properly paid, to the point where I decided to just to pay my podiatrist their normal fees in full. This means I remain out of pocket for those expenses because RACQ do not want to pay what my podiatrist normally charges.

“I cannot help but feel that if RACQ would proactively approve funding and make rehabilitation and medical treatment easier to access, I would have a much better outcome and would now be much further advanced in my recovery. “I feel that with more proactive support from RACQ, there is a good chance I would be back at work by now, rather than still struggling with the physical and emotional consequences of a highly traumatic car accident.”

All CTP insurers in Queensland are bound by the Rehabilitation Standards for CTP Insurers, which requires that insurers must take appropriate action to facilitate access to rehabilitation services – of the claimant’s choice – for their injuries.

Mr Schultz said the RACQ’s view of the Standards is that they can arbitrarily limit what they should have to pay to providers of rehabilitation services because of their “unique” interpretation of the guidelines.

“If you have been injured in a motor vehicle accident through no fault of your own, and need rehabilitation treatment, the last thing you should have to worry about is whether you can arrange those visits with a trusted, local health provider and not be out of pocket,” Mr Schultz said.

“No other CTP insurer in Queensland has attempted to interpret the rules in such an obviously egocentric way.

“How can the RACQ be willing to risk damaging its brand, built on 115 years of devotion to influencing safer driving and better health outcomes for residents, to beef up profits on its Profit and Loss Statement (P & L)?

“I’m certain the 10 founding members of the RACQ, who were themselves medical practitioners, would be disgraced that the very establishment they formed to put its residents’ best interests first is now willing to trade quality of rehabilitation and healthcare for a bigger bottom line!”

The 2017-18 Motor Accident Insurance Commission (MAIC) Annual Report flagged high profits of up to 30.5 per cent as a concern during the previous five years, with total premiums collected sitting at $1.6 billion. This figure has fallen to 25 per cent profit in the 2018-19 MAIC Annual Report.

“I’m aghast the RACQ wants to reduce what it pays to the hard-working allied healthcare providers at the coal-face when the CTP insurers are already taking profits which are three to four times what the government architects of the scheme had designed it to accommodate,” Mr Schultz said.

“In 2016, a review into the scheme recommended the MAIC take action to investigate the high profits being realised by insurers as a matter of urgency. Surely, almost five years later we need to see some action on this by our state’s leading motorist association! This cash grab at the expense on injured motorists and those rehabilitating them, seems to be quite inconsistent with the values of the iconic Queensland motorists association.”

Physiotherapist and Managing Partner of Queensland based Sports & Spinal physiotherapy group, Sean Campbell, said price fixing like what RACQ is doing, drives down quality as clinicians are forced to reduce the quality of their service to deliver healthcare at the budget rate RACQ are dictating.

“With all of the additional paperwork and communication requirements associated with these often complex CTP patients, we cannot possibly deliver the level of service these patients need and deserve at the price they are dictating. Price fixing like this will drive the more experienced, specialised and higher quality clinicians out of this market,” Mr Campbell said.

Practice Partner at Sports & Spinal in Woolloongabba, Bruno Rebello, said unfortunately, we are unable to adjust to such a reduction in fees without compromising the quality of care to our clients under the CTP scheme. “Our current full fees are charged to cover the normal cost of operation in delivering patient care, not only for their actual treatment, but the fee also includes liaison with other parties such as General Practitioners, Specialists and provision of treatment plans,” Mr Rebello said.

“Those activities are commonly more burdensome and time consuming to the practitioners than the provision of care to the client.

“Not to mention the increase in workflow at the front desk and office manager level, where there is a significant increase in the flow of administrative duties involved in the delivery of a CTP rehabilitation service, none of which are billable but all of which add up to the costs the business needs to bear in wages to staff. “Alternatively, we could pass on a gap payment to the clients, which would rightfully refuse to pay and deny their access to a large number of providers.”