Sick or injured through no fault of your own? Relax, we’ve got your back. Here’s your need-to-know guide on lodging a compensation claim and HIF’s role in the process.
What is a compensation claim?
If you’re injured or suffer an illness due to the fault of a third-party (for example, a car accident or medical negligence), or you’re affected by injury or illness in the workplace, you may have the right to pursue a compensation claim against that party.
If you suspect that you’ve been injured or affected by a third-party, you need to alert your health fund immediately.
Why is it important to advise your health fund?
If you’re injured by a third-party, they’re obliged to pay the resulting medical bills. You’ll need to ensure that any claims you make (even if settled out of court) include the cost of your medical bills.
In most cases, HIF will usually pay your bills in the meantime. However, we’ll need to be reimbursed once your compensation claim is settled. That’s why it’s important to ensure you include all medical bills in your compensation claim. We’ll assist you by providing all the details you need, which you or your lawyer can then detail in the claim.
Important, please note: No health insurer is required to pay claims where the Member has a right to pursue a compensation claim. It’s a specific exclusion for all health funds; so, any benefits paid out towards medical claims in-line with a compensation claim will need to be fully reimbursed to HIF once the compensation is accepted or settled.
What must I consider if I’m settling a compensation claim?
If you’re attempting to settle a compensation claim, it’s very important that you (or your lawyer if you have legal representation) advise HIF of all the details from the outset.
We’ll then provide a statement of benefits for you to review. Once you’ve checked each item carefully, please return the statement to us with ticks next to all services relating to your compensation claim.
Please also ensure that when lodging your compensation claim, you (or your lawyer) specifically stipulates that HIF must be reimbursed for all medical expenses covered in the interim period.
What about future medical expenses?
In addition to the medical expenses you’ve incurred so far, it’s important to consider any future expenses that your injury/illness may cause. It’s imperative the amounts required by you for future medical expenses are clearly articulated and recorded by you or your lawyer.
The party that caused the injury/illness is also liable to pay for future medical expenses. That means HIF isn’t obliged to pay benefits on those either. As such, it’s in your best interests to insist that an amount be set aside in your settlement for future medical expenses that may arise further down the track.
Broad types of compensation claims
There are many types of compensation claim scenarios. Here are the most common conditions where a compensable claim may be made:
- Motor vehicle accident
- An injury which occurred in the workplace (this is considered a ‘no fault’ claim regardless of how the incident occurred)
- An illness/injury suffered on account of medical negligence
- An illness/injury where you’ve initiated action under a class action suit
- A mesothelioma claim (cancer caused by exposure to asbestos)
- A silicosis claim (lung disease caused by breathing in silica)
- An occupational or industrial disease
If you’ve suffered or experienced one of the items listed above, please inform us immediately.
Some General Information
In the first instance (regardless of which state or territory you work in), if you’re injured at work you should contact your employer and their insurer (if applicable) to advise them of the claim. If you have difficulty in lodging your claim or you’re unhappy with how your claim is being handled, the following information may assist you.
|State||Injuries at work||Third-party motor vehicle accidents|
|Western Australia||WorkCover WA|
08 9388 5555
|Insurance Commission of Western Australia|
08 9264 3333
|New South Wales||SIRA (State Insurance Regulatory Authority)|
13 10 50
|SIRA (State Insurance Regulatory Authority)|
13 10 50
1800 136 089
|Transport Accident Commission in Victoria.|
1300 654 329
1300 362 128
Not all workers compensation claims in Queensland fall under the purview of WorkCover Queensland however they will direct you to the appropriate authority
|Contact your Third-Party vehicle insurer|
13 22 81.
|CTP insurer of the vehicle that caused the injury.|
If the vehicle is unregistered, contact the Nominal Defendant in the ACT
02 6207 0184.
1800 250 713
|NT Motor Accident Compensation Scheme|
|Motor Accident Insurance Board|
1800 006 224
|Call the insurer of the vehicle that caused the accident. For more information, CTP Enquiry Helpline on 1300 303 558|
Each state government regulates the workers compensation scheme in that state/territory. The various schemes are administered in different ways and insurers may have different roles within the schemes. In WA, Tasmania, ACT and the NT, insurers privately underwrite the scheme. In NSW, SA and Victoria, insurers operate as scheme agents on behalf of the government authority. In Queensland, the scheme is operated entirely by the state.
If you’d like more info on the workers compensation and injury management schemes in each state or territory, please use the links below
Your obligations as a Member of HIF
You’re required to inform HIF as soon as you’re aware of the injury, illness or medical condition that you believe to be caused by the actions of another party. Do not wait for your claim to be lodged or accepted by the insurer.
Once you’ve been in touch, we’ll send you a questionnaire to complete. Please return the completed document to us as soon as possible.
If you’ve appointed legal representation in relation to your compensation claim, please advise your lawyer that you have private health insurance with HIF.
If we pay any claims in relation to the injury, you’ll be required to reimburse the costs to HIF as soon as your compensation claim is settled.
Rules governing compensation claims
If you’d like HIF to continue paying your medical claims benefits prior to the acceptance of your compensation claim, we’ll send you a ‘Provisional Payment Form’ to complete and return to us.
Once we receive your completed form, we may consider paying benefits in-line with your policy until your claim has been accepted by the third-party insurer. In those instances, the benefits being covered are done so on the understanding that any costs incurred by HIF will be reimbursed in full once the claim has been accepted or settled.
If the third-party insurer accepts liability for your claim, HIF won’t pay any benefits for the injury, illness or medical condition to which the accepted compensation claim relates. In that instance, you’ll need to claim those costs directly from the third-party insurer.
If you’re settling a claim, please speak to the defendant/third-party insurer about including an allocated amount to cover future medical expenses. HIF is not required to fund any future medical expenses which relate to the medical incident for which the compensation claim was made.
If you would like to read the HIF Fund Rules in relation to compensation claims, please see Section F6 of our Fund Rules (page 67).