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Benefits Management Policies

Loss of Earning Capacity Benefits (Section 13)

If you are entitled to Loss of Earning Capacity benefits, a valid doctors certificate covering the period of time you are unable to work due to your accident injuries is required prior to certain payments being made on your claim.

While we will attempt to send a reminder prior to the expiry of your certificate, we cannot guarantee that this will occur. You are responsible to obtain an updated medical certificate prior to the expiry date of the existing certificate to ensure that there is no interruption in the periodic payments. You should also provide us with a final clearance certificate when you have been cleared to return to employment.

As a general rule:

1. Benefits will cease if we do not receive an updated certificate prior to the expiry of the dates outlined in the preceding certificate.

2. General Practitioners should not issue certificates that cover dates prior to the date you were examined by that doctor. In the unlikely event that a backdated certificate is received, we will not make payment for the period prior to the examination.

We will pay for a consultation by the doctor (up to the AMA scheduled rate) to enable a doctor to assess whether you have a continuing incapacity, or to obtain a final clearance.

If you claim is accepted for benefits the following may be payable to you. 

• Weekly compensation benefits are paid fortnightly and in arrears from the first working day after the accident;
• "Earning Capacity" refers to the capacity to earn from personal exertion (either physical or mental). This means if you are able to work with skills that you have, whether you choose to work or not you have an earning capacity. If a doctor or specialist says you can work part-time in a position that pays more than the benefit level, benefits are no longer payable.
• To claim fortnightly benefits you must supply us with a medical certificate from your treating doctor or specialist. This certificate should detail the period of your incapacity and the reasons for that incapacity.
• Back dated medical certificates or certificates that state your incapacity as a "medical condition" are not accepted by us.
• Medical certificates should be current. Further certificates should be supplied by the same doctor or specialist where possible and each certificate should not be for longer than 3-months unless otherwise negotiated. You should also provide us with a final clearance certificate when you have been cleared to return to employment.
• If you are in a rehabilitation program and you stop participating fortnightly benefits may stop and may not be back dated.
• Fortnightly benefits can be ceased when:
  - You have returned to work and no further medical certificates are provided.
  - When you are capable of working full-time, whether or not you have returned to work or any job is available.
  - Where you earn in excess of the loss earning capacity benefit for part-time work.
  - Non-compliance with a rehabilitation program approved by TIO.
• We do not issue group certificates for fortnightly benefits paid, as the benefits are not income tax assessable. When you complete your Tax Return all you need to declare is the period (not the amount) that you have been in receipt of fortnightly benefits and quote Australian Tax Office Ruling Number IT2193.

NOTE: The Loss of Earning Capacity benefits (Section 13) are calculated at 85% of the average weekly earning for all employees' total employment earnings in the Territory, less a notional deduction for income tax.

Lump Sum Compensation for Permanent Impairment Benefits (Section 17)

• A lump sum amount may be payable once your injury is permanent and stable.
• Benefits are only payable if you are medically assessed to have a whole person permanent impairment percentage of 5% or more.
• An assessment by an independent specialist in the appropriate field is made once we are notified that your injury, or injuries, are permanent and stable. There may be cases where more than one assessment is needed.
• The assessment by the specialist must be based on the relevant volume of the American Medical Association Guides to Permanent Impairment at the time of the assessment.
• The benefit amount is calculated based on the year it is paid.
• Whole person impairment benefits are paid on a sliding scale where the assessment is between 5% and 14% WPI. (To view the sliding scale table please refer to "Indexed Benefits" under Level of Benefits.)

Medical, Hospital & Rehabilitation Benefits (Section 18) 

The following is payable under the Scheme:

• Reasonable costs that are not more than the recommended fee levels in the Australian Medical Association (AMA) list of Medical Services such as:
  - Medical specialists and doctors' consultations;
  - X-rays and other medical imaging; or
  - Surgery.
• For general consultations with your doctor, we will only pay the AMA scheduled rate (indexed annually on 1 November). If your doctor charges in excess of these amounts, you will be responsible to pay the difference.
• Medication related to the accident and prescribed by a doctor or specialist
• Reasonable rehabilitation services
  - As supported and referred to by your doctor or specialist that is expected to improve your condition; or
  - As needed for return to day-to-day activities and work.
• Hospital Expenses
• Travel to and from medical and rehabilitation treatment or appointments:
  - by private vehicle, to be lodged on a travel claim reimbursement forms which can be supplied on request;
  - by public transport, as receipts are lodged with us;
  - by taxi when pre-approved by a claims officer.

