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Glossary

The words that turn up in a claim, defined in plain English. Each term says which state and which type of claim it belongs to, because the same word can mean different things in Queensland and New South Wales.

Terms used in every claim

Claimant All states: The injured person who makes the claim. In court proceedings the same person is called the plaintiff.
Liability All states: Whether the other party is legally responsible for the injury. Liability is decided before the value of the claim is.
Negligence All states: A failure to take the care a reasonable person would have taken in the same situation, which causes harm to someone else.
Duty of care All states: The legal obligation one person owes another to take reasonable care not to cause them harm.
Breach of duty All states: A failure to meet the standard of care the duty required. Breach is judged against what a reasonable person would have done.
Causation All states: The link between the breach of duty and the injury. The breach must have been a necessary condition of the harm.
Contributory negligence All states: A reduction in compensation because the injured person contributed to the accident or to the extent of their injury.
Damages All states: The money a court awards, or an insurer agrees to pay, as compensation for an injury. Damages are assessed under separate heads.
General damages All states: Compensation for pain, suffering and loss of enjoyment of life. It is the part of a claim that is not tied to a dollar loss.
Economic loss All states: Income and earning capacity lost because of the injury, past and future.
Pre existing condition All states: An injury or illness the person already had before the accident. It does not bar a claim, but the insurer will try to attribute symptoms to it.
Whole person impairment All states: A percentage rating of the permanent effect of an injury on the body as a whole, assessed by a trained doctor against a published guide.
Independent medical examination All states: An examination by a doctor chosen by the insurer, or agreed between the parties, to report on the injury and its effects.
Without prejudice All states: A label on communications made in an attempt to settle, which prevents them being used as evidence if the matter goes to court.
Limitation period All states: The time limit within which court proceedings must be started. Once it passes the claim is barred unless an extension is granted.
Statutory refund All states: An amount repaid from a settlement to a government body that funded treatment or paid benefits, such as Medicare or Centrelink.

Motor vehicle accidents

CTP insurer All states: The compulsory third party insurer of the vehicle at fault. The claim is made against the insurer, not the driver.
Nominal defendant All states: The body that answers a motor accident claim where the vehicle at fault was unidentified or uninsured.
Notice of accident claim form Queensland: The form that starts a Queensland CTP claim. It goes to the CTP insurer of the vehicle at fault within a strict timeframe.
MAIC Queensland: The Motor Accident Insurance Commission, the regulator of the Queensland CTP scheme.
Injury scale value Queensland: The number between 0 and 100 assigned to an injury in Queensland that fixes the amount of general damages.
Rehabilitation funding Queensland: Early treatment paid for by a CTP insurer before liability is decided. In Queensland it is at the insurer’s discretion.
Statutory benefits New South Wales: Treatment, care and a portion of lost income paid by a New South Wales CTP insurer from notification, regardless of fault.
Non threshold injury New South Wales: An injury serious enough, under the New South Wales scheme, to allow a claim for damages on top of statutory benefits.
SIRA New South Wales: The State Insurance Regulatory Authority, the regulator of the New South Wales motor accident and workers compensation schemes.
Personal Injury Commission New South Wales: The New South Wales tribunal that decides disputes in motor accident and workers compensation claims.

Workers compensation

WC insurer Queensland: The insurer that handles a workers compensation claim. In Queensland it is WorkCover Queensland for most employers and a self insurer for some large ones.
Statutory claim Queensland: The no fault stage of a Queensland workers compensation claim: weekly payments, treatment and a lump sum for permanent impairment.
Common law claim Queensland: A claim for damages against the employer for negligence, available after the statutory claim where the employer was at fault.
Degree of permanent impairment Queensland: The percentage assessed at the end of a Queensland statutory claim that sets the lump sum offer and affects the common law election.
Journey claim All states: A workers compensation claim for an injury suffered travelling to or from work.
Certificate of capacity New South Wales: The medical certificate a New South Wales worker needs for weekly payments, stating what work they can and cannot do.
Work capacity decision New South Wales: A decision by a New South Wales insurer about a worker’s capacity to earn, which sets or changes weekly payments.
Section 39 New South Wales: The provision that stops New South Wales weekly payments after a set number of years unless the worker’s whole person impairment exceeds a threshold.
icare New South Wales: The New South Wales government insurer that underwrites most workers compensation policies, with claims managed by its agents.

Public liability

Occupier All states: The person or business in control of premises, who owes a duty of care to the people who enter them.
Public liability insurer All states: The insurer of the party responsible for the place or activity where the injury happened.
Obvious risk All states: A risk that would have been obvious to a reasonable person in the injured person’s position. There is no duty to warn of it.
Reasonable precautions All states: The steps a reasonable occupier would have taken against a foreseeable risk, such as cleaning, signage, repair or inspection systems.

TPD, income protection and superannuation

Total and permanent disability All states: Insurance cover, usually held inside superannuation, that pays a lump sum when illness or injury stops a person working.
Income protection All states: Insurance that pays a monthly benefit while illness or injury prevents a person from working. It does not require permanence.
Own occupation and any occupation All states: The two work capacity TPD tests found in most policies. Own occupation asks whether you can do your usual job; any occupation asks whether you can do any job suited to your background.
Date of disablement All states: The date from which the insurer assesses when the member first became disabled.
Waiting period All states: The period after the person stops work that must pass before a TPD definition can be satisfied or an income protection benefit starts.
Superannuation trustee All states: The entity that runs the superannuation fund and holds the group insurance policy on behalf of members.
Internal dispute resolution All states: The fund’s own review of a declined claim, and the first formal step after a decline.
AFCA All states: The Australian Financial Complaints Authority, the free external complaints body for superannuation and insurance disputes.
Procedural fairness letter All states: A letter from an insurer outlining their preliminary decision to decline a claim, giving the claimant a chance to respond before the decision is made.
Activities of daily living All states: An alternative TPD test in some policies based on inability to perform basic daily tasks, rather than inability to work.
Offset All states: A reduction of an income protection benefit because of other income, such as workers compensation or another insurance policy.

Going to court

Compulsory conference Queensland: A mandatory settlement meeting in Queensland injury claims that must be held before court proceedings can be started.
Mandatory final offer Queensland: The written offer each party must make at the end of a Queensland compulsory conference if the claim does not settle.
Settlement conference New South Wales: A without prejudice meeting between the parties to try to resolve a claim, before or after court proceedings are filed.
Statement of claim All states: The document that starts court proceedings. It sets out the facts relied on, the negligence alleged and the damages claimed.
Disclosure All states: The obligation on each party to give the other copies of the documents relevant to the claim. Called discovery in some courts.
Mediation All states: A settlement meeting run by an independent mediator, usually ordered by the court after proceedings are filed.
Interlocutory application All states: An application to the court for an order about the conduct of the case before trial, rather than a decision on the claim itself.

After a settlement

Deed of release All states: The document signed at settlement in which the claimant accepts the settlement sum and releases the insurer from any further claim.
Medicare notice of charge All states: Medicare’s statement of the treatment costs it funded for the injury, which must be repaid from the settlement.
Centrelink preclusion period All states: A period after a lump sum compensation payment during which Centrelink will not pay income support.
Disbursements All states: The expenses paid to third parties to run a claim, such as medical reports, court filing fees and barristers’ fees.