What types of support are available

Following a motor vehicle accident, you may be treated by Canberra Health Services. Canberra Health Services will anticipate that you as the injured person may make a Personal Injuries Application for defined benefits to an MAI insurer. The Canberra Health Services Patient Accounts Office will make contact with you as soon as practicable, generally within the next day or so, to verify whether an application will be made.

If you make a Personal Injuries Application to an MAI insurer, and it is accepted by the insurer, please inform Canberra Health Services of your MAI insurer and application number. They will send invoices directly to the accepting MAI insurer, otherwise invoices will be directed to you.

If your Personal Injuries Application is not accepted, you need to let Canberra Health Services know as soon as possible so your invoices can be adjusted accordingly.

Additionally, all patients who are injured in a motor vehicle accident on an ACT road or road related area are entitled to free ambulance services (as part of the road rescue fee paid with your registration).

Pre-application treatment expenses.

The MAI insurer can reimburse (pay you back) for some treatment expenses you may have already paid for in relation to injuries sustained as a result of the motor accident.  You can attach receipts for these expenses to your Personal Injuries Application. An insurer can pay you back for:

• 2 visits to your doctor including one long consultation to complete the MAI Medical Report; and
• 2 allied health treatment sessions, on referral from your doctor, such as physiotherapy or psychology (capped at $150, each).

More expenses for early treatment (known as allowable expenses) can be paid once the MAI insurer receives your complete your Personal Injuries Application and you wait for it to be assessed. The MAI insurer can pay you back for other out of pocket expenses once they accept your Personal Injuries Application.

Treatment expenses while you wait for liability to be decided (allowable expenses)

In addition to pre-application treatment expenses, the MAI insurer can reimburse you for some treatments you may need to pay for while you are waiting for your Personal Injuries Application to be assessed. These are known as allowable expenses as they can be reimbursed without prior approval from the MAI insurer.

The insurer can pay you back for up to:

• 4 consultations with your doctor (GP), up to a level C consultation; and
• 8 allied health treatment sessions, following referral from your doctor, with up to 4 sessions for any one service (such as physiotherapy or psychology).

The most the insurer can pay for an allied health treatment session before they accept your application is $150. Only consultations and allied health treatments received by you up to the day the insurer makes its decision on your application can be reimbursed as an allowable expense (up to the specified number).

The MAI insurer can pay for reasonable and necessary treatment and care you need as a result of your injuries. If you make your Personal Injuries Application on time, treatment and care is payable from the date of the motor accident. Treatment and care can be paid for up to 5 years after the motor vehicle accident. The insurer may pay the treatment provider directly or reimburse you for your treatment and care costs.

Treatment and care benefits can cover:

• medical treatment (including mental health treatment and pharmaceuticals)
• dental treatment
• rehabilitation
• respite care
• ambulance transportation
• aids and appliances
• prostheses
• education and vocational training
• home and transport modification
• workplace and educational facility modifications
• care services, like nursing, home maintenance and personal assistance.

Reasonable and necessary travel expenses can be paid to attend treatment. Travel expenses can also be paid for a carer if it is essential for the carer to accompany you to a medical appointment.

The scheme can also pay for domestic care expenses for care provided to the injured person, or for care the injured person usually provides to another family member but cannot provide due to their injuries, such as a child or elderly parent. If domestic care is provided for free, for example, by a family member or friend the MAI Scheme cannot pay for the care. All domestic care expenses must be reasonable and necessary.

More detail about what is considered reasonable and necessary treatment and care can be found in the Treatment and Care Guidelines.

If you are unable to resume your pre-accident activities or work duties within 28 days of receiving your complete application, the MAI insurer will consult with you and your doctor on the development a recovery plan. The recovery plan provides certainty about the delivery and payment of your medical treatment, rehabilitation, and training services for your motor accident injuries and is reviewed at least every 13 weeks. The insurer will tailor each version to your circumstances and your specific treatment and care needs. More information about recovery plans is available in the Recovery Plan Factsheet and the Treatment and Care Guidelines.

The Quality of Life benefit is a payment on a no-fault basis if you have an injury or injuries of a permanent nature as a result of your motor accident. The Quality of Life benefit amount is based on the percentage of whole person impairment (WPI) for your injuries assessed by an independent medical specialist using a standard set of guidelines. You can find these guidelines on the Legislation Register website.

An application for a Quality of Life benefit enables the insurer to arrange for you to have a WPI assessment. You can receive a benefit payment if you are assessed as having a WPI of 5% or more.

