There are several factors that can exclude or limit defined benefit entitlements under the Motor Accident Injuries scheme. A person will be informed by the insurer if any of these exclusions apply.
Serious offenses and driving offenses will limit or exclude an injured person’s entitlements.
For more information as to what constitutes a serious offence, see section 48 part 7 of the Motor Accident Injuries Act 2019. For more information as to what constitutes a driving offence please see section 41 of the Motor Accident Injuries Act 2019.
Workers Compensation insurance claims
Injured people covered under a workers’ compensation scheme have the choice of receiving defined benefits or making a common law claim, if eligible, under either their workers compensation scheme or the new Motor Accident Injuries scheme.
If a person is over the pension age and still employed, income replacement will be provided for two years from the date of the accident. This is intended to provide a period for the injured person to transition to other available income streams of either superannuation or the pension.
Foreign nationals will receive ongoing statutory treatment and care and income replacement payments during their stay in Australia. A foreign national can commute the defined benefits for treatment, care and income replacement as a lump sum once they return home overseas if the amount is AUD $10,000 or greater.
Damages already paid
An injured person is not entitled to benefits if damages related to the loss have already been paid.
Uninsured motor vehicles
A person injured while driving an uninsured vehicle will generally be excluded from income replacement and quality of life defined benefits, except in some circumstances such as a blameless accident.
An injured person is not entitled to benefits (except for treatment and care, and funeral benefits) if the injuries were intentionally self-inflicted.
Detainees and young detainees
If the injured person was a detainee or a young detainee at the time of the accident, they are not entitled to income replacement or treatment and care benefits for the period they are a detainee. They are entitled to a quality of life benefit, if they meet the criteria.
Lifetime Care and Support (LTCS) Scheme
If the Injured person is a participant in the LTCS scheme, they are not entitled to treatment and care benefits.