Motor Accidents Compensation About MAC, the benefits and how to claim Information is current as at February 2012 Contact Us Phone: 1300 301 833, then choose “Option 3” Monday to Friday: 8.30am – 5.00pm Email: [email protected] Fax: (08) 8941 1209 Postal address: GPO Box 770 Darwin NT 0801 2 Contents About MAC 4 How to Make a Claim 5 Working with Us 6 Your Role 6 The Benefits Available 7 Payment for Treatment 8 Travel Costs 8 Loss of Earning Capacity (LOEC) Benefits 9 Permanent Impairment Benefits 9 Independent Medical Examinations 10 Decisions on Your Claim 10 Dispute Resolution 11 Privacy of Your Information 11 3 About MAC In 1979 the Northern Territory Government established a no-fault motor vehicle accident compensation scheme. The Motor Accident Compensation (MAC) scheme is administered by TIO and operates under the Northern Territory Motor Accidents (Compensation) Act (the MAC Act). From 1 July 2007, the scheme covers people who are injured or die as a result of a motor vehicle accident in the Territory, irrespective of where the motor vehicle is registered. Certain exclusions and reductions to benefits may apply where the injured or deceased was involved in criminal or reckless conduct, such as drink driving. All types of road users are protected by the scheme including pedestrians, drivers, passengers, motor cyclists and cyclists. The Motor Accidents Compensation scheme is funded by Territorian motorists when registering their vehicles annually in the NT. TIO is the administrator of the scheme. MAC also promotes road safety in the NT and is dedicated to reducing our road toll. MAC is a no-fault scheme. Even if the accident was deemed your fault, you may still be eligible to receive benefits. 4 How to Make a Claim TIO will be there for you if you are injured in a motor vehicle accident. To receive treatment and support services to help with your recovery, a claim form needs to be lodged with our team. The quicker you lodge a claim the sooner TIO can begin paying for your treatment. Supporting documentation should accompany your claim to assist us in processing your claim quickly. These documents include: • Medical reports • Accident circumstances • Proof of dependency All claims should be lodged within 6 months after an accident. Claims received after this time may be refused and all claims received more than three years after an accident will be refused. You can download a claim form from www.tiofi.com.au or collect one from any TIO branch. You can also call us on 1300 301 833. Claim forms may also be available at the hospital upon admission. 5 Working with Us When your claim has been processed, a TIO Claims Officer will be assigned to your case and you will be given a MAC Claim Number. Have this number handy when you call or attend treatment for your accident injuries. Make sure that your Claim Number is also on all correspondence and documentation that you and your doctors send us. This will ensure your treatment is paid for by TIO. If your contact details change while you are receiving MAC benefits, please inform your MAC Claims Officer. This will ensure your payments are processed quickly and we can send you any important information related to your claim. Contact your MAC Claims Officer to discuss your claim or talk through any concerns. Your Role TIO will support you in your recovery, but the most important person for a successful return to health is you. In working with us, while you are receiving MAC benefits, you are responsible for: 6 • seeking and attending treatment sessions • providing medical certificates as required • staying in contact with your treating team and your MAC Claims Officer • updating your contact details if they change • contacting your MAC Claims Officer if you can’t make a treatment appointment • working with us towards your recovery The Benefits Available The range of medical, rehabilitation and associated costs that TIO will pay for to get your health back on track after an accident include: • Ambulance services: transport from the accident to the hospital in an ambulance and, where required, from one hospital to another. This may include air ambulance services. • Hospital services: treatment at a public or private hospital within Australia for surgery, X-rays or other medical imaging, and other hospital costs. • Medical services: costs to treat your accident-related injuries by a doctor or specialist. • Medical rehabilitation (inpatient or outpatient): post-accident treatment in a rehabilitation facility. • Rehabilitation/Therapy services: physiotherapy, occupational therapy, chiropractic and psychological treatment. • Pharmacy expenses: medications to treat your injuries. • Dental services: dental treatment for teeth damaged in an accident. • Nursing services (not including attendant care services): home visits may be covered if you require nursing treatment after your accident. • Return to work programs: when you need help to get back to work. • Equipment or Appliances: required by you as a result of your accident, including home or motor vehicle alterations recommended by an appropriately qualified health provider. These all require pre-approval by TIO. 7 Attendant Care services: