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The Process

Claim Forms

You are required under the law to notify the third party insurer if you have suffered injury. There are two forms that can be completed;

Accident Notification Form

The accident notification form is a double sided form that is lodged with the insurer within 28 days of the accident.

Download the form here

The form contains basic information relating to the accident and a section for your doctor to complete. The form once lodged with the insurer will allow the payment of medical expenses up to a maximum value of $5,000.
You should remember however that the payment of these expenses under this form does not mean the insurer will accept liability for the claim. It is simply an allowance to pay for a small amount of medical expenses for a relatively insignificant injury that will not result in any lasting difficulties.
Initially you should lodge the accident notification form so that your initial treatment will be paid by the insurer.
For ongoing treatment or claims for loss of income and other benefits, you are required to lodge a personal injury claim form. For more information on this form see the next section about the personal injury claim form.

Personal Injury Claim Form

The Personal injury claim form is a large 16 page form which provides more information in relation to the injuries than the accident notification form.

Download the form here

You must lodge the claim form within six(6) months of the accident. If you do not, then you will be required to provide the insurer with an explanation as to why you did not lodge the form and the explanation must be reasonable and satisfactory. The insurer is not obliged to accept the explanation so it is very important that the form is lodged. If you have had an accident and you have not lodged the form then you should do so urgently. If you have any questions regarding the claim form then you should contact your solicitor if you have one or contact ISN who can offer assistance.

Liability

Once the claim form has been accepted the insurer will determine liability or fault. The insurer is obliged to send out a letter to you notifying you of either acceptance of the claim or denial of the claim. The letter is called a Section 81 Notice. If liability or fault is accepted by the insurer, then they will pay all your reasonable medical expenses as they are needed.
When your doctor refers you to treatment such as physiotherapy or to a specialist, it is important that the referral by the doctor is considered by the insurer first so that they can consider paying those expenses. They may not pay the expenses if you have the treatment before approval is given.

Claiming Compensation

The process of a motor accident case is very much dependant on whether the insurer accepts liability or accepts that the driver that they insure is at fault. If the insurer accepts liability, then the matter can proceed through an informal process in a division of the Motor Accidents Authority called the Claims Assessment and Resolution Service (CARS). If liability is denied then the matter must proceed to Court, usually the District Court.

The Motor Accidents Authority

The Motor Accidents Authority (MAA) is a department of the New South Wales Government. The MAA has two arms to it, one to determine the value of a motor accident claim, the Claims Assessment and Resolution Service (CARS) and one to determine medical issues, the Medical Assessment Service (MAS).

Claims Assessment & Resolution Service

The Claims Assessment and Resolution Service (CARS) will look at a number of different issues including:

  1. Where liability is accepted, the value of the claim;
  2. Whether a claim form that is lodged outside the six month time limit has a full and satisfactory explanation for delay, and
  3. Whether there is a full and satisfactory explanation for not reporting the accident to the police within 21 days.

The process in CARS is an informal process where most of the evidence in the claim is done by paperwork. That includes the medical reports from your doctors and your evidence which is done by written statement. Once the application is lodged CARS will then appoint an assessor to determine the value of the claim. This is usually done in a face to face assessment conference or hearing. You will sometimes be required to answer some questions at the hearing. The decision of the assessor is binding on the insurer if it is accepted within 21 days of being issued.
If you are unhappy with the decision of the assessor in relation to the value of the claim then you may be able to proceed to the District Court.
If you have any questions in relation to the process of CARS then you should contact ISN for further information.
Medical Assessment Service (sub-heading from the motor accidents authority)
The medical assessment service (MAS) is the arm of the Motor Accidents Authority that will look at a number of issues including:

  1. Whether your level of impairment for pain and suffering is greater than 10% whole person impairment; and
  2. Whether your treatment in the past and in the future is reasonable and necessary.

MAS has a number of doctors and specialists who are able to provide opinion in relation to the above issues. MAS will normally organise an appointment for you and it is at no cost to you.
Once the appointment has occurred the certificates are normally binding on both the insurer and the injured person. There can be occasions when a party can appeal the certificate however in the majority of cases they are binding.
If there are any travelling costs associated with the appointment then you should attempt to recover those from the insurer.
For any further questions regarding the process at MAS, contact the Motor Accidents Authority, your Solicitor or contact ISN who can provide further information.

Proceeding to Court

There are a number of circumstances where the claim will not proceed through CARS and will proceed to Court. They may include:

  1. Where liability is denied;
  2. The insurer suggests that you have contributed to the accident by more than 25%;
  3. The person claiming compensation is under 18 years old, and
  4. The facts or medical issues in the case are complex to the extent that the matter should proceed to court.

Where the matter proceeds to Court then you will be required to run your claim before a Judge who will determine the issues in the case. Normally in Court you will be required to give evidence, as well as other witnesses in the case.
It is important you obtain sound legal advice as to the prospects of the success of your claim. If you are not successful in your case then you may be ordered to pay the insurance company’s costs of the case which would include their Solicitors costs, Barristers costs and any other expenses.
You should also be mindful when approaching a Solicitor. If they advertise “no-win, no fee” that will mean they will not charge you for their costs. They cannot however avoid you paying the costs of the insurer if you are unsuccessful.
If you have any questions or concerns regarding the process at Court or the costs of the claim contact ISN for further information.

Download Relevant Forms

download a fileAccident Notification Form.pdf
download a filePersonal Injury Claim Form.pdf

Further Reading

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