Travel by taxi will only be payable if:-

1. Prior approval has been given by either the respective claims officer.
2. The use of public transport is impractical or unavailable.
3. There is reason given, in writing, by the treating doctor or specialist which precludes travel by either public or private transport.

Note: Relatively long distance travel under this category may be limited to suitable rehabilitation at a location nearer to the applicant, or require treatment to be transferred to that point of rehabilitation.

Sponsorship / Re-training Guidelines

The following may be payable under the Scheme:

Reasonable re-training costs for a person who has suffered a significant disability under the provisions of the Motor Accident (Compensation) Act (MAC).

The claimant must satisfy the criteria as described and undertake the responsibility of providing a submission which has been adequately researched.

For further information on the Attendant Care benefits please view the Rehabilitation Sponsorship Agreement (PDF Format)

Attendant Care Benefits (Section 18A & 18B)

The amount payable is up to 32 hours per week at an hourly rate equivalent to 2% of average weekly earnings = ($21.20 as at 1 January 2008). Maximum benefit payable, therefore, is 32 hours multiplied by the current prescribed amount.

Attendant care is payable if either of the following criteria is established:

• The claimant has suffered a permanent impairment of more than 60% whole person for more than two years; or
• The TIO Board is of the opinion that the claimants permanent impairment (defined as over 60% whole person impairment) is likely to continue for more than two years.

For further information on the Attendant Care benefits please view the Attendant / Domestic Care Policy (PDF Format)

Emergency Travel Benefit (Section 18C)

The following may be payable under the Scheme:

A once off benefit of up to $4,000.00 is payable to a close family member for expenses incurred by that family member for the cost of travel, loss of income or other financial loss resulting from a journey of over 1000km to be near an injured person.

Modification / Alterations for your house / car & special facilities Benefits (Section 19)

The following may be payable under the Scheme:

• Certain types of injuries mean that home alterations may be necessary to make the home more accessible to an injured person. These alternations may be temporary, or permanent, and can include the widening of doorways for wheel chair access, ramps to replace steps, lowering of a bath or toilet, grab rails etc.
• At times a motor vehicle may need to be modified to allow an injured person to drive their vehicle safely. This may include the fitting of hand controls to replace foot controls, power steering, a spinner knob etc. The manufacture and fitting of ramps to a vehicle for wheel chair access may also need to be considered in certain cases.
• An occupational therapist will conduct a home / vehicle assessment to identify any required needs and will provide a report to us for our consideration and decision.
• You may be asked to supply details on ownership, proof of purchase, allow a market value assessment or other necessary information for approval of costs to be possible.
• We recommend any of these types of costs and needs are approved by us before any alterations or modifications are made to prevent financial hardship if a request has to be denied under a claim for any reason.

Death Benefits (Section 22)

On the death of a qualifying person, the following benefits may be payable:

• A funeral benefit to the person who paid for the qualifying person's funeral; and
• An amount equal to 156 times average weekly earnings (at time payment is made) to be split amongst the qualifying person's spouse and/or dependent children. The amount may be split in two ways:

1. As prescribed in below table:

2. As the Board determines on the request of a spouse or dependent child, after taking into consideration the level of their dependency on the qualifying person.

Dependent Childrens' Benefits (Section 23) 

• In addition to the benefits payable under Section 22, we are liable to pay each dependent child or carer of each child of a qualifying person, a weekly amount equal to 10% of the average weekly earnings.
• If there are more than 10 dependent children, then we are only liable to pay an amount equal to the average weekly earnings to be split equally amongst the children.

NOTE: Dependent childrens' weekly benefits are paid by the scheme on a monthly basis.

Dependent Parents' Benefits (Section 24)

Where a qualifying person dies in a motor vehicle accident leaving only a dependent parent or parents who normally reside with the qualifying person, then we are liable to pay to the parent or parents a total amount to 156 times the average weekly earnings.

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