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You are here » Home » NIIS Injuries

To be eligible to receive NIIS benefits under the National Injury Insurance Scheme in Queensland, you must have suffered “serious personal injury” on or after 1 July 2016. A “serious personal injury” includes:

  • traumatic brain injury
  • permanent spinal cord injury
  • permanent brachial plexus injury
  • multiple or high level amputations
  • severe burns
  • permanent blindness caused by trauma

If you are injured in a car accident (or other accident on the road) in Queensland, then your claim will be governed by the Motor Accident Insurance Act 1994 (Qld) and any NIIS benefits will be paid under the National Injury Insurance Scheme (Queensland) Act 2016 (Qld).

If you are injured in a work accident, then your claim and any NIIS benefits payable will all be governed by the Workers Compensation and Rehabilitation Act 2003 (Qld).

Can I receive NIIS benefits if I was NOT injured at work or on the road?

No. The Queensland Government has not extended coverage under the National Injury Insurance Scheme to public liability injury claims or medical negligence claims. You have to have been injured at work or in an accident on the road to qualify for NIIS benefits. To find out more about public liability claims, click here. To find out more about medical negligence claims, click here.

You may, however, be entitled to make a claim under the National Disability Insurance Scheme (NDIS). For more information about the NDIS, click here.

How does a claim through NIISQ work when I have been injured in a car accident (or other road accident)?

  • An “Application Form – Interim Participation” has to be lodged with NIISQ.
  • Your doctor must complete the Medical Certificate that forms pages 6 to 9 of the Application Form.
  • The application can be lodged by you, the hospital, your guardian, the CTP insurer or your Solicitor.
  • Your application should be lodged within twelve (12) monthsfrom the date of your injury.
  • Once the application has been lodged, NIISQ must then make a determination as to whether you are eligible to receive NIIS benefits.
  • If NIISQ decides that you are eligible to receive NIIS benefits, they will cover and manage all your necessary and reasonable treatment, care and support needs.
  • A NIISQ Agency Support Planner will be appointed to coordinate and organise all of the necessary and reasonable treatment, care and support services that you need.
  • All participants deemed eligible for NIIS benefits are accepted as an interim participant for up to two (2) years (although very young children remain as interim participants until age six).
  • Your eligibility for NIIS benefits will then be re-assessed by NIISQ after two (2) years to determine whether you qualify as a lifetime participant.
  • If you are found to be eligible as a lifetime participant, NIISQ will then fund your necessary and reasonable treatment, care and support needs for the rest of your life, unless you choose to opt out.
  • Some NIIS participants choose to claim a lump sum for their treatment, care and support needs in their CTP personal injury claim rather than opting to receive lifetime treatment, care and support from NIISQ.
  • To be eligible to opt out of NIISQ, you must satisfy the following conditions:
    • you have to have been accepted as a lifetime NIISQ participant;
    • you have to have a valid CTP claim with contributory negligence of less than 50 percent – ie be able to sue someone for being the main cause of the accident; and
    • you must not have been excluded from receiving a lump sum by the Court – eg where the Court considers a lump sum inappropriate.
  • To opt out of receiving treatment, care and support from NIISQ, you must provide NIISQ and the CTP Insurer with a “Preservation Notice” within fourteen (14) days of being accepted as a lifetime participant of NIISQ or, if your CTP claim is not commenced until after you become a lifetime participant, within 14 days after the CTP Insurer provides written acknowledgment of your CTP claim.

How does a claim through NIISQ work when I have been injured at work?

