A guide for people injured in a motor vehicle crash.

Transcription

1 A guide for people injured in a motor vehicle crash. This guide has been designed to help people who have been injured in a motor vehicle crash and who may be able to make a claim for personal injury compensation.

2 Contents page Introduction 3 CTP insurance in South Australia 4 Making a claim 5 Compensation 8 The claims management process 9 Legal costs 12 Complaints, compliments and feedback 13 Other languages 14 Contact details 17

3 Introduction. Being involved in a motor vehicle crash can be a traumatic experience. That is why Allianz wants to make claiming compensation as simple as possible. This brochure aims to explain, simply and clearly how the claims process works. It contains information on who can claim, how to make a claim, the claim finalisation process and things in between. This is a basic guide to help you understand claiming for compensation and is not a legal document. If you have been injured in a motor vehicle crash and need help or advice on making a claim, please call our office on (cost of a local call from anywhere in Australia) and we will be happy to help. 3

4 CTP insurance in South Australia. The Motor Accident Commission (MAC) is South Australia s Compulsory Third Party (CTP) insurer and provides compensation to victims of motor vehicle crashes. MAC is a statutory authority established under the Motor Accident Commission Act In South Australia, Allianz is responsible for the processing of claims and the handling of enquiries. Allianz Australia Insurance Limited (Allianz) is the Claims Manager for MAC. 4

5 Making a claim. Eligibility You may be able to make a claim for compensation against the South Australian CTP scheme if: the vehicle at fault was registered in SA; you were injured in a motor vehicle crash; or a family member or domestic partner was fatally injured. To make a claim, you must be able to establish that the driver, owner or passenger of a motor vehicle (other than you) was at fault, whether completely or in part. Being injured or involved in a motor vehicle crash doesn t mean you can automatically claim compensation. You may not be able to claim if, for example: you were totally at fault; the person at fault was not the owner, driver or passenger of a motor vehicle (e.g. a pedestrian or push cyclist); the person at fault was the owner, driver or passenger, (whether with or without the consent of the owner) of a vehicle registered in another State or Territory of Australia; the injuries sustained were not caused by, or did not arise from the use of, a motor vehicle in any part of the Commonwealth. You may still be eligible to make a CTP claim in circumstances where the vehicle at fault cannot be clearly identified, or if the South Australian vehicle at fault was unregistered at the time of the crash. If the vehicle at fault was registered in another State or Territory, you will need to contact the relevant CTP insurer in that particular State or Territory. For information about making a claim contact; NSW Motor Accidents Authority VIC Transport Accident Commission QLD Motor Accidents Insurance Commission TAS Motor Accidents Insurance Board WA Insurance Commission of WA ACT NRMA Insurance Ltd NT Territory Insurance Office If you are uncertain about any aspect of your eligibility to make a claim, contact our office on

6 How to make a claim The first thing you ll need to do is complete an Injury Claim Form. This form is available by contacting Allianz on or downloadable from or Within a few days of receiving this letter, a representative from Allianz will contact you to discuss your claim and injuries. How fault is established The circumstances of each crash are investigated to determine who was responsible, before we are able to make any payments of compensation. WCSA 0002 (07/04) South Australia Compulsory Third Party (CTP) Injury Claim Form This form is to be completed by any person who is injured in a motor vehicle accident. A separate form (Accident Report Form) must be completed by the driver, motor cyclist or registered owner, when a person is injured in a motor vehicle accident. This form may be lodged by: Mailing to: Allianz Australia SA CTP GPO Box 2198 Adelaide SA 5001 OR Faxing to: Allianz Australia SA CTP General Fax (cost of local call) OR Lodging personally to: Allianz Australia SA CTP Ground Floor 89 Pirie Street Adelaide SA 5000 If you have any queries, please call Allianz Australia SA CTP Personal Injury Helpline on (cost of local call). Allianz Australia Insurance Limited ABN Registered Office: 2 Market Street, Sydney NSW 2000 You or someone on your behalf needs to complete this form as soon as possible after your crash. A legal representative can also lodge a claim on your behalf. Once we have received your completed Injury Claim Form, your claim will be lodged and an acknowledgement letter sent to you. This letter will notify you of your claim reference details. The drivers involved will be contacted to obtain verbal and written descriptions of the crash and, an Accident Report Form will be sent to them for completion. We will also contact, if necessary, any witnesses to the crash. Depending on the circumstances, an Investigator may be appointed to conduct more detailed inquiries. Our investigations are completely independent of the police or your property damage insurer, however we do sometimes get information from these parties to assist us in making a decision. Once the decision has been made, we will advise you in writing. If you don t agree, you can write or call our office to talk about the decision. If you are partially at fault If you were partially at fault for the crash, or your injuries, you may still be able to make a claim but the amount of compensation you could possibly receive may be reduced. For further information please contact our office on For further information please contact our office on

