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In a life threatening emergency dial Triple Zero (000)
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5124 0000


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Call Mental Health Triage on

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(free call except from mobiles or public phones) or

6205 1065

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For a poison emergency in Australia call

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The Drug and Alcohol Help Line is available 24-hours, 7 days a week on

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For after hours urgent public health matters including environmental health, radiation safety, food poisoning and communicable disease management phone:

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24 hour health advice

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Emergency help
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132 500

For injured people


Who can apply

Anyone injured in a motor accident in the ACT on or after 1 February 2020 can make an application for personal injury benefits. If someone dies from injuries sustained in an accident an MAI insurer can pay for funeral expenses and death benefits to support dependants. It does not matter who was at fault in the accident.

Exclusions from some defined benefits apply to people that break the law, whose injuries are self-inflicted, or who are paid benefits under a workers compensation scheme.

Your MAI insurer can assist you with information on making an application. There is also a Defined Benefit Information Service provided by CARE inc, who will provide free advice and assistance to people on accessing the defined benefits available to them under the Motor Accident Injuries scheme. The Defined Benefit Information Service by CARE can be contacted on 1300 209 642.

How to apply

You can make a personal injury application for:

  • Treatment and care benefits
  • Income replacement benefits

To apply for personal injury benefits, complete an application form and include a medical report from your doctor about your injuries. Personal injury benefits are payable on an ongoing basis.

A separate personal injury application needs to be made for each injured person, even if they were injured in the same accident.

Send your application to the MAI insurer of the vehicle most at fault in the accident. You can find the MAI insurer for a motor vehicle using the Access Canberra registration pages.

If the at fault vehicle was not registered or cannot be identified, the nominal defendant can assist with the application.

If you cannot work out which vehicle was most at fault or you were at fault you can send the application to the MAI insurer of your vehicle.

An application should be made within 13 weeks of the accident. If you make a late application, you will not receive all benefits back to the date of the accident and you will need to provide a clear explanation why you could not make the application within the 13 weeks.

Can I claim the cost of treatment I had before making my application?

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 application.  An insurer can pay you back for:

  • 2 visits to your doctor including one long consultation to complete the 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 can be paid once you complete your application, including while you wait for the insurer to accept your application. The insurer will tell you about these allowable expenses once they receive a complete application. The insurer can pay you back for other out of pocket expenses once they accept your application.

Funeral and Death Benefit applications

Benefits are payable for death and funeral expenses as a result of a motor accident. If you receive a bill for or paid funeral expenses, complete the funeral benefits application form and include a document to show the person died from injuries sustained in a motor accident.  The Coroner’s Court of the ACT can assist you if a death certificate is not available.

You can make a death benefit application if you are a personal representative, dependant or a parent/guardian of a dependant of the deceased person.  An application should cover all of the dependants of the deceased.  You should wait until a death certificate is available before making this application.

What you can receive in defined benefits

Allowable expenses while my application is decided

The MAI Insurer can reimburse you for some treatments you may need to pay for while you are waiting for your application to be assessed. These are known as allowable expenses as they can be reimbursed without prior approval.

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).

Treatment and care benefits

The MAI insurer can pay for reasonable and necessary treatment and care you need as a result of your injuries. If you make your application on time, treatment and care is payable from the date of the 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 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.

Income replacement benefits

If you miss paid work as a result of your injuries, the MAI insurer can pay income replacement. If you apply for these benefits within 13 weeks of an accident, these benefits can be back paid to the date of the 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. 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.

If you were an employee or self-employed person at the time of the accident, you need to show you worked at least 260 hours in the 52 weeks before an accident. You will also 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.

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.

Weekly income thresholds

First 13 weeks

14 weeks to 5 years

Below $800

100% + SG%

100% plus SG%

$800-$1,000

95%

95%

Above $1,000 (subject to a $2,250 cap)

95%

80%

Payments and income thresholds will be increased to reflect average wage rises, twice a year, starting from October 2020 (based on data from the Australian Bureau of Statistics).

If you have capacity to work, or return to work, your income replacement payments may be reduced or stopped. You need to give your MAI Insurer a fitness for work certificate and work declaration to cover any period you receive payments. A fitness for work certificate is obtainable from your treating medical practitioner.

Quality of life benefit

For injured people accepted into the scheme, if you have an injury or injuries of a permanent nature as a result of your motor accident, you may be entitled to a quality of life benefit. The quality of life benefit amount is based on how permanently injured you are, so that people who are more seriously injured will receive a higher payment. This is done through an assessment of your whole person impairment (WPI). 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.

