Wrongs (Part VBA Claims) Regulations 2005

i Wrongs (Part VBA Claims) Regulations 2005 S.R. No. 27/2005 TABLE OF PROVISIONS Regulation Page 1. Objective 1 2. Authorising provision 1 3. Certificate of assessment 1 4. Certificate of assessment where injury has not stabilised 2 5. Agreement to waive assessment of impairment 2 6. Copy of certificate of assessment to be served on respondent 3 7. Respondent must provide information to Medical Panel 5 __________________ SCHEDULE 6 Form 1—Certificate of Assessment of Degree of Impairment Arising From Stabilised Injury 6 Form 2—Certificate of Assessment of Degree of Impairment Where Injury Has Not Stabilised 8 ═══════════════ -- 1 of 10 -- 1 STATUTORY RULES 2005 S.R. No. 27/2005 Wrongs Act 1958 Wrongs (Part VBA Claims) Regulations 2005 The Lieutenant-Governor, having assumed the administration of the government of the State, with the advice of the Executive Council, makes the following Regulations: Dated: 10 May 2005 Responsible Minister: ROB HULLS Attorney-General RUTH LEACH Acting Clerk of the Executive Council 1. Objective The objective of these Regulations is to prescribe forms and other matters for the purposes of Part VBA of the Wrongs Act 1958. 2. Authorising provision These Regulations are made under section 28LZP of the Wrongs Act 1958. 3. Certificate of assessment For the purposes of section 28LN of the Wrongs Act 1958, the prescribed form of a certificate of assessment is Form 1 in the Schedule. -- 2 of 10 -- S.R. No. 27/2005 Wrongs (Part VBA Claims) Regulations 2005 2 4. Certificate of assessment where injury has not stabilised For the purposes of section 28LNA of the Wrongs Act 1958, the prescribed form of a certificate of assessment where the injury has not stabilised is Form 2 in the Schedule. 5. Agreement to waive assessment of impairment For the purposes of section 28LO(1A) of the Wrongs Act 1958, the following information is prescribed— (a) name of the claimant; (b) address of the claimant or the claimant's legal representative; (c) telephone number of the claimant or the claimant's legal representative; (d) date of birth of the claimant; (e) name of the respondent; (f) address of the respondent; (g) telephone number of the respondent (if known); (h) a statement of reasons explaining why the claimant asserts that the respondent is the proper respondent to the claim; (i) name, address and telephone number (if the number is known) of any other party (other than the respondent) who the claimant considers to be a proper respondent to the claim and reasons why that other party is also considered to be a proper respondent; (j) date, time and location of the incident; (k) description of the incident; r. 4 -- 3 of 10 -- S.R. No. 27/2005 Wrongs (Part VBA Claims) Regulations 2005 3 (l) details of the injury suffered as a result of the incident; (m) details of any one or more of the following— (i) pain and suffering; (ii) loss of amenities of life; (iii) loss of enjoyment of life— suffered by the claimant as a result of the injury; (n) details of any report of the incident on which the claimant intends to rely to make the claim, including the date of the report and the person to whom the report was made; (o) name, professional qualifications, address and telephone number of any medical practitioner who has treated the injury of the claimant. 6. Copy of certificate of assessment to be served on respondent For the purposes of section 28LT(2) of the Wrongs Act 1958, the following information is prescribed— (a) name of the claimant; (b) address of the claimant or the claimant's legal representative; (c) telephone number of the claimant or the claimant's legal representative; (d) date of birth of the claimant; (e) name of the respondent; (f) address of the respondent; r. 6 -- 4 of 10 -- S.R. No. 27/2005 Wrongs (Part VBA Claims) Regulations 2005 4 (g) telephone number of the respondent (if known); (h) a statement of reasons explaining why the claimant asserts that the respondent is the proper respondent to the claim; (i) name, address and telephone number (if the number is known) of any other party (other than the respondent) who the claimant considers to be a proper respondent to the claim and reasons why that other party is also considered to be a proper respondent; (j) date, time and location of the incident; (k) description of the