NIIS Injuries

The short answer is “as soon as possible”. This is so we can:

• assist you with lodging your claim(s) with NIISQ, the CTP Insurer, WorkCover Queensland (or a workers’ compensation self-insurer) and/or any other insurer;
• make sure that your version of events surrounding the accident is accurate and comprehensive;
• give you advice in relation to your rights and obligations;
• ensure that you are telling the insurers and the doctors the whole story;
• ensure that your doctors note down in your medical records all injuries that you have suffered, no matter how minor;
• ensure that the insurer is aware of all the injuries you have sustained;
• ensure that NIISQ or another insurer is paying for all reasonable and necessary treatment, care and support (where possible); and
• start compiling the evidence we need in order to put an offer of settlement together for you once your injuries are stable and stationary.

If lodged within twelve (12) months from the date of the accident, NIISQ or WorkCover Queensland (or the self-insurer) have to consider your application for NIIS benefits by determining your eligibility. If the application is lodged outside the twelve (12) months timeframe, it is at NIISQ’s discretion or WorkCover’s discretion as to whether or not they will accept the application.

Once accepted, some NIIS participants later choose to opt out of receiving lifetime treatment, care and support from NIISQ or WorkCover so that they can pursue a lump sum for those expenses instead.

In motor vehicle injury (CTP) claims, in order to notify NIISQ and the CTP Insurer of your decision to opt out, you must provide them with a “Preservation Notice” within fourteen (14) days of being accepted as a lifetime participant of NIISQ or, if your CTP claim is not commenced until after you become a lifetime participant, within 14 days after the CTP Insurer provides written acknowledgment of your CTP claim.

In work injury claims, in order to notify WorkCover (or the self-insurer) of your decision to opt out, you must state in your Notice of Claim for Damages served on WorkCover (or the self-insure), when commencing your common law claim, that you elect to seek treatment, care and support damages for the injury.

Injuries suffered in a motor vehicle accident (CTP claim):

Where you have suffered serious personal injury in a motor vehicle accident, a claim can be made to NIISQ by completing the “Application Form – Interim Participation”, which is available on the NIISQ website. Your doctor can then complete the Medical Certificate that forms pages 6 to 9 of the Application Form.

The application can also be lodged by the hospital, your guardian or the CTP insurer. Your application should be made within twelve (12) months of the date of your injury.

Your eligibility and funding decisions, when you have suffered serious personal injury in a motor vehicle accident, are determined by the National Injury Insurance Scheme (Queensland) Act 2016 and Regulation 2016.

Injuries suffered at work:

Where you have suffered “serious personal injury” at work, you need to make a claim for workers’ compensation through WorkCover Queensland (or your employer’s self-insurer).

The workers’ compensation insurer should automatically make a decision as to your eligibility to receive NIIS benefits for serious personal injury under the Workers’ Compensation and Rehabilitation Act 2003 (Qld). If WorkCover (or the self-insurer) fails to properly consider your eligibility to receive NIIS benefits in a timely manner, you should seek legal advice immediately, so that this can be rectified. 

If WorkCover (or the self-insurer) accepts that you have suffered a serious personal injury and are eligible to receive NIIS benefits, they will engage the NIISQ Agency to manage your necessary and reasonable treatment, care and support needs.

You will be assigned a NIISQ Agency Support Planner who will liaise with you and your treatment providers to ensure that you are receiving all the necessary and reasonable treatment, care and support services that you need.

These are the steps you should take to lodge a claim if you are injured in a road accident:

1. Make sure that the hospital records all injuries and symptoms you have suffered (no matter how insignificant they seem).
2. Obtain a QP number (Traffic Incident Number) from the police, so that we can obtain a copy of the police report.
3. Contact one of our offices to make a time for our of our expert personal injury lawyers to see you.  If it is easier for you, we will come to the hospital or your home or we are happy to meet at a nearby coffee shop.
4. At our initial consultation, we will complete a Notice of Accident Claim Form with you.
5. You will then need to have a doctor complete the Medical Certificate which forms pages 11 and 12 of the Notice of Accident Claim Form. We will provide you with the Medical Certificate to take to your doctor.
6. Provide us with the original Medical Certificate and a copy of any referral(s).
7. We then serve the Notice of Accident Claim Form (with the completed Medical Certificate) and a copy of any referrals upon the CTP Insurer of the vehicle that caused or significantly contributed to the accident.
8. The CTP Insurer will then respond to your claim and start paying for all reasonable and necessary treatment until NIISQ takes over.
9. If you haven’t done so already, we will also complete an Application Form – Interim Participation form to apply for NIISQ to cover all treatment, care and support that you need and will lodge that with NIISQ for you.