Short term benefits may be payable if you are unable to undertake your own personal care needs. Long term benefits may be payable if you suffer a permanent impairment as a result of your injury, and the degree of impairment is assessed at 60% or more. Emergency Travel benefit: Benefits may be payable if a close family member(s) is required to travel at least 1,000 km to be near you following the accident. For more information please contact TIO. Payment for Treatment Contact us before starting treatment to confirm that the service is included in your treatment plan to be paid by TIO. Your treatment needs to be reasonable and contributing to your rehabilitation. Your medical and rehabilitation costs can be paid directly by TIO if you have the service provider bill us or you can be reimbursed. If you choose to pay upfront, the tax invoice must be provided to TIO for reimbursement. Travel Costs TIO can reimburse you for the reasonable cost of travelling to and from your accident-related medical and rehabilitation appointments. This includes travel by public transport, by private vehicle and, in some circumstances, by taxi if pre-approved by your Claims Officer. TIO has a set rate per kilometre to reimburse people who travel by private vehicle. You will need to complete a Travel Reimbursement Claim Form, which can be obtained from your Claims Officer on request. 8 Loss of Earning Capacity (LOEC) Benefits If you need to take time off from work after an accident, we will be there for you. Not only will we help you get your health back on track, but we will ensure you receive financial assistance during this difficult time. If you are eligible TIO can pay LOEC benefits. So if you are aged between 15 and 65 and had a capacity to earn prior to your accident you may be entitled to Loss of Earning Capacity (LOEC) benefits. LOEC benefits are paid fortnightly subject to a valid and current “MAC Medical Certificate” from your doctor or specialist stating your current work capacity. We prefer to pay by Electronic Funds Transfer (EFT) directly into your nominated account. Permanent Impairment Benefits You may be eligible for a lump sum payment if your injury is permanent and stable. Benefits are only payable if you are medically assessed to have a permanent whole person impairment (WPI) percentage of 5% or more. Impairment is a permanent physical or psychological condition resulting from your motor vehicle accident. If you are considered likely to have a permanent impairment, TIO will arrange for your injuries to be assessed by a doctor or specialist. Please see our brochure on Permanent Impairment Benefits. 9 Independent Medical Examinations TIO will ensure that you receive the right treatment to return to health. In some cases, we may require that you attend appointments with an Independent Medical Examiner (IME) for reasons such as – • a general review of your medical situation • advice on your future treatment requirements • assessment of whole person impairment (WPI) • assessment of your ongoing entitlement and benefits You can be assured that we will do our best to arrange appointments with an Independent Medical Examiner at a time and place convenient to you. Any necessary travel and accommodation for you to attend an IME will be paid for by TIO. Decisions on Your Claim We are required to make decisions in accordance with the MAC Act. The Act sets out which services and benefits you are entitled to. Once a decision has been made about your claim, TIO will advise you of the outcome. We will also advise you in writing when a decision has been made to reduce or cease any benefits. 10 Dispute Resolution If you disagree with a decision made on your claim, you can elect either an Internal Review by an independent MAC staff member or for a TIO Designated Person Review. You or a representative must complete and lodge a Review Request Form within 90 days of the decision. Contact TIO for a form. If you disagree with the outcome of your review, you can refer the matter to the Motor Accidents (Compensation) Appeal Tribunal. For more information on the Appeal Tribunal process please contact TIO. Privacy of Your Information TIO is committed to protecting the privacy and confidentiality of your personal information. We act in accordance with the Information Privacy Principles of the Northern Territory Information Act. TIO collects your personal information for the primary purpose of evaluating and administering your claim. Generally we receive your personal information directly from you however there may be times when we collect personal information from other sources. You can apply for access to your personal information that has been collected and held by TIO. For information about access to or correcting your personal information, or if you would like a copy of our full Privacy Policy document, please contact us on 1300 301 833 or visit our website at tiofi.com.au. 11 Contact Us For More Information 1300 301 833 (then choose “Option 3”). Phone Monday to Friday: 8.30am – 5.00pm. Write GPO Box 770 Darwin NT 0801 Email [email protected] Fax (08) 8941 1209 TIO is Government guaranteed and not regulated by APRA. TIO ABN 72 532 995 678. MACG0212