New laws in 2019
It is illegal in Queensland for lawyers to pay a fee to a car crash scammer.
Legislation was introduced in December 2019 to stop insurance car crash scamming (commonly known in the insurance industry as ‘claim farming’). A person making a CTP insurance claim must now state whether they are making the claim on their own initiative or if they were contacted by another person who solicited or induced them into making a CTP insurance claim. If they have engaged a law firm, the person making the claim must also advise whether they are aware of anyone having given a fee, gift or benefit to another person for the referral of their claim to that law firm. This practice is referred to as ‘claim farming’ or ‘car crash scamming’ and is illegal in Queensland. Severe penalties have been introduced including fines as high as $40,035.
Requirement for a Medical Certificate
A person who has been injured and wishes to make a CTP insurance claim must complete a Notice of Accident Claim Form (Non-Fatal Injury) through our eNOAC form or PDF version (see our Forms page for more details). The form comprises information about the claimant and the crash, a Medical Certificate, Claimant Certificate; Law Practice Certificate and an authority for the insurer to access information from specified sources.
Completing the Medical Certificate is required on all CTP claims and for the insurer to consider the funding of treatment and rehabilitation. 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.
The Medical Certificate (PDF, 530 KB) has been updated as a result of the new laws so that you MUST:
- physically examine the injured person and provide the date that the physical examination occurred
- state whether the injured person was, at the date of the crash, an existing patient of yours at a medical practice in which you practise or were practising
- include your AHPRA registration number
- initial at the bottom of the first page and sign at the end of the second page, where indicated.
Importance of the Medical Certificate
The Medical Certificate (PDF, 530 KB) 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 injuries arising from the motor vehicle crash. If the diagnosis is not clear and/or the certificate is not complete, the insurer may need to follow up to clarify which may delay the processing of the claim. Together with the authority to obtain information, the Medical Certificate should lead to more open dialogue between the insurer and treating doctor at an earlier stage after the injury to ultimately benefit the injured person.
It is important to note that physical examination of the injured person must be performed by the medical practitioner before or when the Medical Certificate is completed by the medical practitioner. If a physical examination does not take place, this will delay the claim.
Authority to obtain information
Doctors are specifically authorised under CTP insurance legislation to disclose information to insurers. Additionally, the NOAC includes an authority from the claimant allowing the insurer to obtain records or information that may affect their claim; including information on their circumstances before the crash. The insurer must forward a copy of any information obtained under this authority to the claimant or their solicitor.
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 reports 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.
If the Medical Certificate (PDF, 530 KB) is completed during a consultation, it is envisaged that you as the doctor will charge for the consultation, including the time it takes to fill in the certificate. Medicare benefits are payable for the entire consultation time if a clinically-relevant and medically-indicated service is performed at the same time the certificate is completed. 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 medical practitioners.)
If the only service the doctor provides is completing the Medical Certificate, medical practitioners may choose to 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. This scenario may occur when a lawyer simply sends the doctor the form, or the patient just presents and there is no history taken; or no examination done; or no relevant clinical service performed (because the physical examination has already occurred). Recovery of that cost would be subject to the limitations imposed in respect of legal costs and outlays.