FROM CAR CRASH TO COMEBACK: BICYCLE RIDER REHABILITATION SECRETS REVEALED

THE NSW COMPENSATION SCHEME

Injured cyclists need to follow specific steps to obtain treatment through the NSW CTP compensation scheme. These steps are set out as follows:

1. Complete Necessary Documentation
   Complete an Application for Personal Injury Benefits, making sure that all injuries are individually documented (not summarised) on the form. This needs to be accompanied by a Certificate of Capacity completed by a nominated treating doctor.
   
   
2. Obtain Referrals
   Typically, a cyclist’s regular GP will be their nominated treating doctor and the person who recommends the treatment required in the aftermath of the accident. To obtain treatment through a NSW CTP claim, a GP will need to provide treatment referrals along with an explanation outlining why the treatment is related to the accident and considered reasonable and necessary. Examples of treatment include radiological investigations, specialists consultations and allied health provider sessions (e.g. physiotherapists).
   
   
3. Submit Documents
   Once the claim form (Application for Personal Injury Benefits) and medical certificate (Certificate of Capacity) has been completed and referrals obtained, they need to be sent to the CTP insurer of the vehicle involved in the accident.
   
   
4. Await Approval
   Upon receipt of all documentation, the CTP insurer will register the claim and issue a claim number. The claim number should be provided to all treatment treatment providers after the date of claim registration.

In the future when additional treatment is requested from the insurer, the claim number will need to be quoted as part of the process. Upon receipt of the request for treatment, the CTP insurer has 10 days to advise you whether the treatment is approved or not.

COVERING OUT-OF-POCKET EXPENSES

Whilst Australians are able to access emergency healthcare free under the Medicare health scheme, some costs such as NSW Ambulance fees are not covered. If an ambulance was called to the accident scene and the injured cyclists later receives a request for payment from the NSW Ambulance Service, the invoice can be forwarded to the CTP insurer for payment once the CTP claim has been registered.

For any subsequent treatment needs, it is essential that injured cyclists receive written approval from the CTP insurer before incurring the treatment cost. In our experience, insurer’s will decline to pay for treatment if they believe that the request overlaps with a pre-existing condition or alternatively if the treatment relates to an injury that they have not been notified about  on the certificate of capacity or Application for Personal Injury Benefits.

COMMUNICATION BETWEEN TREATMENT PROVIDERS, LAWYERS AND INSURERS

Communication between insurers, treatment providers and legal representatives is an important notion that underpins effective claim management in the NSW CTP scheme. Unfortunately, there is often a perception that lawyers don’t assist with rehabilitation, but rather impede it. Whilst this may be the case with some law firms, the Advantage Legal team are very supportive of rehabilitation and always request to be included in communications between treatment and rehabilitation providers in real time. This approach leads to more accurate reporting, prompt resolution of omissions/errors in reports and increased support to injured cyclists.

Increased communication in real time between treatment providers, insurers and legal representatives also helps reduce inappropriate treatment requests and unnecessary legal disputes. It also allows injured cyclists to received increased support from their legal representatives which in turn allows them to focus more on their rehabilitation and return to work goals.

Put simply, increased communication between the parties involved in the claim helps a cyclist get back on their bike sooner!

COMMON INJURIES AND REHABILITATION PROCESS

Generally, cycling is a very safe leisure, recreational and sporting activity. When cycling accidents involving a car or other motor vehicle do occur, the injuries can be quite significant and can include:

• Loss of consciousness
• Spinal injuries
• Broken bones
• Shoulder dislocations
• Tendon and muscle tears.
• Degloving injuries (loss of skin)
• Mental trauma (psychological injury)

The rehabilitation process typically involves initial treatment in a hospital, followed by ongoing care from a GP and specialist. In the case of physical injuries, once the initial trauma period has passed, a detailed assessment by a physiotherapist will usually occur to focus rehabilitation efforts on manual treatment and exercise based rehabilitation to improve function and mobility. This assessment is crucial for understanding the specific needs of the patient and developing an effective treatment plan.

Personalised home exercise programs are also an essential part of the rehabilitation process. These programs are designed to help restore an injured cyclist’s pre-injury capacity and ensure a steady progress toward recovery.

Additionally, addressing accident related trauma is a critical component of the rehabilitation process. Psychological support, including counselling, therapy and medication can help patients manage the emotional impact of their injuries, promoting a holistic recovery that encompasses both physical and mental health.

OBLIGATIONS AND ENGAGEMENT IN REHABILITATION

Injured cyclists who have made a claim through the NSW CTP scheme are expected to take reasonable steps to recover from their injuries, and where relevant, return to work as soon as possible in order to mitigate their losses. Compliance with agreed treatment plans and communication with insurers and rehabilitation providers are an essential part of this process as well.

In the majority of cases, active engagement in rehabilitation leads to better health outcomes, including a faster resolution of physical symptoms and improved mental health. Conversely, non-compliance can lead to adverse health outcomes as well as insurance companies denying future treatment requests and suspending weekly benefits.

THE KEY POINTS TO REMEMBER

• Ensure that the Certificate of Capacity and Application for Personal Injury Benefits outline each and every injury sustained in the accident and are submitted with all treatment referrals as soon as possible, preferably at the time of claim lodgement.
  
  
  
• When submitting a request for treatment, ensure that you allow 10 days for the insurer to approve the request or risk being out of pocket if the treatment proceeds without insurer approval.
  
  
  
• If a lawyer is engaged to represent an injured cyclist, make sure that they are actively communicating with the medical practitioners, rehabilitation providers and the CTP insurer in real time. This typically results in an improved understanding of treatment needs and less disputes if the lawyer adopts a pro-rehabilitation mindset.