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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.
TAC索赔知识库：什么是Serious Injury (“严重伤害” ）? 在维多利亚，若您因别人的过失而发生交通意外，并且能证明您遭受的伤害属于“严重伤害”(Serious injury)，您或许可追讨普通法(Common Law)赋予的一次性赔偿，来弥补您的损失。 “严重伤害”在法律上有一定的标准，目前可通过以下两个方式来达到： 1. 全人障碍(Whole Person Impairment，简称WPI)达到30%或以上 (Deemed test) 当您受伤的情况稳定以后，您将接受专科医生的鉴定，按照特定的标准及测量方式计算您的WPI百分比。如果交通事故委员会（Transport Accident Commission，简称TAC)认同您的WPI为30%或以上，那您将被“视为(deemed)”拥有“严重伤害”。然而，WPI百分比要达到30%或以上比较少见，绝大部分的申请者经专家鉴定后得出的WPI百分比皆少于30%。 2. 通过叙述的方式满足法律的定义 (Narrative...Read More