Costs and compensation after major trauma

If you or a family member experiences a major trauma incident, you may face an array of medical bills, and they can be confronting when they start to arrive. Bills can relate to costs such as transport to hospital, hospital services, medical care, aids and equipment, medications and rehabilitation services.

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

• whether you are eligible for compensation through a transport accident scheme
• a workplace injury scheme or a veterans’ scheme
• support as the victim of a crime

In some cases, people also have associated legal costs. How your hospital costs are met depends on your local health system. In many countries, treatment as a public patient in a public hospital is covered by the public health system, while as a private patient some or all of your costs may be covered by health insurance, depending on the type of cover you have. Some costs may also be met by compensation schemes. In certain circumstances, there may be costs you need to pay out of pocket.

It is a lot to take in and can feel overwhelming, particularly when you are also coping with the effects of major trauma. The summary below outlines the key financial costs and the potential compensation that may be available.

Ambulance and emergency transport#

Emergency transport services are not always free and may not be covered by the public health system. Some people hold ambulance cover or membership that protects them against the cost of clinically necessary ambulance transport by road and air. Without ambulance cover, you may have to pay for these services unless you hold a concession or healthcare card.

Some private health insurance policies include ambulance cover, but the level of cover varies. It is important to check exactly what your policy includes, because in some cases private health insurance may not fully cover the cost of ambulance services.

Hospital costs#

Most emergency medical treatment is carried out in public hospitals. In an emergency, ambulances will usually transport you to a public hospital unless you specify otherwise. Some areas also have a limited number of private emergency departments that operate on a user-pays model, where charges depend on the hospital, whether you have private health insurance, and what your policy covers. Contact your insurer or review your policy to find out what costs you may incur and what length of stay is covered.

Where public hospital care is free to citizens and most permanent residents, there is generally no cost to you for treatment as a public patient after a major trauma incident, including for a private patient who chooses to be treated as a public patient. You will usually be asked whether you want to be admitted as a public or a private patient on arrival, or at a suitable time if you are unconscious.

If you choose to be admitted as a private patient, your hospital accommodation, theater fees and doctors’ fees may not be covered by the public system, and these costs will be billed to you or your health insurer. If you are not covered by the public health system, you may have to pay for hospital services.

Your healthcare team can usually arrange for a hospital social worker or case manager to help with your emotional and practical needs. They can advise you on the process for hospital costs and payments, compensation, and other healthcare services you may need. You can also speak to the hospital directly or check their website for information about costs.

Overseas visitors#

If you are an overseas visitor, speak to the hospital administration team about any costs you may need to pay. If you have health insurance for your time abroad, speak to your insurer and review your policy to see what cover you have and what your next steps might be. Some countries also have reciprocal health care agreements with one another, under which residents of certain countries can get help with the cost of essential medical treatment while visiting.

Government and carer support#

Governments often provide a range of supports for people and families affected by major trauma. These can include:

• access to a range of subsidized medical services
• lower-cost prescription medicines
• free care as a public patient in a public hospital

If you are a carer, or you have a support person who cares for you, dedicated carer support services can be a useful place to find information.

Compensation schemes#

Several types of scheme may provide compensation for eligible people, depending on how the injury occurred:

• Transport accident schemes pay for treatment and support services for people injured in transport accidents. In some places these are funded by a charge paid as part of vehicle registration. A hospital liaison officer may be able to lodge a claim on your behalf, and the scheme can pay for medical treatment, rehabilitation, disability services, home services and child care.
• Workplace injury schemes provide compensation to workers for work-related injuries or illnesses. If you are injured at work or have a work-related illness, you may be able to claim for treatment expenses, rehabilitation costs and replacement of lost income, whether you are permanent or casual, full time or part time, and whether employed directly or through an agency. You usually need to record the injury in your workplace’s register of injuries, or otherwise notify your employer in writing, within a set time, and let them know about any time you need away from work or help to return to safe work.
• Veterans’ schemes may pay for hospital services and other support for eligible people.
• Victims of crime assistance may provide financial assistance to victims of violent crime, usually where the crime was reported to police within a reasonable time and the claim is made within a set period.

Keep all your receipts and invoices for any treatment you receive. Be aware that sometimes your compensation may not be confirmed before the bills begin to arrive.

Insurance#

Private health insurance varies depending on the type of cover you have, so contact your insurer and review your policy wording to find out what you are covered for.

If you have income protection insurance, contact your insurance fund and check your policy. Income protection insurance provides cover if you get sick or injured and cannot work. 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.

Financial and legal matters#

Free, trusted financial information and advice services can help with issues ranging from being a carer or dealing with illness, to budgeting and managing money. Not-for-profit debt helplines can also help people tackle debt problems.

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

It can help to find out what is covered by the public health system and what is not, what other government support you may qualify for, what your private health insurance will cover, and what your income protection insurance will cover.

Key points#

• Major trauma can bring many bills, but public hospital treatment as a public patient is often free where a public health system covers you.
• Emergency ambulance transport is not always free and may need separate ambulance cover.
• Compensation may be available through transport accident, workplace injury, veterans’ or victims-of-crime schemes, depending on how you were injured.
• Keep all receipts and invoices, and be aware compensation may not be confirmed before bills arrive.
• Free financial advice, debt helplines, power of attorney and advance care plans can help you manage during recovery.