Claim processing and settlement

Within 14 days of your Notice of Accident Claim Form submission, the insurer will contact you to advise whether your form was lodged correctly (is ‘compliant’).

They may ask you to provide more information. You must provide any outstanding information as requested by the insurer to reach compliance. Delays may occur if you do not provide the requested information.

Within 14 days of your Notice of Accident Claim Form submission, the insurer will contact you to let you know whether they will pay for any reasonable and appropriate rehabilitation expenses you may need. You can request pre-approval for treatment and other rehabilitation costs.

See Rehabilitation information for claimants for more information.

The insurer considers the accident information, including whether you contributed to it, and makes a liability decision within six months of your Notice of Accident Claim Form being ‘compliant’.

You may be asked to provide further information or evidence to support your view on liability. The insurer may admit liability but argue the injury was not caused by the accident.

Once the insurer accepts liability, or agrees to pay for the costs of reasonable and appropriate rehabilitation, they must:

• take steps to ensure reasonable and appropriate rehabilitation services are provided
• meet the reasonable costs of treatment and rehabilitation expenses:
  • the insurer may not pay the full amount of these costs if they decide that you are partially at fault for the accident
  • the insurer may be prepared to pay for treatment and rehabilitation services without accepting liability, however the insurer must first give approval.

The insurer may not agree to fund treatment and rehabilitation if liability has been denied.

For further information on insurer funding of treatment and rehabilitation, see Rehabilitation information for claimants.

If you disagree with a liability decision, see Resolving CTP claim disagreements for further information.

Both parties may get reports from medical specialists to assess injuries and whole person impairment (if any). The insurer may require you to attend a medico-legal examination at their expense and you must cooperate.

Consider if your injuries have reached maximum medical improvement based on medical advice. You may request that you and the insurer obtain a joint medico-legal report, but it is not required.

Generally, claim settlements happen when:

• liability has been decided by the insurer
• your injury is stable
• the impact of your injury is known.

You can discuss settlement with the CTP insurer at any stage. Either you or the insurer can make an offer of payment that would settle your claim. If you have a lawyer acting for you, they will discuss settlement with the insurer on your behalf. Most claims are settled through negotiation with the insurer and do not require further action.

When you accept a settlement offer from the insurer, this finalises your claim and you can no longer make a claim for injuries from that accident.

Can a claim for a child be settled?

If a child (someone who is under 18 years of age) is injured in a motor vehicle accident, they may be entitled to compensation under Queensland’s CTP insurance scheme. A claim involving a child can be settled, but extra protections apply.

Because children cannot legally agree to a settlement themselves:

• any final settlement of a child’s claim must be approved by a Court or the Public Trustee
• it must be satisfied the settlement is fair and in the child’s best interests
• the litigation guardian cannot finalise the claim without court approval (sanction) or sanction by the Public Trustee.

This process is designed to protect children and ensure their long-term interests are considered.

For more information, see FAQs – Claims involving children (under 18 years).

Either party can request a settlement conference. If requested, both parties must agree on a date and time to attend.

At the settlement conference, you will informally present your case and try to negotiate settlement. If it is a compulsory conference and you do not reach settlement, you and the insurer must exchange final offers in writing. You can accept or reject the final offer.

If settlement is not reached between you and the insurer, you may pursue a claim in the courts and are bound by their timeframes and legislative steps.

As with other stages of your claim above, you may wish to seek legal advice.

Make sure you communicate with the insurer throughout the claims process.

Get key information so you can follow up

• Ask for the name and contact details of the person who is handling your claim
• Ask for your claim number and quote it whenever you contact the insurer.

Stay informed about your claim

• Read everything the insurer sends you. Contact them if anything is unclear or you have questions.

Keep the insurer updated

• Let the insurer know the best way to contact you (e.g. mobile, email or post).
• Let the insurer know if your circumstances change – for example, if your contact details change, you move house, you change or stop work, or your medical condition changes.

The insurer may ask for more information to investigate the accident and assess your claim. You may need to:

• provide specific information, photographs, documents or records
• attend a medical examination or assessment
• complete an Additional Information Form.

To work out a fair CTP claim settlement amount, consider the costs you have already had and any future costs caused by your injuries.

This may include:

• treatment and rehabilitation costs
• loss of income
• general damages (pain and suffering)
• some costs related to gathering evidence for your claim.

For more details, see What can be claimed.

Keep records such as doctor’s reports, receipts and proof of lost wages to support your claim.

You don’t have to rush to settle – take time to understand how your injuries might affect you in the future.

If you’re unsure of what can be claimed, check with your insurer.