  • The first step is to lodge a Claim Form (i.e. a statutory workers’ compensation claim) with WorkCover Queensland (or your employer’s self-insurer) (“WorkCover”).
  • Once WorkCover has accepted the claim as being work related, they will then consider whether you are eligible to receive NIIS benefits;
  • If WorkCover decides that you are eligible to receive NIIS benefits, then they will appoint NIISQ to manage all of your necessary and reasonable treatment, care and support needs.
  • A NIISQ Agency Support Planner will be appointed to coordinate and organise all the necessary and reasonable treatment, care and support services that you need.
  • All participants deemed eligible for NIIS benefits are accepted as an interim participant for up to two (2) years (although very young children remain as interim participants until age six).
  • Your eligibility for NIIS benefits will then be re-assessed by WorkCover Queensland after two (2) years to determine whether you qualify as a lifetime participant.
  • If you are found to be eligible as a lifetime participant, WorkCover Queensland and NIISQ will then fund and manage your necessary and reasonable treatment, care and support needs for the rest of your life, unless you choose to opt out.
  • Some NIIS participants choose to claim a lump sum for their treatment, care and support needs in their workers’ compensation common law claim (personal injury claim) rather than opting to receive lifetime treatment, care and support from WorkCover and NIISQ.
  • To be eligible to opt out of NIISQ, you must satisfy the following conditions:
  • you have to have been accepted as a lifetime participant;
  • you must be able to pursue a workers’ compensation common law claim where you allege negligence against your employer; and
  • you must not have been excluded from receiving a lump sum by the Court – eg where the Court considers a lump sum inappropriate.
  • To opt out of receiving treatment, care and support from WorkCover and NIISQ you must notify WorkCover Queensland, in the Notice of Claim for Damages used to commence your common law claim, that you elect to seek treatment, care and support damages for the injury.

What benefits are payable under the National Injury Insurance Scheme (Queensland)?

NIISQ provides the following treatment, care and support, provided it is considered necessary and reasonable:

  • medical or pharmaceutical treatment
  • hospitalisation
  • dental treatment
  • rehabilitation
  • ambulance transportation
  • respite care
  • attendant care and support services
  • aids and appliances, other than ordinary personal or household items
  • prosthesis
  • education or vocational training
  • home, transport or workplace modifications

Do I have to refund any benefits NIISQ has paid out of my settlement monies from my CTP injury claim?

No. You will not have to repay any amounts paid by NIISQ for treatment, care and support, even if you opt out of the scheme, as the settlement amount would be exclusive of any amounts funded by NIISQ.

Any benefits paid by the NDIS, however, will be refundable. We will include an amount for the benefits paid by the NDIS in any offer of settlement, so that when that amount is refunded you are not disadvantaged in any way.

Do I have to refund any benefits WorkCover or NIISQ has paid out of my settlement monies from my workers’ compensation common law claim?

No. Common law claims are settled on the basis that the amount is “clear of” any refund payable to WorkCover Queensland or the workers’ compensation self-insurer for statutory benefits paid (which includes any NIIS benefits).

Any benefits paid by the NDIS, however, will be refundable. We will include an amount for the benefits paid by the NDIS in any offer of settlement, so that when that amount is refunded you are not disadvantaged in any way.

So, what can East Coast Injury Lawyers do to help?

We provide free initial advice. We will consider all available information, undertake investigations where needed, and provide you with our opinion regarding your claim. This would include whether we believe you would succeed in a claim, what your options are with respect to the various insurance schemes, NIISQ and the NDIS and what you should do immediately to ensure that you receive the best treatment, care and support possible as quickly as possible.

If we consider that your claim is likely to have reasonable prospects of success, then we will agree to take your matter on, on a “no win no fee” basis. Click here for more information on how we charge.

Strict time limits apply to personal injury claims, so speak with one our expert personal injury lawyers today.

When to engage a personal injury lawyer?

You should engage a personal injury lawyer as soon as possible. This is so we can:

  • provide you with all the advice and assistance you need, including setting out what your options are;
  • help you lodge your claim(s) with NIISQ, the CTP Insurer, WorkCover Queensland (or a workers’ compensation self-insurer) and/or any other insurer;
  • track down witnesses and obtain statements and other liability evidence about the accident before it goes missing or memories fade;
  • assist with coordinating your treatment, care and support, including any home and transport modifications required;
  • ensure that NIISQ or another insurer is paying for all the treatment, care and support you need;
  • make sure that your treatment providers are undertaking all appropriate investigations and providing the best possible treatment; and
  • make sure that the insurer is fully aware of all the injuries you have sustained, so that you can be properly compensated for them
What are the time limits for lodging a claim with NIISQ?

