Are you eligible?

Anyone who experiences serious personal injuries as a result of a motor vehicle accident in Queensland, on or after 1 July 2016, may be eligible to receive support from NIISQ. 

NIISQ is a no-fault scheme. This means we can provide treatment, care and support regardless of who was at fault in the accident, as long as you meet all eligibility criteria as outlined in the National Injury Insurance Scheme (Queensland) Act 2016 and National Injury Insurance Scheme (Queensland) Regulation 2016. 

In line with the NIISQ Act and Regulation, a serious personal injury includes: 

Permanent spinal cord injuries

Permanent injury to the brachial plexus

Traumatic brain injuries

Severe burns

Multiple or high-level limb amputations

Permanent blindness caused by trauma

You can read more about specific eligibility requirements by clicking on each injury type below. This information can also be found in section 5 of the NIISQ Regulation. We also have an overview information sheet that you can view by clicking here.

• Permanent spinal cord injuries

  • The eligibility criteria for a permanent spinal cord injury resulting in a permanent neurological deficit suffered by an adult or a child aged more than 8 years are—
    (a) the permanent neurological deficit is classified as grade A, B, C or D on the ASIA impairment scale, as assessed under the ISNCSCI; and
    (b) the injury has resulted in a residual significant impact on the function of the autonomic nervous system, evidenced by a score of 0 for an item relating to bladder,
    bowel or sexual function, as assessed under the ISAFSCI.
  • The eligibility criteria for a permanent spinal cord injury resulting in a permanent neurological deficit suffered by a child aged 8 years or less are—
    (a) the injury has resulted in an ongoing bladder or bowel dysfunction; and
    (b) an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical
    specialist’s opinion, the injury has resulted in—
    (i) the condition mentioned in paragraph (a); and
    (ii) a permanent neurological deficit.
  • In this section—
    ASIA impairment scale means the scale, known as the American Spinal Injury Association impairment scale, used
    for measuring impairment resulting from a spinal cord injury and published by the American Spinal Injury Association.
    ISAFSCI means the document called ‘International standards to document remaining autonomic function after spinal cord injury’, published by the American Spinal Injury Association.
    ISNCSCI means the document called ‘International standards for neurological classification of spinal cord injury’, published by the American Spinal Injury Association.

• Traumatic brain injuries

  • The eligibility criteria for a traumatic brain injury resulting in a permanent impairment suffered by an adult or a child aged more than 8 years are—
    (a) any or all of the following apply—
    (i) the injury results in post-traumatic amnesia lasting 7 days or more as evidenced by an assessment using an approved scale;
    (ii) the person is or was in a coma, other than an induced coma, for 1 hour or more as a result of the injury;
    (iii) brain imaging shows a significant brain
    abnormality as a result of the injury; and
    (b) the person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—
    (i) for an adult—the functional independence measure instrument; or
    (ii) for a child—the childrens functional independence measure instrument.
  • The eligibility criteria for a traumatic brain injury resulting in a permanent impairment suffered by a child aged between 3 years and 8 years are—
    (a) either or both of the following apply—
    (i) on resuscitation or admission to an accident or emergency department of a hospital, the child was given a score of less than 9 on the Glasgow coma scale;
    (ii) brain imaging shows a significant brain
    abnormality as a result of the injury; and
    (b) the child’s functional ability as a result of the injury is assessed as 2 points or more below the age norm for the child for a motor or cognitive item using the childrens functional independence measure instrument.
  • The eligibility criteria for a traumatic brain injury resulting in a permanent impairment suffered by a child aged less than 3 years are—
    (a) the injury is likely to cause a significant adverse impact on the child’s normal development; and
    (b) a relevant medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the injury is likely to cause a significant adverse impact mentioned in paragraph (a).
  • In this section—
    approved scale, for assessing post-traumatic amnesia, means—
    (a) the Westmead PTA scale; or
    (b) a clinically accepted scale similar to the Westmead PTA scale approved by the agency for this definition.
    Glasgow coma scale means the scale, known as the Glasgow coma scale, used for assessing the level of consciousness of a person following a traumatic brain injury, using eye, verbal and motor responses.
    relevant medical specialist means—
    (a) a paediatric rehabilitation specialist; or
    (b) a paediatric neurologist.
    Westmead PTA scale means the clinical tool, known as the Westmead Post-traumatic Amnesia Scale, used to assess the period a person suffers post-traumatic amnesia.

• Multiple or high-level limb amputations

  Eligibility criterion for the amputation of a leg through or above the femur

  • The eligibility criterion for the amputation of a leg through or above the femur is that the amputation involves the loss of 65% or more of the length of the femur.
    The percentage of the length of the femur
    lost must be worked out by—
    (a) comparing the length of the femur before and after the amputation using X-rays taken before and after the amputation; or
    (b) if X-rays of the femur are not available—comparing the length of the femur of the amputated leg with the length of the contralateral femur.
    To remove any doubt, it is declared that the eligibility criterion may be satisfied even if the person suffers from a personal injury that is the amputation of more than 1 limb or parts of different limbs.

  Eligibility criteria for the amputation of more than 1 limb or parts of different limbs

  • The eligibility criteria for the amputation of more than 1 limb or parts of different limbs are—
    (a) the amputations involve the loss of 50% or more of the length of each of the person’s tibias; or
    (b) both of the person’s upper limbs are amputated at or above the first metacarpophalangeal joint of the thumb
    and index finger of each hand; or
    (c) the amputations involve—
    (i) the loss of 50% or more of the length of 1 of the person’s tibias; and
    (ii) 1 of the person’s upper limbs being amputated at or above the first metacarpophalangeal joint of the thumb and index finger of the same hand.
    The percentage of the length of the tibia
    lost must be worked out by—
    (a) comparing the length of the tibia before and after the amputation using X-rays taken before and after the amputation; or
    (b) if X-rays of the tibia are not available—comparing the length of the tibia of the amputated leg with the length of the contralateral tibia; or
    (c) if the length of the contralateral tibia can not be determined—using the estimated knee height based on overall height before the amputation.

