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Part 4 of the Motor Accident Guidelines: Claims

Claims

Application of the Guidelines

4.1 These Guidelines commence on 18 December 2021 and apply to all current and future claims made on insurers in respect of motor accidents that occur on or after 1 December 2017. They apply until they are amended or replaced.

4.2 The Motor Accident Guidelines: ‘Claims handling & medical (treatment, rehabilitation & care)’, which were issued by the Authority on 1 January 2017, continue to apply to claims in respect of motor accidents occurring on and from 5 October 1999 to 30 November 2017.

Introduction and purpose

4.3 These Guidelines are made under the Motor Accident Injuries Act 2017 (NSW) (the Act), including Division 6.1 of the Act. They make provision with respect to the manner in which insurers and those acting on their behalf are to deal with claims.

4.4 These Guidelines are to be read together with relevant provisions of the Act and Regulation. They are ordered in accordance with the claimant journey to help insurers read them in conjunction with the Act and Regulation, and to progress claims promptly.

Principles

4.5 Insurers and those acting on their behalf are to deal with claims in a manner consistent with the objects of the Act, the below principles and the general duties under Division 6.2 of the Act.

These principles apply across all claims management aspects for the life of a claim:

(a) proactively support the claimant to optimise their recovery and return to work or other activities

(b) make decisions justly and expeditiously

(c) act objectively with honesty and professionalism at all times

(d) detect and deter fraud

(e) communicate with the claimant and keep them informed of the progress of their claim

(f) take into account the health emergency caused by the COVID-19 pandemic on a claimant’s circumstances when making decisions about a claim, including decisions related to disputes, and the claimant’s ability to comply with obligations or timeframes under the Act, regulations or these Guidelines.

4.7 If an insurer does not deal with claims in a manner consistent with these principles, the Authority will take appropriate action as per the Authority’s compliance and enforcement strategy.

4.8 In circumstances where more than one insurer is involved in the management of a claimant’s statutory benefits claim and/or damages claim, the insurers must:

(a) proactively and regularly share information with each other

(b) promptly respond to requests from each other

(c) ensure the claimant understands which insurer will be managing each aspect of the claim process and the reasons why

(d) work collaboratively to ensure a consistent and seamless claim experience for the claimant.

Communication with claimants

4.9 When communicating with claimants, insurers must:

(a) communicate directly with the claimant to deal with the claim, regardless of whether the claimant is legally represented, unless the clause below applies

(b) where a friend assists the claimant with the claim, communicate directly with that friend instead of, or in addition to, the claimant, as appropriate, regardless of whether the claimant is legally represented

(c) if requested in writing to do so by the claimant, friend or the claimant’s legal representative, copy the claimant’s legal representative into all written correspondence

(d) in this clause: friend means a person, including a family member, who is assisting the claimant with the claim and has authority from the claimant to give and receive information about the claim. It does not include a legal representative acting on instructions. The claimant can revoke the authority at any time by notifying the insurer or can limit the friend’s authority to a specified timeframe.

4.10 If a dispute arises between the insurer and a legally represented claimant and is before the Dispute Resolution Service (DRS), the insurer is not to communicate with the claimant directly about the dispute and must communicate only with the claimant’s legal representative.

Making a statutory benefits claim

Verifying motor accident

4.11 Before making a claim for statutory benefits, a claimant must verify the motor accident by:

(a) reporting the accident to the NSW Police Force within 28 days after the accident, unless a police officer attended the motor accident, and

(b) providing the accident event number from the NSW Police Force to the insurer if available.

4.12 If a claimant cannot provide the accident event number, the insurer must request other information from the claimant to verify the motor accident. Information requested may include:

(a) photographs taken at the scene of the accident

(b) witness statements

(c) a hospital discharge summary

(d) media reports

(e) property damage insurance claim information

(f) CCTV or dashcam footage.

4.13 If the claimant cannot provide the information requested by the insurer, they must provide a statutory declaration explaining why. It should include whether or not the NSW Police Force provided an accident event number.

4.14 A claim for statutory benefits need not be dealt with by the insurer until the:

(a) motor accident verification requirements are complied with, or

(b) DRS determines that sufficient cause existed to justify non-compliance.

Time for making a statutory benefits claim

4.15 As per Division 6.3, sections 6.12 and 6.13 of the Act, to make a claim for statutory benefits, a claimant must give notice to the relevant insurer within the following timeframes:

(a) three months after the date of the motor accident to which the claim relates, or

(b) to be entitled to receive weekly payments of statutory benefits from the day after the date of the motor accident, within 28 days after the date of the accident.

4.16 Where the at-fault vehicle is unidentified or uninsured a statutory benefits claim must be made on the Authority within 28 days after the date of accident to be entitled to receive weekly payments of statutory benefits from the day after the date of the motor accident.

4.17 Where an insurer directly receives a claim where the insurer of the at-fault vehicle is not a licensed CTP insurer in NSW, the insurer must notify the Authority of the claim as soon as possible.

Notice of a statutory benefits claim

4.18 As per Division 6.3, section 6.15(1)-(3) of the Act, a claimant can give a notice of a claim either:

(a) online using the online claims submission system operated by the NSW government, or

(b) in writing using the claim form available on the Authority’s website and sent to the insurer by email, personal delivery, facsimile or post.

4.19 The notice must be given in the following manner and must contain the following information:

(a) For notice of a claim for statutory benefits for a personal injury claim using:

(b) For notice for a claim for statutory benefits for funeral expenses using:

4.20 A claimant must provide a signed authority within the claim form authorising the insurer to release information and documents to relevant parties, and obtain information and documents relevant to the claim.

4.21 In claims for personal injury, a claimant must also provide a certificate from a treating medical practitioner such as a certificate of fitness (available on the Authority’s website).

4.22 A licensed insurer must enable a notice of claim for statutory benefits for personal injury to be received electronically in the following manner:

(a) as a single transfer of data from the NSW government’s online claims submission system directly to the insurer’s Electronic claims-handling system, or

(b) as a transfer of data to the Insurer portal, but only if the Authority grants permission to the insurer for a specified period of time.

For the purposes of this clause:

Electronic claims-handling system means an electronic system designed to enable an insurer to hold information about CTP claims made on it.

Insurer portal means the system maintained by the NSW Government which insurers can use to download attachments submitted by claimants (including the claim summary PDF form) and to enable the making of a claim.

4.23 If a claimant gives a notice of claim via the online claims submission portal, the notice must be made available electronically to the insurers when the claimant (or their representative) receives an email notification and reference number confirming a successful transmission.

