Insurance claims: what you and your patients need to know

THE FOLLOWING information has been provided to AMA (NSW) by SIRA, to assist treating doctors understand the changes.

CTP GREEN SLIP

A new CTP Green Slip scheme starts on 1 December 2017 to better support people injured on NSW roads. The new scheme is focused on early support and recovery, with a six-month safety net for injured people – regardless of who was at fault in the accident.

If you have a patient who has been injured in a motor vehicle accident in NSW, it’s important that they lodge a CTP claim within 28 days to receive the full range of new benefits.

Benefits can include:

• reasonable medical and treatment expenses
• weekly income payments if they need time off work
• vocational rehabilitation programs
• attendant care services if they need help at home

A claim can be lodged within three months of the crash, but should be lodged as soon as possible to guarantee back pay of weekly income payments.

The new CTP scheme is no-fault for the first six months. This removes the need for insurers and lawyers to determine fault and negotiate compensation, which can add years to settlement timeframes and result in more stress for injured people when they should be focusing on recovery.

Your patient will not need to engage a lawyer to lodge a claim or to receive initial benefits.

Benefits can continue for up to two years, provided the person has more than a minor injury and they were not at fault in the accident. Medical benefits may continue as required, for life if needed.

To continue to receive income payments after two years, the person must have ongoing work incapacity. A common law claim for damages for economic loss and non-economic loss for the more seriously injured can still be made under the new scheme.

The easiest way for your patient to make a claim is to contact CTP Assist on 1300 656 919 or by email: CTPassist@sira.nsw.gov.au. This is a new service provided by the State Insurance Regulatory Authority (SIRA). CTP Assist can provide information and answer questions about the new scheme. We can connect your patient with the right insurer, help them fill in claim forms, and provide advice and support throughout the claims process.

As the treating doctor you will be required to complete certificates of fitness for patients who have not returned to work and may be eligible for income payments. You will also be asked to provide information to the insurer, which will help your patient get the treatment and benefits they need to recover.

More information will be available at www.sira.nsw.gov.au from 1 December 2017.

HELPING WORKERS COMPENSATION PATIENTS UNDERSTAND SECTION 39

From late 2017 some patients will no longer be entitled to weekly payments as a result of legislation passed in 2012. This is the first year payments will cease for workers as a result of this legislation.

Section 39 of the Workers Compensation Act 1987 provides that weekly payments are available for a maximum 260 weeks (five years). This applies unless the worker has been assessed as having a permanent impairment of more than 20 per cent.

Workers whose entitlement ceases will continue to be eligible for medical and related expenses for either two or five years after their weekly payments cease – depending on their level of permanent impairment.

To help doctors and their patients who have further questions about section 39, SIRA established a new service.

The service can be accessed by calling 13 10 50, or emailing transitionsupport@sira.nsw.gov.au