The Quality of Life Tables 141 KB set out the amounts you may be paid for each percentage of WPI. These amounts are adjusted to reflect average wage rises on 1 October each year.

You can apply to your MAI insurer for a WPI assessment from six months after your accident, and once your injuries are stable and are considered permanent. Further information about making an application for this benefit can be found in the Quality of life benefit information 163.1 KB

If the insurer considers your injuries are stable and of a permanent nature, they will refer you to the authorised Independent Medical Examiner (IME) provider, MLCOA.

If you were not at fault in the accident and have a WPI assessment of 10% or more from either your physical or primary psychological injuries you may choose to make a Common Law Claim for damages, which includes a higher Quality of Life amount for your permanent injuries.

What is a Whole Person Impairment (WPI)?

Whole person impairment (WPI) is an internationally-recognised way of determining how permanently impaired a person is from an injury. It expresses the degree of a person’s permanent impairment resulting from the injury sustained in motor accident as a whole number percentage. A WPI is established through an assessment done by an independent medical examiner.

If you miss paid work as a result of your injuries, the MAI insurer can pay income replacement. If you make your Personal Injuries Application on time, these benefits can be back paid to the date of the motor accident. You can also receive income replacement if you are unable to start work after the accident, for example if you were on unpaid leave at the time of the accident or you would have finished your studies after the accident.

Income replacement payments can be paid for up to five years after the accident, with changes based on your return to work. Payments will generally be on a fortnightly basis to your bank account.

You can refer to the Income Replacement Guidelines about when you can be paid income replacement and what evidence, such as payslips or PAYG summaries, you will need to give to an MAI insurer about your work and pay arrangements.

You will need to give the insurer enough information so they can work out your weekly pay, or your net business income, over the 52 weeks before the accident. For a casual worker, you will need to have been in paid work at least 260 hours in the 52 weeks before an accident to obtain income replacement.

Income replacement payments are worked out as a percentage of your weekly income. If you are a low-income earner you can receive full income replacement and also an extra amount to cover the superannuation guarantee (SG) amount you miss out on.

Income thresholds in the table are as at 1 February 2020. Refer to Indexation guide PDF 356 KB for up to date income thresholds.

Payments and income thresholds are adjusted to reflect average wage rises twice a year, starting from 1 October 2020 (based on data from the Australian Bureau of Statistics). You can find adjustment factors and threshold amounts that apply from 1 October 2020 in the Indexation guide PDF 356 KB.

You need to give your MAI Insurer an MAI Fitness For Work Certificate 277 KB to cover any period you receive payments. Your treating medical practitioner needs to complete the fitness for work certificate , and you need to sign the work declaration (at the bottom of the certificate). A doctor’s usual medical certificate is not sufficient as additional information is required. If you have capacity to work, or return to work, your income replacement payments may be reduced or stopped.

The person paying for the funeral can apply for funeral benefits. Funeral expenses of up to $15,000* are covered and can include:

• transport;
• certificates and permits;
• funeral director fees;
• the cremation or burial; and
• the funeral or memorial ceremony.

The Scheme will not pay the costs of a wake or memorial service.

The maximum amount above is as at 1 February 2020. The maximum amount of funeral benefits will be adjusted to reflect average wage rises on 1 October each year. You can find the amount that applies from 1 October each year in the Indexation guide PDF 356 KB.

The dependants of a person that dies as a result of an accident can apply for dependant benefits (also known as death benefits).

A dependant can include the following members of the person’s family when they died:

• a domestic partner
• a child of the person; or
• a former domestic partner.

A child must be at least one of the following:

• under 18 years old,
• a fulltime student under 25 years old; or
• a person with a disability receiving financial support from the person.

A child can include a grandchild or step-child living with the person’s family or an unborn child. A former domestic partner must show they were receiving financial support from the person who died.

Dependant benefits are not payable in certain circumstances, for example, the person was engaging in a serious offence at the time of the accident.

The benefit paid for a domestic partner or former domestic partner is $190,000* and then $40,000* can be paid for each child up to 4 children. The ACT Civil and Administrative Tribunal will determine the amount each person receives. For example, if the person who died had both a domestic partner and a former domestic partner, the Tribunal will determine how much of the $190,000* benefit each person receives. The maximum amount of death benefits that can be paid for all dependents is $350,000*.

Benefit amounts above are as at 1 February 2020. Amounts of dependant benefits will be adjusted to reflect average wage rises on 1 October each year. You can find dependant benefit amounts that apply from 1 October each year in the Indexation guide PDF 356 KB.