4.24 If a claimant contacts the insurer by phone and provides the required details, the insurer must send a pre-filled claim form to the claimant for their review and declaration that the information is correct. Notice of the claim is not given until the completed form is returned to the insurer.

4.25 The insurer must acknowledge the date of receipt of the claimant’s claim form, the assigned claim number and the dedicated insurer contact assigned to manage the claim, in the communication method preferred by the claimant.

4.26 In accordance with Division 6.3, section 6.15(4) of the Act, if notice of a claim has been given to an incorrect insurer and the claim must be transferred to the relevant insurer, the claimant is excused from giving notice of a claim to the relevant insurer. The insurers must cooperate so that the necessary information is exchanged, and the claimant’s recovery and benefits are not adversely affected.

Sharing Agreements

4.27 If more than one vehicle is involved in the accident and the insurers agree to share the claims between or among the insurers, a managing insurer will be nominated by the insurers.

4.28 Until the managing insurer has been nominated, the insurers on whom the claims are made are to continue to manage the claims.

4.29 When the managing insurer has been agreed to and appointed, the insurers on whom the claimant has made a claim must each immediately write to the claimant and inform the claimant:

(a) that the sharing agreement has been applied

(b) the name, contact details and reference number of the managing insurer

(c) the role of the managing insurer in managing all the claims,

and provide a copy of this notice to the managing insurer.

4.30 Insurers must communicate in a clear and timely manner and give sufficient information to enable the claimant to progress the claim, including where the sharing agreement is relevant. The insurer must not require the claimant to gather evidence as to fault or as to other matters that are not needed in the circumstances. Any sharing disputes between insurers must not negatively affect the claimant’s experience.

4.31 If the claim is transferred after resolution of the dispute, the insurer must contact the claimant and advise the reasons for the transfer of the claim and the date of the official transfer. Notice of the transfer must be given to the claimant by both insurers within two days of the transfer.

Liability decisions in a statutory benefits claim

4.32 Acceptance of liability for a claim for statutory benefits is detailed in Division 6.4, section 6.19(1)-(8) of the Act.

4.33 The insurer must give written notice to the claimant to confirm if the insurer accepts or denies liability for the payment of statutory benefits, including when the decision will take effect and how it will take effect (for example, weekly payments will be paid fortnightly for a specific amount each week).

4.34 Where the insurer denies liability in whole or in part for the payment of statutory benefits, the notice must include:

(a) an explanation of why the insurer must determine liability

(b) an explanation of the consequences of the decision, including any effects on the claimant’s entitlement to statutory benefits or damages

(c) the reasons why the insurer has made the decision with reference to the information relied upon in making the decision (where the insurer denies liability on the basis of fault, the insurer must still include its assessment of contributory negligence and minor injury)

(d) where the insurer declines the payment of statutory benefits on the basis that the claimant’s injury was not caused by the motor accident, an explanation of which injury the insurer asserts is not covered and why

(e) a list of all information relevant to the decision, regardless of whether the information supports the decision. The insurer must provide copies of all listed information to the claimant, unless the information has previously been provided to the claimant

(f) an explanation of the insurer’s internal review process, including the timeframe in which an application for internal review must be made and/or right to make an application to DRS

(g) an explanation that the claimant may seek further information from the insurer or the Authority and/or a lawyer to understand the decision and rights of review.

4.35 The insurer must give notice as follows:

(a) for statutory benefits during the first 26 weeks after the accident:

  • a. within four weeks after a claimant makes a claim for statutory benefits
  • clearly identified as Liability Notice – benefits up to 26 weeks

(b) for statutory benefits after the first 26 weeks after the accident:

  • within three months after a claimant makes a claim for statutory benefits
  • clearly identified as Liability Notice – benefits after 26 weeks.

4.36 Where a claimant is legally represented, the insurer must provide the claimant’s legal representative a copy of the liability notice.

4.37 If the insurer denies liability in whole or in part for the payment of statutory benefits, the insurer must also provide to the legal representative copies of all information provided to the claimant with the notice.

4.38 Where the vehicle considered at fault was registered under the law of a place other than NSW, the NSW insurer managing payment of statutory benefits on behalf of the Nominal Defendant must provide a copy of the liability notice to the insurer of the vehicle considered at fault when the initial liability decision is made and each subsequent liability decision made under section 6.19 including Liability Notice – benefits after 26 weeks.

4.39 If the insurer denies liability and issues a notice to the claimant, the insurer must inform the service provider when responding to any treatment and care requests that treatment and care benefits may not be available after 26 weeks.

4.40 If the claimant is a participant (interim or lifetime) in the Lifetime Care & Support Scheme, the insurer must provide the Lifetime Care & Support Authority with a copy of the Liability Notice – benefits after 26 weeks at the same time the notice is given to the claimant.

4.41 If the insurer is considering ceasing, reducing or suspending payments of statutory benefits to a claimant who is a participant in the Lifetime Care & Support Scheme, the insurer must notify the Lifetime Care and Support Authority of NSW before the decision is made and briefly explain the basis of the decision.

New information relevant to a liability decision

4.42 If at any time an insurer receives new information relevant to its liability decision, the insurer must:

(a) ensure the claimant has a copy of the new information

(b) ask the claimant for any other relevant information not previously provided

(c) review the liability decision within 21 days after it has received all relevant information

(d) if the new information causes the insurer to change its liability decision, issue a new liability decision in writing

(e) if the change results in a denial of liability in whole or in part, the new decision must address the matters set out in the section ‘Liability decisions in a statutory benefits claim’ in this Part of the Guidelines.

Weekly payments decisions

4.43 After an insurer accepts liability for statutory benefits, weekly payments may be payable to a claimant. Division 3.3 and Schedule 1 of the Act provide for Guidelines to be made in relation to:

(a) the first 13 weeks – interim payment (i.e. where pre-accident weekly earnings cannot yet be determined),

(b) earning capacity decisions, and

(c) student pre-accident weekly earnings.

First 13 weeks – interim payment

4.44 The interim payment amount referred to in section 3.6(5) of the Act is calculated at 12.5% of the maximum weekly statutory benefits amount set out in section 3.9 unless the claimant nominates a lower amount.

Earning capacity decisions

4.45 Division 3.3, section 3.16(1)-(2) of the Act refers to decisions about earning capacity.

Decision-making principles

4.46 An insurer may follow its own procedures in connection with an earning capacity decision, but the procedures must align with the following principles and legal requirements:

(a) insurers comply with statutory duties

(b) claimants are given procedural fairness

(c) communication is in plain language

(d) insurers fix errors promptly.

