Costs and compensation after major trauma

If you or a family member experience a major trauma incident there will be an array of medical bills coming your way – and when they start to arrive they can be quite confronting. Bills will relate to costs such as your transport to hospital, hospital services, medical costs, aids and equipment, medications and rehabilitation services.

You will find yourself needing to understand administrative matters such as:

• what is covered by Medicare and what isn’t
• what other Government support you may qualify for
• what your private health insurance will cover (if you have it)
• what your income protection insurance will cover (if you have it)
• whether you are eligible for any compensation through the Transport Accident Commission, WorkSafe or Veterans’ Affairs, or as the victim of a crime.

In some cases, people will also have associated legal costs.

As a public patient (if you are an Australian citizen with a Medicare card), your hospital costs will be paid by Medicare. As a private patient, depending on the type of cover you have, you will have some or all of your medical costs covered by your health insurance. Some costs may also be covered by compensation providers. However, in certain circumstances, there may be some costs that you need to pay out of pocket.

It’s a lot to take in and can feel overwhelming, particularly when you are also coping with the effects of major trauma. Here is a summary of the key financial costs and potential compensation available after you have experienced a major trauma incident.

Ambulance costs after major trauma

Emergency transport services in Victoria are not free and are not covered by Medicare. However, if you have an Ambulance Victoria membership you will be protected against the costs of:

• all emergency road and air ambulance transport
• all MICA (Mobile Intensive Care Ambulance) attendance and treatment
• all ambulance treatment when transport is not required
• interstate ambulance treatment and transport services to the same level as is covered in Victoria
• all clinically necessary non-emergency patient transport by road and air ambulance.

If you do not have ambulance cover you will likely have to pay for these services unless you have a concession card or healthcare card.

Some private health insurance policies include some ambulance cover. It is important to check what your private health insurance includes as insurance companies do not buy Ambulance Victoria membership on your behalf, and what degree of ambulance cover they offer can vary. This means that in some cases your private health insurance may not fully cover the cost of ambulance services.

To learn more visit the Ambulance Victoria website.

Hospital costs after major trauma

Most emergency medical treatment in Victoria is performed in public hospitals. In an emergency, ambulances will always transport you to a public hospital unless you specify otherwise. There are a limited number of private emergency departments in Victoria, and they operate on a user-pays model.

Private emergency care attracts a charge (the rate depends on how much the hospital charges, whether or not you have private health insurance and what your policy covers). Contact your health insurer or review your policy to find out exactly what costs you may incur and for what length of hospital stay you are covered.

Public hospital healthcare is free to all Australian citizens and most permanent residents via Medicare. This means that if you have been a patient in a critical care hospital ward after a major trauma incident there is no cost to you for treatment as a public patient. There is also no cost for treatment as a ‘private patient who chooses to be treated as a public patient’.

You will be asked if you want to be admitted as a public or a private patient upon arrival or at a suitable time if you are unconscious.

If you choose to be admitted as a private patient, your primary healthcare costs will still be covered by Medicare but your hospital accommodation, theatre fees and doctors’ fees will not. These costs will be billed to you or your private health insurance provider.

If you do not have a Medicare card you will have to pay for hospital services.

At the hospital where you are treated, your healthcare team can arrange for a hospital social worker or case manager to oversee your relationship with their healthcare team and help you with your emotional and practical needs. They can advise you of the process for hospital costs or payments, compensation and other healthcare services you may need.

You can also talk to someone at the hospital directly or visit their website for more information about costs:

• The Alfred Hospital – Will I have to pay for any services?
• The Royal Melbourne Hospital – Who pays for our services?

Overseas visitors and reciprocal health care agreements

If you are an overseas visitor to Australia, speak to the hospital administration team about any costs you may need to pay. If you have health insurance for your time in Australia then speak to your insurer and review your policy to see what cover you have and what your next steps might be.

Note that Australia has Reciprocal Health Care Agreements (RHCA) with over ten countries. Most residents of these countries can get help with the cost of essential medical treatments while visiting Australia.

