After a claim is lodged
Who decides if liability for a claim is accepted
A claims manager from the insurance company will decide whether liability for your claim is accepted. For liability to be accepted, negligence must be established against another person. The insurer may need to investigate the accident to determine liability. The insurer may ask you to provide additional information about the claim and the circumstances out of which it arises. You must cooperate with the insurer and give information reasonably requested.
The insurer has six months after receipt of the claim form in which to make a determination on liability. By admitting liability the insurer agrees that the vehicle insured by them was at fault for the accident. If liability is denied you will have to take the matter to Court for resolution.
The CTP insurer's obligations
On receipt of your claim, the insurer must:
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Determine liability within six months of receiving a satisfactorily completed Notice of Claim Form.
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Attempt to settle the claim as soon as practicable.
Once liability has been admitted or a decision made on rehabilitation, the insurer must:
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Meet the reasonable costs of medical, hospital and pharmaceutical expense based on the extent of liability, which is measured as a percentage.
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Take steps to ensure reasonable and appropriate rehabilitation services are provided.
The insurer may be prepared to pay for treatment and rehabilitation services without accepting liability. In these instances the insurer must first give approval.
Claimant's obligations
As a claimant, you must be prepared to help the insurer with its investigation of the accident. You may be required to give specific information, photographs, documents or records, and you may be required to have a medical examination or assessment. You must also take all reasonable steps to recover from your injury. Reasonable steps may include:
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having recommended medical treatment;
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undergoing recommended rehabilitation therapy or rehabilitation programs;
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returning to work or taking specified steps to obtain employment.
Last reviewed 13 February 2008
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