Statutory duties

4.47 The procedures to be followed in connection with a decision about a claimant’s earning capacity must comply with the insurer’s statutory duty to act with good faith under Division 6.2 of the Act.

Procedural fairness

4.48 An insurer must give a claimant procedural fairness when it makes a decision about that person’s pre-accident earning capacity or post-accident earning capacity. In addition to the statutory duties, this includes:

(a) giving the person a fair opportunity to give information to the insurer to consider for the decision

(b) ensuring the decision-maker is not, or is not reasonably perceived to be, biased toward a particular outcome

(c) providing the person with all the information the insurer is considering in making its decision, regardless of whether that information supports the decision

(d) giving the claimant a right of response, including the right to provide new relevant information held by the claimant within a reasonable time in respect of an earning capacity decision that may adversely affect them.

4.49 If the claimant is a participant in the Lifetime Care & Support Scheme, the insurer must consult the Lifetime Care & Support Authority before any potential adverse decision.

Plain language

4.50 An insurer must give information about all decisions to a claimant in plain language. This means a claimant must be able to easily find, understand and use the information they need.

Correcting errors

4.51 An insurer must correct any errors in its decisions about a claimant’s pre-accident earning capacity or post-accident earning capacity promptly after it becomes aware of the error, including after the decision has been made. An insurer is responsible for having procedures in place to fix an error of fact or law.

4.52 If an error can be corrected, the insurer must correct the error and not require a claimant to make an application for internal review or an application to DRS.

Model procedures

4.53 Alternatively, an insurer may follow the model procedures in Figure 4.1 (below).

Student pre-accident weekly earnings

4.54 In making a decision regarding a student’s pre-accident weekly earnings, the matters to be considered in determining the weekly earnings that the person would have received upon being employed on the completion of the course of studies in which the person was a full-time student include:

(a) the course of study being undertaken

(b) pre-accident academic results

(c) published wage data for new graduates relevant to the course undertaken

(d) previous work experience

(e) Australian Bureau of Statistics (ABS) data for age and industry

(f) the individual circumstances of the claimant

(g) any other relevant circumstances.

Post-accident earning capacity (after 78 weeks)

4.55 When determining employment reasonably available to a claimant at any time after the second entitlement period (from week 79 after the motor accident), the matters to be considered include:

(a) the nature and extent of the claimant’s injuries

(b) the claimant’s age, education, skills and work experience

(c) rehabilitation services that are being or have been provided

(d) the nature of the claimant’s pre-injury employment

(e) the claimant’s place of residence at the time of the motor accident

(f) the details given in the claimant’s certificate of fitness

(g) the length of time the claimant has been seeking employment

(h) any other relevant circumstances.

Non-compliance with providing evidence of fitness for work

4.56 Before an insurer can suspend weekly payments for failure of the claimant to comply with requirements for evidence as to fitness for work, the insurer must:

(a) contact the claimant (via the claimant’s preferred method of communication) to ensure that the claimant is aware of their duty to provide this evidence

(b) clearly state to the claimant the consequences of not providing the evidence

(c) provide the claimant with a reasonable time within which to comply

(d) if the claimant is a participant in the Lifetime Care & Support Scheme, the insurer must contact the Lifetime Care & Support Authority of NSW before any potential adverse decision is made

(e) provide the claimant with contact details of the Authority.

4.57 If the claimant continues to fail to comply without a reasonable excuse, a suspension notice giving the claimant seven calendar days to comply must be sent in writing.

4.58 The suspension notice must clearly state the insurer’s reasons for suspending weekly payments, actions the claimant must take to avoid suspension of their weekly payments and the claimant’s rights of review. A copy of this notice must be provided to the claimant’s legal representative where the claimant is legally represented.

Notice before benefits discontinued or reduced

4.59 If a decision is made to discontinue or reduce weekly payments, the insurer must give the required period of notice before that decision takes effect, in accordance with Division 3.3, section 3.19 of the Act.

4.60 Notice may be given verbally but must also be given in writing and delivered by electronic or postal means, using the claimant’s preferred method of delivery. The notice must include:

(a) information about the claimant’s rights of review of the insurer’s decision

(b) contact details of the Authority.

4.61 A copy of this notice must be provided to the claimant’s legal representative where the claimant is legally represented.

Claimant’s responsibilities for ongoing weekly payments

Evidence of fitness for work

4.62 A claimant must provide to the insurer a certificate of fitness for work to be eligible for weekly payments. The required form of a certificate given under section 3.15(3) of the Act is a certificate of fitness (including the declaration of employment) and is available on the Authority’s website.

4.63 The first certificate of fitness for work must be given by the claimant’s treating medical practitioner. The second and any subsequent certificates of fitness for work must also be given by the claimant’s treating medical practitioner unless it is a certificate given in the defined period as outlined in the clause below.

4.64 The following requirements apply during the health emergency caused by the COVID-19 pandemic in the period starting on the commencement of these Guidelines and ending on the day that is 12 months after the commencement (the defined period). The second and any subsequent certificates of fitness for work given during the defined period, may be given by:

(a) the claimant’s treating medical practitioner, or

(b) if a health professional with general registration under the Health Practitioner Regulation National Law (NSW) No 86a as a physiotherapist or psychologist is providing medical or related treatment for all of claimant’s injuries as a result of the motor accident – the physiotherapist or psychologist.

4.65 Where a medical practitioner or a physiotherapist or psychologist referred to in the clause above gives a certificate of fitness for work covering a period that overlaps wholly or in part with a period covered by an earlier certificate, the later certificate prevails.

4.66 The insurer that receives a certificate of fitness for work given by a physiotherapist or psychologist must, as soon as possible after receiving the certificate, give a copy of the certificate to the injured person’s treating medical practitioner who provided the first certificate.

Change in circumstances

4.67 A claimant must notify an insurer of a change in circumstances, in accordance with Division 3.3, section 3.18(1)-(2) of the Act. Initial notice may be given verbally; however, notice must also be given in writing, which may include documentary evidence, such as payslips or certificates of fitness for work depending on the change notified. If requested, other documentary evidence or written notice must be provided to the insurer as soon as possible by the claimant.

