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Motor Vehicle, Injury and Rehabilitation | 05 March 2020

CTP Claims Guide NSW – Know Your Rights.

If you’ve been injured in a car accident in NSW, you might be entitled to make a CTP claim. This claims guide answers the most commonly-asked questions and includes legal advice, links to other articles and information on how to get help with CTP claims NSW.

 

What is a CTP claim?

A CTP claim is an insurance claim that you make to get compensation for being injured in a motor vehicle accident.

It’s compulsory for all vehicles in NSW to have CTP (Compulsory Third Party) insurance. If you’re injured in an accident you can make CTP claim for personal injury benefits to cover certain losses you’ve incurred. These losses can include past and future lost earnings, medical, treatment and care expenses and pain and suffering.

The CTP claim NSW process is managed by SIRA (the State Insurance Regulatory Authority) but claims are assessed and processed by the CTP insurers.

 

Does CTP cover personal injury?

Yes, CTP claims in NSW specifically cover personal injury, and don’t cover property damage. A CTP injury claim covers personal injury to drivers, passengers, cyclists, motorcycle riders and pedestrians who are injured in motor vehicle accidents.

The payments you receive if you’re injured in an accident will depend on the extent of your injuries. The CTP claims process classifies injuries as either “minor” or “non-minor” – here’s a brief definition of these:

  • A minor personal injury is a soft-tissue or muscle injury, like a muscle strain or a sore back. The most common soft tissue injury after a crash is whiplash, which often results in neck pain.
  • A minor psychological or psychiatric injury is a psychological or psychiatric injury that’s not a recognised psychiatric illness.
  • Non-minor personal injuries are more serious injuries like fractures or injuries that affect your organs. They also include nerve injuries, injuries that require surgery, brain injuries and scarring.
  • Non-minor psychological or psychiatric injuries include diagnosed psychological or psychiatric illnesses such as depression or post-traumatic stress disorder (PTSD), as well as a range of others.

Click here for a detailed article on minor and non-minor injuries.

 

Who pays for personal injury in a car accident?

When you make a successful CTP insurance claim, payments will be made to you by the CTP insurer of the car that was mostly at fault in the accident. For example, if you were stationary at traffic lights and you were hit from behind by another vehicle, then the CTP insurer for that vehicle will make your CTP compensation payout. In some accidents there might be more than one vehicle at fault – in that case, it’s the insurer of the vehicle that’s mostly at fault that will pay.

If you’re the driver mostly at fault in an accident, then anyone who was injured in the accident may be able to make a claim under your vehicle’s CTP policy. So it will be your insurer that pays the CTP insurance claim.

The CTP claim NSW insurers are NRMA, QBE, GIO, Allianz, AAMI and CIC-Allianz.

For more information on how to make a CTP injury claim, refer to this article.

 

What does CTP insurance cover you for?

CTP insurance covers payments under three categories, described in the following table:

Payment Description
Medical and treatment expenses
  • Reimbursed to you after you submit receipts to the insurer.
  • Insurer will generally approve a number of sessions with you GP and other treatment providers.
  • Insurer will generally write directly to your provider and notify them of the approval.
  • Insurer will pay the GP or treatment provider directly – these expenses won’t form part of your regular payments.
  • These benefits are not capped.
  • You should receive whatever treatment is necessary to make sure you recover from your injuries.
Care expenses
  • Generally treated in the same way as medical and treatment expenses.
  • Benefits are capped depending on the severity of your injuries.
Income support payments
  • Weeks 1-13: 95% of pre-accident earnings.
  • Weeks 14-26: 80-85% of pre-accident earnings.
  • If the insurer cuts off your benefits it will need to give you four-weeks’ written notice.

Your compensation payout will also depend on whether your injuries are classified as minor or non-minor and your “whole person impairment” (WPI). WPI is a measurement of the severity of your injuries and the extent to which they permanently impair you on a scale of 0 – 100%.

Category Entitlements
1. Minor injury
  • Income support and medical expenses for up to 6 months
2. Non-minor injury
  • Income support and medical expenses for up to 24 months
  • A lump sum for future lost income
3. Non-minor injury over 10% WPI^
  • An additional lump sum for pain and suffering

Find out how much you can claim.
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How long does a CTP claim take?

Once you submit your CTP injury claim it will be reviewed by the insurer, who must send you a letter within four weeks to tell you if they’re accepting or denying the claim.  Then the insurer will start making payments to you within 14 days if they accept the claim.

The insurer’s letter will state the insurer’s decision on whether your injuries are considered “minor” or “non-minor”, who was at fault in the accident and what payments you’re entitled to.

However, it’s important to understand that insurer’s decisions can be challenged. The first step is to request an “Insurer Internal Review”, then if you’re still not satisfied with the outcome you can escalate your dispute to the Dispute Resolution Service.

For more information, here’s a detailed article on checking and disputing insurers’ decisions.

 

What is the CTP claim time limit?

You must make your CTP insurance claim within 28 days to be eligible for income loss from the date of the accident. The final lodgment date is 3 months from the accident, although this can be extended in certain circumstances.

If your claim is successful:

  • You should receive 95% of your pre-accident earnings for the first 14 weeks
  • Your payments will drop to 80-85% of your earnings after week 14
  • Income benefits will stop at 26 weeks if you were the driver mostly at fault or your injuries are minor
  • Treatment is available after 26 weeks even if your injuries are minor or you were at fault
  • Income support stops at 24 months – to receive support beyond that, you’ll need to submit a separate application for a lump sum

For more information on benefits and lump sums – see ctpclaimadvice.com.au.

 

What are the average CTP compensation payouts?

In the 19 months to June 30, 2019, the average CTP payout in NSW for a car accident injury was $10,984. A total of $179.5 million was paid out in benefits and 16,342 CTP claims were submitted*.

It’s important to remember that your CTP payout will depend on the extent of your injuries and your losses (such as lost income). To get an indication of your payout amount you can use this CTP compensation calculator.

*Average CTP payout NSW data according to SIRA Green Slip scheme quarterly insights, June 2019.

 

Does CTP cover the at fault driver?

Yes, the at-fault driver, or the driver mostly at fault, can can make a CTP claim in NSW, however personal injury benefits will be restricted to lost income, treatment and care expenses for a maximum of six months after the accident.

If you’re at fault and the other driver is injured, then the other driver may claim personal injury benefits under your vehicle’s CTP insurance policy. You should provide the other driver with your CTP policy details.

Find out how much you can claim.
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