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Employment Injury - Medical Expenses

Medical Expenses are paid to an insured person who incurs the cost of medical treatment for the personal injury or prescribed industrial disease up to a maximum of $22,500.00 per injury. Prior to March 01 2004, the maximum amount payable was $15,000.00.

Medical Expenses include the following: -

  • Doctor’s Fees.
  • The cost of drugs & dressings.
  • Hospital Expenses.
  • Operations.
  • The cost of necessary para-medical treatment e.g. physiotherapy, appliances.
  • The cost of travel incidental to an insured person receiving care and treatment.
  • Constant care and Attendance Allowance (regular or periodic care as recommended by the attending doctor).
     

Who Can Claim?

You may make a claim for medical expenses where, as an insured person, you are eligible to receive Employment Injury Benefit. Medical Expenses are payable for as long as you can produce evidence from the doctor that you are under treatment for the particular injury and/or disease. Medical Expenses will not be paid in circumstances where the employer has met such costs.
 

Form To Be Completed

NI114 - Application for Medical Expenses.

From the 1st March 2004, the NIBTT will accept a certificate from a Paramedical Practitioner for Employment Injury Benefit claims only if the insured was referred by a medical practitioner with a written proof of referral.

Required Documentation

The expenses must relate to medical attention you received for injuries caused by an accident arising out of and in the course of your employment or for a prescribed industrial disease. The following documents must be submitted to support your claim:

  • Bills and receipts for any of the medical expenses identified above.
  • Foreign medical certificates must be accompanied by a letter of authentication in respect of the doctor’s status from a Notary Public in the country where medical attention was sought or a member of a Trinidad and Tobago High Commission. The responsibility for authenticating the status of the attending doctor rests with the insured.
    •  
  • Any referral letters to specialist or Paramedical Practitioner for foreign treatment.
     

The following information must be shown on the receipt from pharmacy:

  • Pharmacy Number.
  • Name of doctor.
  • Name of patient/claimant.
  • Date of prescription.
     

Para-medical treatment/equipment:

 
  • A letter of referral from the attending doctor recommending treatment and/or equipment to be provided by a particular person/institution MUST be produced.
  • Where the attending doctor himself administers such para- medical treatment or provides para-medical equipment, a letter of referral is not required.
  • Where expenses are incurred for para-medical treatment/equipment provided while the claimant is hospitalised, such expenses must be considered.

 


 

Cost of Travel

  • The full name of the claimant should be written on each bill/receipt in addition to Vehicle Registration Number, Date and Amount.
  • The normal route-taxi fares are to be applied in normal circumstances.
  • Where you use your own car, reimbursement in relation to route-taxi fares will be paid.
  • If there is doubt whether hired transport should have been used, the claimant may be asked to obtain a statement from his doctor to this effect.
  • Where under Traveling Expenses a claim is made for the traveling expense of an escort, the claimant must submit a letter from the attending doctor certifying that there was a need for an escort. Where an escort is used on the day of the injury to accompany the claimant to the doctor’s office/hospital, then the above will be waived for that day only, depending on the nature and extent of the injury.
     

Constant Care and Attendance Allowance

  • A certificate from the attending doctor, advising that constant care and attendance is required, and the period for which same is required.
  • A statement from the person or institution (e.g. convalescent home) providing the care, indicating the period(s) for which the services were rendered.
     

A Paramedical Practitioner means a person who is not a Medical Practitioner but supplements and supports medical work and includes a Chiropractor, Physiotherapist, Dental Technician or Psychologist.

When To Apply?

You must apply for the benefit within 3 months of the date on which the expenses were incurred.

Late Applications

You must apply on time to ensure that you receive your benefit.  Failure to submit your claim to the Board within 3 months of incurring the medical expense can result in you losing all or part of your benefit. You may lose benefit for any expense incurred that is more than 3 months earlier than the date on which the Board receives your claim unless you can show there was good cause for the delay in submission. Your explanation must be submitted in writing. Even with good cause you may still lose your benefit.

Even with good cause, if your claim is made more than 12 months after incurring the expense the benefit shall be forfeited.

How To Apply?

Submit your claim to the NIBTT Service Centre most convenient to you. There, one of our customer service representatives will accept your claim for processing.

How Much Will Be Paid

The rates of payment for the categories of Medical Expenses are described below with the exception of (e), (f) and (g). There are limits in each category with the maximum amount payable as medical expenses for an injury being $22,500.00.

 

Use of National Insurance Forms
Whenever  you perform National Insurance functions under the National Insurance Act or Regulations, you must accurately complete the specific National Insurance forms that are designed so that you can give all the information required.

All of these forms are available FREE of charge at any National Insurance Service Centre or are downloadable.