7 Other factors that may reduce compensation As provided by the Civil Liability Act, 1936, as amended, the following Statutory Reductions may result in a reduction of the amount of compensation paid to you: Seatbelts. A fixed 25% reduction applies for persons (16 years or older) not wearing a seatbelt as required under the Road Traffic Act, Safety Helmets. A fixed 25% reduction applies for persons (16 years or older) not wearing a safety helmet as required by the Road Traffic Act, Passenger Compartments. A fixed 25% reduction for persons (16 years or older) travelling as a passenger in or on a motor vehicle with a passenger compartment, but not within the compartment (for example a van or utility). Alcohol or Drug Consumption Drivers who have contributed to a crash and were intoxicated. There is a minimum 25% reduction in cases where the Blood Alcohol Content (BAC) is less than 0.15%; and a minimum 50% reduction when it is 0.15% or higher, or where the driver was so much under the influence of alcohol or drugs to be incapable of exercising effective control of the vehicle. Passengers (16 years or older) travelling with an intoxicated driver. Where the driver s BAC is less than 0.15%, there is a fixed 25% reduction. Where the driver s BAC is 0.15% or more, there is a fixed 50% reduction. However, the passenger must be aware, or ought to be aware, that the driver was intoxicated. Pedestrian/Cyclists who have contributed to their injuries and were intoxicated. There is a 25% or more reduction. These compulsory reductions are in addition to any other reductions which may be applied for contributory negligence. 7

8 Compensation. What you can claim for These are examples of what you may be entitled to reasonably claim; necessary hospital, medical and rehabilitation expenses loss of earning capacity (past and future), excluding the first week s loss future treatment an allowance for any pain and suffering experienced by you as a result of your injuries travelling expenses to and from treatment, an allowance for any homecare services you may require as a result of your injuries (for example, cleaning and gardening). Claiming compensation for a family member who was fatally injured in a motor vehicle crash If you are a family member of a person who was fatally injured as a result of a motor vehicle crash, you may be able to claim compensation. You may be entitled to claim, for example, the reasonable cost of funeral and memorial expenses and loss of dependency. Time limits Time limits to lodge a claim do apply, depending on your age and situation. If you have not lodged your claim within 3 years from the date of crash you may be legally barred from pursuing a claim. If it appears you will not finalise your claim within 3 years from the date of the crash, you should seek legal advice as you may be required to issue Court proceedings to preserve your claim. If you are under 18 years of age at the time you were involved in the crash, you have until the time you reach 18 years plus 3 years. Claims for financial dependency must be lodged within 3 years of the date of death. Time limits to lodge a claim do apply, depending on your age and situation. 8

