Table 1 Comparison of the Victorian and NSW compensation scheme design
| Â | NSW motor accidents scheme | Victoria transport accident scheme |
|---|---|---|
Scheme structure and administration | ||
1. Legislation | Motor Accidents Compensation Act | Transport Accident Act |
2. What type of law governs the scheme: no-fault, hybrid, common law? | Hybrid. Mainly fault. Injured people have to prove that somebody else was at-fault. People can lodge a no-fault claim regardless of fault up to $5000. No-fault claims were excluded in this study. | Hybrid. Mainly no-fault. Injured people can claim regardless of fault. People with serious injury have access to common law, which is fault-based. Common law claims were excluded in this study. |
3. Is the compensation scheme mechanism-based or disability-based? | Mechanism-based (injury resulting from motor vehicle/land-based transport accident) | |
4. How does the compensation system interact with other societal structures? | Both systems purchase healthcare from national publicly funded and private healthcare systems. Both have involvement with legal systems for dispute resolution. | |
5. Is the insurance compulsory? How is the scheme funded? | Compulsory insurance. Funded by annual insurance premiums paid by motor vehicle owners as part of registration. | |
6. Does the jurisdiction insure through private carriers or a state insurance fund? | 7 Third party private insurance companies (profit) | 1 First party state government compensation agency (non-profit) |
Scheme eligibility | ||
7. Is liability assessment a feature of the scheme? | Yes. Liability is assessed within 3Â months after claim lodgement | No. Coverage is accepted for all transport accident related injuries. |
8. What proportion of the total transport injury population is covered by the scheme? How is the total transport injury population defined? | The transport injury population are those who are injured in a transport accident that occurred in the state under investigation (respectively Victoria or NSW) AND anyone traveling in a vehicle registered by that particular state (respectively Victoria or NSW) in any part of Australia | |
9. Which injuries and afflictions are covered and which are not? Are mental health claims covered? | All injuries arising from the transport accident are covered including mental injury. | |
10. What is the time frame to lodge a claim? | The fault-based claim has to be lodged within 6Â months post-injury | The no-fault claim has to be lodged within 12Â months post-injury |
Medical assessments | ||
11. Who conducts the medical assessments? What is the role of the physician in injury certification and fitness for work? | Medical assessments are conducted by doctors assigned by the insurance company or assigned by the injured person’s lawyer. For disputed medical assessments there is an independent medical assessment service | <18 months: assessments are conducted by injured person’s general practitioner. >18 months: there is a change in income replacement benefits so people still on benefits at this time commonly undergo a medical assessment by an assessor nominated by the TAC to determine work capacity |
Scheme benefits and entitlements | ||
12. What benefits are paid for? | Compensation can be paid for medical and rehabilitation services, past (i.e. between injury and claim settlement) and future (i.e. after claim settlement) income replacement, travel, and household support, legal services, and pain and suffering | No-fault benefits include medical and rehabilitation services, income replacement, travel, and household support. Legal costs related to disputes (protocol disputes and Victorian Civil Appeals Tribunal) are reimbursed. |
13. What is the level of income benefits/loss of wages? Are there caps on the wages earned? | Loss of wages involves 100Â % of previous/future salary. Capped at $4,412 net weekly earning (2014). Payments are tax-free, provided certain conditions are met. | The claimant has to cover the first 5 working days before compensation of loss of earnings commences. <18Â months: Income benefits will generally be 80Â % of pre-accident weekly earnings, capped to a maximum of $1,250 per week (2014/15). Clients who were earning less than $612 will get 100Â % of the pre-accident earnings. These payments are taxed. >18Â months: Based on work capacity assessment. Payments are capped at $1,060 per week and they are not taxed. >36Â months: Continuing benefits only with an impairment of at least 50Â % |
14. What is the duration and frequency of payments? | Treatment is paid as long as it is reasonable and necessary. Usually paid on an as incurred basis. Loss of income comprises 100Â % of pre-injury earnings. Capped at $4,412 net weekly earning (2014). Loss of past and future income reimbursements are paid as a lump sum at claim settlement. Periodic financial hardship payment can be paid. | Treatment is paid as long as it is reasonable and necessary. Usually paid on an as incurred basis. Income benefits for no-fault claims are limited to 3Â years from the accident unless they have a permanent impairment level of at least 50Â %. Income benefits are paid fortnightly. Claims do not formally close. |
Scheme Changes | ||
15. Has the compensation scheme undergone any significant changes during the study period? | No changes during the study period. | The claims process changed in October 2013. The main changes with respect to perceived fairness were an easier claims form and faster approval of services. Also a joint medical examination process was introduced reducing the number of medical assessments. |