Updates to version 9 of the Motor Accidents Guidelines
The State Insurance Regulatory Authority (SIRA) regularly reviews and updates the Motor Accident Guidelines (the MAGs) to ensure that the CTP Scheme is functioning optimally and that it continues to support the objectives of the Motor Accident Injuries Act 2017.
Version 9 of the MAGs incorporates a number of proposed changes which respond to recommendations made by the Statutory Review of the Motor Accident Injuries Act 2017, including recommendations 3, 9, 16, 29 and 35. It also includes changes in response to stakeholder feedback received during the Post-Implementation Review of the Authorised Health Practitioner Framework. There are also minor additions and amendments to provide greater clarity to terminology, process and procedure in the regulation of the CTP Scheme.
Consultation was recently undertaken on new stand-alone Motor Accident Guidelines: CTP Care. These guidelines are intended to replace clauses 4.103-4.105 and Part 9 of the MAGs.
This summary of changes table outlines what has changed from the previous version of the MAGs (version 8.2), and the rationale for the proposed changes.
Clause (version 9) | Proposed change | Rationale |
|---|---|---|
Preamble | Addition | Clarifies terminology and removes unnecessary provisions. |
Part 1 | ||
1.2 | Amendment | Clarifies that Part 1 is effective for policies that come into effect on the set commencement date. |
1.13(q) | Amendment | ‘Sensitivity analysis’ section moved from clause 1.65-1.67 (version 8.2) to form part of clause 1.13. |
1.18 (version 8.2) | Deletion | This clause is no longer relevant. |
1.27-1.30 | Amendment | New clauses clarify that approval must be given by the Authority prior to the use of proposed risk rating factors. |
1.66 | Amendment | Clarifies that the Authority's motor accident filing template must be attached to every filing report and the data format must not vary from the specifications prescribed in the motor accident filing template. |
Part 3 | ||
|---|---|---|
3.3 | Amendment | New requirement that insurers must clearly indicate in the business plan how all brands including co-labelling or white labelling arrangements (where they deviate from arrangements in the business plan) meet the license conditions. |
3.10(e) | Amendment | New requirement that insurer business plans must include consideration of fraud deterrence and prevention under section 6.39 of the Act. |
3.10(l) | Amendment | New requirement that insurers report on the management of claims involving a psychological injury to ensure that these claims are managed in a way that addresses the unique challenges of psychological injuries. |
3.15, 3.20 | Amendment | New requirement that insurers must report on culture requirements to the Authority, reflecting Recommendation 3 of the CTP Statutory Review. |
3.22 | Amendment | Clarifies that insurers should keep a record and provide a report to the Authority of all complaints received, including a complaints trend analysis of the risks and issues. |
3.29 - 3.30 | Addition | New requirement that insurers report on policies and procedures to prevent, detect and respond to fraud in insurer business plans |
3.40-3.41 (version 8.2) | Deletion | Self-assessment requirements will be published separately to the Guidelines. |
Part 4 | ||
4.34-4.36 | Amendment | Amended liability notice requirements to allow a combined notice to be provided if wholly denying liability for statutory benefits for the first 26 weeks. |
4.47-4.49 | New clause | New requirements that clarify process for payment of interim rates, including allowing the insurer and claimant to negotiate payment of a higher interim rate, and guidelines for instances of over/underpayment. In line with Recommendation 16 of the CTP Statutory Review. |
4.54 (version 8.2) | Deletion | Model referred to is no longer relevant. |
4.82, 4.83, 4.85, 4.87, 4.89, 4.91, 4.93, 4.94 | Amendment | Minor amendments to reflect that recovery plans may consider options for recovery that are additional to treatment, including vocational support, and to include a greater focus on return to activity where that is relevant. Amendments also highlight the need to engage the claimant in the development process. |
4.105 | Amendment | Clarifies that insurers must both make a decision regarding a treatment request and notify the claimant within the timeframes provided. |
4.105(c) | New clause | Clarifies the process for notifying of a treatment request decision where further information is required. |
4.107 | New clause | New requirement that insurers must provide the claimant with copies of all correspondence with the claimant’s treating practitioner or, for unwritten communication with the treating practitioner, provide a written notification to the claimant outlining the matters discussed and the outcome of the communication. In line with Recommendation 9 of the CTP Statutory Review. |
4.108-4.110 | New clause | New provisions related to the management of death claims, in line with expectations provided in SIRA’s Standards of Practice for Workers Compensation claims, to ensure that these claims are handled with the necessary sensitivity and urgency. |
| Part 5 | ||
|---|---|---|
5.4 | Amendment | Clarification that insurers should not require injured persons to undergo diagnostic imaging for the purpose of determining whether the injury related to the claim is a minor injury. In line with Recommendation 35 of the CTP Statutory Review. |
5.11 | Amendment | Updated reference to latest version of DSM. |
Part 8 | ||
|---|---|---|
Title | Amendment | Authorised health practitioner terminology changed to 'Health practitioners authorised to give evidence' to align with how they are described in the legislation. The AHP acronym was also causing confusion, given it is the acronym used for allied health professionals. |
8.4-8.5 | Amendment | Requirements to apply to all health practitioners authorised to give evidence, not just those who are on SIRA’s list. Clause around ethical behaviour strengthened to include procedural fairness. |
8.7 | New clause | New requirement that both parties shall use their best endeavours to agree to a joint medical or other health-related assessment, taking into account the individual circumstances and preferences of the injured person, to minimise the number of assessments that they are required to attend. Either party may initiate a request for a joint or other health-related assessment. |
8.16 | Amendment | Amendments to eligibility requirements following stakeholder feedback. |
8.17 | Amendment | Removed ten-year period for past criminal convictions. |
8.18 | New clause | Clarifies that health practitioners are appointed to SIRA’s list for up to three years, with an option for the Authority to extend the appointment, and must re-apply to continue to be authorised to give evidence beyond that period. |
8.23 (a) (d) | New clause Amendment | New CPD requirement. Additional requirement that practitioners should notify the Authority within seven days of changes to any circumstances that may compromise their ability to meet eligibility requirements and comply with the terms of appointment. |
8.32 | New clause | New requirement that practitioners whose authorisation ceases or is revoked must cancel appointments, notify affected people and not accept any new bookings for medical assessments as a health practitioner authorised to give evidence. |
8.35 | New clause | Practitioners authorised on application by the parties must meet the requirements in clauses 8.4 and 8.5. |
8.38 | New clause | Strengthened eligibility requirements for practitioners appointed on application by the parties. |
Part 9 | ||
|---|---|---|
Deletion | Part 9 (version 8.2) is removed as requirements relating to this area will be released in a separate CTP Care Guidelines document. Clauses 4.102-4.104 (version 8.2) have also been removed for this reason. | |