9 The claims management process. What happens once you have lodged a claim? You will receive a letter from us acknowledging your claim which will include a claim reference number. This number is for you to use when contacting us about your claim. You will also receive a phone call from an Allianz Claims Consultant who will assist you with any questions regarding you claim. They will then write to you to confirm their name and contact details. Investigating who was at fault Allianz will investigate the crash circumstances to establish who was at fault. This may involve the appointment of an investigator to obtain statements from the people involved and any witnesses to the crash. We will also request information from the police where necessary. On completion of our investigations we will write to you advising whether your claim has been accepted. If your claim is not accepted or only partially accepted we will include information about the reasons for our decision. Medical treatment If you have been injured in a crash you should see a doctor immediately. If you have symptoms that are likely to be long term, you should continue seeing your doctor from time to time so that we can obtain medical reports about the progress of your treatment and recovery and to assist us in considering the ongoing payment of your medical accounts. We will not stop you from having any type of treatment, but you should contact us to make sure we ll pay the associated costs. Generally, we won t continue to pay for medical treatment, on an ongoing basis, unless there is evidence that it is providing some sustained improvement in your medical condition. Allianz may ask you to provide further information to support the payment of your medical treatment. Allianz may authorise payment for treatment expenses including, but not limited to the following: medical practitioners medications ambulance hospital physiotherapy chiropractic hydrotherapy massage gym program All providers of medical and allied health services (e.g. physiotherapy, chiropractic, hydrotherapy and massage treatment) must be WorkCover accredited or your expenses will not be covered. Payment of accounts for these treatments will be made at WorkCover gazetted rates. If you are unsure of whether the treatment recommended is covered, please contact us to discuss. Paying for treatment? Legally, you are responsible for the payment of all accounts for treatment expenses until your claim is settled. However, wherever practicable (see the section Medical Treatment ), Allianz will pay your accounts. If there is any doubt, payment will not be made until further investigations or inquiries have been completed. We will also consider reimbursement of accounts paid by you. Original accounts and/or receipts should be sent directly to Allianz, but you should keep a record of all treatment dates and copies of any accounts and receipts. You will generally not be billed direct for ambulance services or public hospital care in South Australia, if it relates to injuries you have sustained in a motor vehicle crash. If your claim is denied, you are responsible for your expenses. You may be able to claim part, or all, of your expenses from Medicare or your Private Health Insurer. 9

10 Contact from Allianz about your claim Your Claims Consultant will make regular contact with you until the finalisation of your claim. You can, of course, contact your Claims Consultant at any time, to discuss your claim, treatment and progress. If you have engaged a legal representative to act on your behalf, Allianz will not contact you directly and all information regarding your claim will be directed through your legal representative. If you wish to discuss any aspect of your claim you should speak to your legal representative who will contact Allianz on your behalf. Criteria for some compensation other than medical expenses Certain criteria need to be satisfied before some types of compensation can be paid. For example, you may be entitled to claim for non-economic loss if: your ability to lead a normal life is significantly impaired by your injury for a period of at least 7 days; or your medical expenses incurred in connection with your injury have exceeded the prescribed minimum amount, (eg $3, for a crash that occurred in 2008). Advance payments Although we are not legally required to pay for a loss of earning capacity prior to settlement of your claim, advance payments against your claim for loss of earnings can be considered upon request. Independent medical experts Allianz may decide to arrange for you to be seen by an independent medical expert. This is generally to assess the progress of your injury and your treatment requirements. If you do not attend a scheduled appointment with an independent medical expert, compensation for medical treatment may be put on hold, and your rights to commence or move forward with legal proceedings may be delayed. You may also be charged a cancellation fee for the missed appointment. Assessing claims To ensure that fair and reasonable compensation is assessed correctly, Allianz will consider all evidence available to us. For example, compensation for non economic loss is assessed on an individual basis and a numerical value is assigned on a 0 to 60 (the scale value), with 60 being generally awarded to a person who has sustained the most serious kind of injury conceivable. Claims for loss of earning capacity are generally assessed on Medical Reports, Payslips and Sick Certificates. Any other entitlements to compensation will be determined on the evidence available. 10

