As many drivers would be aware, there were significant changes to the compulsory third party (CTP) scheme which came into effect on 1 December 2017.
The Insurance industry lobbied heavily for the changes and in introducing the new scheme, the New South Wales Government cited a need to reduce green slip premiums.
Although there has been a slight drop in premiums, it is the writer’s experience that persons injured on New South Wales roads are now being paid far less compensation than even the Insurers and New South Wales Government forecasted. That is, it would appear that very little of each dollar in premiums paid are being returned to injured persons whom the scheme purports to protect.
Due to extremely harsh legislation which essentially determines that all but the most serious of injuries are “minor injuries”, the majority of injured road users are prevented from accessing treatment after 6 months have elapsed from the motor accident.
It is the writer’s experience that after accepting the initial claim, Insurers seem to take very little action in relation to their files and simply await the expiration of the 6 months. There appears to be very little investigation made with the Claimant’s treating doctors as to the diagnosis, what investigations may be required, and what treatment is required. Once the 6 months expires, the Insurers simply close the file.
For the above reasons, it is crucial that Claimant’s act with urgency when injured in a motor vehicle accident. There can be no delay in seeking medical treatment and advice. Claimants should consult their doctors in relation to what investigations may be required and what treatment they need to undergo in order to effectively recover. All requests for treatment and investigations should be lodged on the Insurer without delay so that it may be considered for approval.
Put simply, if there is no request for the treatment then the Claimant will not be entitled to anything. Even when treatment is requested, it is our experience that there are usually significant delays in the Insurer approving that treatment and more often than not, the treatment is refused without good reason despite it being recommended by a medical professional and the Insurer having no contradictory medical evidence.
There has certainly been a push by the Insurer’s and the New South Wales Government to prevent Claimants obtaining assistance from lawyers in pursuing their statutory entitlements under the scheme.
Unfortunately, in circumstances where the Insurer regularly denies treatment, Claimants are at a disadvantage trying to navigate through complicated dispute resolution processes with the Insurer. There are steps that can be taken to challenge the Insurer’s decision however this requires careful planning and persuasive submissions. Often, the Insurer will reject the Claimant’s application for a compulsory internal review and the matter will need to be referred to the Dispute Resolution Service.
Quite often, it is found that the Dispute Resolution Service will actually overturn a decision made by the Insurer particularly where it relates to a denial of treatment. Accordingly, Claimants should ensure that they do not delay when challenging an Insurers decision and it is highly recommended that Claimants seek legal advice for assistance with these matters.
It is also important to remember that strict time frames apply to requests for review of an Insurer’s decision as well as referral to the Dispute Resolution Service. If for example, a Claimant does not seek an internal review within 28 days of the Insurers decision to deny treatment, the Insurer is not obliged to consider any future request. If an internal review is not conducted then the Claimant cannot refer the matter to the Dispute Resolution Service as the Dispute Resolution Service will find that they do not have jurisdiction. In those circumstances, the only way to challenge the Insurer’s decision would be to commence action in the Supreme Court. Unfortunately, the expense of such action generally makes it non-viable.
Due to the limitations of the current scheme, Claimant’s should seek medical advice immediately after the accident and ensure an Application for Personal Injury Benefits is lodged within 28 days of the accident, particularly where there is a claim for loss of wages. It is important that Claimants liaise with their doctors to ensure that treatment and investigations are commenced as soon as possible.
Due to the complicated processes and the apparent reluctance of Insurers to be proactive in assisting Claimants, it is recommended that Claimants seek legal advice as soon as possible after the accident for assistance with lodging their application and so that any treatment disputes can be appropriately challenged within their statutory time frames.