Car accidents (or other accidents on the road):

Where you are injured in a car accident or other accident on the road, you only have twelve (12) months from the date of accident to lodge an “Application Form – Interim Participation” with NIISQ.  You can still lodge the application outside that twelve (12) month timeframe but NIISQ then has a discretion as to whether they accept the application or not.

Of course, it is preferable that the application be lodged as soon as possible after the accident, so that you can start receiving the best possible treatment, care and support as early as possible.

If you are deemed eligible for NIIS benefits, you then remain an interim participant for up to two (2) years (although very young children remain as an interim participant until they turn six), after which NIISQ re-assesses your eligibility to determine whether you qualify as a lifetime participant.

If, at the time, you have a current CTP personal injury claim and have decided that you want to opt out of receiving NIIS benefits (so as to be able to claim a lump sum for all treatment, care and support that you will need in the future), you must provide NIISQ and the CTP insurer with a “Preservation Notice” within fourteen (14) days after being accepted as a lifetime participant by NIISQ.

If you have not commenced a CTP claim by the time you are accepted as a lifetime participant by NIISQ, then the “Preservation Notice” must be provided to NIISQ and the CTP Insurer within fourteen (14) days after the CTP Insurer provides written acknowledgment of your CTP claim (ie after they have received your CTP claim form).

Work accidents:

A Claim Form (for workers’ compensation) must be lodged with WorkCover Queensland (or your employer’s self-insurer) within six (6) months from the date of accident / injury. There are some limited exceptions to this rule, so please seek legal advice if you are outside this timeframe.

Once the claim is lodged, WorkCover should then automatically consider whether you are eligible to receive NIIS benefits under the Workers’ Compensation and Rehabilitation Act 2003 (Qld).

If you have a “serious personal injury” and WorkCover does not automatically consider your eligibility to receive NIIS benefits, then you should ask them to do so.  WorkCover will then have twenty (20) business days from the date they receive the request to make a determination as to your eligibility.

If you are deemed eligible for NIIS benefits, you then remain an interim participant for up to two (2) years (although very young children remain as an interim participant until they turn six), after which WorkCover and NIISQ re-assess your eligibility to determine whether you qualify as a lifetime participant.

If you have an entitlement to pursue a common law claim against your employer (for negligence), then you can choose to opt out of receiving NIIS benefits (so as to be able to claim a lump sum for all treatment, care and support that you will need in the future).

To opt out of receiving treatment, care and support from WorkCover and NIISQ you must notify WorkCover Queensland, in the Notice of Claim for Damages used to commence your common law claim, that you elect to seek treatment, care and support damages for the injury.

How do I apply to NIISQ or WorkCover Queensland to receive NIIS benefits?

Car accidents (or other accidents on the road):

  • An “Application Form – Interim Participation” needs to be lodged with NIISQ.
  • Your doctor must complete the Medical Certificate that forms pages 6 to 9 of the Application Form.
  • The application can be lodged by you, the hospital, your guardian, the CTP insurer or your Solicitor.
  • Once the application has been lodged, NIISQ must then make a determination as to whether you are eligible to receive NIIS benefits.
  • If NIISQ decides that you are eligible to receive NIIS benefits, they will fund and manage all your necessary and reasonable treatment, care and support needs.
  • A NIISQ Agency Support Planner will be appointed to coordinate and organise all of the necessary and reasonable treatment, care and support services that you need.

Work accidents or injuries:

  • The first step is to lodge a Claim Form (i.e. a statutory workers’ compensation claim) with WorkCover Queensland (or your employer’s self-insurer) (“WorkCover”).
  • Once WorkCover has accepted the claim as being work related, they will then consider whether you are eligible to receive NIIS benefits;
  • If WorkCover fails to automatically consider your eligibility, you should ask them to do so. They are then obliged to make a determination in that regard.
  • If WorkCover decides that you are eligible to receive NIIS benefits, then they will appoint NIISQ to manage all of your necessary and reasonable treatment, care and support needs.
  • A NIISQ Agency Support Planner will be appointed to coordinate and organise all the necessary and reasonable treatment, care and support services that you need.
How to start a CTP claim?

