APPLICATION FOR COMPENSATION 1 (Where there is a court order) Criminal Offence Victims Act S.32 Criminal Code S.663C

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1 RETURN FORMS TO: Your Legal Representatives Or Criminal Injury Compensation Unit Department of Justice & Attorney-General GPO Box 149 BRISBANE QLD 4001 APPLICATION FOR COMPENSATION 1 (Where there is a court order) Criminal Offence Victims Act S.32 Criminal Code S.663C SECTION A DETAILS OF APPLICANT (Victim or agent to complete) Name Address Sex Male Female Date of Birth: Have you made any previous claim(s)? Yes/No Date: Reference if any: Have there been any order(s) to pay criminal injury compensation made against you at any stage? Yes/No Date: Reference if any: Are you aware of any pending applications for criminal injury compensation against you? Yes/No Date: Reference if any: SECTION B DETAILS OF CRIME/OFFENCE Date of offence Location of offence (Town or city) Brief summary of the circumstances surrounding the offence/s (this section must be completed). 1 All sections are to be completed unless otherwise stated and all requested information is to be attached. Failure to do this will prevent processing of the claim. Claims are limited to the prescribed amount from time to time

2 Date of offence Please also provide a copy of your initial statement to police following the offence/s. Prepared and relevant as at: June If this form is over 12 months old, kindly contact the Criminal Injury Compensation Unit on to ensure that its contents are current. Page 2 of 9

3 SECTION C DETAILS OF INJURIES Brief description of injuries. SECTION D DETAILS OF CONVICTION Name of offender/s Date of conviction (please provide a certificate of conviction) Court where conviction made NB: No compensation is available for matters heard summarily in Magistrates or Children's Court (If heard on indictment in Children's Court you may be able to claim) Details of offences for which offender was actually convicted in Court Page 3 of 9

4 DETAILS OF ANY SPECIAL CIRCUMSTANCES Relationship of offender/applicant (including living in same household) Is there any possibility that offender may benefit from the claim (such as by living in same household). If so please explain how it will be ensured offender does not get benefit of compensation. Are there any other matters you believe should be taken into account in assessing this application? SECTION E COMPENSATION ORDER (please attach copy of Compensation Order) Page 4 of 9

5 SECTION F ACTION TAKEN TO ENFORCE AWARD Action taken to ascertain the ability of the Offender to pay the Court Order: eg Lands Dept search; Transport Dept search; oral examination (copies of both searches are required) Steps taken to enforce the Court Order [in full or in part]: e.g. letter of demand; warrant of execution; garnishee of wages; bankruptcy action; or other. ATTENTION - Applicants must demonstrate that the offender has been served with the Court Order and that payment in full or in part has been sought. A minimum requirement is proof of forwarding the Court Order and a letter of demand to the offender. Money received from Other Sources 1. Have any Moneys been received from: a) A civil claim in the Courts or otherwise for personal injuries; eg. any negligence action. NB: if such action can be brought this application will not be considered until the Personal Injuries Action is finalised. b) Any law relating to Workers' Compensation; NB: If the Offence(s) occurred at work (or on the way to or from work) this application for compensation will not be considered until Workers' Compensation has been finalised. c) An insurance claim; d) Any other source? 2. If moneys have not yet been received can moneys be recovered from any of the above sources? 3. Have all steps been taken to recover moneys from all of the above sources (give details of steps taken) NB That section 663E of the Criminal Code and section 38 of the Criminal Offence Victims Act 1995 provide that should you receive any payment from the offender, or become entitled, whether by an order of a court or by a compromise of action, to receive an amount of money in respect of the injury in relation to which this approval has been given, that amount is charged by way of a first charge in favour of the Attorney-General and Minister for Justice to the extent of the amount of the payment received by your client from the Queensland Government. Page 5 of 9

6 TO BE COMPLETED BY APPLICANT OATHS ACT 1867 (as amended) I, make this solemn declaration by virtue of the Oaths Act 1867 (as amended) that, to the best of my knowledge and belief, the information supplied on this application for Criminal Injury Compensation is true and correct in every particular. I acknowledge and make this declaration in the belief that a person making a false declaration is liable to the penalties of perjury. Signature (applicant) Taken and Declared before me at this day of 20. Witness Justice of the Peace for Queensland/Solicitor If not in Queensland at the time of completing this form please ensure that this statutory declaration is amended and completed according to the law of the place where it is sworn Page 6 of 9

7 CHECKLIST Criminal injury compensation for applicants with court orders Before posting your application please make sure you have included: A completed application form, signed and dated by the applicant and witnessed A signed client authority to act on the applicant s behalf (see the last paragraph of frequently asked questions for suggested wording). Self represented applicant s need not do this. A copy of the sealed court order A copy of the reasons for judgment (from the criminal injury compensation hearing, not the sentencing remarks) A copy of the certificate of conviction A copy of the letter of demand sent to the offender The offender s response to the letter of demand (if any) or statement advising no response A copy of the applicant s statement(s) to police (applicants can obtain this free of charge from the investigating officer) If the compensation awarded includes an amount for mental or nervous shock; a psychiatric report must be included Copies of the property and motor vehicle searches conducted in the offender s name If the searches reveal that the offender owns a vehicle or vehicles; copies of the valuations (these can be obtained free from redbook.com.au) If criminally injured in the course of employment; either a letter from WorkCover or a submission addressing this issue (see frequently asked questions for details) We will contact you if we need further information. Please don t send the following unless we ask for them: Medical report(s) Photographs of injuries Court brief Copies of documents generated during police investigations Copies of witness statements (other than the applicant s statement) The application/affidavit material for the court order Page 7 of 9