Residing outside of Australia

4.68 Division 3.3, section 3.21(1)-(2) of the Act outlines details for weekly statutory benefits to claimants residing outside Australia. The claimant must submit a certificate of fitness form (including declaration of employment)  (available on the Authority’s website) from a treating medical practitioner every three months to establish their identity and continued loss of earnings.

Minimising loss

4.69 The claimant must do all such things as may be reasonable and necessary for their rehabilitation.

4.70 If the claimant must take all reasonable steps to minimise loss caused by the injury resulting from the motor accident as per Division 6.2, section 6.5(1)-(3) of the Act, the insurer is authorised to suspend weekly payments in writing, but only if the insurer contacts the claimant to ensure that the claimant:

(a) is aware of their duty to minimise loss

(b) understands what is expected of them to comply with the duty

(c) understands the consequences of failing to comply

(d) has had a reasonable opportunity to comply

(e) has the Authority’s contact details.

4.71 If the insurer considers that the claimant has had a reasonable opportunity to comply with the duty but has failed to do so, a suspension notice giving the claimant 14 days to comply must be given.

4.72 The duties of the claimant must be defined in the notice. The insurer may provide notice by phone or in person; however, the notice must be confirmed in writing to the claimant.

4.73 Insurers must contact the Lifetime Care & Support Authority before making adverse decisions regarding compliance for those claimants engaged in the Lifetime Care & Support Scheme or with severe injuries.

Treatment, rehabilitation, care and vocational support

Treatment before a claim is made

4.74 The insurer may approve access to treatment before a claim is made but after notification of injury has been given. This may also apply where a notice of claim has not included all required information and documents and the insurer is waiting for further information from the claimant.

4.75 Any treatment approved before a claim is made is approved at the insurer’s discretion and will only be approved within the first 28 days from the date of the motor accident. However, if further treatment is required after 28 days, a claim for statutory benefits must be made by the injured person. The insurers’ and claimants’ obligations about treatment, rehabilitation and vocational training are detailed in Division 3.3, section 3.17 and Division 6.2, section 6.5(1)-(3) of the Act.

Recovery plans

Recovery approach

4.76 People respond differently after a motor accident injury. The insurer must manage claims in a manner that is tailored to the claimant, providing support based on best practice and tailored to their individual circumstances and needs.

4.77 The insurer should apply the principles of the nationally endorsed Clinical Framework for the Delivery of Health Services, which sets out five guiding principles for consideration by health professionals and insurers when reviewing treatment plans and requests for services:

(a) measure and demonstrate the effectiveness of the treatment

(b) adopt a biopsychosocial approach – consider the whole person and their individual circumstances

(c) empower the injured person to manage their recovery

(d) implement goals focused on optimising function, participation and where applicable, return to work

(e) base treatment on the best available research evidence.

4.78 Consideration for service requests should also include Guidelines developed by the Authority, for example:

(a) the Whiplash Guidelines for the management of acute whiplash-associated disorders for health professionals

(b) the Neuropsychological Assessment of Children & Adults with Traumatic Brain Injury Guidelines.

Screen and assess risk of poor recovery

4.79 A claimant must be screened initially for risk of poor recovery within three business days of lodgement of their claim. This must include direct contact with the claimant where available and consideration of recent information by the treating doctor. The outcome of this screening must be recorded on the claimant’s file.

4.80 Where a claimant is identified to be at or above a medium risk of poor recovery, the insurer must take action to support the claimant through the appropriate internal claims management stream. The insurer should conduct a comprehensive assessment to determine the relevant course of treatment. The outcome of this assessment must be integrated into the claimant’s recovery plan.

4.81 The insurer should regularly engage with the claimant and stakeholders involved to review progress and continue to assess risk of poor recovery. The outcome must be recorded on the claimant’s file and integrated into the recovery plan.

Recovery plan

4.82 All claimants must have a tailored recovery plan with the following exceptions:

(a) where the claimant is performing their pre-injury duties

(b) where the claimant is performing their usual activities

(c) where the claimant is part of the Lifetime Care & Support Scheme

(d) where the claim is denied

(e) where a claimant has returned to their pre-injury duties and activities within 28 days of the claim being made.

4.83 The recovery plan may simply monitor treatment progress. It does not necessarily incorporate return to work support or vocational retraining where full return to work has been achieved. The recovery plan must be established, in consultation with the:

(a) claimant who has an obligation under the Act to minimise loss and participate in reasonable and necessary treatment and care and rehabilitation

(b) recent status of the claimant from the claimant’s treating doctor

(c) claimant’s employer, where the claimant has authorised contact with the employer and the employer elects to be part of recovery, and to the maximum extent that their cooperation and participation allows

(d) any treating clinicians or therapists as appropriate.

4.84 An insurer must, as far as possible, ensure that any vocational support provided or arranged under an individual’s recovery plan is reasonable and necessary to support the claimant’s return to work.

4.85 An insurer must fulfil their obligations under any recovery plan they have established for a claimant.

4.86 The recovery plan must be:

(a) completed within 28 days of the claim being made or within 28 days of the claimant’s initial discharge from hospital in circumstances where the claimant has been admitted to hospital within two days of the date of the motor accident and remained in hospital for a period of not less than three continuous weeks, whichever is the later

(b) reviewed no less than at 12 weekly intervals or as pertinent changes occur.

4.87 Where a claimant fails to comply with a recovery plan that has been developed and provided to them, the insurer must provide notice to the claimant that weekly payments may be suspended during the period of non‑compliance in terms of Division 3.3, section 3.17(2) of the Act. See Division 3.3, section 3.19 of the Act for required notice periods when discontinuing weekly payments.

Development of a recovery plan

4.88 When developing a personalised recovery plan for a claimant, an insurer must consider:

(a) the nature of the injury and the likely process of recovery

(b) treatment and rehabilitation needs, including the likelihood that treatment or rehabilitation will enhance earning capacity and any temporary incapacity that may result from treatment

(c) any employment engaged in by the claimant after the accident

(d) any certificate of fitness provided by the claimant

(e) the claimant’s training, skills and experience

(f) the age of the claimant

(g) accessibility of services within the claimant’s residential area.

Minimum requirements in recovery plans

4.89 Within the recovery plan that is sent to both the claimant and their nominated treating doctor, the following details must be included at a minimum:

(a) name of claimant

(b) claim number

(c) date of injury

(d) current treatment being undertaken

(e) future treatment expected to be undertaken

(f) current fitness for work and/or usual activities

(g) expected fitness for work and/or usual activities with milestones

(h) obligations of the claimant

(i) consequences for the claimant if they do not adhere to the recovery plan

(j) contact details of the insurer representative

(k) what action the claimant can take if they disagree with the recovery plan.

