Here’s a quick summary of entitlements, to help you determine if you’re getting what you should be:
Injury/ months since accident | Medical, treatment and care expense entitlements |
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All injuries, first six months |
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Minor injuries, beyond six months |
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Non-minor injuries, beyond six months |
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All injuries, beyond 24 months |
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Similar rules apply to income support:
Injury/ time since accident | Income support payment entitlement |
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Weeks 1-13 |
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Weeks 14-26 (i.e. up to six months) |
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Minor injuries, beyond six months |
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Non-minor injuries, beyond six months |
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All injuries, beyond 24 months |
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To assess your pre-accident income, the insurer will ask you for evidence of your earnings, like twelve months’ pay slips. Then the insurer will estimate your income by taking an average.
What you should realise is that there are a number of ways this could be unfair to you. Here are two examples:
You can request information from the insurer about how they calculated your income. Once you get their reply, if you think they’ve got it wrong you can lodge a dispute to get it corrected.
This video explains how to check your payments in more detail.
If you’ve checked your payments and you believe they’re wrong, or you’re being denied “reasonable and necessary treatment”, you should lodge a dispute with the insurer.
It’s at this point that you should engage a lawyer. For most disputes SIRA allows you to engage a lawyer at no cost to you. Please call 1800 888 529. to find out if this applies to your dispute.
The following table lists the steps you’ll need to go through in order to dispute your payments. Please note that if you’ve engaged a lawyer, they will handle the whole process on your behalf.
The first step in the dispute process is to request an “Insurer Internal Review”, or IIR. After the insurer has provided you with their IIR determination, if you’re unhappy with the outcome, you can escalate the dispute to SIRA’s Dispute Resolution Service (DRS).
Steps | Helpful information |
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Step 1 – Insurer Internal Review (IIR) |
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Step 2 – Personal Injury Commission (PIC) |
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Strict time limits apply to IIR and PIC dispute applications. However, you’re entitled to get legal assistance to help you submit your dispute so it’s best to get legal advice as quickly as possible.
Remember, SIRA generally allows you to engage with a lawyer to represent you at PIC at no cost to you. Call 1800 888 529 and speak directly to a specialist CTP lawyer to understand the options available to you. It’s a free service.
Make sure the insurer is paying for all the treatment and care expenses you’re entitled to.
Check your income support payments, to make sure you’re not being under-paid.
Call our advice line if you’re planning to lodge a dispute – it’s a free service.