Draft Motor Accident Guidelines: CTP Care summary of changes

SIRA have undertaken a review of Part 9 of the Motor Accident Guidelines (MAGs), version 2 effective 8 April 2022 which relate to CTP Care.

This review has been undertaken as part of the program of work underway to support transition of claims for treatment and care statutory benefits for more than 5 years from the motor accident, or earlier by agreement.

Claims will transition from the CTP Licenced Insurer to the Lifetime Care and Support Authority (LCSA) on and from December 2022 (or earlier by agreement). This review has considered feedback raised by stakeholders, with changes proposed to enhance clarity to support a smooth transition for the injured person.

New stand-alone Motor Accident Guidelines: CTP Care have been drafted, which are intended to replace clauses 4.103-4.105 and Part 9 of the MAGs. Broadly these guidelines set out the required procedures for the transition of the payment of statutory benefits for treatment and care from a licenced insurer to the LCSA in accordance with the Act.

This summary of changes table outlines the proposed changes under consideration in preparing the new guidelines, what has changed from the MAGs, and the rationale for the change.

Current guidelines	Proposed change	Rationale
Clause 9.1 outlines that the guidelines are made under section 6.1 of the Motor Accidents Injuries Act 2017 (the Act).	Now included under ‘guideline-making powers’ in the introduction. The guidelines are made under sections 6.1 and 10.2 of the Act. Explanatory content also provided in relation to section 3.45(1) of the Act.	New standalone guidelines are proposed which include relevant information under the introduction with content tailored to treatment and care statutory benefits after 5 years (or earlier by agreement) and the transition process from licenced insurers to the LCSA.
Clause 9.2 outlines application of the guidelines to licenced insurers and the LCSA.	Now included under ‘application’ in the introduction.	New standalone guidelines are proposed which include relevant information under the introduction, similar to the MAGs however with content tailored to CTP Care.
Clause 9.3 describes the two sections of the guidelines to reflect the key stages of the transition process.	New stand-alone guidelines contain the same parts together with expanded content (now 8 Parts - refer to ‘Parts of the Guidelines’ in the introduction).	The new structure reflects differing areas of claims handling and transition requirements from principles and general obligations (Part 1), transfer expectations both before and after the LCSA is the relevant insurer (Parts 2 and 3), complaints (Part 4), recovery plans (Part 5), treatment and care (Part 6), claims made more than 5 years from the accident (Part 7), internal review and disputes (Part 8) together with information and data provision (Part 9).
Clause 9.4 (a) – (f) outlines principles which apply when transitioning the payment of statutory benefits for treatment and care from a licenced insurer to the LCSA.	New guidelines include streamlined principles at clause 1.1 in Part 1, which are to be read together with the principles outlined in Part 4 of the MAGs. These are supplemented by general obligations at clause 1.3.	The overarching principles to guide conduct in the transition process have been refined and are supported by more specific obligations on the parties as outlined in clause 1.3. These should be read together with the principles in Part 4 of the MAGs.
N/A	New requirements have been included in Part 1 under ‘General Obligations’	These provisions articulate general claims handling obligations for licenced insurers and the LCSA to ensure the injured person is kept informed, not adversely impacted by the transfer process, with prompt sharing of information where relevant to enable proactive and timely management.
Before the LCSA is the relevant insurer Clauses 9.5 to 9.8 outline requirements for data and information before the LCSA is the relevant insurer	Now Part 2: Before the LCSA is the relevant insurer Data and information requirements now included in Clauses 2.1 to 2.4 with modification: Clause 2.1 now specifies ‘accurate and current data’ is to be provided Clause 2.2 has been expanded to clarify handover information to be provided for active claims with ongoing treatment and care needs The former Clause 9.7 has been removed Inserted a new clause at 2.4.	Minor modification to the provisions under ‘Data and Information’ include specifying a timeframe for provision of data for certainty. Clause 2.2 has been expanded and outlines what data and information is to be included as part of the transfer advice. Clause 9.7 has been removed as SIRA has no statutory basis to issue a Direction. A new clause has been included at 2.4 to provide additional clarity in relation to the management of inactive claims should they once again become active.
N/A	New explanatory content and clause 2.5 included under ‘CTP Care Early by Agreement under section 3.45 of the Act’ Explanatory content clarifies Nominal Defendant matters.	Explanatory content has been provided to enhance understanding for the reader by providing additional context. New provision clarifies expectations with the early by agreement process following the pilot.
N/A	New clauses 2.6 to 2.8 included under ‘Active and Inactive claims’	Seeks to provide clarity around expectations for active / inactive claims.