The steps that you should take after being injured in a motor vehicle accident are as follows:

  1. See your doctor and report all injuries, no matter how insignificant they seem at the time.
  2. Report the accident to the police and ask them to provide you with a traffic incident number.
  3. Contact us to make a time to meet with one of our expert injury lawyers. We will come to you, if you would prefer, at no additional cost.
  4. We will complete a Notice of Accident Claim form (“NOAC”) with you.
  5. We will provide you with the medical certificate that forms pages 11 and 12 of the NOAC and ask that you have your doctor complete it.
  6. You will also need to obtain referrals from your doctor for any further investigations or treatment that you might require, like x-rays or other scans, specialist reviews, physiotherapy or psychological counselling.
  7. We serve the NOAC with the completed medical certificate on the CTP Insurer and they then acknowledge the claim.
How to lodge a workers’ compensation claim?
  1. Notify your employer of your accident and injury as soon as possible, preferably in writing.
  2. Attend upon your doctor for treatment and to obtain a WorkCover Queensland “Work capacity certificate – workers’ compensation”: https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0007/77119/form-132m-work-capacity-certificate-workers-compensation.pdf
  3. Send a copy of your work capacity certificate to your employer.
  4. Complete WorkCover’s online Claim form: https://ols.workcoverqld.com.au/ols/public/claim/lodgement.wc
    OR
    Print the Claim form out, complete it and then upload it using WorkCover’s online service (https://ols.workcoverqld.com.au/ols/public/uploadNewClaim.wc?code=NEWCLAIM), or fax it to 1300 651 387, or post it to GPO Box 2459, Brisbane Qld 4001.  This is where the pdf of the Claim form can be found: https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0015/3057/Claim-form-FM106-v10.pdf
    OR
    Where urgent surgery is required or where there has been a fatality / death, you can call WorkCover on 1300 362 128 to lodge the claim over the phone.
  5. Upload a copy of the work capacity certificate using WorkCover’s online service (https://ols.workcoverqld.com.au/ols/public/uploadNewClaim.wc?code=NEWCLAIM) or fax it to WorkCover on 1300 651 387.
  6. Once the claim form and work capacity certificate has been uploaded, WorkCover will contact you (usually via text and/or email) to confirm that they have received the claim. They will then contact your employer to obtain their version of events.  If WorkCover accepts that you have suffered a work related injury, your claim will be officially accepted. WorkCover will then commence paying you weekly benefits for your time off work and any reasonable and necessary treatment and rehabilitation.
Who will my compensation claim be against?

Car accidents (and other accidents on the road):

Your claim will be against the CTP insurer of the vehicle that caused the accident.  You will be alleging that the driver of that vehicle was at fault but the CTP insurer is the one that conducts the defence of the claim on behalf of that driver.

In circumstances where the vehicle is unregistered or cannot be identified, then the claim is against the Nominal Defendant (a government insurer).

Work accidents:

In order to pursue a workers’ compensation common law claim you have to prove that your employer or a co-worker was negligent in some way.  Your employer will be held liable for the actions of any co-workers, provided they were acting within the scope of their employment.

As a result, when you bring a common law claim you are effectively suing your employer for negligence but they are then covered by their insurer, which is WorkCover Queensland (or a self-insurer). WorkCover assumes the defence of the claim and ultimately pays out any settlement amount or court award.

What if the person who caused my car accident was a family member or friend?

Car accidents (or other accidents on the road):

Provided your family member’s vehicle or friend’s vehicle was registered and there is nothing else untoward (see the exceptions listed below), then there will be absolutely no issue at all. They will not even have to pay an excess to the CTP insurer. The CTP insurer of the vehicle simply assumes control of the claim and communicates directly with your lawyers.

This means that passengers in cars can bring claims against their own family member, if the accident was caused by their family member, without fear of any financial or other penalty.

