If you’ve suffered an injury at work or on the road, you’re likely to be entitled to some benefits and possibly compensation from a workers’ compensation or third-party motor accident insurer to help with your recovery—such as covering medical costs and loss of income from not working- and other potential health and personal challenges.
While insurance companies may position themselves as giving you access to all the care and ongoing support you need after an accident, the truth of the matter is, they have their interests top of mind, and they have a lot of resources behind them to support them.
In this article we look at why it’s critical to seek independent advice as early as possible after an accident to make sure your interests are looked after. We’ll look at important information you need to know, so you feel more aware and empowered to take the right steps for you —and help get you the best support and entitlements you deserve at law.
Injuries can and do strike at any time
While we all hope we won’t ever be seriously injured, unfortunately, none of us are immune. Every year many Australians are injured, particularly on the road or at work.
Key Injury Facts
In 2016-17, Safe Work Australia reported Australians made around 106,260 serious claims for workplace injuries nation-wide, with an average time lost from work of 5.6 weeks, and an average compensation payout of $11,500 per claim.
For motor vehicle accidents, the latest data tallied more than 1,200 deaths in Australia in 2017 and 37,082 injuries requiring hospitalisation (2015).
In 2017, the estimated gross ultimate cost of CTP insurance claims from motor vehicle accidents in Australia was more than $3.6 billion.
These are not small numbers. And these numbers don’t capture the significant flow-on effects an injury can have on families, our communities and the economy.
Workers compensation and CTP insurance schemes work differently in each state
If you’re one of many Australians who’ve suffered an injury at work or on the road you may be entitled to certain benefits and compensation to help with your recovery.
Each State and Territory has its own workers’ compensation and CTP insurance schemes. While the schemes work a little differently depending on where you live, the schemes are all “statutory” (set up in law) and compensation is generally paid by an insurance company, regulated by a government agency.
Workers' compensation is a compulsory form of insurance for all Australian employers and provides protection to workers if they suffer a work-related injury or disease.
You can read more about the workers’ compensation scheme that applies to you on the website of your State’s regulator:
Motor Accident Compulsory Third Party (CTP) insurance is required when you register your motor vehicle. Licensed insurers in the CTP schemes protect vehicle owners from liability if a driver of their vehicle causes injury or death to other road users. As with workers’ compensation, you’ll need to check what scheme applies in your State or Territory:
- Australian Capital Territory: ACT CTP Regulator
- New South Wales: State Insurance Regulatory Authority
- Northern Territory: Territory Insurance Office
- Queensland: Motor Accident Insurance Commission
- South Australia: CTP Insurance Regulator
- Tasmania: Motor Accidents Insurance Board
- Victoria: Transport Accident Commission
- Western Australia: Insurance Commission of Western Australia
Insurance companies have their own agenda and won’t necessarily pay your full entitlement
Although the Government puts laws in place to regulate the big insurance companies and tries to make sure compensation schemes fairly protect injured people, insurers are often “adversarial” to claimants—in other words, they pursue their own agenda at the expense of the injured person.
And like all large corporations, the big insurers have teams of experienced claims officers and inhouse lawyers handling your claim, as well as external lawyers advising them of their obligations to pay out benefits and compensation. They also have access to external investigators, accident reconstruction experts and forensic accountants – all to advise them – not you. They may not automatically pay your full compensation entitlement.
In NSW, some CTP insurance companies are behaving badly, denying payments to accident victims despite what they need and deserve.
In NSW, the State Insurance Regulatory Authority (SIRA)—has licensed six insurers to operate in the CTP scheme. After an accident, an injured person lodges a CTP claim with the insurer of the at-fault vehicle. The insurance company will then investigate the claim.
Part of the Government’s plan with the MAI Act was to change the way insurers approached claims, encouraging them to be less aggressive, and more focused on the people impacted. The Act also aimed to reduce people using private legal representation for CTP claims.
While the Act reduced independent legal representation, with only 1820 of over 7500 people who made claims represented by an private legal representative, in my view it’s failing those who’ve been affected.
Let’s look at some recent examples of how some insurers are behaving under NSW’s new motor vehicle accident scheme. In NSW, some CTP insurance companies are behaving badly, denying payments to accident victims despite what they need and deserve.
