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
- respite care
- ambulance transportation
- aids and appliances
- 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
100% + SG%
100% plus SG%
Above $1,000 (subject to a $2,250 cap)
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.
The person paying for the funeral can apply for funeral benefits. Funeral expenses of up to $15,000 are covered and can include:
- 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.
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.