The CTP Insurer won’t pay for my medical treatment – What should I do

One of the primary reasons injured people make a personal injury claim after a car accident is to receive help with paying for medical and rehabilitation expenses. Rehabilitation can get expensive – particularly if you’re unable to work because of an injury. One of best aspects of Queensland’s CTP scheme is that necessary treatment can be paid for by the CTP insurer, helping injured people to recover faster.  

Although the CTP insurer is not obliged to fund rehabilitation until they have admitted liability (meaning that they admit their insured driver caused the accident), they will usually offer to fund rehabilitation expenses within a few weeks of receiving a compliant notice of claim. Once an insurer has offered to fund rehabilitation, their obligation to continue funding reasonable treatment has been triggered and cannot be withdrawn.  

Rehabilitation expenses covered by the insurer may include surgery in a private hospital, specialist consultations, physiotherapy, occupational therapy, psychiatric treatment, psychological counselling, medication, and medical aids and equipment. For people whose injuries affect their ability to drive or manage at home, the insurer may fund home or vehicle modifications, and personal care and domestic assistance if required.  

In addition to funding treatment directly, CTP insurers should also reimburse you for rehabilitation or other expenses you have incurred as a result of your injuries. This not only includes treatments like physiotherapy, but also medication or travel expenses to attend rehabilitation appointments.  

But what if the insurer refuses to reimburse you or fund any treatment – or refuses to fund the rehabilitation being recommended by your treatment providers? This can be a very distressing experience for injured people as they struggle to pay for the treatment they need to get better.  

The insurer’s obligation only extends to paying for treatment and rehabilitation that is “reasonable and necessary”. But what does this mean? There are a number of different factors that may determine whether a treatment is reasonable and appropriate, including:-

• What is being recommended by your treating doctors?
• What is being recommended by your allied health providers?
• Are specific recommendations being made or do you need to consult with a specialist for more specific advice?
• Have you sustained a serious or catastrophic injury? If so, you might need assistance with personal care or domestic tasks, aids and equipment, or home modifications. You may also need additional therapies such as occupational therapy or speech therapy.
• Have you sustained a psychiatric injury that may be making your recovery more difficult?   
• Has your need for this treatment arisen as a result of injuries sustained in the accident? 

CTP insurers usually require a recommendation or referral for treatment to have been made by a doctor or allied health provider. This means that your General Practitioner needs to be a regular point of contact to discuss your symptoms and treatment options. It is essential that you tell your GP about all of your symptoms and any difficulties you have had since your accident. They can then provide any referrals you need to ask the insurer for treatment funding. You should also make sure to keep receipts for anything you have spent on treatment or other expenses, so that you can give these to the insurer when requesting reimbursement.  

Unfortunately, CTP insurers may still refuse to fund a particular treatment, even when recommendations are being made by your doctor. However, there are steps that can be taken to protect your entitlements to funding of your recommended rehabilitation. To protect your interests, contact our experienced personal injury lawyers for a free consultation.