The Catastrophic Injuries Support (CIS) scheme dispute resolution process allows for decisions to be made for disputes on:
- CIS scheme eligibility; and
- amount or type of treatment, care and support services to be provided to people with catastrophic injuries.
If you or someone you know does not agree with one of our decisions, you should first discuss this with the Insurance Commission.
If you are still unhappy with the outcome following your discussion, you can ask for the matter to be reviewed further by the Insurance Commission.
Lastly, if the matter is still not resolved to your satisfaction, you may be able to apply for a review of the decision by a medical expert review panel.
The panel is independent and made up of up to three health professionals. The application must be made in writing within 28 days after the person is given written notice of the written eligibility decision (eligibility disputes) or the assessment decision (treatment, care and support disputes) and should include:
- applicant’s name, address and contact details;
- statement that there is disagreement with the decision (eligibility or assessment);
- detailed reasons why there is disagreement with the decision;
- for assessment disputes, reasons why the request is necessary and reasonable in the event a service has not been approved by the Insurance Commission and is the subject of the dispute; and
- any other relevant information or reports.
A dispute could be about:
- whether the crash that results in an injury was a motor vehicle crash; or
- whether an injury results from a motor vehicle crash or was attributable to some other condition, event, incident or factor; or
- whether a motor vehicle injury meets the catastrophic injury criteria; or
- a prescribed matter; or
- a decision made by the Insurance Commission to suspend the participation of a person in the scheme (following acceptance for ongoing treatment, care and support); or
- a decision not to approve an amount or type of treatment, care and support service.
The Motor Vehicle (Catastrophic Injuries) Regulations 2016 provides further information.