MAIC guidance: reasonable and appropriate treatment expenses

A number of matters have been brought to the attention of MAIC recently regarding an insurer’s approach to funding for CTP claimant treatment costs.

MAIC has engaged with licensed CTP insurers and confirmed all are now adopting a consistent approach in approving reasonable and appropriate treatment expenses. The guidance MAIC has provided to all insurers in relation to treatment costs is as follows:

  • The cost is in line with what a member of the public without a CTP insurance claim would be charged for the same service.
  • The fee is in line with normal market rates.

MAIC has never intended that the above be interpreted in a manner that creates a schedule of fees or places caps on fees for Queensland CTP claims.

Equally, this does not mean insurers should not challenge instances involving excessive fees or treatment – but this should be done in relation to the specific cases where the conduct occurs.

Injured claimants are at liberty to choose their treatment provider and the treatment regime and cost should be reasonable and appropriate.

MAIC is presently exploring a roundtable meeting of relevant stakeholders to seek to ensure there is clarity around the intent and application of the scheme approach to treatment expenses. We will provide more details shortly and will call for agenda items ahead of the meeting.

If you require further information, please contact us at maic@maic.qld.gov.au or 1800 CTP QLD (1800 287 753).

Last modified 8 September 2020

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