Clauses 4.103 to 4.105 in Part 4 and 9.9 to 9.13 in Part 9 outline notification requirements for licenced insurers, including both 2 & 6 month notice periods.	Requirements outlined in clause 4.103 are now captured in Part 1 principles and general obligations. Notification requirements are now included at Clause 2.9 to 2.14 with modification so that all notification requirements are included on the one Part.	Seeks to provide clarity around active / inactive claims and streamlines notification requirements previously in Parts 4 and 9 of the MAGs into the one part so expectations are clearer. Clause 2.9 seeks to ensure that only those injured people whose claims will transfer to LCSA for future treatment and care needs are notified. Clause 2.14 makes clearer that when contacting the current treatment and care service providers that LCSA will soon be the relevant insurer, it should include to whom accounts should be directed and from when.
After the LCSA is the relevant insurer Clauses 9.14 to 9.15 outline data and information requirements after the LCSA is the relevant insurer.	Now Part 3: After the LCSA is the relevant insurer Clauses 3.1 to 3.2 outline data and information requirements, and now also include the requirement for the licenced insurer to share any new communication with the claimant with the LCSA as soon as practicable, and no more than 5 business days from receipt.	This minor modification ensures that any communication with the claimant is shared with the LCSA in a timely manner.
Clauses 9.16 to 9.17 outline initial notification requirements.	Initial notification requirements are now included at Clauses 3.3 to 3.4. Clause 3.3 has been expanded to require that the LCSA must also notify the injured person in writing of contact details of who the injured person can contact if they have an inquiry or complaint.	This ensures the notification to the injured person clarifies contact details for who they can contact should they have an inquiry or complaint.
Clauses 9.18 to 9.19 outline ongoing notification requirements.	Ongoing notification requirements are now included in clauses 3.5 to 3.6 with modification: Clause 3.5 now specifies 5 business days rather than 7 calendar days Clause 3.6 requires notification within 5 business days (no timeframe was previously specified under clause 9.19)	Enhanced consistency with timeframe requirements.
Clauses 9.20 to 9.21 outline requirements for communication with the injured person	Communication with the injured person is now included at clauses 3.7 to 3.8	No changes to provisions
Clause 9.29 to 9.33 outline information and data provision requirements	Part 9 now outlines information and data provision requirements.	Minor changes only (reference to Authority now SIRA)
Clause 9.34 to 9.37 outline requirements in relation to recovery plans	Part 5 now outlines requirements in relation to recovery plans Clause 5.1 outlines exceptions for when an injured person is required to have a recovery plan, including where they no longer have treatment needs but have not returned to pre-accident function Clause 5.3 now included to require the recovery plan is to be reviewed where significant changes occur where the transition occurs early by agreement Minor changes at clause 5.5 to refer to ‘pre accident activities’ rather than usual activities New clause 5.6 confirms these provisions are to be read together with relevant provisions in Part 4 of the MAGs relating to recovery plans.	Minor changes only based on stakeholder feedback, including removing reference to ‘usual activities’ recognising usual activities change through the lifespan of a claim. New clause clarifies how Part 5 of the CTP Guidelines are to be read together with relevant provisions in the MAGs.
Clauses 9.38 to 9.44 outline requirements for treatment and care	Part 6 now deals with treatment and care under facilitating referrals, determining requests, and SIRA funded programs. Clause 6.5 specifies accounts to be paid as soon as possible and within 20 days (previously 30 days); and includes the requirement to verify expenses outlined in Part 4 of the MAGs New clause 6.6 requires the insurer to provide relevant information within two days if active, or 5 days if inactive, to enable a decision within 10 days (or 10 days from receipt for inactive claims) New clauses at 6.9 to 6.11 outline eligibility for SIRA funded programs under section 3.41 of the Act.	The change to payment within 20 days is to align with expectations in the MAGs. Additional clarity around expectation for timely provision of information to enable early decision making for treatment and care. Additional content to confirm access and eligibility for SIRA funded programs under section 3.41 of the Act, noting that only the licenced insurer can administer a SIRA funded program under the 2017 Act.
Clauses 9.45 to 9.48 outline requirements for claims made more than 5 years from the date of accident	Part 7 now outlines requirements for claims made more than 5 years from the date of accident.	No changes to provisions
N/A	Part 8 now includes new clauses 8.1 to 8.5 in relation to internal review and disputes during transition. These clauses are to be read together with relevant provisions in Part 7 of the Act, Part 7 of the MAGs, and applicable PIC Rules.	These new provisions seek to provide clarity in relation to who will undertake an internal review where the claim is transitioning from the licenced insurer to LCSA. Similarly, which party will respond to an application to the Commission.
N/A	Included glossary	Outlines meaning of relevant terms used through the guidelines.