Personal injury claim process

I found whole claim process exceptionally stressful. QBE and their lawyers McInnes Wilson Lawyers did more that I could have imagined prolonging this process and make it more difficult and stressful. Unfortunately, personal injury lawyers, whom I hired to represent me made it even more stressful. As sed as it sounds it was deeply retraumatizing experience.

There were many things that can be done to make it different, but as I am still in the process the one thing that I can do now is to write about it while all my memories are fresh. Knowing about the process would have helped me a lot. As I am at late stages of my claim now, I will start from there and come back to earlier stages when I have time.

This is based only on my experience. You process might be different, but I hope lessons from my journey still can help reducing stress.

Incident notification

Personal injury claim form

Personal Injury Claim form has to be submitted to the insurer within 6 month since the injury.

Collecting evidence

Medical assessments

SIRA provides detailed information how injuries are assessed:

Motor accident permanent impairment guidelines. Guidelines are based on AMA guidelines. Published as AMA Guides to the Evaluation of Permanent Impairment, Fourth Edition, 1993, ISBN: 9780899705538.
Whole Permanent Impairment - workers compensation, but still has some useful information.

However, my experience shows, that what is written may be far from what is happening.

PIC provides short information about medical disputes pathways. My solicitors did not provide me with information what is going to happen and when. The sad part is that I was not able to read it myself. However, when I can, I will digest this information using my experience. I will come back to this later.

Assessors

SIRA maintains a list of health practitioners authorised to give evidence for personal injury assessment. My impression is that they represent either insurance companies or injured people. There is also third group: independent medical assessors that are assigned by PIC to provide independent medical assessment in case of dispute. I have seen 10 of them and I have very mixed experience: from very professional and accurate assessment to absurd lies that would require me to have teleportation device, time travel and other fantasy features to be make it physically possible.

I believe that such experience must be shared as it would have saved me from a lot of unnecessary suffering, so I am writing about my experience on this site and posting on other relevant sites.

Calculating whole person impairment

Unfortunately AMA Guides to the Evaluation of Permanent Impairment is not freely available and I doubt it would be an easy read. I am collecting some internet resources that can be useful to learn more about it:

How To Calculate An Impairment Rating For A Traumatic Brain Injury
Head Injury, Concussion - I recommend reading about traumatic head injury, especially concussion. It is scary, but if you already have it, knowing about it only might help. It took me 9 years to start reading about it. You may wonder why it took so long, well because I have it and it is impactful.

Disputes

You can contact PIC if you can not come to agreement with insurance you can lodge a dispute with PIC. In my case QBE was refusing to cover any expenses and to provide any compensation related to injury. If you lodge dispute online you get access to portal where you can provide all relevant information, tract progress and see insurance response.

Tribunal

Payout

Medicare Compensation Recovery

I was notified that my solicitor got money to his bank account. I was surprised that it was way less than I have expected. He wrote to me that it is because Medicare withheld 10% until, they will resolve how much money I have to pay back to them. Previously, I was told by my solicitor that Medicare will deduct automatically the sum that is awarded by tribunal. So, now I am trying to find out what is an actual process.

My current understanding is that that insurance company transfers 10% of compensation to Medicare. Medicare deduct from it what is owned to them and returns the rest. There were 2 sums:

about $10k that was listed in Medicare declaration
about $5k was awarded by PIC member as the rest was disputed by insurance.

I find out that insurance is disputing medical expenses only at the tribunal. That was big shock for me. I tried to fix situation showing that all medical expenses are direct consequence of the injury, but PIC member ignored it saying that I forgot to duplicate sums for services. Now I do not know what I will be charged, but I hope solicitor told me truth as from his side it was very easy to get it covered by insurance. I have been asked to fill in 3 forms to recover money from Medicare.

This is the information I found on Medicare site:

M0021 Medicare Compensation Recovery Third party authority (MO021). Use this form to give us permission to release your compensation information and to give permission to a third party to sign relevant documentation on your behalf.
M0023 Medicare Compensation Recovery Section 23A statement form (MO023). Use this form to declare you received no benefits, or received no further benefits since your most recent expired notice, for your compensable injury or illness.
M0026 Medicare Compensation Recovery Notice of past benefits request form (MO026). Use this form to get a copy of your Medicare history and care services statement, to find out what benefits and subsidies we will recover from your compensation.

Problems and complaints

The first think that I learned about insurance claim with QBE that nothing goes the way it is meant too. I was not able to get QBE to do the things they were required to do by law, and I could not find a way to complain about it. I am still struggling with it as my head shuts down and reading legal stuff is like hitting brick wall with my head.

I found one interesting page, that I should read when I am calmer (I may need many attempts and few months). It is on The Financial Rights Legal Centre (a community legal centre specialising in financial services) website but you may have a look at one way to complain to Australian Financial Complaints Authority (AFCA) about insurance company.

Australian Financial Complaints Authority

Australian Financial Complaints Authority (AFCA) is a free, and independent dispute resolution scheme functioning Australia wide. There are two ways to make a complaint:

Download and will in PDF form
Make a complaint online

Time limits

AFCA provides the following information:

How soon should I make a complaint to AFCA after I have become aware of an issue?

