CTP, Compulsory Third Party insurance (Green Slips) in NSW are looking increasingly like a scam. In theory, if you are injured in a motor vehicle accident that is not your fault, all ‘reasonable and necessary’ treatment is currently paid for by your insurer. People might assume this means good, standard medical practice. This is not so.
In principle, patients are entitled to immediate and early treatment but the first problem is that insurers have up to 3 months to decide if they are liable for the accident. Payment can be delayed until the liability is accepted. Sometimes when two cars collide both insurers decide that the other is liable, and neither will pay. This is quite common.
Even if insurers decide that they are liable for treatment, all medical decisions have to be referred to them. Sometimes, despite overwhelming medical evidence such as MRI scans, severe symptoms and a specialist confirming that their injuries are serious and at risk of worsening, they still deny or delay payment. In theory they have to give a reason for the refusal, but the reasons are so general that it is not clear why the refusal happens. Insurers saving money seems a cynical but likely explanation. A considerable number of patients wait indefinitely in pain for treatments that are both reasonable and necessary.
If the injured person or his/her doctor try to challenge the insurer’s denial of treatment, the system is murky, complex and slow. Doctors or patients can appeal to the insurer, and then to the government appointed Medical Assessment Service (MAS), which guarantees to assess the disputed issue and rule within 3 months! This is a very long time to wait for treatment, particularly if you cannot work and are quietly going broke.
The patient can pay for treatment or try to get Medicare themselves- (obviously), but if that is the case, why have CTP insurance at all? The undue delay by insurers results in some GPs treating patients under Medicare, which is then rarely recovered by the taxpayer. This is a dubious form of cost-shifting from the insurer onto the public purse!
But if the system is working poorly as it is, beware also the ‘reforms’ being driven by the industry, particularly NRMA (a.k.a. IAG). There have been some little publicised inquiries and the issue has been portrayed as a fight between venal lawyers who want a cut of the lump-sum settlements and insurers trying to limit costs. The idea that it is a way of ensuring optimum medical treatment for road injuries seems to have been totally forgotten, and the medical profession has been strangely silent in the debate. Perhaps only a small percentage of their members actually treat these cases, and the CTP schemes are State-based.
The NSW insurers, led by NRMA have complained loudly that the system is cluttered up by ‘minor’ claims, ‘minor’ being defined as under 10% in the AMA guidelines. (The AMA guidelines are officially the American Medical Association Guidelines for the Evaluation of Permanent Impairment). The insurers want to pay a statutory amount for ‘minor’ claims to avoid legal costs and disputes. But many people under 10% under the AMA guidelines cannot work, or cannot do their previous job and will get very little money under the changes suggested. Insurers claim that there are a lot of fakes, brought by a system where lawyers are paid on contingency, but this belief is a very convenient one for insurers who do not want to pay. Doctors who work in the area do not report a lot of fakes; it seems a very small percentage. Far more people need help and do not get it than are faking it.
The other ‘reform’ suggested is that the insurers only have to pay for treatment for a period, say 2 years in minor cases or 5 years if it is a bit worse, and then it reverts to the welfare system, Centrelink, Newstart, or a disability pension. It is all a very good deal for the insurers who currently take 19% of the premiums as profits, when it is compulsory for everyone to get insurance as a condition of registering their car. They will pocket the premiums, and dump the long-term problems on the taxpayer funded welfare system, while continuing to deny, delay or dispute standard medical treatment as they do now.
In NSW insurers are generous donors to the major political parties and the ‘reforms’ are likely to succeed, with a huge fanfare about the drop in premiums. It is all great if you don’t get injured.
Dr Arthur Chesterfield-Evans is a medical practitioner with degrees in Surgery, Occupational Health and Political Economy. He spent some years in tobacco control, and was a NSW State member of Parliament for the Australian Democrats. He is currently treating Workers Compensation and Third party injuries.