11 Finalising claims Once your injuries have stabilised you may contact Allianz or, Allianz will contact you to discuss the finalisation of your claim. Every person responds differently to injuries and circumstances. Some people may recover within weeks or months while others, with more serious injuries, may take years. If you are entitled to receive compensation as a result of your injuries, an offer of settlement will be made directly to you or your legal representative. Any offers made will include a detailed summary of all the items payable. Before deciding whether or not you are happy with the offer made, we invite you to discuss the offer in detail with your Claims Consultant. Once settlement has been agreed the appropriate documents will be sent to you for your signature. Medicare Australia may seek from Allianz, a refund from your agreed settlement as part of the claim finalisation process if any treatment has been paid by them. Other Statutory bodies, such as Centrelink, may also seek reimbursement from your settlement. Problems finalising a claim Allianz prefers to settle claims out of the Court system, as legal action can be long and costly. In order to avoid legal proceedings we will make every effort to resolve any disputes either directly with you, or with your legal representative. This may involve the use of an informal settlement conference to facilitate the settlement of the claim. If you start legal proceedings, the Courts require that all parties hold a settlement conference to discuss and hopefully resolve your claim. If agreement cannot be reached, your claim may go to Trial for the matter to be determined by the Court. If you are entitled to receive compensation as a result of your injuries, an offer of settlement will be made directly to you or your legal representative. 11

12 Legal costs. At any stage throughout the life of your claim you have the right to seek representation from a legal representative. Allianz may be obliged to make a contribution towards your legal costs when your claim is finalised. Before you engage a legal representative, you should discuss how you will be charged and what the cost is likely to be. Legal Costs may include not only the services of your legal representative but also other associated costs such as medical reports, police reports and any court costs. If you are not successful with your claim or the court awards you less than the final offer made to you, you may be ordered by the court to pay Allianz s legal fees. You will need to discuss this with your legal representative. 12

13 Complaints, compliments and feedback. Complaints Allianz is committed to providing you with a positive customer experience. To do this, we would appreciate your feedback. If you are not happy with our service or the way in which it was provided, you have the right to make a complaint. If you have a complaint about the timeliness or standard we provide, please discuss this with your Claims Consultant. If you cannot resolve the issue at this point, we encourage you to discuss the complaint with your Claims Consultant s direct Manager. Compliments and feedback If you want to tell us what we have done well, or make a suggestion on how we can improve the process, please phone us and ask to speak to your Claims Consultant s direct Manager. Allianz is committed to providing you with a positive customer experience. To do this, we would appreciate your feedback. 13

14 Other languages. If you need an interpreter please call the Translating and Interpreting Service (TIS National) on and ask to be connected to Allianz on between 8:30 am and 5:00 pm, Monday to Friday. μ μ (TIS National) μ Allianz μ 8:30.μ. 5:00 μ.μ. μ. Ti ng Vi t 14

15 (TIS National) Allianz :30. 17:00., (TIS National) Allianz, , 8.30am 5.00pm,. 15

16 HVRATSKI Ako Vam je potreban tuma, molimo nazovite Prevoditeljsku i tuma ku službu (TIS National), na telefon i tražite da Vas spoje sa Allianz, iji je telefonski broj , od ponedjeljka do petka, izme u 8.30am i 5.00pm. (TIS) (Allianz) " " :00 8: Thu jä 16

17 Contact details. Allianz Australia Limited (Compulsory Third Party) is located at Ground Floor, 89 Pirie Street, Adelaide. Other contact details are provided as follows: Phone: Fax: Postal Address: GPO Box 2198, ADELAIDE Website: Office Hours: 8:30 am to 5:00 pm, Monday to Friday 17

18 Allianz Australia Limited (Compulsory Third Party) is located at Ground Floor, 89 Pirie Street, Adelaide. Other contact details are provided as follows: Phone: Fax: Postal Address: GPO Box 2198, ADELAIDE Website: Office Hours: 8:30 am to 5:00 pm, Monday to Friday 18