Exceptions to the rule:

  1. If the vehicle was being used without the owner’s authority or without legal justification or excuse, then the insurer may have a right to recover all the compensation and costs paid from the driver.
  2. If the driver intended to harm you or some other person (resulting in your injury), then the insurer may have a right to recover all the compensation and costs paid from the driver.
  3. If the driver was under the influence of alcohol or drugs at the time of the accident, which then caused or contributed to the accident, the insurer may have a right to recover all the compensation and costs paid from the driver.
  4. If the vehicle was being used to commit a crime or for some other illegal purpose, then the insurer may have a right to recover all the compensation and costs paid from the driver.
  5. If the vehicle was not registered at the time of the accident, then the Nominal Defendant may have a right to recover all the compensation and costs paid from the driver or owner of the vehicle.
Should I opt out of NIIS or not?

Some of the advantages of opting out of the National Injury Insurance Scheme include the following:

  1. Being able to manage and invest the monies that are awarded to you for treatment, care and support;
  2. Having total control over the decisions that are made with respect to your treatment, care and support;
  3. Not having to deal with the red tape of an insurer (eg having to seek approval from NIISQ for things you want); and
  4. Being able to avoid any adverse changes (ie reductions) the State government makes with respect to NIISQ’s funding. 

When it comes time to decide whether to opt out or not, we will discuss the advantages and disadvantages with you and you can then decide what you want to do.

When do I have to decide whether to opt out of receiving treatment, care and support from NIISQ?

Car accidents (or other accidents on the road):

Once you are deemed eligible for NIIS benefits, you then remain an interim participant for up to two (2) years (although very young children remain as an interim participant until they turn six), after which NIISQ re-assesses your eligibility to determine whether you qualify as a lifetime participant.

If you have a current CTP personal injury claim and want to opt out of receiving NIIS benefits, you must provide NIISQ and the CTP insurer with a “Preservation Notice” within fourteen (14) days after being accepted as a lifetime participant by NIISQ.

If, at the time you are accepted as a lifetime participant by NIISQ, your CTP claim has not been commenced, then you must provide NIISQ and the CTP Insurer with a “Preservation Notice” within fourteen (14) days after the CTP Insurer provides written acknowledgment of your CTP claim (after they have received your CTP claim form).

Work accidents:

If you are deemed eligible for NIIS benefits, you remain an interim participant for up to two (2) years (although very young children remain as an interim participant until they turn six), after which WorkCover and NIISQ re-assess your eligibility to determine whether you qualify as a lifetime participant.

If you have an entitlement to pursue a common law claim against your employer (for negligence), then you can choose to opt out of receiving NIIS benefits (so as to be able to claim a lump sum for all treatment, care and support that you will need in the future).

To opt out of receiving treatment, care and support from WorkCover and NIISQ you must notify WorkCover Queensland, in the Notice of Claim for Damages used to commence your common law claim, that you elect to seek treatment, care and support damages for the injury.

If I opt out, when do my NIIS benefits cease?

Your benefits payable under the National Injury Insurance Scheme only cease once your damages award or settlement monies are paid to you or your trustee (ie at the end of your personal injury claim).

What is my claim worth?

​How much compensation or damages you will be entitled to receive is dependent on a lot of different factors, including:

  • The nature and extent of your injuries
  • What ongoing problems and needs you have as a result of your injuries
  • What the doctors say about your restrictions and the degree of impairment you have
  • Whether you had pre-existing injuries or other conditions that were impacting on you, or were going to impact on you in the future
  • What restrictions and difficulties you look like having in the future, particularly with respect to your work capacity
  • What your income earning capacity was like pre-accident, compared to what your income earning capacity is now like
  • Your age, which impacts on how long you were going to work for and how long you will experience pain and suffering from your injuries
  • Your life expectancy
  • What treatment, care and support needs you have
  • Whether you have needed voluntary (unpaid) care and assistance as a result of your injuries and, if so, the nature and extent of that care and assistance
  • Whether you have needed paid care and support as a result of your injuries and, if so, the nature and extent of that care and support
  • Whether you have a need for home or vehicle alterations and other aids or equipment
  • How much ongoing treatment, medication and care and support you are going to need in the future

Serious personal injuries like spinal cord injuries and brain injuries often settle for millions of dollars.

