Motor Vehicle Injury / CTP Claims
Claims Procedure Overview
Notice of Claim and Reply
A person who proposes to make a motor vehicle accident claim (including a person acting in a representative capacity) must ensure that appropriate notice of the accident has been given to a police officer.
The claimant must give written notice of the motor vehicle accident claim to the insurer or 1 of the insurers, against which the action is to be brought. If it is to be given to the Nominal Defendant because the motor vehicle can not be identified notice mus be given within 3 months after the motor vehicle accident; or within 9 months in any other case. Within that period, also 1 month after the claimant first consults a lawyer about the possibility of making a claim.
The insurer must, within 14 days after receiving the notice give the claimant written notice stating whether or not the insurer is satisfied that the notice has been given as required and if not, how not.
A claimant must cooperate with the insurer and, in particular must provide the insurer with copies of reports and other documentary material (including written statements made by the claimant or by witnesses) in the claimant’s possession about the circumstances of the accident or the claimant’s medical condition or prospects of rehabilitation. The claimant must also comply with a request by the insurer to undergo, at the insurer’s expense a medical examination by a doctor to be selected by the claimant from a panel of at least 3 doctors nominated in the request.
Equally, the insurer must cooperate with a claimant and, in particular must provide the claimant with copies of reports and other documentary material in the insurer’s possession about the circumstances of the accident or the claimant’s medical condition or prospects of rehabilitation; and must, at the claimant’s request, give the claimant information that is in the insurer’s possession, or can be found out from the insured person, about the circumstances of, or the reasons for, the accident.
A claimant or insurer is not obliged to disclose information or documentary material under this division if the information or documentary material is protected by legal professional privilege.
Decision on Liability
Within 6 months after an insurer receives notice of a motor vehicle accident claim under this division, the insurer must take reasonable steps to inform itself of the circumstances of the motor vehicle accident out of which the claim arises. It must give the claimant written notice stating whether liability is admitted or denied; and if contributory negligence is claimed the degree of the contributory negligence expressed as a percentage.
Once liability has been admitted, it is the duty of the insurer to make payments to or for the claimant for private hospital, medical and pharmaceutical expenses reasonably and appropriately incurred because of the injury or a proportionate part of the expenses reflecting the extent of the insurer’s responsibility (assuming the claimant to be guilty of contributory negligence as asserted by the insurer). Once liability has been admitted on a claim, or the insurer has agreed to fund rehabilitation services without making an admission of liability, the insurer must, at the claimant’s request, ensure that reasonable and appropriate rehabilitation services are made available to the claimant.
Offers and Compulsory Conference
As soon as practicable after an insurer receives notice of a claim under the division, the insurer must make a fair and reasonable estimate of the damages to which the claimant would be entitled in an action against the insurer; and make a written offer (or counter offer) of settlement to the claimant setting out in detail the basis on which the offer is made, or settle the claim by accepting an offer made by the claimant.
Before the claimant brings an action in a court for damages for personal injury arising out of a motor vehicle accident, there must be a conference of the parties (the compulsory conference). Either party may call the compulsory conference at a time and place agreed between both parties; or if the relevant date (6 months after the claimant gave notice to the insurer of the claim) has passed—at a reasonable time and place nominated by the party calling the conference.