Compulsory Third Party claims and public hospital services payments

Under the Motor Accident Insurance Act 1994 motorists pay a Compulsory Third Party (CTP) insurance premium to the State government which is managed by the Motor Accident Insurance Scheme (MAIC).

MAIC pay a levy to Queensland Health (QHealth) and the Queensland Ambulance Service to cover hospital and emergency services for people injured in motor vehicle accidents who are claimants under the CTP scheme.

Public hospitalisation costs in the Queensland workers' compensation scheme are covered in our Public health services table of costs and guidelines and insurers invoice public hospitals when costs are incurred for any patient with an accepted workers' compensation claim.

An area of concern has arisen for some insurers when an accepted workers' compensation claim also has possible CTP involvement. We would like to remind all insurers until you're able to provide evidence to QHealth that a CTP claim has been accepted, you're responsible for payment of associated medical and hospitalisation costs for an accepted workers' compensation claim.

Withholding payments for a 'potential' CTP claim shouldn't occur.

You can action QHealth invoice in three ways:
1.      pay the invoice (for an accepted workers' compensation claim with no CTP involvement)
2.      pay the invoice and if the CTP claim is accepted at a later date, recover the monies paid for hospitalisation from QHealth or the relevant CTP insurer
3.      decline payment when a CTP claim has been accepted and provide QHealth with evidence of CTP claim by providing details such as CTP claim number and the insurer.

If you're seeking recovery from QHealth for an accepted CTP claim, then send to QHealth:

• a refund request along with a copy of the previously paid invoice
• evidence of an accepted CTP claim, such as a verifiable claim number.

This documentation can be sent to:

Mortuza Huq
Manager, Funding Agreements
Own Source Revenue Unit
Finance Branch
Queensland Health Corporate Office
GPO Box 48
QLD 4001

For more info please contact your Insurer Advisor.