How much will it cost me in legal fees to bring a claim?

This depends on how much work is done. Every matter is different. Our hourly rates are extremely competitive. For more information on how we charge, click here.

Do I have to pay the insurer’s costs if I lose?

This is extremely unlikely. You only have to pay some of the insurer’s costs if you proceed to trial and lose completely or if you receive a judgment for less than what the insurer has previously offered to pay you.

The number of personal injury claims that actually proceed to trial is less than 2 in 100, so the chances of having to pay the insurer’s costs are very slim.  During the course of your claim, we will provide you with detailed advice about the quantum of your claim (what we believe a court would award you), so that you know what amount would constitute a reasonable settlement of your claim.

What treatment, care and support does NIISQ provide?

NIISQ provides the following treatment, care and support, provided it is considered necessary and reasonable:

  • medical or pharmaceutical treatment
  • hospitalisation
  • dental treatment
  • rehabilitation
  • ambulance transportation
  • respite care
  • attendant care and support services
  • aids and appliances, other than ordinary personal or household items
  • prosthesis
  • education or vocational training
  • home, transport or workplace modifications
How does NIISQ work when you have a CTP claim as well?

When you suffer a “serious personal injury” in a motor vehicle accident in Queensland, you are eligible to receive benefits from the National Injury Insurance Scheme (Queensland) (NIISQ).

You, your guardian or the hospital can lodge an “Application Form – Interim Participation” with NIISQ, who then make a determination in relation to your eligibility.  Once you are deemed eligible to receive NIIS benefits, NIISQ takes over the management of your reasonable treatment, care and support needs.

The Application for NIIS benefits can be lodged before or after your CTP claim is lodged. Often, it is lodged beforehand, but the CTP claim should then be lodged as soon as possible thereafter.

A CTP claim entitles you to recover additional heads of damage, over and above what NIISQ provides, including an amount for pain and suffering, loss of amenities and loss of enjoyment of life, past lost income, future lost income, past loss superannuation and future lost superannuation, which can be very significant. This is in addition to any amount required to compensate you for your treatment, care and support needs.

The CTP claim proceeds as normal whilst all treatment is being provided by NIISQ, although there is an option to opt out of NIISQ, which normally occurs around 2 years after the accident. We will assess your situation and provide you with advice on whether you should or should not opt out of NIISQ.

For more information on CTP claims click here.

How does NIISQ work when you have a workers’ compensation claim as well?

When you suffer a “serious personal injury” in a work accident in Queensland, you are eligible to receive National Injury Insurance Scheme benefits from WorkCover Queensland (or the workers’ compensation self-insurer).

Once you are deemed eligible by WorkCover to receive NIIS benefits, they engage NIISQ to manage all of your treatment, care and support needs.

WorkCover continues to pay your weekly benefits and manages your WorkCover claim but they are not involved with your treatment or rehabilitation, which they leave to NIISQ.

For more information on WorkCover claims click here.

Do I have to pay tax on any compensation I receive?

No. This is because any claim we make on your behalf for lost income or economic loss is made on a net basis (ie after tax), so as you have not claimed tax from the CTP Insurer or WorkCover you do not have to pay any tax on your settlement monies. Of course, if you subsequently invest your settlement monies and earn income from those monies, then you may be liable to pay tax on those earnings. You should speak with your accountant and/or financial advisor in that regard.

During your free consultation, we will take steps to:

  • Determine exactly what injuries you have suffered;
  • Work out precisely how the accident occurred;
  • Decide whether someone else caused or significantly contributed to your accident;
  • Provide you with our opinion as to your prospects of success;
  • Discuss the claims process and what is involved;
  • Answer any questions you have about NIISQ and the NDIS;
  • Determine what treatment and rehabilitation you need;
  • Discuss what care and support services you require;
  • Ascertain what home modifications and transport modifications you might need;
  • Work out what aids and appliances you might need;
  • Discuss the steps that we need to take to get you all the care, support, treatment, modifications and aids that you need;
  • Discuss what costs will be involved with your claim; and
  • Respond to any questions that you might have in relation to your claim.