QLD CTP: An Introduction to the National Injury Insurance Scheme

William Deicke

Legal Practitioner

The National Injury Insurance Scheme Queensland commenced in 2016 and its operation is governed by the National Injury Insurance Scheme (Queensland) Act 2016 (‘the Act’) and the National Injury Insurance Scheme (Queensland) Regulation 2016 (‘the Regulation’). The stated aim of the Scheme, and its establishing legislation, was to ensure that individuals who suffer particular serious injuries as a result of a motor vehicle accident in Queensland receive necessary and reasonable treatment, care, and support, irrespective of fault. Given the nature of the Scheme, individuals who pursue a Compulsory Third Party (CTP) claim may come in to contact with the Scheme. As such, it’s important that CTP claimants understand the way in which the Scheme operates, and the potential implications of becoming a participant.

Eligibility

The Act and the Regulation impose certain eligibility criteria for prospective participants, predominantly based on the nature of the serious personal injury suffered by the individual. Pursuant to the Regulation, an eligible serious personal injury includes: –

Permanent spinal cord injuries;
Traumatic brain injuries;
Multiple or high-level limb amputations;
Permanent injury to the brachial plexus;
Severe burns; and

Permanent blindness caused by trauma.

Matters that could preclude an individual from becoming a participant in the Scheme include the date of the injury and whether the individual has already received damages in relation to their treatment, care, and support needs as a result of the subject injury.

Procedure

An individual may apply to the National Injury Insurance Scheme Queensland Agency (‘the Agency’) directly, or an application may be made by a CTP insurer on the individual’s behalf. Once accepted, the individual enters the Scheme as an interim participant. Thereafter, the Agency will facilitate funding for necessary and reasonable treatment, care, and support pertaining to the participants accident-related injuries for a period of two years.

As a participant in the Scheme, individuals may be entitled to funding for a wide range of services such as rehabilitation, medical and pharmaceutical treatment, prostheses, aids and appliances, educational and vocational training, and attendant care and support. The nature of services received will depend on an assessment of the participants specific needs.

Sometime before the expiry of the two-year interim participation period, the participant will be assessed for the purposes of determining whether they have recovered to a sufficient standard to exit the Scheme, or whether they are eligible to become a lifetime participant, continuing to receive necessary and reasonable treatment, care, and support for the rest of their life.

Lump Sum Payment

There are additional considerations that CTP claimants who are accepted as lifetime participants in the Scheme should be aware of. Certain claimants are entitled to elect to ‘opt out’ of the Scheme, and instead pursue a lump sum payment from the Agency for treatment, care, and support, in lieu of remaining in the Scheme for the rest of their life. Strict timeframes may apply to making this election.

The decision whether or not to elect to pursue a lump sum payment in lieu of remaining as a lifetime participant in the Scheme is a significant one. Whilst this decision is ultimately one for the Claimant and will depend on their particular circumstances, Littles can provide advice with respect to the implications of this decision.