For most complaints, you should get in touch with us:

within six years after you first became aware, or ‘should reasonably have become aware’, that you suffered the loss you want to complain about; or
if you have already complained directly to your financial firm through its internal dispute resolution (IDR) process, and they replied, then you should complain to us within two years of getting this response.

Monetary limits

Monetary limits for general complaints are listed for general insurance complaints as follows: compensation amount limit per claim $631,500, Monetary restriction on AFCA's jurisdiction per claim - Amount claimed by claimant must not exceed $1,263,000.

Making a complaint online

Online portal has 6 steps.

Financial firm

QBE insurance

Type of service

My complaint relates to general insurance
Another type of general insurance

Main complaint

My claim was accepted but there is a dispute over the amount

Please provide a summary of your complaint. Include details of any other issues you wish to raise. If you have supporting documents, you will be able to attach them (up to 15 in total) in the final section of the form.

Form size 2000

I was cycling in Sydney on 2015-03-30. I was crossing an intersection on a green light. A car from oncoming traffic made a right turn straight into me. I was sure I was going to die when I saw a car accelerating towards me. I survived, but the fear stayed, among other things, like chronic pain. Since then, I am struggling with PTSD. Basically all my life was put on hold.

Having a claim with QBE was a re-traumatizing experience. It took more than 8 years to get some compensation, that is absurdly little. QBE dragged time and disregarded the law in ways I did not expect. They used incorrect information to minimize the compensation and significantly contributed to my mental health problems originally caused by road traffic injury.

I felt pressured to withdraw my claim starting from the first call from QBE after I notified them about the road collision.
They are required by law to respond about liability in 3 months (and there was no doubt about it), but they took 3 years to respond. Then there was a prolonged personal injury claim process that finished in 2023.

QBE never paid for any treatment. Instead, I was sent to different specialists with an empty promise that they will pay after assessment. I never got their psychologist report, but instead, later I was sent to another one.

The statements they provided (including their lawyers and specialists) break basic laws of physics: I would need a teleportation device and time travel for it to be true, other statements are just pure fiction. It significantly affected the compensation. The end result is very unfair. For example, for the loss of income for more than 8 years I got $100,000. In reality, this is less than what I would have earned in a year.

I suspect that collusion took place, but I believe it to be very difficult to prove. But, I do not see any other logical explanation.

I am writing a complaint only now, because QBE dragged time, and till the assessment conference I had a chance of a reasonable outcome.

No reference

If you have lodged this complaint elsewhere, please tell us where

Communications with QBE

January 2016, I have asked one lawyer for advice what to do that QBE is ignoring me. He contacted QBE on the phone and QBE mentioned that they will respond about liability soon. QBE case manager actually called me about two months after the call from lawyer to QBE and she told me that they are finalising the decision and will contact me soon. Every time I spoke with someone from QBE (and most of the time it was same case manager) I felt completely hopeless. They been just promising to do what they are required to do and not doing it. I got so overwhelmed, that could not cope with it anymore and went into shut down mode. I got stuck at that time and it has been 8 years. After this call I have only very few fractured memories for a very long time.

Unfortunately, I waited for that response for another 2 years.

Government organizations

There are several government organizations involved in personal injury claim process in New South Whales and some Australia wide. To make it easier to identity I provide list of them:

State Insurance Regulatory Authority (SIRA): https://www.sira.nsw.gov.au/ They regulate motor incidents CTP insurance, workers compensation insurance and the home building compensation scheme in NSW. They used to be in charge of whole process, but now you mostly will be dealing with PIC.
Personal Injury Commission (PIC): https://www.pi.nsw.gov.au/ They resolve disputes between people injured in motor incidents and workplaces, employers and insurers in NSW.

Personal Injury Commission

Getting information

You will not be allowed access to portal if you have legal representation. This gave opportunity for my lawyers to misrepresent me without me knowing about it. You will be at the mercy of your legal representation. There are 3 ways to attempt to get information:

Phone PIC 1800 742 679 - while they are polite, some persistence will be needed to get information and there is good chance you will not get it.
Write to PIC help@pi.nsw.gov.au
Use GIPA request

I have not checked yet

https://www.police.nsw.gov.au/about_us/organisational_structure/units/professional_standards_command?fbclid=IwZXh0bgNhZW0CMTAAAR2bq6dZyTfYh9eED_MWEP_3IqYCX_Ljj_105NVusP1QshH1M8JkfJav_pM_aem_fNK_h9xmXhj_H9vkOqhjGg#:~:text=The%20Professional%20Standards%20Command%20

Acronyms

There are many acronyms used in various documents as it some organization titles are very long.

Compulsory Third Party (CTP) insurance: Provides cover for death and personal injury when you, or the person driving your vehicle, is at fault in a road collision.
American Medical Association (AMA): https://www.ama-assn.org/about They define the Guides To The Evaluation of Permanent Impairment. Same guides are used for assessment of permanent impairment in Australia.