1. Ask the hospital to complete a work capacity certificate: https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0007/77119/form-132m-work-capacity-certificate-workers-compensation.pdf
2. Provide your employer with a copy of the work capacity certificate.
3. Complete WorkCover’s online Claim form, which can be found here: https://ols.workcoverqld.com.au/ols/public/claim/lodgement.wc
   OR
   Complete a hard copy of the Claim form and upload using WorkCover’s online service (https://ols.workcoverqld.com.au/ols/public/uploadNewClaim.wc?code=NEWCLAIM), or fax it to 1300 651 387 or post it to GPO Box 2459, Brisbane Qld 4001. 
   The pdf of the Claim form can be found here: https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0015/3057/Claim-form-FM106-v10.pdf
   OR
   Where urgent surgery is required, a claim can be lodged over the phone by calling WorkCover on 1300 362 128.
4. Upload a copy of the work capacity certificate using WorkCover’s online service (https://ols.workcoverqld.com.au/ols/public/uploadNewClaim.wc?code=NEWCLAIM) or fax it to WorkCover on 1300 651 387.
5. WorkCover will then contact you to confirm that the claim has been received and will contact your employer to obtain confirmation that the injury is work related.  If satisfied it is a work related injury, your claim will be officially accepted and WorkCover will then pay weekly benefits for your time off work and any reasonable and necessary treatment and rehabilitation.
6. Once WorkCover accepts that you have sustained a “serious personal injury”, as defined by the National Injury Insurance Scheme (Queensland) Act 2016, they will ask NIISQ to manage all of your treatment, care and support needs.

Who you make the claim(s) against will depend on how you sustained your injury (eg in a road accident, at work, in a hospital or in a public place).

If you were injured on the road:

Provided the accident was not your own fault, or not entirely your fault, you will be able to make a CTP claim. You cannot claim against a CTP Insurer if the accident was your fault.

Your claim will be against the CTP insurer of the vehicle that caused or significantly contributed to the accident. Negligence is alleged against the driver of that vehicle but the CTP insurer then takes over the conduct of the matter.

Where the vehicle that caused the accident cannot be identified, the Nominal Defendant (a government insurer) becomes the relevant insurer in relation to your claim.

For “serious personal injuries” sustained in a motor vehicle accident a claim can also be lodged with NIISQ, irrespective of whose fault the accident was.

If you were injured at work:

In a common law claim you are alleging that your employer or a co-worker was negligent in some respect, so the claim is directed at your employer but WorkCover Queensland takes the claim over as your employer’s insurer and handles the claim on their behalf.

For “serious personal injuries” WorkCover Queensland (or the workers’ compensation self-insurer) will ask NIISQ to manage all of your necessary and reasonable treatment, care and support needs on their behalf.

If you were injured on the road:

Subject to the exceptions set out below, there are simply no adverse consequences to your family member or friend, if they caused the accident, provided their vehicle was registered. They do not even have to pay an excess when you make a claim. The CTP insurer of the vehicle simply takes over the conduct of the matter.

If you were the passenger in a vehicle driven by a family member or friend, you can still make a claim against the CTP insurer of that vehicle (even if it is your own vehicle) and there is no impact upon your family member or friend.

Of course, the CTP insurer will want a statement from your family member or friend about what happened but that would be it. In the unlikely event that the matter was to proceed to trial, they may also be called upon to give evidence if liability is in dispute (ie there is some doubt as to who caused the accident).

Exceptions to the rule:

1. If your family member or friend was using the vehicle without the owner’s authority or without legal justification or excuse for using the vehicle, then the insurer will have a right of recovery against the driver for some or all of the compensation and costs paid.
2. If your family member or friend intended to harm you or some other person (resulting in your injury), then the insurer will have a right of recovery against the driver for some or all of the compensation and costs paid.
3. If your family member or friend was under the influence of alcohol and/or drugs at the time of the accident and their intoxication caused or contributed to the accident, the insurer will have a right of recovery against the driver for some or all of the compensation and costs paid.
4. If your friend’s vehicle or family member’s vehicle was not registered, then the Nominal Defendant will have a right of recovery against the owner of the vehicle for some or all of the compensation and costs paid.

If you were injured at your friend’s home or property or when using their equipment:

Most homeowners have home and contents insurance, which has public liability insurance attached to that. Most boats, jetskis and the like also have public liability insurance.

Your family member or friend will only have to pay the (usually quite small) excess on their insurance policy and the public liability insurer then takes over the claim. Sometimes no excess at all is payable.