4.90 The recovery plan may be provided to all stakeholders including treating practitioners as deemed appropriate.

Obligations of the claimant

4.91 The claimant must agree to participate in the recovery plan and must, when requested to do so by the insurer, nominate a treating medical practitioner who is prepared to participate in the development of and in the arrangements under, the recovery plan.

4.92 The insurer must advise the claimant that they may change their nominated treating practitioner if required due to, for example, the claimant moving house or their doctor leaving the area. The claimant needs to advise the insurer of any change and the reasons for the change.

4.93 A medical practice may be nominated as a treating medical practitioner for the purposes of a recovery plan. Such a nomination operates as a nomination of the medical practitioners of the practice who may treat the claimant from time to time. A reference in this section to the nominated treating doctor is a reference to the medical practitioners of the practice.

4.94 The claimant must authorise their nominated treating medical practitioners to provide relevant information to the insurer for the purposes of a recovery plan.

Treatment and care decisions

Limits on treatment and care expenses

4.95 In terms of section 3.31(4) of the Act, the limit is the applicable Australian Medical Association (AMA) rates at the time the treatment/service is provided.

Facilitating referrals

4.96 An insurer who has identified a claimant requiring treatment, rehabilitation and attendant care services must facilitate referral to an appropriate treatment provider (including vocational provider, if appropriate) within 10 days, with the claimant’s agreement.

4.97 The insurer must refer the claimant to an appropriate service provider reasonably accessible to the claimant.

4.98 If the claimant expresses a preference for a particular provider, the insurer must refer the claimant to that provider subject to the insurer being satisfied as to the suitability of that provider. If the insurer determines that the claimant’s preferred service provider is not suitable, the insurer must notify the claimant of the reasons for its decision and refer the claimant to an appropriate service provider reasonably accessible to the claimant.

Determining requests

4.99 Where the insurer determines the claimant’s request for treatment, rehabilitation, vocational support and attendant care services, it must advise the claimant and service provider in writing as soon as possible but within 10 days of receipt of a request, and

(a) if approved:

  • state the costs the insurer has agreed to meet
  • pay the account as soon as possible but within 20 days of receipt of an invoice or expense
  • advise the claimant of the insurer’s obligation to pay all reasonable and necessary costs and expenses – including travel expenses to attend approved treatment, rehabilitation services or assessments, including all services or assessments conducted by DRS’ medical assessors – as soon as possible (no later than 20 days after receiving the account or request for reimbursement).

(b) if declined, provide:

  • the reasons for the decision with reference to the information relied upon in making the decision.
  • a list of all information relevant to the decision, regardless of whether the information supports the decision. The insurer must provide copies of all listed information to the claimant, unless the information has previously been provided to the claimant
  • an explanation of the insurer’s internal review process, including the timeframe in which an application for internal review must be made and/or right to make an application to the DRS.

4.100 If requested by the claimant or the claimant’s nominated treating doctor subject to the claimant’s authority, the insurer must copy the nominated treating doctor into all written correspondence concerning the claimant’s treatment and care. The claimant can revoke the authority at any time by notifying the insurer.

Treatment and care after 26 weeks for claimants with only minor injuries

4.101 ‘Part 5 of the Motor Accident Guidelines: Minor injury (Soft tissue & minor psychological and psychiatric injuries)’ outlines the specific treatment and care which may be authorised by an insurer after 26 weeks for claimants with only minor injuries.

Verification of expenses

4.102 Where an invoice is issued to the insurer directly from a treatment or care provider, the following should be included on the invoice:

(a) the claimant’s first and last name

(b) the claim number allocated by the insurer

(c) payee details

(d) the Medicare provider number, if relevant

(e) the Australian Business Number (ABN) of the provider

(f) the name of the medical practitioner or service provider

(g) the date of the service (the date of invoice must be on the day of or after last date of service listed on the invoice)

(h) the payment classification code from the Authority or AMA item number, where applicable

(i) the service cost for each payment classification code from the Authority or AMA item number, where applicable

(j) the service duration, where applicable.

4.103 These provisions do not apply to reimbursement for treatment and/or expenses to the claimant. These expenses should be reimbursed to the claimant by the insurer on provision of a receipt confirming the expenses incurred, where the insurer has provided pre-approval and/or the expenses are reasonable and necessary in the circumstances. Insurers should request details of regular service providers to establish direct billing and reimbursement between the insurer and provider to reduce the financial burden on the claimant.

Lifetime Care and Support Authority’s responsibility for the payment of statutory benefits for treatment and care

4.104 This clause relates to claimants for whom the Lifetime Care and Support Authority will assume responsibility for the payment of statutory benefits for treatment and care by agreement or more than 5 years after the motor accident. In such cases, the insurer and the Lifetime Care and Support Authority must:

(a) act in good faith

(b) regularly share complete, accurate and up to date information about the claim relevant to the payment of statutory benefits for treatment and care

(c) respond to requests for information about the claimant or claim as relevant to the payment of treatment and care expenses.

4.105 At least two weeks before the likely date of transfer, the insurer must notify the claimant in writing of the following:

(a) the transfer process and the likely effect on the management of the person’s claim

(b) the ongoing responsibilities of the insurer including the payment of weekly statutory benefits and/or claims management of any damages claim

(c) that the Lifetime Care and Support Authority will notify the claimant in writing to confirm the transfer has taken place and the contact details for the Lifetime Care and Support Authority contact officer.

4.106 The insurer must provide the Lifetime Care and Support Authority with a copy of the notice.

Making a damages claim

Time for making a damages claim

4.107 Division 6.3, section 6.14 of the Act provides for the timeframes in which to make a claim for damages.

Request to concede degree of permanent impairment

4.108 When the insurer receives a request by the claimant to concede that the injured person’s degree of permanent impairment as a result of the injury caused by the motor accident is greater than 10%, the insurer must accept or decline the request and notify the claimant of this decision within 90 days of receipt.

4.109 The insurer must acknowledge the request within 14 days of receipt. The acknowledgement must include:

(a) any request for relevant information from the claimant required to make an assessment of the injured person’s degree of permanent impairment

(b) the due date for providing a decision, and the claimant’s right to request an internal review if the decision is not provided by this due date.

4.110 The notification of the insurer’s decision must include:

(a) the insurer’s reasons for its decision

(b) the claimant’s right to request an internal review of the decision.

