Providing medical certificates

Requirement for a medical certificate

From 1 October 2000, an injured person wishing to make a CTP claim must complete a Notice of Accident Claim Form (NOAC form). This claim form is a pre-printed form consisting of information about the claimant and the accident, a medical certificate and an authority to access information from specified sources.

Completion of the medical certificate (page 7 of the Claim Form) is a pre-requisite for the insurer to consider funding treatment and rehabilitation and/or settlement of a claim. As the medical certificate is part of the claim form, the patient will generally present the certificate to the doctor to be completed. Doctors do not need to have a supply of certificates on hand.

Importance of the medical certificate

The medical certificate will provide the insurer with a diagnosis, and indicate the extent of the injuries and any proposed treatment. The availability of this medical information at the outset of the claim will facilitate early intervention for treatment of injuries and payment of reasonable medical, rehabilitation and pharmaceutical costs.

Insurers are only liable for the injuries arising from the motor vehicle accident. If the diagnosis is not clear and/or the certificate is not complete the insurer may need to follow up to clarify the situation and this may delay processing the claim. Together with the authority to obtain information, the medical certificate should lead to more open dialogue between insurer and treating doctor at an earlier stage post-injury and ultimately, benefit the injured person.

Authority to obtain information

Doctors are specifically authorised under CTP legislation to disclose information to insurers. Additionally, the NOAC form includes (on page 6) an authority from the claimant allowing the insurer to obtain records or information that may affect his/her claim (including information on his/her pre-accident circumstances). Note that the insurer must forward a copy of the information obtained under this authority to the claimant or their solicitor.

Medical Reports

A CTP insurer or a solicitor acting on behalf of the injured person may request medical reports from the claimant’s treating doctor or another medical practitioner. The type and purpose of the report requested may vary from a treatment plan to a medico-legal report. The insurer or solicitor will detail in their request what information is required.

Fees

If completion of the certificate occurs as part of a consultation it is envisaged that the doctor will charge for the consultation including the time it takes to fill the certificate in. Medicare benefits are payable for the entire consultation time provided that at the same time the certificate is completed, a clinically relevant and medically indicated service is performed. Alternatively, the patient may choose to recover the cost of the consultation direct from the insurer if and when, liability is accepted. It will be paid as a medical cost.

(Note: Medicare Australia have arrangements in place to recover from CTP insurers any medicare benefits paid on a compensation claim once a settlement or judgement is made, but these arrangements do not impact on medical practitioners.)

If however, the only service the doctor provides is completion of the medical certificate – which will be the case where the solicitor just sends the doctor the form, or the patient just presents and there is no history taken, examination done or relevant clinical service performed – medical practioners (if they wish) may charge the patient for the service and the patient will have to initially bear that fee and submit it to the CTP insurer as a claims cost. Recovery of that cost would be subject to the limitations imposed in respect of legal costs and outlays.

 

Last modified 20 July 2016