Of course, the public liability insurer will want a statement from your family member or friend about what happened but that would be it. In the unlikely event that the matter was to proceed to trial, they may also be called upon to give evidence if liability is in dispute (ie there is some doubt as to who caused the accident).

Exceptions to the rule:

Your friend’s public liability insurance may not cover them if, for example:

1. Your family member or friend was using a vehicle, machinery, equipment or property without the owner’s authority or without legal justification or excuse for using it.
2. Your family member or friend intended to harm you or some other person (resulting in your injury).
3. Your family member or friend was under the influence of alcohol and/or drugs at the time of the accident and their intoxication caused or contributed to the accident.

The advantages of opting out of receiving treatment, care and support from NIISQ or the workers’ compensation insurer and, instead, pursuing a lump sum from the CTP Insurer or WorkCover for these expenses in your common law claim include the following:

• You are able to manage your own money and have control over the funding of your treatment, care and support;
• You are able to maintain control over the decisions that are made with respect to your treatment, care and support;
• You do not have to liaise with an insurer and seek approval for every little thing you want; and
• You are able to avoid any changes or reductions in the funding of treatment, care and support that the government might introduce in the future.

In motor vehicle injury (CTP) claims, in order to notify NIISQ and the CTP Insurer of your decision to opt out, you must provide them with a “Preservation Notice” within fourteen (14) days of being accepted as a lifetime participant of NIISQ or, if your CTP claim is not commenced until after you become a lifetime participant, within 14 days after the CTP Insurer provides written acknowledgment of your CTP claim.

In work injury claims, in order to notify WorkCover (or the self-insurer) of your decision to opt out, you must state in your Notice of Claim for Damages served WorkCover (or the self-insure), when commencing your common law claim, that you elect to seek treatment, care and support damages for the injury.

Every case is different and the amount of compensation or damages payable to you will depend on many things, including:

• How you recover from your injuries
• The medical evidence
• Your age
• What other pre-existing injuries or conditions you had
• What permanent restrictions you have, particularly with respect to your work capacity
• What your earning capacity was like prior to the accident, compared to what your earning capacity now looks like
• How much care and support you have needed in the past and how much you are likely to require in the future
• How much ongoing treatment and medication you need

Many serious personal injury claims that end up under the care of NIISQ resolve for well in excess of one million dollars.

Costs are only payable to the insurer if you proceed to trial and lose or receive a judgement for less than what the insurer has previously offered to you.

Less than 2% of claims actually proceed to trial, so there is almost no chance of you having to pay the insurer’s costs.

• daily personal activities needs
• transport to enable participation in community, social, economic and daily life activities
• workplace help to allow a participant to successfully get or keep employment in the open or supported labour market
• therapeutic supports including behaviour support
• help with household tasks to allow the participant to maintain their home and home environment
• help to a participant by skilled personnel in aids or equipment assessment, setup and training
• home modification design and construction
• mobility equipment
• vehicle modifications

The NDIS will NOT fund a support that is:

• the responsibility of another government system or community service (eg something funded by NIISQ)
• not related to a person’s disability
• relates to day-to-day living costs that are not related to a participants support needs
• is likely to cause harm to the participant or pose a risk to others

If you have a “serious personal injury” from a motor vehicle accident in Queensland, you will be eligible to receive benefits from the National Injury Insurance Scheme (Queensland) (ie NIISQ).

Once NIISQ accepts that you are eligible to receive benefits, they will take over the management of, and pay for, all the necessary and reasonable treatment, care and support needs that you have.

The CTP Insurer will then manage your CTP claim procedurally but will not be involved with your treatment and rehabilitation, unless you choose to opt out of receiving lifetime treatment, care and support from NIISQ and instead pursue a lump sum for those expenses.

We can advise you on whether you should or should not opt out from NIISQ. For further information on NIIS benefits and how the scheme works with CTP claims, click here.

If you have a “serious personal injury” from a work accident in Queensland, WorkCover will ask NIISQ to manage all necessary and reasonable treatment, care and support needs that you have.

WorkCover will continue to pay your weekly benefits and manage your WorkCover claim but they will not be involved with your treatment and rehabilitation, unless you choose to opt out of receiving lifetime treatment, care and support from NIIS and instead pursue a lump sum for those expenses.

In Australia, you are not taxed on any settlement monies that you receive from your personal injury claim. If, however, you invest that money and earn interest or a have a capital gain from that investment, then tax may be payable on that interest or capital gain. You should seek financial and/or accounting advice about this where applicable.