Medical Evidence In Personal Injury Claims – What To Expect

Sustaining injuries in a car crash is not only traumatic but can significantly impact your quality of life and leave you with hefty medical bills.

To make the best of your situation, it is important to know how to claim for personal injury compensation from your CTP (compulsory third party) insurer and how to obtain and submit medical evidence that supports any claim. In Western Australia, that is The Insurance Commission of Western Australia (often referred to as “ICWA”).

In this article, we will explore what you can expect when going through the process of making a personal injury claim and how best to navigate this process as efficiently as possible.

Steps To Take After An Accident

Whether or not you suffered any obvious injuries during your road accident, it is wise to consult your doctor for a thorough physical and mental examination. The adrenaline hormone and other pain-numbing chemicals such as endorphins are released in high-stress situations which help mask pain and could make you unaware of injuries you have suffered.

Seeing a doctor after an accident is a prudent and often necessary measure which can help identify any underlying issues and avoid possible health implications later on. For example, headaches after an accident may be temporary or long-lasting and should be investigated to establish whether there is some serious underlying problem. Medical conditions usually respond better to prompt treatment and this may help avoid injuries becoming chronic over time with lack of treatment.

Another reason to consult your doctor is because of the medical records created each time you see a treating specialist. This is evidence of the assessment and treatment you receive following your accident and makes it easier for the Insurance Commission, your lawyer and ultimately the court to establish exactly what complaints were made and when.

This helps to avoid the uncertainty associated with situations where there is delay in reporting the injuries and seeking treatment. Often victims of road crash injuries wait to see whether they improve and delay getting the treatment they need to reduce their symptoms. This may delay not only their recovery but also the processing of their claim. It is also useful to show what medication costs (past and future) you may need to claim from your CTP insurer.

You may also be able to claim for the reasonable cost of any psychological treatment or physical rehabilitation that is directly related to the accident. This means that any medical costs, whether physical or mental, that directly relate to your accident can be claimed back. This often takes the form of post-accident anxiety or, in serious cases, post-traumatic stress disorder (“PTSD”).

It is important to remember that if you are partly to blame for the accident, you will only be able to recover that proportion of your expenses which is attributable to the other driver’s fault. So, if both drivers are equally to blame, each would recover 50% of their treatment costs and any compensation for pain and suffering would be reduced in the same way.

Reimbursement for Your Medical Bills

After establishing who was responsible for the accident, provided you were not entirely to blame, you will be able to reclaim some or all of the cost of your medical bills. You will need to complete and lodge a “Notice of Intention to Claim” form with ICWA as the CTP insurer for the “at fault” driver. You will also need to provide them and your lawyer with a signed consent form which will allow them access to your medical records (hence the importance of proper record-keeping as mentioned above).

After receiving your claim, the CTP insurer will examine all of the medical evidence that supports the claim and may arrange further medical examinations to establish the seriousness and long-term implications of your crash injuries.

Once they are notified about a claim, the CTP insurer will need to investigate the accident before it will make a decision on your claim. They may need to interview witnesses and it may therefore take some time for them to reach that decision. You will need to co-operate with them, but most claims are dealt with promptly. Many claims will settle within two years of the accident, but more serious or complicated claims may take 3 years or more to settle in full. This is often because the medical situation is still unclear and further treatment needed but it may also be because there is a dispute about the claim itself, for example the medical experts may disagree about the prognosis or there may be an ongoing dispute about who was to blame for the accident.

Upfront Reimbursement

Although a CTP insurer must first accept liability before it can reimburse any medical costs, some CTP insurers will fund certain medical treatments upfront (on a “without prejudice” basis) if they consider that they are ultimately likely to deal with the claim and that it is in everyone’s interests to support such treatment.

Making Claims for Medical Bills

You will need to fill in a personal injury claim form (Notice of Intention to Claim) if you want to claim for medical costs. You also need to submit your claim as soon as reasonably practicable after an accident, as delay can affect how long it takes to process the claim. In cases of serious delay, the claim may be rejected altogether on the basis that the CTP insurer has been denied a reasonable opportunity to investigate the accident and injuries.

When it comes to road accidents, you can claim medical expenses for the following:

  • Ambulance and hospital costs, medical attention and the reasonable rehabilitation costs directly related to the accident
  • Any necessary care, for example where assistance is needed with normal daily tasks
  • Medical devices, aids and any home modification costs directly attributable to the accident.
  • Economic losses or expenses as a result of the injuries (usually loss of earnings)

You will need to show that the amount claimed is reasonable and based on your needs, that it can be medically verified and that the injuries suffered were caused by the accident alone and not some other unrelated condition or event.

By submitting copies of all the relevant medical records or other documentation that the CTP insurer may need, you will help to speed up the process.

Factors that may reduce the amount you receive include:

  • Not wearing a seatbelt or a helmet
  • Not sitting properly in the correct part of the car.
  • Presence of drugs and alcohol
  • Travelling in a vehicle with a driver who is known to be unfit to drive

Although no-one wants to think about preparing for life’s unfortunate events, being prepared in situations like these will help you to stay calm during and after an accident. One of the most important factors is to keep a detailed record of your medical situation following a car crash. By doing so, you will have all you need when it is time to claim back for medical expenses.