Olla Kutieleh writes about eligibility and entitlements under South Australia’s motor accident Lifetime Support Scheme.
TGB’s Olla Kutieleh writes about eligibility and entitlements under South Australia’s motor accident Lifetime Support Scheme.
The Lifetime Support Scheme was introduced by the Motor Vehicles Accidents (Lifetime Support Scheme) Act 2013, which came into effect on 1 July 2014.
The intention of the scheme is to provide support to all people seriously injured as a result of a motor vehicle accident in South Australia, regardless of who is at fault for the accident.
The Scheme is administered by the Lifetime Support Authority and is funded by a levy which is encompassed into your motor vehicle registration.
Who is Eligible to Access the Lifetime Support Scheme
An application to access the Lifetime Support Scheme can be made by the injured person, their representative, someone acting on their behalf or by an insurer.
If the criteria to access the Scheme is met, the injured person may be accepted into the scheme as an interim or lifetime participant. That person can remain an interim participant for up to three years while their injuries are stabilising. However, if accepted as an interim participant, the Lifetime Support Authority may at anytime during or after the interim period accept the injured person as a lifetime participant if the criterion is met.
If the Lifetime Support Authority determines an injured person is not eligible to access the Scheme, an eligibility dispute can be lodged. This dispute must be lodged with the Lifetime Support Authority in writing within six months of the determination. The dispute can be lodged by the applicant, their lawyer, someone acting on their behalf or by an insurer.
Depending on the circumstances, the dispute will be reviewed by a Review Officer or the Expert Review Panel.
If the injured person remains dissatisfied with the decision of the Review Officer or the Expert Review Panel, the decision may be appealed may to the District Court of South Australia within 28 days.
Part 2 of the Lifetime Support Scheme Rules provides that in order to be eligible for interim or lifetime participation in the Scheme, at the time the application is made, the injured person must meet one or more of the following injury criteria:
1. Spinal cord injuries;
2. Traumatic brain injuries;
4. Severe burns;
5. Permanent blindness
Entitlements under the Scheme
The support offered through the scheme includes funding of the costs associated with ‘reasonable and necessary’ treatment, care and support services that relate to the motor vehicle injury.
When considering whether a treatment or service is ‘reasonable and necessary’ the Lifetime Support Scheme will take into consideration the following factors:
1. Benefit to the participant;
2. Appropriateness of the service or request;
3. Appropriateness of the provider;
4. Cost effectiveness considerations; and
5. Relationship of the service or request to the injury sustained in the accident.
‘Treatment, care and support’ is defined in Part 4 of the Lifetime Support Scheme Rules to include :
1. Medical treatment, including pharmaceuticals;
2. Dental treatment;
4. Ambulance transportation;
5. Respite care;
6. Attendant care and support services;
7. Aids and appliances;
9. Educational and vocational training;
10. Home and transport modification;
11. Workplace modification;
12. Such other kinds of treatment, care and support services as may be prescribed by the regulations; and
13. Such other kinds of treatment, care and support or services as may be determined by the Authority (either generally, for specified classes of cases, or for a particular person).
These factors can add up to significant costs that you may be entitled to, so it is important to be fully informed.
People injured in motor accidents who believe they may qualify for the Lifetime Support Scheme, or have any query about their motor accident compensation claim, should seek expert legal advice as soon as possible.
For a free initial interview about your motor accident claim contact Olla Kutieleh or your nearest TGB office.