Compulsory Third Party Insurer Obligations
In Queensland, if you have suffered injuries as a result of a motor vehicle accident, depending on the circumstances of the accident, you may be entitled to make a claim under the Compulsory Third Party (CTP) scheme. A CTP Insurer is legally obliged to cover your reasonable and appropriate rehabilitation and medical treatment expenses that relate to injuries you sustained in the accident if it has:
Admitted liability; or
Agreed to fund such expenses without an admission of liability
Medical treatment and rehabilitation expenses may include General Practitioner consultations, specialist consultations, surgery costs, radiological and other investigations, physiotherapy, gym reconditioning programs, medications, job seeking or educational measures, etc.
The Motor Accident Insurance Commission (MAIC) has developed Rehabilitation Standards A to F to ensure that CTP insurers comply with their legal obligations.
“Rehabilitation” is defined under the CTP legislation as follows:
the use of medical, psychological, physical, social, educational and vocational
measures (individually or in combination) —
(a) to restore, as far as reasonably possible, physical or mental functions lost or impaired through personal injury; and
(b) 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.
Many CTP insurers have in-house rehabilitation consultants who review and coordinate your rehabilitation needs with external treatment providers such as physiotherapists, specialists, etc.
CTP Insurer Pre-approval
If you require treatment, you should speak to your lawyer and seek pre-approval from the CTP insurer. This will need to be done well before the appointment to ensure that the CTP Insurer has agreed to cover those costs. Without pre-approval, the CTP insurer may refuse to reimburse you for those expenses.
Where an insurer refuses to fund your reasonable and appropriate rehabilitation you can apply in writing to the MAIC for a mediator to be appointed. The mediator can assist you to resolve the issue with the CTP insurer or apply to the court to determine whether the rehabilitation should be funded. Alternatively, you can retain the receipts and claim these costs as part of your compensation claim for damages.