incident; (l) details of the injury suffered as a result of the incident; (m) details of any one or more of the following— (i) pain and suffering; (ii) loss of amenities of life; (iii) loss of enjoyment of life— suffered by the claimant as a result of the injury; (n) details of any report of the incident on which the claimant intends to rely to make the claim, including the date of the report and the person to whom the report was made; (o) name, professional qualifications, address and telephone number of any medical practitioner who has treated the injury of the claimant. r. 6 -- 5 of 10 -- S.R. No. 27/2005 Wrongs (Part VBA Claims) Regulations 2005 5 7. Respondent must provide information to Medical Panel For the purposes of section 28LZA(1)(a)(ii) of the Wrongs Act 1958, the following information is prescribed— (a) name of the respondent; (b) address of the respondent; (c) telephone number of the respondent; (d) date on which the respondent received the claimant's certificate of assessment; (e) name, address and telephone number of the respondent's legal or other representative (if any); (f) name of the claimant; (g) address of the claimant or the claimant's legal representative; (h) telephone number of the claimant or the claimant's legal representative; (i) date, time and location of the incident; (j) description of the incident; (k) details of the injury the claimant alleges to have suffered as a result of the incident. __________________ r. 7 -- 6 of 10 -- S.R. No. 27/2005 Wrongs (Part VBA Claims) Regulations 2005 6 SCHEDULE FORM 1 Regulation 3 CERTIFICATE OF ASSESSMENT OF DEGREE OF IMPAIRMENT ARISING FROM STABILISED INJURY Wrongs Act 1958 Section 28LN DETAILS OF MEDICAL PRACTITIONER Name: Qualification: Address: Telephone: Fax: CERTIFICATION I certify that on: (date) I examined: (insert name of person seeking the assessment) of (address of person seeking the assessment): and I am satisfied/I am not satisfied (delete whichever inapplicable) that: (tick appropriate box/boxes) † the degree of impairment resulting from this person's injury is more than 5%. Brief description of injury assessed: † the degree of impairment resulting from this person's psychiatric injury is more than 10%. Brief description of psychiatric injury assessed: SIGNED: DATED: Form 1 -- 7 of 10 -- S.R. No. 27/2005 Wrongs (Part VBA Claims) Regulations 2005 7 Please note: This certificate must be provided by a medical practitioner who is an "approved medical practitioner" within the meaning of section 28LB of the Wrongs Act 1958. This certificate must not state the specific degree of impairment. Impairment means permanent impairment. __________________ Form 1 -- 8 of 10 -- S.R. No. 27/2005 Wrongs (Part VBA Claims) Regulations 2005 8 FORM 2 Regulation 4 CERTIFICATE OF ASSESSMENT OF DEGREE OF IMPAIRMENT WHERE INJURY HAS NOT STABILISED Wrongs Act 1958 Section 28LNA DETAILS OF MEDICAL PRACTITIONER Name: Qualification: Address: Telephone: Fax: CERTIFICATION I certify that on: (insert date) I first examined (insert name of person seeking the assessment): of (address of person seeking the assessment): in relation to: (tick appropriate box/boxes) † an injury. Brief description of injury assessed: I certify that I have conducted a subsequent examination today in relation to the same injury and I am unable to determine the degree of impairment. However, I am satisfied that the degree of impairment resulting from this injury will be more than 5% once the injury has stabilised. † a psychiatric injury. Brief description of psychiatric injury assessed: Form 2 -- 9 of 10 -- S.R. No. 27/2005 Wrongs (Part VBA Claims) Regulations 2005 9 I certify that I have conducted a subsequent examination today in relation to the same psychiatric injury and I am unable to determine the degree of impairment. However, I am satisfied that the degree of impairment resulting from this psychiatric injury will be more than 10% once the injury has stabilised. SIGNED: DATED: Please note: This certificate must be provided by a medical practitioner who is an "approved medical practitioner" within the meaning of section 28LB of the Wrongs Act 1958. The date of the first examination of the person seeking an assessment must be at least six months before the date of this assessment. Impairment means permanent impairment. ═══════════════ Form 2 -- 10 of 10 --