WHAT ARE THE CTP INSURERS DUTIES?

Published 15 Jul 2011
It is important that all individuals are aware of their entitlements, responsibility, and more importantly the responsibilities of the CTP insurer while pursuing a claim under the Motor Accidents Compensation Act 1999 for injuries that he or she had sustained as the result of a motor vehicle accident.
 
It is evident that the CTP insurer of the motor vehicle at fault has a responsibility, and this is primarily located under Part 4.3 of the above mentioned act between s80-87 of the Motor Accidents Compensation Act 1999.
 
We confirm the CTP insurer of the motor vehicle at fault has the following responsibilities:

1.    General duty to try and resolve claims expediously. In other words the insurer has to endeavour to resolve a claim by settlement or otherwise, as justly and expediously as possible. S80 (2) of this act indicates that it is a condition of an insurers license that under part 7.1 that the insurer must comply with this section. Failure to do so can equal grave consequence against the CTP insurer and the CTP insurer’s licence.

2.    The insurer has a responsibility to determine liability, meaning to admit the breach of duty of care and/or deny a breach of duty of care within 3 months of when the claimant gives notice of the claim under s72 of the act. The CTP insurer of the motor vehicle at fault has a responsibility to clearly indentify whether or not the admission of liability is for the entire claim and/or a portion of the claim.

3.    A CTP insurer has a duty to make an offer of settlement within 1 month after the injury in sufficiently recovered, or within 2 months after the claimant has provided to the insurer all relevant particulars regarding the claim as required by s85A. We confirm this section of the act has been implemented with s80 of the act, attempting to create increased communication between the CTP insurer and the claimant in an attempt to encourage parties to resolve matter amicably. The insurer is not entitled to delay the making of an offer of settlement under s82 of the act, on the ground that any particulars about the claim are insufficient, unless the insurer has requested further relevant particulars within 2 weeks after the claimant has provided particulars, again it is specified in s82 (7) that it is a condition of an insurers licence under part 7.1 that the insurer must comply with this section.

4.    The CTP insurer of the motor vehicle at fault has a duty to attend to the payment of hospital, medical, pharmaceutical, rehabilitation, respite care and attendant care services expenses. We confirm it is the insurer’s responsibility to attend to the abovementioned payments when those expenses are considered to be reasonable and necessary in the circumstances, are properly verified and relate to the injury caused by the fault of the owner of the vehicle which the third-party policy has been issued. This in essence reduces the financial burden of the claimant and protects his or her interests in an attempt of treatment and rehabilitation of his or her injuries.

5.    The insurer has an obligation to do all things that is considered to be reasonable and necessary for the rehabilitation of an injured person including needing the reasonable and necessary costs and expenses of travel and accommodation incurred by the person in order to obtain rehabilitation services, if the injured person is under the age of 18 years, needing the reasonable and necessary of costs and expenses of travel and accommodation incurred by a parent or other carer of the injured person in order to accompany the injured person while he or she is obtaining rehabilitation services. The insurer must as far as is practical, ensure those services are provided to an injured person as soon as possible after an admission of liability is made by the insurer, we confirm however that once a full and final settlement of the matter at hand has been entered into, the insurer will have no responsibility for the rehabilitation of an injured person after the claim has been settled or a judgement has been entered except if provided by the terms of any order referred to in s143.

6.    It is not uncommon that as a result of serious injuries sustained as result of a motor vehicle accident that he or she may find it very difficult if not impossible to attend to work, make repayments of debts, and may in fact be faced with the real consequence of suffering financial hardship. S84A of the act makes specific provision for people of whom are in those circumstances. It is a requirement of this section on act that once liability has been admitted or determined the insurer is to make payment or on behalf of the claimant in respect of economic loss but only to the extent that such a payment is necessary to avoid the claimant suffering financial hardship. For example mortgage payments, overdue debt that would have been paid but for the accident and as a consequence of the claimants inability to attend to full time work. Given the complexity of the matter and the possible dispute that could arise between the claimant and the CTP insurer, if for any reason there is a dispute this matter can be referred to a claims assessor under s96 of the act for assessment. In this situation an independent assessor will be allocated to the file and a determination is made by the assessor as to whether or not the above mentioned payment and or payments in relation to economic loss needs to be made under this section of the act.

In essence and in summary the CTP insurer of the motor vehicle at fault has an obligation in relation to resolution of the claim, admission and or denial of liability, making an offer of settlement, making hospital, medical and other payments, making payments in respect to the rehabilitation of the injured person, duty to make interim payments in case of financial hardship.