4.111 If the insurer fails to either accept or decline the request and notify the claimant within 90 days, the insurer’s decision is taken as declining to concede that the injured person’s degree of permanent impairment is greater than 10%, and the claimant may request an internal review of that decision.

Late damages claims – specific requirements

4.112 If the insurer does not accept that the claimant’s explanation for the delay in lodging a claim is full and satisfactory, the insurer must explain the reasons for its decision, including informing the claimant of the matters or grounds upon which is does not consider the explanation to be full or satisfactory or both.

4.113 The insurer must not delay its investigation of the claim including each of the elements of liability on the basis that the claim is lodged late.

4.114 When exercising discretion relating to late claims (received by the insurer more than three years from the date of the accident or Nominal Defendant claims received by the Authority more than three years from the date of the accident), the insurer must act reasonably and in accordance with its duties to resolve claims justly and expeditiously. The insurer should not delay the progress of claims by relying on technical defences or minor procedural defects or irregularities.

Notice of a damages claim

4.115 A notice of a damages claim is made when an insurer receives a signed application for damages under common law form (available on the Authority’s website) and all information required within the application for personal injury benefits form (available on the Authority’s website).

4.116 The notice of claim must contain the following information:

(a) for a damages claim – the CTP Green Slip claim form – Application for damages under common law, containing the information relevant to the claim as set out in Table 4.4 of Schedule 4.1 (below)

(b) for notice for a compensation to relatives claim – the CTP Green Slip claim form - Application to compensate relatives containing the information relevant to the claim as set out in Table 4.5 of Schedule 4.1 (below).

4.117 A claimant must provide a signed authority with the notice of claim authorising the insurer to release information and documents to relevant parties and obtain information and documents relevant to the claim.

Liability decisions in a damages claim

4.118 When the insurer makes a determination of liability, it must notify the claimant of its decision in writing. The notice must be clearly identified as a Liability Notice – Claim for damages, and must explain the insurer’s decision to admit or deny liability, including:

(a) whether its insured driver or owner owed the claimant a duty of care and whether they breached that duty

(b) whether the claimant suffered loss, injury or damage as a result of the insured’s breach of duty

(c) a reference to the nature and the source of the evidence that supports the allegation

(d) if liability is admitted for only part of the claim, sufficient detail to ascertain the extent to which liability is admitted with reference to the nature and the source of the evidence that supports the allegation

(e) if the insurer alleges contributory negligence, the degree of contributory negligence it says can be attributed to the injured person and the reasons for that allegation, with reference to the nature and the source of the evidence that supports the allegation

(f) an explanation of the consequences of the decision, including any effects on the claimant’s entitlements

(g) explanation of the review process, including the timeframe in which an application for review must be made

(h) explanation that the claimant may seek further information from the insurer or the Authority and/or a lawyer to understand the decision and rights of review.

4.119 The notice Liability Notice – Claim for damages must also contain copies of all the information relevant to the decision, regardless of whether the information supports the decision.

Claimant failure to provide relevant particulars – damages claim

4.120 Under Division 6.4, section 6.26 of the Act, if a claimant has failed without reasonable excuse to provide the insurer with all relevant particulars of their claim within two years and six months, insurers may send a direction to provide particulars (available on the Authority’s website).

Non-economic loss – specific requirements

4.121 The insurer must make decisions relating to non-economic loss based on all the available information and documents, consistent with the facts and in accordance with the law. For example, the insurer should concede an entitlement to non-economic loss when it is in possession of health service provider examination reports that indicate that a claimant’s WPI is greater than 10%.

4.122 The insurer must in every case, regardless of whether the claimant makes a damages claim for non-economic loss:

(a) clearly indicate that it has determined whether or not the claimant is entitled to non-economic loss

(b) when a claimant claims to be entitled to non-economic loss but the insurer disagrees, clearly explain the reasons and detail any medical information considered in the course of making its decision that the injured person’s WPI is not greater than 10%

(c) ensure that the explanation is sufficient to enable the claimant to make an informed decision about whether to accept the insurer’s decision

(d) where a claimant has sufficiently recovered to enable the claim to be quantified, and the insurer is unable to determine whether the claimant’s WPI is greater than 10%, refer the matter to the DRS for assessment.

Reasonable offers of settlement and finalising claims

4.123 In acting to resolve a claim justly and expeditiously, insurers should continually review and identify whether a claimant who is eligible for economic and/or non-economic loss has sufficiently recovered to enable quantification of the claim, and if so, make a reasonable offer of settlement. A reasonable offer is one that is based on the facts and evidence, and is reflective of the injuries and losses the injured person has suffered as a consequence of the motor vehicle accident.

4.124 The insurer must make a reasonable offer of settlement to the claimant, as required by Division 6.4, section 6.22 of the Act, unless it wholly denies liability for the claim. The offer of settlement must be recorded on the claim file.

4.125 The insurer’s initial and final offer of settlement must:

(a) be set out in writing to the claimant (and copied to their legal representative where the claimant is represented)

(b) list amounts (including zero) offered for economic loss and non-economic loss separately or include a method for determining an amount of damages

(c) where the insurer admits liability for only part of the claim, include details necessary to determine the extent to which liability is admitted

(d) where applicable, identify as a separate amount any allowance for the claimant’s legal costs and disbursements

(e) where applicable, identify any deductions that have been made or are likely to be made, and how they have been determined or calculated

(f) include a reference to the insurer’s duty under the Act to make an offer of settlement on a damages claim.

4.126 A damages claim cannot be settled until DRS has approved it, unless the claimant is legally represented. Where the claimant is not legally represented, the insurer must proactively approach DRS to have the settlement approved.

Confirming payment of a settlement amount

4.127 When a damages claim settles, the insurer must notify the claimant confirming the total settlement amount

(a) to whom the payment has been made

(b) the method of payment (for example, cheque or EFT)

(c) the date the payment was made

(d) if the claimant has engaged legal representation, the insurer must also provide them with a copy of the correspondence.

Nominal Defendant claims

4.128 The insurer acting on behalf of the Nominal Defendant claim, regarding a motor vehicle that is unidentified, explain to the claimant in writing of the requirement for the claimant to make due inquiry and search to ascertain the identity of the vehicle alleged to have been at fault in the accident.

4.129 The insurer will promptly advise the claimant in writing whether the claimant has, in the insurer’s view, satisfied the requirement for due inquiry and search, and:

(a) if the insurer determines that the requirement has not been met, it must provide details of the deficiency and the means by which the requirement could be satisfied by the claimant.

