The role of GPs and other treating health practitioners
A General Practitioner (GP) has a key role in supporting a person's recovery from motor accident injuries.
A patient applying for personal injury benefits under the MAI scheme may ask you to complete a medical report to accompany their personal injury application. In completing the report, you will also be asked to agree to be the treating doctor nominated for the ongoing management and coordination of your patient's treatment and recovery from their motor accident injuries.
The medical report includes an assessment of your patient's injuries, initial treatment recommendations and details of any referrals you make to other health practitioners. If your patient was in paid work before the accident you will also need to complete the fitness for work section of the medical report. You will also have ongoing obligations with respect to fitness for work certificates.
The fitness for work certificate is a primary tool for you to communicate with your patient and an insurer about your patient's treatment and recovery. You should discuss with your patient whether information in the certificate for the insurer may also be shared with their employer. A fitness for work certificate should generally only be given for a prospective period of up to one month unless clinical reasoning supports a longer period. A current certificate will be required from a nominated treating doctor or practice to cover any period your patient is receiving income replacement under the MAI scheme. You should therefore schedule review appointments with your patient before the expiry of any certificate you provide.
In response to ongoing public health measurers, an insurer may approach a GP to discuss the appropriateness of issuing a fitness for work certificate for a period of longer than one month to reduce risks to you and your patient from a physical consultation. You may also issue a fitness for work certificate following a telehealth consultation and desk top review of your patient's medical records if you consider this appropriate.
An MAI insurer may contact you to obtain further information about your patient's injuries and treatment to support their personal injuries application. Your patient will have given consent for their personal and health information to be disclosed to the insurer when completing their personal injuries application form.
If your patient is more seriously injured, an insurer will prepare a recovery plan for their ongoing reasonable and necessary treatment and care. A draft recovery plan will be prepared for a patient unable to resume their pre-injury duties and activities within 28 days of an insurer receiving their personal injury application.
An MAI insurer will develop a recovery plan in consultation with you and your patient and also any other health service provider involved in their treatment as appropriate. You will be given an opportunity to review a draft plan and to make recommendations to the insurer about reasonable and necessary treatment and care to be included in the plan. You will also be given a copy of the final recovery plan.
More information about recovery plans is available in the Recovery Plan Factsheet and the Treatment and Care Guidelines.
As a medical specialist or allied health practitioner you will be part of your patient’s treating team.
An MAI insurer may contact you to obtain further information about your patient’s injuries and reasonable and necessary treatment to support their personal injuries application. You may also be asked for input into the development of a recovery plan for your patient. Your patient will have given consent for their personal and health information to be disclosed to the insurer when completing their personal injury application form.
If you are nominated as a provider of services in a recovery plan you will receive a copy of the final plan. The plan will also set out payment arrangements for your services.
Payment for health services
The MAI insurer will be responsible for payment for services, that are reasonable and necessary, that you perform in relation to a personal injuries application that is accepted by the insurer. There is no set schedule of fees for your services, however in approving a treatment and care expense an insurer will consider recommended rates or charges for members of a professional association (e.g. AMA rates), availability and charges of like providers in your location and your area of specialisation, skills and experience. There are no particular "billing codes" or "service codes" specified by the MAI Commission. You should contact the MAI Insurer to obtain any information on the billing process used by the insurer. The insurer may also contact you about billing arrangements, particularly where there may be ongoing treatment associated with your patient.
Early treatment expenses
An MAI insurer can reimburse an injured person for some early treatment expenses while they are waiting a liability decision on their personal injuries application. For more information, see the What types of support are available page.