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What can an injured person do if the insurer rejects rehabilitation?

Compulsory Third Party insurers (“CTP insurers”) are a business. The objective of any business is to generate profits, and this is no different for a CTP insurer. An injured person would usually experience this at the conclusion of a claim, when negotiating a settlement. An insurer will seldom agree to pay the injured person exactly what has been asked for compensation and will negotiate downwards. However, insurers will sometimes seek to reduce their costs earlier in the claim by declining to fund rehabilitation for an injured person.

Certain obligations are placed on CTP insurers under the Motor Accident Insurance Act 1994 (Qld). This Act requires insurers to provide rehabilitation services to injured person who have made a claim, but is subject to conditions. If liability has not been admitted or the insurer has not agreed to provide rehabilitation services, they are not required to provide the rehabilitation services.

Without the legal obligation to provide rehabilitation services, a CTP insurer cannot be compelled to provide the services, even when presented with a treatment plan by a health professional. Once liability has been admitted, the CTP insurer becomes responsible for funding any medical expenses incurred because of the injury they sustained from the accident.

The Motor Accident Insurance Regulation 2018 (Qld) sets out guidelines and standards for insurers to follow. When a rehabilitation plan is submitted to the CTP insurer for approval, it can be wholly approved, partially approved, or the insurer can request further information to properly consider the plan. To be able to reject the rehabilitation plan or any part of it, it must fail to be “reasonable and appropriate”. Provided the treatment plan follows the guidelines, the Courts often favour the injured person and direct the CTP insurer to fund the rehabilitation services.

If the insurer rejects a rehabilitation plan, they must provide their reasoning in writing to both the health professional and the injured person. If the injured person is unsatisfied with the insurer’s decision regarding their treatment plan, they can apply to have a mediator appointed to resolve the disagreement via the Motor Accident Insurance Commission, or the injured person can apply to the Court to determine what rehabilitation services are reasonable and appropriate.

For more information about motor vehicle accident claims read our other articles available on our website or call one of our injury compensation lawyers on 13 58 28. If your insurer rejects your rehabilitation plan, you can see one of our injury lawyers in Ipswich, Gatton, Springfield or at your home.


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