4.130 In statutory benefits claims made on the Nominal Defendant, the insurer must make the liability decision within the timeframes specified under section 6.19(1)-(2) of the Act. If the insurer has not yet determined due search and enquiry at the time the liability decision is due, the insurer must inform the claimant in the notices of liability that it will make:

(a) a decision on whether due inquiry and search has been established

(b) a further liability decision once it is satisfied that due inquiry and search has been established.

4.131 The insurer will promptly advise the claimant in writing whether the claimant has, in the insurer’s view, satisfied the requirement for due inquiry and search.

4.132 An insurer’s decision must be based on all available information, and should be consistent with the facts. Where the insurer alleges that the requirement has not been met, the insurer must include sufficiently detailed written reasons for its decision and details of the deficiency and manner by which the requirement could be satisfied by the claimant.

4.133 The insurer must perform as a model litigant in Nominal Defendant claims, which includes acting with complete propriety, fairly and in accordance with the highest professional standards.

Investigations

4.134 The insurer should always consider whether investigations are required in the first instance and, if so, ensure that such investigations are appropriate with respect to the issues arising in the claim.

4.135 The insurer must promptly investigate liability for a claim by requesting information and documents about the claim in a timely manner, and regularly following up any requests.

Medical investigations

4.136 Insurers should not arrange frequent examinations. The request to arrange a medical examination should be reasonable in the circumstances and, where applicable, the medical examination should be conducted by the same examiner who previously examined the claimant if they are available.

4.137 A claimant is only required to comply with an insurer’s request to arrange a medical examination if:

(a) the treating practitioner has not responded to a request for information from the insurer

(b) information provided by the treating practitioner to the insurer is inadequate

(c) the insurer’s communication with the treating practitioner cannot resolve a dispute.

4.138 The insurer must retain evidence to support its decision to request a medical examination and provide this information to the claimant or the Authority on request.

4.139 For the purpose of medical investigations, an insurer may use the Authorised Health Practitioners list on the Authority’s website to search for health practitioners who are authorised under Division 7.7, section 7.52(1)(b) of the Act to give evidence when required during the management of a claim.

4.140 If practitioners on the list are unavailable for an appointment within the required timeframes for the issues to be assessed, an independent medical examiner with availability chosen by the insurer or claimant may be proposed to the Authority for authorisation, following the guidelines prescribed in ‘Part 8 of the Motor Accident Guidelines: Authorised Health Practitioners’.

4.141 A rehabilitation service provider cannot be deemed a health practitioner with regard to Division 7.7, section 7.52 of the Act.

Surveillance investigations

4.142 The insurer must conduct surveillance of the claimant only when there is evidence to indicate that the claimant is exaggerating an aspect of the claim or providing misleading information or documents in relation to a claim, or where the insurer reasonably believes that the claim is inconsistent with information or documents in the insurer’s possession regarding the circumstances of the accident or medical evidence.

4.143 The insurer must only conduct surveillance in places regarded as public or where the claimant, while on private property, is observable by members of the public going about their ordinary daily activities.

4.144 The investigator acting on behalf of the insurer must not actively interfere with the claimant’s activities while under observation or interact with the claimant so as to have an impact on their activities.

4.145 The insurer or investigator acting on behalf of the insurer must not engage in any acts of inducement, entrapment or trespass when carrying out factual investigations and/or surveillance activities. Inducement or entrapment can include social media activities such as sending friend requests with the intention to induce, entrap or deceive.

4.146 The insurer must be sensitive to the privacy rights of children, take reasonable action to avoid unnecessary video surveillance of children and, where possible, hide images of children in reports that contain still photographs of children.

4.147 The insurer must take reasonable action to avoid unnecessary video surveillance of children when undertaking surveillance of a claimant. Persons who are under the age of 18 years are regarded as children.

4.148 Where the insurer sends surveillance material to a third party, it must inform that party about confidentiality and relevant privacy obligations.

Schedule 4.1 CTP Green Slip Claim Forms

Table 4.1: Application for personal injury benefits

Form field

Form field

Form field

Full name

Date of birth

Gender

Interpreter language

Medicare number and reference number

Driver licence number

Mobile phone number

Home phone number

Work phone number

Email address

Home address

Contact preference

Preferred contact time

Payment preference and details

Account name

BSB

Account number

Have you ever made a CTP claim for injury

Date of injury

Claim number

CTP insurer at time of injury

Please provide your police event number

Date of the accident

Approximate time of accident

Where did the accident occur

In the accident, were you the

In your own words, please describe (or draw) the motor vehicle accident you were involved in

In your own words, please outline all injuries you received as a result of the accident you have described above

Details of all vehicles involved in the accident

What is the registration number of the car you believe to be most at fault

Did you receive treatment at hospital after the accident

Name of the hospital where you were treated

Were you taken to hospital in an ambulance

Have you been discharged from hospital

Date of discharge

Were you suffering an illness or injury affecting the same or similar parts of your body at the time of the accident

Have you been away from work as a result of the accident

Length of time off work due to the accident

What was your employment status at the time of the accident

What is your usual occupation

Please outline your earnings at the time of the accident (Please circle whichever time frame applies)

Please provide your/your employer’s company name

Were you receiving Centrelink benefits at the time of the accident

Would you like us to obtain your wages information directly from your employer

Employer contact name

Email address

Mobile phone number

Contact address (unit, street number, street name, suburb, state, postcode)

I, (print name)

Claimant's declaration, authorisation and signature

Date

Table 4.2: Online application for personal injury benefits

Form field

Form field

Form field

Accident description

Accident location

Accident location description

Accident postcode

Accident role

Accident role other

Accident state

Accident street

Accident street number

Accident suburb

Date of accident

Did the accident take place in NSW

Police event number

Time of accident

At fault vehicle known

Claimant agrees to continue (late claims)

Confirm most at fault vehicle details

Correct registration entered

Description – most at fault vehicle information does not match

Enter name – final declaration

Enter name – initial declaration

Existing claim number

Final declaration

Has claim number been provided

Initial declaration

Registration of vehicle most at fault

State of registration known

Submitter is claimant

Vehicles involved are known

Date of birth

First name

Gender

Home address

Home street address

Home suburb

Home state

Home postcode

Home country

Employer phone number

Home phone

Interpreter language

Last name

Mobile phone

Preferred contact method

Preferred contact time

Preferred email address (injured person)

