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Private health cover and accident compensation

Private health cover and accident compensation: get the facts on who pays what

If you’re planning to pay your medical expenses for injuries after an accident using your private health insurance, there are some important things to know. It’s not black and white and it can get confusing.

1. Some private health insurers won’t pay benefits for a condition, injury or ailment if you are entitled to compensation, even if the compensation excludes medical expenses. If you have no right to compensation, they will pay benefits.

2. Some private health insurers will pay benefits if the amount of a claim for compensation or damages is less than the benefits they would have otherwise paid. But they won’t pay more than the difference between your compensation and the benefits they would have ordinarily paid.

3. They may pay benefits for a condition, injury or ailment which might be entitled to compensation or damages if you agree in writing that you will:

a. make a claim for compensation and damages

b. pursue the claim with all due diligence

c. include in your claim all hospital, medical, dental, paramedical and related expenses

d. reimburse the insurer for any benefits they have paid you (if your claim is successful).

4. You must tell your insurer if you intend to claim compensation, and then inform them as soon as you have received compensation.

There is plenty more fineprint around the issue of private health and injury compensation. For example, an insurer might withhold payment of benefits if they think you have a right to claim compensation but haven’t yet had your right to claim established. Or, in some cases, insurers will pay a provisional payment to assist with the financial costs of medical treatment while you’re waiting for your compensation claim to be settled.

You can see how important it is to get specific advice on your special case. Check with your own private health insurer or call GC Law for advice on 1300 302 318. As compensation lawyers and personal injury specialists, we can help you with your claim. 

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