Medical Expenses

Medical expenses are paid for employment injury to an insured person who is rendered incapable of work through personal injury caused by an accident, which arises out of and during his employment, or through a prescribed industrial disease caused by the nature of his employment. 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 $28,125.00 per injury. Prior to March 04 2013, the maximum amount payable was $22,500.00.

Medical Expenses include the following: -

  • Doctor’s Fees.
  • The cost of Drugs and 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 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 which are derived from an accident, up to the maximum allowance of $28,125.00. Medical Expenses will not be paid in circumstances where the employer has met such costs.

Time Frames:
    0 - 3 months             -   Claim on time and can be accepted
                          3 - 12 months           -    Claim late and may be accepted with good cause
                        12 months and over    -    Claim late and shall be disallowed

Form To Be Completed

NI 114 - Application for Medical Expenses.

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:

Effective March 01 2004, the NIBTT began accepting 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.

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

Required Documentation

  • 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.
     

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Medical Expenses cont'd - How Much Will Be Paid

 

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.

 

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National Insurance Board of Trinidad and Tobago (NIBTT)