Catastrophic Injury Support Scheme: Car Crash Claims Western Australia
The Catastrophic Injuries Support Scheme cares for People catastrophically injured in car accidents who need lifetime care, support and treatment. That cost is significant. It can range between $3million to $15million or more. The issue is who pays for the lifetime care and treatment? If the injured person is injured by a negligent driver then that injured person can potentially claim against the negligent driver. But what if the person cannot prove that the car accident was caused by the negligent driving of a motor vehicle?
The West Australian Government’s response is the Catastrophic Injuries Support Scheme (CIS). On 1 July 2016 the scheme came into effect and is administered by the Insurance Commission of Western Australia (ICWA).
The CIS system funds treatment and care services for people catastrophically injuries in Western Australian motor vehicle accidents. Significantly the CIS system operates as a no-fault system. Because it is a no-fault system, passengers and drivers, and pedestrians who are catastrophically injured in a motor vehicle accident can get lifetime care and treatment even if they cannot prove that another driver was negligent and liable for the accident.
How To Qualify For The Catastrophic Injuries Support Scheme?
First, the catastrophic injuries must have been caused in a motor vehicle accident.
Second, the motor vehicle accident must have happened after 1 July 2016.
Third, the car accident must have happened in Western Australia.
Fourth, your injuries must be ‘catastrophic’. Catastrophic injuries are defined in the Regulations published under the Motor Vehicle (Catastrophic Injuries) Act 2016. Catastrophic injuries include:
- Spinal cord injuries;
- Traumatic brain injury;
- Amputations;
- Serious burns;
- Permanent blindness.
There are a number of circumstances that are not covered, including:
- Accidents involving unlicensed vehicles on private property;
- Sports events; and
- Terrorist acts.
How To Be Accepted As A Participant In The Catastrophic Injury Scheme
After an accident, the online crash report must be completed as soon as reasonably possible. An application to participate in the CIS Scheme must also be completed. A copy of the CIS application form can be found here.
On admission to the hospital, the hospital team will usually complete the required medical forms. Those forms include the Notification of Catastrophic Injury Form and the Functional Independence Assessment.
The forms must be submitted to the Insurance Commission of WA and ICWA will then assess eligibility to participate in the scheme.
If the forms have not been completed then you may make an application for participate. You need to make the application within 3 years of the accident, and you must use the required forms and provide the supporting documents.
What Sort Of Expenses Are Covered In The Catastrophic Injury Scheme?
Once accepted as a participant in the scheme, most reasonable care and support expenses are covered by the Catastrophic Injury Support Scheme, including:
- medical treatment (including pharmaceuticals);
- dental treatment;
- rehabilitation;
- ambulance transportation;
- respite care;
- domestic assistance;
- attendant care services;
- aids and appliances;
- prostheses;
- education and vocational training;
- home and transport modification;
- any other kinds of treatment, care, support, or services
that are approved by the Commission.
There are other case specific funding options that may be considered depending on your unique circumstances and on the recommendation of medical professionals like Surgeons and Occupational Therapists.
What is not covered In The Catastrophic Injury Support Scheme?
You cannot claim the cost of damage to your vehicle or other personal property damage.
There are also restrictions on making a claim for other types of compensation to be aware of.
Within the CIS scheme, you cannot claim:
- pain and suffering, also known as General Damages; or
- past and future lost income.
Living overseas also disqualifies you from being covered under the scheme.
As a general principle, you can claim any care or support, or medical expense for so long as the expense is reasonable. What qualifies as reasonable is dependent on what is being claimed, the circumstances, and the benefit to the injured person.
Do I Need A Lawyer?
Obtaining funding for some types of treatment or equipment often requires careful negotiation and research. Given the complexity of these cases, it is advised to have someone on your side who has experience in dealing with your treatment needs. In other cases, such as where a minor or SAT caregiver is involved then a lawyer must be involved to ensure everything is in the claimants’ best interests.
If you have any questions about the Catastrophic Injuries Support Scheme speak to your ICWA Case Manager or get in contact with Lian Hall Injury Law today for a no obligations chat.
