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The Motor Accident Insurance Act 1994 (QLD) (‘the Act’) governs the operation of Queensland’s Compulsory Third Party (CTP) insurance scheme, as well as Queensland’s scheme of statutory insurance for uninsured and unidentified vehicles. A stated object of the Act is to promote and encourage, as far as practicable, the rehabilitation of claimants who sustain personal injury because of motor vehicle accidents. Accordingly, the Act imposes obligations on CTP insurer’s pertaining to funding rehabilitation and treatment for claimants in certain circumstances.
Pursuant to Section 51 of the Act, once liability has been admitted by the CTP insurer, or the insurer has agreed to fund rehabilitation services without making an admission of liability, the CTP insurer is required to ensure that reasonable and appropriate rehabilitation services are made available to you.
Whilst everyone’s injuries and recovery are different, and in turn the treatment that is recommended to them by their treating medical providers, physiotherapy is a commonly prescribed treatment option. Other forms of treatment that typically involve ongoing consultation with a suitably qualified treatment provider is psychological treatment. Systems have been established with respect to funding arrangements for ongoing pre-approved treatment options such as these.
Ongoing, pre-approved funding of treatment options like physiotherapy and psychological treatment can take the stress out of your recovery journey, allowing you to focus on getting better. But how do you establish such an arrangement?
Following an initial consultation with a treatment provider, the treatment provider will complete a Provider Treatment Plan, requesting funding from the CTP insurer. The Provider Treatment Plan sets out a number of matters, including a subjective or objective assessment of your condition, the treatment provider’s provisional diagnosis of your injuries, your functional ability, factors affecting your recovery your injuries and symptoms. Importantly, it also detail’s the nature of the treatment provider’s proposed treatment, along with the frequency of treatment required (e.g. X number of sessions over Y weeks).
Thereafter, your treatment provider will provide the Provider Treatment Plan to the relevant CTP insurer. The CTP insurer than assesses the Provider Treatment Plan and determines whether they consider the treatment to be reasonable and appropriate in the circumstances. In addition to legislative obligations, the Motor Accident Insurance Commission has developed rehabilitation standards and guidelines for CTP insurers, which provide best-practice industry standards when assisting claimant’s with their rehabilitation journey. Whilst not legally binding in the same way as the Act, the Commission expects that CTP insurers decisions are made consistent with these rehabilitation standards and guidelines. In the event that funding for the requested treatment is approved, you can then attend the number of sessions approved, without having to worry about the cost of these appointments.
After the pre-approved funded sessions have been attended, the above process repeats.
Finding the paperwork associated with a QLD CTP overwhelming? Has the CTP insurer advised you that they don’t consider the treatment your treatment provider has requested to be reasonable and appropriate? Reach out to Littles Lawyers today. We consider it a privilege to be able to help you at your time of need.