Work phone

Away from

Away from work due to accident

Away until

Previous illness or injury description

Currently away from work

Earning period

Employee or self‑employed

Employer company name

Employer contact address

Employer contact first name

Employer street address

Employer suburb

Employer State

Employer postcode

Employer country

Were you in this vehicle

Employer contact last name

Employer contact email

Employment status at the time of accident

Length of time off work

Occupation description

Permission to obtain wages directly from employer

Receiving Centrelink benefits

Total earnings

Type of benefits received

Injury description

Account name

Account number

BSB

Driver license number

Medicare number

Medicare reference number

Payment method

State of driver license

Month of previous CTP claim

Year of previous CTP claim

Previous claim number

Previous CTP claim

Previous CTP insurer

Previous CTP insurer
– other

Injury description

Previous illness or injury

Send correspondence to

Nominated representative required

Representative email

Representative first name

Representative language required

Representative last name

Representative phone

Representative preferred contact time

Representative role

Representative role other

Preferred submitter email address

Reason submitting

Submitter SNSW email address

Submitter first name

Submitter is a nominated representative

Submitter last name

Submitter phone

Submitter type

Submitter type other

Ambulance service received

Ambulance used

Date of discharge

Discharged from hospital

Hospital name

Treatment description

Treatment received at hospital post accident

Approximate date of previous injury

Driver's email

Driver's first name

Driver's last name

Driver's phone number

Number of passengers

Number of passengers known

Registration number

Vehicle make

Vehicle model

Vehicle state

Vehicle year

  
Table 4.3: Application for funeral expenses

Form field

Form field

Form field

Full name

Date of birth

Gender

Home address (unit, street number, street name, suburb, state, postcode)

Email address

Mobile phone number

Home phone number (if applicable)

Work phone number (if applicable)

Contact preference

Preferred contact time

If you need an interpreter, please tell us your preferred language

Full name of the deceased

Date of birth

Date of death

Address of the deceased (unit, street number, street name, suburb, state, postcode)

What is your relationship to the deceased

Please provide the police event number (e.g. E12345678)

Date of the accident

Approximate time of accident

Where did the accident occur (e.g. corner, intersection, street, number/name, suburb, state)

In the accident, the deceased was the: driver/passenger/cyclist/ pedestrian/other

Please provide a brief description of the accident.

Details of all vehicles involved in the accident

Registration

Driver’s name and contact (e.g. phone, email)

Number of passengers

What is the registration number of the car you believe to be most at fault (if known)

At-fault: Still being determined/I’m unsure

Funeral director name

Funeral director contact number

How would you like to be reimbursed

Account name

BSB

Account number

I, [Name]

Signature

Table 4.4: Application to compensate relatives

Form field

Form field

Form field

If you need an interpreter, please tell us your preferred language

Are you the executor/administrator of the person deceased Yes / No

If no, what is your relationship to the deceased

Full name

Date of birth

Gender

Mobile phone number

Home phone number (if applicable)

Work phone number (if applicable)

Email address

Home address (unit, street number, street name, suburb, state, postcode)

Contact preference - mobile, email, home phone, work phone

Preferred contact time

Are you representing or acting on behalf of the claimant identified above Yes / No

Full name

Relationship to the claimant

Mobile phone number

Home phone number (if applicable)

Work phone number (if applicable)

Contact address (unit, street number, street name, suburb, state, postcode)

Full name

Date of birth

Gender

Medicare number and reference number (if known)

Driver’s licence number (if known)

What is your relationship to the deceased

Date of the accident

Please provide the police event number (e.g. E12345678)

Who was involved in the accident (Provide as much information as you can)

Were there any expenses or financial losses suffered by the deceased resulting from the accident in the time between the accident and the date of death (e.g. intensive care fees, lost wages)

If yes, please outline these expenses or financial losses

If no, skip to next page

Registration number

Driver’s name

Driver’s contact (e.g. phone, email)

Number of passengers

Funeral director name

Funeral director contact number

If the claimant hasn’t been reimbursed for the cost of funeral expenses, please provide payment details.

Direct deposit

Cheque

Account name

BSB

Account number

Was the deceased employed at the time of the accident No / Yes

What was the deceased’s employment status at the time of the accident

Company name

Employer’s phone number

Standard weekly earnings of the deceased (include overtime, regular bonuses and commission)

Name of business

Type of business (e.g. building, accounting, optometry, childcare)

Accountant’s name

Estimated earnings lost (weekly)

Accountant’s phone number

Employer’s name

Employer’s address (unit, number, street, suburb, state, postcode)

Self-employed (go to next section)

Retired/student

Was the deceased receiving any other form of income at the time of the accident

(e.g. investments, workers compensation, social security benefits or income protection payments)

Prior to the accident, had the deceased person made any firm arrangements to stop work, start a new job, change duties, change working hours or earnings

If yes, please provide workers compensation insurer and claim number; Centrelink benefit number; disability or income protection policy insurer and policy number; details of investment bonds, stocks, property etc.

New job. If yes, please provide details of when the new arrangements were expected to start and the name of the proposed employer (if applicable).

Dependant number

Full name

Relationship to the deceased

Date of birth

Gender

Relationship to the deceased

Describe how much financial support the deceased person provided the dependant each week. For example, consider money for board and allowances, food, clothing, housing services (housekeeping and childcare) rent, mortgage payments, car payments, car expenses, education expenses, health and medication expenses, utilities and entertainment.

Type of support. $ per week; how it was provided

Is the dependant employed

Does the dependant have any other employment

Does the dependant have any other income (e.g. investments, pension, Centrelink, workers compensation, disability or income protection policy)

If yes, please provide employment details below

If yes, please attach details of all other employers to this form

If yes, please describe what other kinds of income the dependant receives, including a weekly sum

Employer’s phone number

Dependant’s weekly earnings at time of deceased’s death

Dependant’s weekly earnings at present

Employer’s name

Employer’s address (unit, number, street, suburb, state, postcode)

Interpreter language

I, [name]

Signature

Date

 
Table 4.5: Application for damages under common law

Form field

Form field

Form field

Full name

Date of birth

Gender

Mobile

Email

Home phone

Work phone

Email address

Home address (unit, street number, street name, suburb, state, postcode)

Mobile phone number

Home phone number (if applicable)

Work phone number (if applicable)

Contact preference

Preferred contact time

Medicare number and reference number

Driver licence number (if applicable)

Direct deposit

Cheque

Please provide your CTP claim number (if known)

Payment preference and details

Account name

BSB

Account number

Claimant’s signature

Interpreter language

I, (print name)

Signature

Date