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 per cent or more. The threshold to access common law compensation is 10 per cent.

You can apply to your MAI insurer for an assessment from six months after the accident for this benefit once your injuries are stable and considered permanent. The assessment will be carried out by an independent medical specialist and not your treating doctor.

Funeral benefits

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.

Death benefits

The dependants of a person that dies as a result of an accident can apply for 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.

Death 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.

After lodging your application

The MAI insurer will write to you to let you know they received your application.  The insurer may ask for further information while reviewing your application. The insurer is to decide your application within 28 days of receiving a complete application.

Quality of life application

For injured people accepted into the scheme, if you have an injury or injuries of a permanent nature as a result of your motor accident, you may be entitled to a quality of life benefit. You can apply to your MAI insurer for an assessment from six months after the accident for this benefit once your injuries are stable.

Disputes regarding an insurer's decision

When an insurer makes a decision about your application, or the defined benefits that are paid to you or on your behalf, they must write to you with their decision and the reasons for that decision. The letter will also tell you if you can ask for that decision to be reviewed.

Most, but not all, of the decisions an insurer makes about your application can be reviewed if you consider the insurer has made an incorrect decision. These include when the insurer has rejected your application for defined benefits or rejected a request for certain benefits (eg. a certain aid or appliance recommended for you).

If you want the decision to be reviewed you must write to the insurer within 28 days after the date of their decision, explaining that you want the decision reviewed and why. If you need more time to request the review, you must write to the insurer as soon as practicable explaining why the additional time is required.

Once your request for internal review has been received the insurer has 10 business days to review the decision. The insurer has more time to undertake the review in certain circumstances, such as the insurer considers there is a need to request additional information or documents. The insurer will then write to you with the outcome and the reasons for that decision. This letter will also tell you if you can request an external review of the decision by the ACT Civil and Administrative Tribunal (ACAT) if you are still unhappy with their decision. You can visit the ACAT website for information on making an application for external review.

If you wish to make an application to the ACAT, there is an application fee that you will have to pay (you may request a fee waiver in certain circumstances). Please note that the ACAT is a jurisdiction where the parties normally bear their own costs. The ACAT has a limited ability to award costs and there is no guarantee you will be able to recover any costs you incur in making your application to the ACAT even if the tribunal decides in your favour.

There is a free defined benefit information service provided by CARE Inc to assist you with information on the types of decisions that can be reviewed and with information about understanding how to make an application for an internal and/or external review.

CARE Inc can be contacted on 1300 209 642.

Common law claim

Common law compensation under the Motor Accident Injuries scheme will only be available for people who were injured by someone else’s negligence in the accident and meet at least one threshold category:

  • have a whole person impairment of at least 10 per cent, or
  • is a child still receiving treatment and care benefits four years and six months after the accident, or
  • is an adult still receiving income replacement benefits four years and six months after the accident and is assessed with a significant occupational impact.

In the case of a blameless accident, such as where the driver has a heart attack or a kangaroo hops onto the road, the driver may be said to be at-fault (or deemed at-fault), to allow for other persons injured in the accident to make a common law claim.

A common law claim can be made for:

  • reasonable and necessary treatment and domestic care (paid care only) for as long as the person is likely to need it.
  • income replacement for as long as the person is likely to need it. The first 12 months is limited to the amount available under the defined benefits. After 12 months, 100 per cent of loss of earning capacity plus superannuation can be claimed. A maximum pre-injury weekly earnings amount of $4,500 applies.
  • loss of quality of life compensation, up to a maximum of $600,000, based on the whole person impairment (WPI) scale and any impacts the Court considers were not taken into account as part of the WPI assessment (such as a particular effect on the person’s quality of life). This does not apply to children - the court will determine the amount payable for a child.
  • death benefits (funeral costs plus compensation for dependants).

A common law damages award will take into account any benefits already received under the scheme.

A common law award is paid as a lump sum.

Forms

Please complete a personal injuries application and a medical report to start your application for defined benefits.

During the receipt of the income replacement benefit, a fitness for work certificate is required to be completed by a medical practitioner. You will need to give this form to your medical practitioner for the certificate, and to provide your own work declaration.

If you have a family member who died as a result of a motor accident, you can use the following forms to apply for funeral benefits and dependent benefits.

A quality of life benefit form is available for use if you have an injury or injuries of a permanent nature as a result of your motor accident and it has been more than 6 months from the date of your motor accident.

A notice of claim form is required to give notice to an insurer that you intend to commence court proceedings for common law compensation. There are certain requirements to be met before this form may be submitted, including whether you meet certain thresholds.


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