How to lodge an eligibility dispute with Lifetime Care
If you're not happy with a decision made about your eligibility for participation in the Lifetime Care and Support Scheme, you can dispute the decision, which will be resolved through a formal dispute process.
A dispute occurs when someone disagrees with a decision we’ve made about your eligibility for either ‘interim participation’ (for an initial two years) or ‘lifetime participation’ (for life) in the Lifetime Care and Support Scheme.
Eligibility for participation in the Scheme can be disputed on either medical or legal grounds.
You can lodge a dispute if you disagree with our decision about whether your injury meets the criteria specified in the Lifetime Care and Support Guidelines for participation in the Scheme (medical eligibility).
We have an independent assessment panel of medical and healthcare professionals who’ll resolve the dispute about whether your injury meets the criteria for participation in the Scheme.
You can also lodge a dispute if you disagree with our decision about whether your injury is a ‘motor accident injury’ which is whether it meets the legal definition of a motor accident (legal eligibility).
We use an independent assessment panel of legal professionals who’ll resolve the dispute about whether your accident meets the legal definition of a motor accident.
How decisions about eligibility are made
We’ll make a decision about your eligibility based on the information provided in your application form, and additional information provided in other reports we receive such as police and ambulance reports and hospital records.
To determine eligibility, we assess the information to see if you meet the criteria in our Guidelines.
The process is the same for both interim participation and lifetime participation.
Learn more about what we cover for motor accident injuries.
What you need to know about lodging a dispute about eligibility
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Disputing our eligibility decision
It’s okay to disagree with a decision we’ve made.
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Disputes must be lodged within 6 months of the decision we have made
Disputes can be lodged verbally (in person or by phone), or in writing, within six months of when you received the decision.
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Who can lodge a dispute about eligibility
An eligibility dispute can be lodged either by you, your representative, or a relevant CTP insurer. A representative can include a family member, solicitor or advocate.
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We can help you lodge a dispute
If you need help to lodge a dispute, we have a support and advocacy service that can assist you to navigate our dispute process. See our advocacy page for more information on accessing this service.
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Dispute assessment process
Once we’ve received your dispute, it will be assessed by either an independent assessment panel of dispute assessors who are experienced medical and health professionals (eligibility dispute) or a panel of claims assessors who are experienced legal professionals (motor accident injury dispute).
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Providing information to the panel
You can provide additional information to the panel throughout the process. It’s important to make sure the panel has access to the relevant information as early as possible.
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Receiving your dispute outcome
Once a decision has been made, you’ll be notified of the outcome in writing with a certificate outlining the panel’s reasons.
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Challenging your dispute outcome
For an eligibility dispute, if you don’t agree with the outcome, you have the option to request a review of the assessment panel’s decision.
For a motor accident injury dispute, the decision is legally binding and there is no option in our legislation to appeal this decision.
- Reasons you might ask for a review
- How to lodge an application for a review
- Next steps after you request a review
- Who is on the review panel
- How the review panel will assess your dispute
- Length of review process
- Paying for the review panel assessment
Requesting a review of an assessment panel's decision
- What disputing your 'motor accident injury' means
- Who can lodge a 'motor accident injury' dispute
- How to lodge your 'motor accident injury' dispute
- Who assesses your dispute
- How the panel will make their decision
- Providing information to the panel
- Length of dispute process
- What happens next