Once your injury is medically stable, the CTP Insurer handling your claim may discuss arranging an Injury Scale Value (ISV) medical assessment. It will take into account available medical evidence, a medical examination and how an individual has been impacted by their injury (see Part 2 of the Civil Liability Regulations 2013 for more information).
The purpose of an ISV Medical Assessment is to determine the item number for your injury (or injuries). Following receipt of your ISV report, the CTP insurer will determine the type/s and amount of compensation you are eligible for.
An ISV medical assessment is not required in every case. The CTP Insurer (or your legal representative – if you have one) will inform you on whether you need to have an ISV medical assessment. The Regulator has developed a guideline to assist if you and your CTP Insurer wish to arrange a joint independent medical assessment. Arranging a joint medical assessment can reduce the number of assessments you need to attend.
Schedule 1 of the Civil Liability Regulations 2013 sets out item numbers, injury descriptions and a range of values for particular injuries, on a scale of 0-100. If you have multiple injuries, your dominant injury (on which your compensation will be based) is the injury with the highest ISV. View the ISV Table, listing ISVs and their associated monetary value.
When you can request an ISV medical assessment
You, or your legal representative, may request the CTP Insurer to arrange an ISV medical assessment if:
- your injury is medically stable
- liability for the accident has been determined, and
- you have not reached a settlement agreement with the CTP Insurer.
If the above requirements are met, but your injuries are unlikely to receive an ISV of 8-100, or are not sufficiently stable, the CTP Insurer may decline your request. They must notify you and provide a basis for the decline. If your request was declined because of insufficient evidence, they must notify you of what additional evidence is required.
Who conducts ISV medical assessments?
ISV medical assessments are undertaken by an Accredited Medical Practitioner, through the Motor Accident Injury Accreditation Scheme (MAIAS). The assessment must be undertaken by an Accredited Medical Practitioner, however, in some circumstances (for example, if you and the CTP Insurer mutually agree that it is not required, if there is no health professional accredited to undertake the assessment, or if the court determines an ISV assessment is not required), the CTP Insurer may obtain a report from a health provider who is not accredited under the MAIAS.
About the MAIAS
The MAIAS was established to create an independent system that provides consistent, objective and reliable ISV medical assessments. It accredits health professionals to undertake ISV medical assessments and allocate an injury item number based on the description of injuries sustained in motor vehicle accidents which occurred on or after 1 July 2013.
For further information about how doctors are accredited under this scheme, visit MAIAS.
Who pays for the assessment?
If a CTP Insurer arranges an independent assessment or ISV medical assessment, they must cover the cost. If you or your legal representative arrange the assessment, the CTP Insurer will cover the cost, provided they have been given reasonable notice to approve it before the date of the assessment.
Organising your assessment
The CTP Insurer must:
- take into account any issues that may impact your ability to attend an assessment (such as disability access requirements)
- give you at least seven business days’ notice of the appointment details (such as date and time, location, specialty of the health professional and the reason you are required to attend), and
- arrange a translator or interpreter, at the insurer’s cost, if required.
The CTP insurer will forward documentation to the health professional in advance, but will only provide information that is relevant to the assessment.
As a result of the COVID-19 pandemic, it is currently possible to use videoconferencing (telehealth) for pure mental harm Injury Scale Value (ISV) medical assessments.
Expenses and cancellations
You can claim the reasonable costs of attending an independent assessment (such as travel expenses). If you are unable to attend an independent assessment or ISV medical assessment, you must notify the CTP Insurer at least two business days in advance to avoid a cancellation fee, which may be deducted from your compensation.
The CTP Insurer has 21 days from receipt of the report to provide you with a copy of an independent assessment or ISV report, and they may contact you (or your legal representative - if you have one) to discuss the findings. When you receive a copy of the report, if you dispute or do not understand any of the information it contains, you should contact the CTP Insurer.
Information and assistance
Our “ISV Medical Assessments” fact sheet is available to download. Or you can contact the claims consultant managing your claim for further assistance.