About MAC, the benefits and how to claim Motor Accidents Compensation

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: maca@tiofi.com.au
Fax: (08) 8941 1209
Postal address: GPO Box 770 Darwin NT 0801
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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.
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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.
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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:
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•
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.
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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.
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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.
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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.
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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.
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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 maca@tiofi.com.au
Fax (08) 8941 1209
TIO is Government guaranteed and not regulated
by APRA. TIO ABN 72 532 995 678.
MACG0212