Before you lodge your application for personal injury benefits, take a few minutes to understand what you might be entitled to and how your application will be assessed. Then you can follow our Step by Step Guide to lodging your application for an explanation of what to do next.
The first thing to understand is that the CTP scheme is managed by the State Insurance Regulatory Authority – SIRA. However, SIRA doesn’t actually look at your CTP claim – your application goes straight to the insurer. The information provided by SIRA is designed to help you understand the process and lodge your claim, but it won’t tell you how to maximise your claim. So it’s up to you to complete your application thoroughly, and make sure you don’t miss out on benefits you should be getting.
After you’ve notified the insurer of the vehicle mostly at fault in your accident, you need to lodge an “application for personal injury benefits”.
You have 28 days after the date of the accident to lodge this application in order to get back-payment for any lost wages since the date of the accident. The final deadline for lodging your claim is three months from the date of the accident.
Your application for personal injury benefits is to cover:
- Income you’ve lost through time off work
- Your treatment expenses
- Your care expenses
However this application doesn’t cover future loss of wages or pain and suffering payments. You need to apply for these separately as a lump sum claim – please read this article for more information.
The benefits you receive will be based on your medical assessment, and whether your injuries are classified as minor or non-minor. This is the most critical part of your application, and you should pay careful attention to this part of the form. If your injury is classified as minor you won’t be entitled to claim a lump sum for future loss of wages or pain and suffering, and your benefits will be cut off after a maximum of six months, even if you haven’t fully recovered.
Minor vs non-minor injuries.
A minor injury is a “soft-tissue” or muscle injury, like a muscle strain or a sore back. Non-minor injuries are more serious injuries like fractures, or injuries that affect your organs. For more information on this, please refer our article on Minor and non-minor injuries explained.
A minor psychological or psychiatric injury is a psychological or psychiatric injury that’s not a recognised psychiatric illness.
To be assessed as having a non-minor psychiatric illness, your symptoms must continue for more than one month. Here are some examples of these symptoms:
- Reduced ability to look after yourself (self-care and personal hygiene)
- Reduced social/recreational activities
- Reduced ability to travel
- Reduced ability to maintain relationships with friends and family
- Reduced ability to concentrate
- Reduced ability to work
You need to lodge your application for personal injury benefits within 28 days after the date of the accident, which is generally not long enough to know whether you’re suffering from non-minor psychological or psychiatric illness. So it’s important that you document how the accident affects you. For example: inability to fall asleep at night; flashbacks of the accident; feeling unusually irritable or angry; being easily startled or having put on or lost more than five percent of your body weight.
Your medical evidence.
If you need to see a psychologist or psychiatrist, then you should immediately request a referral from your GP and request approval for this treatment from the insurer. To prove that your psychological or psychiatric injury is non-minor you’ll need to show that you’ve had the symptoms for some time.
To make sure nothing’s missed when the doctor does assess your injuries, you should read our article on how to get a full head to toe assessment and download our head to toe self-assessment checklist.
Your income assessment.
You’ll need to prove what your income was prior to the accident so that the insurer can start paying your weekly payments to cover your lost wages.
You’ll receive up to 95% of your pre-accident earnings from weeks 1-14 after the date of the accident and 80-85% of your pre-accident earnings from weeks 15-26. You’ll only continue to receive benefits beyond 26 weeks if you weren’t the driver mostly at fault, or your injuries have been assessed as non-minor.
You may be asked to provide 12 months’ pay slips, and the insurer will take an average over the 12 months to calculate your pre-accident earnings.
Please note that this method could work against you if you’ve had a period of no income or lower than normal income, so if that’s happened you should make a note on your application, to make sure your income is assessed fairly. Refer to our article on What you need to know about checking and disputing insurer’s decisions for more information on this.
Your certificate of capacity.
After you lodge your application for personal injury benefits, you’ll need to continue to see your GP and have them complete a certificate of capacity once every 30 days, or whenever your current certificate expires. You must do this to continue to receive your benefits.
Make sure all of your injuries, including any new injuries, are documented. If you’re suffering psychologically, then you need to demonstrate that the injury has not simply come and gone.
If you have any questions about lodging your application, you can call 1800 888529 and speak to a specialist CTP solicitor. It’s a free service.