Forms

Motor Injury Insurance Forms

Crash Report  - for owners/drivers, passengers, cyclists, pedestrians and witnesses to report crash injuries.

Electronic Funds Transfer Application for Claimants - to request a reimbursement for out-of-pocket expenses.

Employers Confirmation of Loss of Salary - to confirm employment details and weekly wages.

Medical Information Disclosure Authority - to authorise the release of their medical information to the Insurance Commission.

Medial Information Disclosure  Authority for minors -  to authorise the release of the medical information of a minor to the Insurance Commission.

Notice of Intention to Make Claim - please contact your claims officer to have it emailed to you.

Notification of Catastrophic Injury - for hospitals to report a catastrophic injury.

Potential Economic Loss - to report economic loss from employment.

Request for Advance Payment - to request advance payment of weekly wages.

Self Employed Economic Loss - to prove loss of income by self-employed claimants.

Statement Sheet - for parties involved in the crash to provide further information about the crash.