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MAIB - Claims

Dr Rosalie Woodruff MP

Dr Rosalie Woodruff MP  -  Wednesday, 1 December 2021

Tags: MAIB, Health

Dr WOODRUFF - Minister, I'm interested in getting a profile of MAIB's claimants and what proportion of claimants receive daily care payments, housekeeping payments, loss of income allowances, and I think you referred to attendant care and other services. Do you have that information, please?

Mr KINGSTON - The majority of the payments are to our lifetime care scheme. We have 100 claimants in that lifetime care scheme. To become lifetime care, you need at least two hours of daily care for an indefinite period, usually for the rest of their lives. Once they're in they can then get access to unlimited benefits. If you're not in that scheme, our normal scheduled benefits scheme, you can still access that care but it is capped at an absolute maximum of $500 000 for a claim. Most of the attendant care we provide and the bigger services are to our lifetime care group. As I said, there is 100 in that scheme. The vast majority of those would receive attendant care. Some of those people that are receiving 24/7 care. We even have clients who need two people 24/7 looking after them. We pay for attendant care for the rest of their life, we have people on site looking after them. They would be the biggest users of our attendant care and other services.

It is difficult to say the exact numbers. They do change but as I said most of the 100 clients would and we probably have about the same number again in our general claims at any point in time accessing attendant care services who are being looked after.

Dr WOODRUFF - In the capped group?

Mr KINGSTON - Yes, about the same amount in the capped group.

Dr WOODRUFF - Do they purchase service that MAIB provides or do they purchase them anywhere in the community? Is the $500 000 that constrained in terms of the attendant care aspect?

Mr KINGSTON - Not necessarily. That is a total cap for their claims. So, if they need lots of attendant care they can have that but they usually have a range of services, hospital fees when they are first injured, or in rehab and recovery. That smaller group of scheduled benefits where there is a limit are usually, hopefully, right within a couple years and back to their pre-injury state. They are more in recovery and rehab than in long-term attendant care. They have access to all the benefits and whatever amount of that $500 000 is spent on any benefit is for what their need is. We don't tell them what they can use it on.

Again, we need to make sure through a medical assessment that it is required. Once it is, we then pay for it.

Dr WOODRUFF - Minister, I have some questions about the maximum coverage by MAIB. I understand MAIB only covers for personal income for up to two years. Is that true and how does that compare to other jurisdictions?

Mr KINGSTON - Two years is the standard for our wage allowance that we provide but if somebody meets certain criteria under the legislation around the severity of their injury and time in hospital they can extend that to five years. So, we have a maximum of five years of what we call 'wage displacement' at 80 per cent of their salary. It's not easy to compare across the other schemes because half the schemes are 'at fault' where you have to prove someone's at fault and go to court to get a common law settlement. They don’t give 'no fault' benefits.

For the schemes that are 'no fault' we're pretty comparable with most of them on most of our requirements. I don't know exactly for every other scheme but most of our benefits are as good as anyone's in the country.

Dr WOODRUFF - Thank you. The two years limitation seems fairly narrow compared to other compensation schemes. I think workers' compensation can have it extended for up to 20 years. Given that MAIB has a stellar and consistently strong financial position, why have the two-year limit with the potential for a maximum extension up to five years?

Mr CHALLEN - It's a provision of the act. We don't have any option.

Dr WOODRUFF - Thank you. Question to the minister then, why is that the case?

Mr FERGUSON - I can only answer very broadly. Tasmania's scheme is recognised as, if not the most generous, one of the most generous no-fault schemes in the country. The Government has no intention, nor plan to deviate from the well-established rules that are in place by the act. I have no advice in front of me to change that position of Government. We need to continue to prudently look after the resources as well as ensure that we look after people who are in need of financial or other support as a result of a car crash.

Dr WOODRUFF - Minister, how does the MAIB assess average weekly earnings? For example, if someone has only recently commenced work after a period of unemployment, is their salary taken to be their average weekly earnings, or is it an average weekly income over a 12 month period?

As another example, if a person is recently unemployed, how does that affect the calculation of average weekly earnings?

Mr FERGUSON - Thank you, Dr Woodruff, we will get that answer for you.

Mr KINGSTON - Through you, minister, it isn't quite a straightforward answer. We calculate based on their earnings in the 12 months prior. That is the first point we go to, and that is capped at three times average weekly earnings. So, if there are any above that, then they get three times the average weekly earnings. That is just to protect the scheme from having to pay out huge amounts of money if somebody was on an extreme salary. That has been in place a long time and is similar to most other jurisdictions.

If they haven't worked consistently for that 12 month period, we can look back further, or when they were working what they were getting, to try to work out their average weekly earnings, and then we pay 80 per cent of that. It is an immediate stepdown and stays at 80 per cent for that entire period.

Dr WOODRUFF - If somebody has come in with a high income, but they had previously been unemployed for that long period of time, is that what you just said then?

Mr KINGSTON - No. If they had been unemployed for some time, we will try to find the period when they were earning money, to work out what their average weekly earnings were, and we will pay that. We pay 80 per cent across the board of their average weekly earnings is what I was trying to say.

Dr WOODRUFF - As I understand it, if the maximum treatment expenses that MAIB will cover is between $400 000 and $500 000, depending on circumstances, can you tell me what proportion of claimants have actually reached that threshold?

Mr KINGSTON - I can't tell you the exact proportion, but in the last couple of years there has been two or three, out of 2500 claims a year. In one case they went to lifetime care, because they were obviously continuing to need care beyond that. In the other case they had a common law settlement that enabled them to settle their claim and get their money out. Beyond that, I don't know of any cases where they have hit their limit and we have stopped paying benefits, at least in the last few years.

Dr WOODRUFF - Two or three over that whole period, not in a year, out of the 2500 new claims.

Mr KINGSTON - Over that whole period. Every year we get just under 2500 new claims. It's very rare they hit their limit, and if they do we will look for proactive ways to settle common law so that they don't hit that limit, if they have the rights to common law. If they are beyond that, usually they are more likely to be lifetime care clients because they are obviously severely impacted for a long time.