8 FREQUENTLY ASKED QUESTIONS How long will an application take to process? The Criminal Injury Compensation Unit receives as many as 100 applications a month. Although everything is done to expedite processing, it may take 4-6 months, or more, for an application to be finalised from the date all necessary material is received. Can an applicant recover their legal costs? As a matter of policy, legal costs are not included in ex gratia payments. The applicant was injured at work. What should they provide? Applicants criminally injured in the course of their employment must provide either: a letter from WorkCover (if the applicant has already applied to WorkCover) which states what amounts, if any, the applicant has received or can receive from WorkCover as a result of the injuries sustained, OR if there is obviously no prospect of a claim to WorkCover succeeding; a medical report which makes it clear that the applicant has no permanent impairment/disability from the injuries in question and details the injuries that the applicant did receive as a result of the incident AND a submission addressing in detail why an application to WorkCover has no prospect of success. What if the applicant can take civil action because of their injuries? Where an applicant is injured as a result of a criminal act and has an entitlement to pursue a civil action (for example against the owner of licensed premises), the applicant or their representative are required to provide advice on the applicant s prospects of success in that action. Either a solicitor or barrister may prepare an advice fully canvassing the relevant legal issues. As criminal injury compensation is an ex gratia payment payable from the public purse, where an applicant is involved in other proceedings relevant to the consideration of their application, processing of their application may be suspended until the other matter/s are finalised. What should the letter of demand contain? All Court Orders must be served on the offender accompanied by a letter of demand that requires the offender to list all their assets. The letter MUST NOT refer to any entitlement to apply to the State for criminal injury compensation. What if the offender owns assets? If Queensland Transport and Queensland Lands Title searches reveal that the offender may own assets, advice must be provided to show what steps have been taken to execute against these assets. What if the applicant has drug or alcohol issues? Ex gratia payments of criminal injury compensation are made from the public purse. Using public money to acquire illicit drugs or to support alcohol or gambling dependency would be seen as contrary to public policy. Where there is evidence to indicate that an applicant is using or has been using an illicit drug in the seven years prior to the date of receipt of the application, the applicant will be requested to provide a pathology test result to indicate whether they are currently using illicit drugs. Where an applicant chooses not to provide a pathology test result or tests positive to illicit drugs, the Governor in Council or Attorney-General may decide that any ex gratia payment approved should be forwarded to the Public Trustee to be held in trust for the applicant. Page 8 of 9

9 What if the offender could benefit from the money awarded? Similarly where a criminal injury compensation payment may benefit the offender this would be seen as contrary to public policy. Where for example there is evidence to show that an applicant continues to reside with the offender, the Governor in Council or Attorney-General may decide that any ex gratia payment approved should be forwarded to the Public Trustee to be held in trust for the applicant. How does an applicant find out what is happening with their application? If at any stage applicants have any questions relating to their application they should contact the Department through their legal advisers. This will ensure that the issue has not already been dealt with by their solicitors and may save legal costs, as the department s practice is to contact an applicant s solicitor to discuss any issues raised directly by the applicant. What if an applicant is not happy with the outcome of their application? Under the Judicial Review Act 1991 applicants are entitled to request a Statement of Reasons within 28 days of receiving notification of the decision of the Attorney-General or Governor in Council. Applicants can also make application to the Supreme Court to seek a review of the decision ; or make a written complaint to the Ombudsman in accordance with the provisions of the Parliamentary Commissioner Act 1974 in respect of any recommendation made to the Minister. Can applicants get Legal Aid? The Government has provided Legal Aid Queensland (LAQ) with a grant to enable LAQ to assist victims of crime obtain criminal injury compensation. No means test is applied by LAQ for these purposes and legal fees are capped at $4,400. LAQ can be contacted on What if an applicant needs counselling? The Government provides funding to victims of crime groups to offer a number of counselling to victims of crime. If you are in need of support or counselling the Victims of Crime Association can be contacted on Who has access to the information provided to the Department? The information collected for an application is collected to enable the Department of Justice & Attorney- General to process the application for an ex gratia payment of criminal injury compensation. This information may be disclosed to those persons necessary to verify a claim, to any person with a lawful entitlement to obtain the information, departmental officers involved in processing the application, the Attorney-General and/or the Governor in Council. If an applicant does not supply the information required the Criminal Injury Compensation Unit will not be able to process the application. What should a Client Authority include? We recommend wording similar to the following: I [Name of Applicant] am represented by [Name of Solicitors] in relation to my criminal injury compensation application. I have discussed the particulars of my application, including the costs associated, and I hereby authorise them to act on my behalf in this matter. [Name of Solicitors] are further authorised to receive all material on my behalf with respect to my criminal injury compensation application. Page 9 of 9

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