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You are here » Home » News » What is the National Injury Insurance Scheme (NIIS)?

NIIS is a scheme that provides necessary and reasonable treatment, care and support, regardless of fault to those that are catastrophically injured in a motor vehicle accident or injured at work after 1 July 2016.

To be eligible you must have sustained one of the following serious injuries:

  1. Permanent spinal cord injury;
  2. Traumatic brain injury;
  3. Multiple or high level limb amputations;
  4. Permanent injury to the brachial plexus;
  5. Full thickness burn to all or part of the body;
  6. Inhalation burn resulting in a permanent respiratory impairment;
  7. Permanent blindness caused by a trauma.

Applications to NIIS must be lodged within 12 months of the date of the accident. The application can be lodged by the injured person or a person/hospital authorised by the injured person or the insurer.

If NIIS deems that the injured person is eligible, they will enter the scheme as an Interim Participant. NIIS will fund treatment, care and support for a two-year period. At or near the conclusion of the two-year period, NIIS will then determine if the injured person continues to meet the eligibility criteria to remain in the scheme as a Lifetime Participant.

Treatment, care and support includes:

  • Medical or pharmaceutical treatment
  • Rehabilitation
  • Attendant care and support services
  • Prostheses
  • Home and transport modifications
  • Dental treatment
  • Respite care
  • Aids and appliances (e.g. wheelchair)
  • Education and vocational training
  • Ambulance transportation

Importantly, for those that are a participant in NIIS and can establish fault (or negligence), they retain those rights to pursue a workcover injury common law claim or a motor vehicle injury CTP claim. NIIS does not cover economic loss, capital costs (such as house/car), ordinary living costs, costs related to an injury or condition not related to the accident, transport to places other than approved treatment. These damages can be recovered through the workcover injury common law claim or a motor vehicle injury CTP claim.

Where a Lifetime Participant can pursue a workcover injury common law claim or a motor vehicle injury CTP claim, the injured person also has the option to seek to ‘Opt Out’ of the Scheme and pursue those entitlements by way of a lump sum.

There are important time frames and notices that must be adhered to and provided when:

1If it is an injury at work, WorkCover will determine eligibility and apply to NIIS.

  1. Applying to the scheme;
  2. Seeking a review of a decision (internally and externally);
  3. Once having been accepted as a Lifetime Participant;
  4. Preserving the entitlement to be able to Opt Out;
  5. Deciding whether to remain in the scheme or Opt Out.

It is important that appropriate legal advice is sought from specialist personal injury lawyers.