Forms and resources

You can read more about NIISQ’s application process here.

If you can’t find what you are looking for, or would like some help in completing one of our forms, please contact your Support Planner.

Are your contact details up to date?

To ensure we can always reach you with the latest NIISQ information, please let your Support Planner know if your contact details or the contact details of your support network change. If you have recently updated your contact details with us, thank you, we don’t need you to provide this information to us again.

Resources

• SMART goal cards

  The NIISQ Agency has developed SMART goal cards to assist in creating meaningful and relevant goals post-injury. SMART goals can be a useful tool in the support planning and service providing process funded by NIISQ.

  Watch a short video or read for more information on how cards can be used.

Personal information

• Consent to exchange personal information

  While you are dealing with the NIISQ Agency, we may need to ask others for your personal information. This could include reports, clinical notes, medical reports, imaging, results, medical and other information about you. If you are a NIISQ participant, this information helps us to provide you with treatment, care and support services.

  By signing this form, you are providing your consent for other parties to give us your personal information.

  Consent to exchange personal information (PDF)

• Preservation notice

  Refer to CTP frequently asked questions for further information about giving a preservation notice.

  Preservation Notice

• NIISQ Agency authority to act form

  This form allows you to authorise a person to act on your behalf. We call this person your NIISQ Agency nominee.

  NIISQ Agency authority to act form

Financial

• Bank Details Form

  You may need to supply your bank details to NIISQ. This is the form you will need to use.

  Bank Details Form – Participants or Individuals (updated November 2024)

• Reimbursement (refund) of treatment, care and support and/or transport expenses

  There are two ways you can submit a request for a refund/reimbursement of approved treatment, care and support and/or transport expenses. Before you pay for the services, you should check your MyPlan so that you can be sure the expenses will be reimbursed. Expenses incurred without prior approval may not be reimbursed.

  View the Guideline: Reimbursement for approved treatment, care and support expenses, or approved transport expenses

  1. Online via the NIISQ Direct portal
  2. Manually via completing a reimbursement form.

  Reimbursement forms

  Application for reimbursement of approved treatment, care and support expenses (PDF)

  Application for reimbursement of approved transport expenses (PDF)

  Application for reimbursement of approved treatment, care and support and transport expenses_combined form (PDF)

• Service Approvals

  We’re moving from Purchase Orders to a new process called Service Approvals.

  This new process will help make sure all the services you receive match your MyPlan. It’s all about supporting you better and meeting your changing needs.

  With Service Approvals, we’ll clearly list the service/s you’re receiving, how long it will last, who’s providing it, and how much it costs. This means less confusion and quicker approval times.

  If you have approved reimbursements, you will get a Service Approval that gives the details of the reimbursement, including what has been approved and how much it will be.

  Here are the key changes you need to know:

  • We won’t be issuing new Purchase Orders to providers anymore, but this won’t affect the services you are receiving.
  • We’ll use Service Approvals for new or changes to your services.
  • If your providers have existing Purchase Orders, they’ll still be used until they’re finished, or they expire.
  • You will receive a Service Approval if you have approved reimbursements.
  • We’re here to help you through this change. If you have any questions or need more information, please email us at requests@niis.qld.gov.au, or check out our frequently asked questions on our website here.

• Statutory declaration (if you have lost your receipt)

  If you have lost your receipt and wish to claim a reimbursement, a statutory declaration is required by the NIISQ Agency. The statutory declaration forms are located on the courts.qld.gov.au website at:

  Statutory Declaration (Fillable PDF form)

  Statutory Declaration (Word document)

Pharmacy and medication

• Accepted injury-related pharmaceutical or medications form

  This form is to assist your doctor to provide NIISQ Agency with information required to fund your accepted injury-related pharmacy or medication needs. Your NIISQ Support Planner may also organise a pharmacy account with your chosen pharmacy for supply of your accepted injury medications.

  When booking your appointment, an extended consultation may be required for the completion of this form.

  This form is to provide:

  • Current list of medications/pharmaceuticals prescribed to you by your doctor
  • Doctor’s clarification of what each medication is being prescribed to treat/manage
  • Prescribing doctor’s details and signature.

  Accepted injury-related pharmaceutical or medications (PDF)

  Accepted injury-related pharmaceutical or medications (Word Document)

  Additional Accepted injury-related pharmaceutical or medications (PDF)

   

Requests for review of agency decisions

• Internal review

  The below form is for requesting a review of a decision made by the NIISQ Agency.

  National Injury Insurance Scheme (QLD) Internal Review Application Form (PDF)

  You can find out more information here or refer to our information sheets:

  • Review of eligibility decisions
  • Review of decisions treatment, care and support

• External review

  If you are not satisfied with the outcome of an internal review, you can make a request within 28 days for your matter to be reviewed by an external review tribunal.

  • The Medical Assessment Tribunal (MAT) can review decisions that are medical in nature, such as whether an injury meets the medical requirements in the NIISQ eligibility criteria. To be referred to the MAT contact NIISQ at internalreview@niis.qld.gov.au or GPO Box 1391, Brisbane QLD 4001 letting us know you would like to be referred to the MAT. Once the request is received, the NIISQ Agency will be in touch to assist you through the review process.
  • The Queensland Civil and Administrative Tribunal (QCAT) can review decisions that are non-medical in nature, such as whether the circumstances of an accident meet the legal definition of a ‘motor vehicle accident’. 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 Queensland Civil and Administrative Tribunal (qcat.qld.gov.au).

  More information about external review can be found in Chapter 6, Part 2 of the National Injury Insurance Scheme (Queensland) Act 2016.

Help for communicating in a hospital or healthcare setting

Read about Julian’s Key, a patient/carer-controlled tool designed to improve communication and empower people with disability, their families and carers to be more involved in their healthcare.

In an emergency always call 000. If you have additional health-related questions, you can also contact your GP.