Children used in Compulsory Third Party insurance car crash rorts
CHILDREN, some aged as young as 14 months, are increasingly being used in brazen and fraudulent vehicle accident insurance claims.
NSW
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CHILDREN, some aged as young as 14 months, are increasingly being used in brazen and fraudulent vehicle accident insurance claims.
In the past two years, there has been a huge spike in insurance payouts to families whose kids have allegedly suffered whiplash, nightmares and psychological trauma in staged crashes.
An investigation by the State Insurance Regulatory Authority (SIRA) also revealed it is the same doctors and legal firms repeatedly being used to lodge the claims under the Compulsory Third Party personal injury scheme.
In one accident, a family wrongfully claimed seven children were in the vehicle and the insurance company paid out a whopping $285,000 to settle the claims.
The report said that because children are excluded from a mediation process companies settle rather than go to court.
With regard to this particular accident legal fees would have exceeded $800,000 to take the matters to court with little chance of recuperating costs even if it was won.
The state government-funded probe found claims for injuries such as whiplash and psychological trauma had spiralled out of control.
One major insurer said it is a “lawyers picnic’’ and that claims involving children have escalated to massive proportions in recent years.
“CTP fraud is a very serious issue,” said Victor Dominello, NSW Minister for Innovation and Better Regulation.
“The close relationships between some service providers with regard to CTP claims is concerning and the fraud taskforce will help the government to respond to fraudulent and exaggerated claims.
“The growth in minor severity claims appears to originate from newly established legal firms,’’ the report stated.
“The growth of these firms has occurred in the southwestern suburbs of Sydney.
As an example, six relatively newly established legal firms acted in only 61 minor severity claims that were commenced in 2011, but 859 minor severity claims that were commenced in 2014.
The report also found evidence claims handled by lawyers acting in a large number of cases used a small number of medical providers.
“One medical provider was the treating doctor in more than 200 of these claims.
“Given the number of GPs in NSW and the number of minor severity claims, on average in a year a GP would expect to see two CTP claimants.
“The fact that some of these doctors are seeing hundreds of claims over three years is unusual,’’ the report added.
“CTP fraud results in motorists paying higher green slip prices and the government is committed to cracking down on this behaviour.”
CASE STUDY
· Eight claimants in one vehicle accident
· Accident occurred recently in NSW
· This accident involves 8 claimants — one driver and 7 passengers, 6 of which are children in a people mover. Their vehicle was hit from behind. Both cars travelling in the same direction, front car preparing to turn.
· Police report recorded “no persons were injured or conveyed to hospital”.
Claim Details: Lists info from both the claim lodgement form and the accompanying medical certificate)
1. 9 year old claimant:
Medical certificate injuries — diagnosis and description: “neck pain R, mid back”
Clinical findings: “whiplash, STI”
Settled for $30,000 $15k medical & $15k legal costs
2. 2 year old claimant:
CTP claim form injury details “not being limited to injury to back, psychologic injury”
Affect: “cried at night. Afraid to getting into car”
Medical certificate injuries — diagnosis and description: “unsettled overnight”.
Clinical findings: “normal examination”
Settled for $25,000, $10k medical & $15k legal
3. 7 year old claimant:
CTP claim form injury details “not being limited to injury to neck, back, psychologic injury”
Affect: “Pain and discomfort to injured areas. Restriction in movement of injured areas. Psychological problems.”
Medical certificate injuries — diagnosis and description: “bruise R cheek, neck pain”
Clinical findings: “whiplash, soft tissue injury, xray was normal”
Settled for $30,000, $15k Meds and $15k Legal
4. 6 week old claimant:
CTP claim form injury details “not being limited to injury to back, psychological injury”
Affect: “Cried at night. Afraid to getting into car.”
Medical certificate injuries — diagnosis and description: “involved in mva, in capsule, very unsettled at night and vomiting”
Clinical findings: “medical exam was normal.”
Settled for $25,000, $10k Meds and $15k Legal
5. 4 year old claimant
CTP claim form injury details “not being limited to injury to back, psychological injury”
Affect: “Cried at night. Afraid of getting into car.”
Medical certificate injuries — diagnosis and description: “involved in mva, crying all night”
Clinical findings: “medical exam was normal.”
Settled for $25,000, $10k meds and $15k legal.
6. 5 year old claimant
CTP claim form injury details “Not being limited to injury to back, psychological injury”
Affect: “Cried at night. Afraid of getting into car”
Medical certificate injuries — diagnosis and description: “Involved in mva, back passenger, sore neck on R side, low back pain”
“Clinical findings: “Whiplash, soft tissue injury”
Settled for $30,000, $15k Meds and $15k Legal
7. 37 year old claimant
CTP claim form injury details “Not being limited to injury to neck back, psychological injury”
Affect: “Pain and discomfort to injured areas. Restriction in movement of injured areas, Psychological problems”
Medical certificate injuries — diagnosis and description: “mva, sore neck, back and R hand”
Clinical findings: “Whiplash, soft tissue injury to hand, xray was normal”
Ticked Yes for ambulance on claim form (no ambulance attended).
Settled for $60,000, Care $25k, Meds $25k, Legal $10k
8. 20 year old claimant (driver)
CTP claim form injury details “Not being limited to injury to neck, back, psychological injury”
Affect: “Pain and discomfort to injured areas. Restriction in movement of injured areas. Psychological problems”
Medical certificate injuries — diagnosis and description: “driver in mva, vomiting all night, headaches, neckpain, backpain, L ear pain”
Clinical findings: “Whiplash, soft tissue injury xray of neck was normal.”
Ticked Yes for ambulance on claim form (no ambulance attended).
Settled for $60,000, $15k Future economic loss, $10K Care, $25k Meds, $10k Legal costs
Originally published as Children used in Compulsory Third Party insurance car crash rorts
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