• Permanent injury to the brachial plexus

  A permanent injury to the brachial plexus resulting in an impairment equivalent to a shoulder disarticulation amputation.

• Severe burns

  The eligibility criteria for a full thickness burn to all or part of the body are—

  • (a) the full thickness burn is to—
    (i) for a child aged less than 16 years—more than 30% of the total body surface area; or
    (ii) for a person other than a child aged less than 16 years—more than 40% of the total body surface area; or
    (iii) both hands; or
    (iv) the face; or
    (v) the genital area; and
  • (b) if the injured person is an adult or child aged more than 8 years—the person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—
    (i) for an adult—the functional independence measure instrument; or
    (ii) for a child—the childrens functional independence measure instrument; and
    (c) if the injured person is a child aged between 3 and 8 years—the child’s functional ability as a result of the injury is assessed as 2 or more points below the age norm for the child for a motor or cognitive item using the childrens functional independence measure
    instrument; and
    (d) if the injured person is a child aged less than 3 years—
    (i) the child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and
    (ii) an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent
    impairment.

  Eligibility criteria for an inhalation burn resulting in a permanent respiratory impairment.

  • If the injured person is an adult or child aged more than 8 years—the person’s functional ability as a result of the injury is assessed as 5 or less for a motor or cognitive item using—
    (i) for an adult—the functional independence measure instrument; or
    (ii) for a child—the childrens functional independence measure instrument; or
  • If the injured person is a child aged between 3 and 8 years—the child’s functional ability as a result of the injury is assessed as 2 or more points below the age norm for the child for a motor or cognitive item using the childrens functional independence measure
    instrument; or
  • If the injured person is a child aged less than 3 years—
    (i) the child is, as a result of the injury, likely to suffer permanent impairment requiring attendant care and support services; and
    (ii) an appropriately qualified medical specialist has given a medical certificate or report stating that, in the medical specialist’s opinion, the child is, as a result of the injury, likely to suffer the permanent
    impairment.

• Permanent blindness caused by trauma

  The eligibility criterion for permanent blindness caused by trauma is that the injured person has a visual defect, or a combination of visual defects, that result in visual loss that is,
  or is equivalent to—

  • visual acuity of less than 6/60 in both eyes, assessed using the Snellen scale after correction by suitable lenses; or
  • the constriction of the person’s field of vision to 10 degrees or less of the arc around central fixation in the person’s better eye, regardless of corrected visual acuity (equivalent to 1/100 white test object).
  • In this section—
    Snellen scale means the scale for measuring visual acuity using rows of letters printed in decreasing sizes.

To enable us to make a decision regarding your eligibility, we need information about the motor accident and your injuries. This may include information from police, ambulance, hospitals, and insurance companies. 

Click here to find out more about the application process. 

If you need further assistance, please contact us. 

Review of eligibility decisions 

You have the right to request a review of our decision about your eligibility for NIISQ. The injured person, someone acting on their behalf or the CTP insurer can dispute the eligibility decision. 

Our review of Eligibility Decisions information sheet provides more information, or you can read more information below.

• Internal review

  If you do not agree with our decision about your eligibility for NIISQ, you can request an internal review of the decision. This will be conducted by a senior person within the National Injury Insurance Agency, Queensland (NIISQ Agency) who did not make the original
  decision.

  You must request this review within 28 days on the Internal Review application form.

  The process for internal reviews is:

  1. NIISQ Agency makes its original decision about your treatment, care and support.
  2. You receive a notice advising you of the NIISQ Agency’s original decision.
  3. If you don’t agree, you have 28 days to request an internal review. Complete the
     Internal Review application form and submit it to the NIISQ Agency.
  4. The NIISQ Agency will review the original decision within 28 days. Extensions may occur if further information is required.
  5. The NIISQ Agency lets you know the internal review decision within 14 days of making the decision.

• External review

  If you are not satisfied with the internal review decision, you can apply for an external review of the decision. You must request an internal review before you request an external review of the decision about your eligibility for the scheme.

  The NIISQ Agency will provide you with an internal review decision notice which includes specific information about how to apply for an external review of the decision.

  Two tribunals are used for external reviews of eligibility decisions:

  • Medical Assessment Tribunal (MAT) for decisions that are medical in nature, such as whether your injury meets the medical matters in the eligibility criteria.
  • Queensland Civil and Administrative Tribunal (QCAT) for decisions that are non-medical in nature, such as whether the circumstances of your accident meet the legal definition of a ‘motor vehicle accident’.

  If the MAT is the appropriate external review body, you will need to contact the NIISQ Agency to request a referral to the MAT within 28 days of the internal review decision. You can do this by contacting NIISQ at internalreview@niis.qld.gov.au or GPO Box 1391, Brisbane QLD 4001. Once the request is received, the NIISQ Agency will be in touch to assist you through the review process.

  If QCAT is the appropriate external review body, you will need to complete a QCAT application (Form 23 – Application to review a decision) and lodge the application with QCAT within 28 days of receiving the internal review decision.

  Further information can be found on the QCAT website qcat.qld.gov.au.

You must first request an internal review before an external review of the decision can occur. An internal review must be requested within 28 days of our decision, and can be submitted via the Internal Review application form below:

You may disagree with us on a decision we’ve made about your treatment, care or support needs. It is okay if you don’t agree and it won’t affect how we work with you.