How people who’ve been injured are missing out
Some insurers are taking aggressive advantage of people who aren’t represented by an independent lawyer.
In our experience, CTP insurers will often not seek medical information to support a claim if there is a chance it will increase their liability to pay out.
Rather than look for all the evidence, they will rely on the often-limited information a person submits at the very start of their claim, before the full extent of their injury was known. And the insurer makes really important determinations very early after an accident, determinations that if unchallenged can have major consequences for the injured person down the track.
Sadly, but not surprisingly, there have also been multiple examples of CTP insurers misinterpreting and misapplying the new law, with the result being people having their claims wrongly denied.
Often, these mistakes have not been picked up by government regulators Claims Assist service, even if the injured person knew to ask. They’ve been found and fixed when those affected by an injury have sought independent lawyers.
Why independent legal advice is key—it’s time to level the playing field
The NSW motor accident scheme paints a clear picture of why independent legal advice is so important to the success of your compensation or benefits claim. With insurers using so much legal muscle, it’s wise and often necessary to have your own legal representation.
While insurance companies may withhold information or fail to give you advice, you can ask your lawyer any question and get an answer for your circumstances.
An independent lawyer will tell you what you can and can’t claim, helping you understand what’s possible, having seen many cases go ahead of yours.
An independent lawyer will also get to the bottom of your unique case, digging for information to support your claim that an insurance company may pass over. You will have an experienced guide to walk you through the complexities of the scheme and fight on your behalf for your full entitlements.
I often hear motor vehicle accident clients say, “I just want to be sure I’ve done everything I can for my family.” It’s my privilege to assure them, “Yes, you have.” Whether you’re seeking a claim for yourself or your family, if you’re supported by an independent lawyer you’ll have peace of mind that you’ve got the best chance of success.
What to do if you’re injured
If you’re injured in a workplace or motor vehicle accident, seek medical attention as soon as possible.
Your treating doctor will record all your injuries and manage your treatment and direct you to specialists or other treatment providers if needed. Be careful not to ignore the psychological impact of an accident, if this is you. Be proactive in getting treatment – it will lead to better faster recovery and better claim outcomes.
Exactly how the accident happened is important – some of the available benefits are payable regardless of fault – so use your smart phone and take photos and take down the names of witnesses.
If is it a car accident you will need to report the accident to the police and obtain an event number. If it is a work accident you will need to report the accident to your employer as soon as possible.
And, depending on the circumstances of your injury - whether it’s a workplace accident or a motor vehicle accident - you'll need to make a claim with the insurance company or government agency that manages these types of claims in your State or Territory
Most of the information you’ll need to get started is available online. Time limits do apply when making a claim, for example, you'll need to lodge within 28 days for a CTP claim in NSW or you’ll risk missing out on some entitlements.
Get in touch with a lawyer as soon as possible.
Your lawyer will assess your situation and talk you through your options. They will also walk you through the claim process and point out critical dates and time limits.
How Slater and Gordon will help you with independent legal advice
Slater and Gordon are highly experienced in all areas of personal injury law and will advocate on your behalf, ensuring you get the best possible outcome for your circumstances.
When my team helps someone with their personal injury claim, we know that above all, people need to be heard—to have the opportunity to express themselves and all the frustration they’re feeling. We give our clients the chance to tell us what’s bothering them, to listen and understand. We let you express everything on your mind without shutting you down.
Get In Touch
We are proud to provide our clients with access to leading, affordable legal services, including our “No Win, No Fee"* offer, as well as a free social work service upon referral from a lawyer, if needed.
If you have a question, want some more information or would just like to speak to someone, make an enquiry now and our Personal Injury team will be in touch with you as soon as possible. You can make an enquiry online or phone us 1800 555 777.
*No Win, No Fee conditions apply. See here.
Injured on the road?
If you or a family member have been injured in any kind of road or transport accident, even as a pedestrian, cyclist or public transport user, you may be entitled to a range of compensation benefits.
The contents of this blog post are considered accurate as at the date of publication. However the applicable laws may be subject to change, thereby affecting the accuracy of the article. The information contained in this blog post is of a general nature only and is not specific to anyone’s personal circumstances. Please seek legal advice before acting on any of the information contained in this post.