Government support for major trauma

The Australian Government provides various supports for people and families who are affected by major trauma. These include:

• Medicare provides access to a range of medical services, lower cost prescriptions and free care as a public patient in a public hospital.
• Centrelink provides payments and services to help you if you have an illness, injury or disability that means you can’t work, or can only do a limited amount of work.
• Payments for carers include the Carer Payment, Carer Allowance, Carer Supplement, Carer Adjustment Payment, Child Disability Assistance Payment.
• The Carer Gateway provides practical information and resources to help carers. If you are a carer or if you have a support person who cares for you, the Carer Gateway and Carers Victoria are a useful place to find information.

Major trauma and compensation

There are several bodies that provide compensation for eligible people in Victoria. These include:

• Transport Accident Commission(TAC)– motorists in Victoria pay a transport accident charge as part of their vehicle registration each year. This charge funds the TAC and pays for treatment and support services for people injured in transport accidents. More information about who is eligible and how to make a claim is available on the TAC website. Speak to your hospital's Patient Liaison Officer for more information about how they can lodge a TAC claim on your behalf.
• WorkSafe – if you are injured at work in Victoria (or have a work-related illness), you may be able to claim WorkSafe compensation for things such as treatment expenses, rehabilitation costs and replacement of lost income.

This is the case whether you are permanent or casual, full time or part time, employed by the people where you work or by an employment agency.
Be aware that you need to:

• keep all your receipts and invoices for any treatment you receive
• record your injury in your workplace's register of injuries within 30 days (in person or by someone on your behalf). If you are not able to do this, you still need to notify your employer in writing within 30 days
• talk to your employer and let them know about any time you need away from work or any help that you need to return to safe work.

For more information read:

• Financial support after workplace major trauma
• Veterans’ Affairs
• Victims of Crime – to apply for financial assistance from the Victims of Crime Assistance Tribunal (VOCAT):
  • you must be a victim of a violent crime that occurred in Victoria
  • the crime must have been reported to police within a reasonable time
  • the crime must have happened within the last two years (except in the case of some childhood sexual crimes).

The average amount of financial assistance paid by VOCAT is around $7000.

The following links can help you to work out what to do after an accident, and whether you are eligible for compensation:

• Transport Accident Commission (TAC) – What to do after an accident
• WorkSafe Victoria – Claims process and what to expect
• Veterans' Affairs – Compensation
• Victims of Crime – Compensation and financial assistance in Victoria.

Private health insurance

Private health insurance varies depending on the type of cover you have. Contact your health insurance company and review your policy wording to find out what you are covered for. The Australian Government's PrivateHealth website may also be of assistance.

Income protection insurance

If you have income protection insurance, contact your insurance fund and check your insurance policy. Income protection insurance provides cover if you get sick or injured and cannot work. It may also contribute towards your superannuation. You may receive this benefit for a few months, or it could replace your income until a nominated age; it depends on your policy, and the insurer.

Compensation providers

The Transport Accident Commission (TAC) pays for the treatment and support services you need to get your life back on track after a transport accident. This includes medical treatment, rehabilitation and disability services and things like home services and child care. Discuss with your healthcare team the most appropriate treatments for you. For a full list of the treatment and support services the TAC can pay for, visit the TAC website and search for 'treatment'.

Worksafe Victoria provides compensation to workers for work-related injuries or illnesses. If you have a work-related injury or illness, you may be able to claim WorkSafe entitlements. You are entitled to claim whether you are permanent or casual, full time or part time, employed by the people where you work or by an employment agency.

Veterans' Affairs may pay for hospital services. Contact them to find out more.

Be aware that some times you may not have had your compensation confirmed before the bills begin to arrive.

Free financial advice

MoneySmart is the Australian Government's financial advice website that provides you with trusted financial information. There is a range of advice on this website from being a carer, dealing with illness, to accessing superannuation early, budgeting and more.

The National Debt Helpline is a not-for-profit service that helps people tackle their debt problems. Visit them online or call 1800 007 007.

Legal matters after major trauma

If you are incapacitated and can no longer handle your finances or you can see a time when this will be difficult. It is a good time to assign a trusted person/s as your power/s of attorney. You may also want to prepare an advance care plan to ensure your wishes for healthcare are known.

More information

Medical power of attorney

Advance care plans

Making healthcare decisions for someone else

Paying for healthcare

Aids and equipment

Working with your healthcare team

Financial support for carers

Overseas visitors and healthcare