NOTE: This Guide is designed to help victims who are not represented by a solicitor complete the Application for Compensation and/or Expenses Form.

Section 1: Help with the Application Form - General

Why do I need to give so much information?

The information you provide on your application form is very important to support your claim for compensation.
If information is missing it may delay the processing of your claim.
You can write to us to add information or change the information that you gave us on your application form up until the time the claim is finalised.

Can someone help me fill in the application form?

Yes. You may call our enquiry number, (02) 8688 5511 or 1800 069 054 (toll free) and the support staff will help you.

Many claims are straightforward and do not need a solicitor.

LawAccess is a free telephone and internet service providing information about legal services in New South Wales. You may call LawAccess on 1300 888 529 and ask for legal information, referral or advice about your compensation claim.

If you want a solicitor to assist you, the Law Society of NSW’s Solicitor Referral Service can help you find a solicitor near where you live who specialises in victims compensation claims. You can call the Law Society on (02) 9926 0300 or 1800 422 713 (toll free). You will not have to pay solicitor costs in victims compensation applications. If an assessor awards costs, it does not come out of your award.

NOTE: If a solicitor is representing you in your compensation claim, all our letters will go directly to your solicitor. It is up to your solicitor to keep you informed of the progress of your case.

You can fill out the application form yourself using this guide. At a later date you can choose to have a solicitor help you if your claim is complicated and you are having problems providing the information we need.

When should I claim victims compensation?

You should make your claim within two years of the act of violence.

If we receive your application form more than two years after the day (or last day if it was over a period of time) of the act of violence, you will need to give us reasons why your claim was late. The Director then decides whether to accept your application.

You may put your claim in straight away after you were injured or you may prefer to wait (within the two year timeframe) and see if you have suffered a more serious or permanent injury. Once we determine your claim, you cannot put in another claim for the same act of violence.

Can I put in a claim if no offender has been caught? Or should I wait until the matter goes to court?

You may put in your application form whether or not an offender is identified or charged.

You do not have to wait until the court finalises your matter before you lodge your application form.

Section 2: Help with Answering the Questions

Part 2 Details of the victim applying for compensation

The victim applying for compensation may be a primary or secondary victim. (Please refer to the first page of the application form for the definition of a primary or secondary victim). The victim is the person who has been injured as a result of an act of violence committed by another person and who is seeking compensation for their injuries and expenses.

It is important that you provide your date of birth. If you do not provide your date of birth, it will hold up the processing of your claim.

Please provide contact numbers that we can call you on during business hours if necessary. If you don’t want us to phone you please note that on the form but you must give us your current address.

If your address changes before we finalise your claim you must write and give us your new address.

Part 4 Details of person applying on behalf of the above victim (if applicable)

Only complete this section if you are applying on behalf of a child under 18 years or if the victim has a disability and is unable to complete the form themselves.

Qu. 17: You will need to tell us the reasons why the victim cannot complete the application form and you are acting for the victim, for example, the victim is under 18 years and you are the parent; the victim has an intellectual disability; or the victim has a visual impairment.

Part 5 Details of legal representative (if applicable)

Only complete this section if a solicitor is helping you in this compensation claim.

Note: All correspondence will be sent directly to the solicitor.

Do not put down the name of the Office of Director of Public Prosecutions (ODPP) prosecutor who assisted you during the criminal trial. They cannot represent you in your compensation claim.

Part 6 Primary/secondary victim

Qu. 23 and 24: A secondary victim is someone who either witnessed an act of violence on a primary victim or is a parent or guardian of a child who became aware of the child being injured. Secondary victims will have to show they have received a psychological injury relating to the act of violence.

Only complete Qu. 24 if you are a secondary victim.

Part 7 Details of act(s) of violence

Qu. 30: Provide as much information as you can about where the act of violence happened. For example, if it was an assault in a hotel, provide the name of the hotel plus the street and suburb. If you do not know the full address it is important you provide the suburb or town. Your claim will not proceed if we do not have that information. We need to be able to check if there is a police report available and the act of violence happened in NSW.

NOTE: If the act of violence occurred in a number of different locations, please provide all addresses (together with the date(s) for each one). You may add an attachment if there is not enough room on the form.

Qu. 32: You only need to give a brief description of what happened. For example, “I was walking home and I was assaulted by two men who held a knife to my throat and stole my wallet.” Another example could be: “I was sexually assaulted between 2002 and 2004.”

NOTE: Do not just write: “See police statement”. You need to say in one or two sentences what happened. If you have your police statement, please attach it to the form.

Part 8 Reporting to the police

Qu. 33: If no one has reported this incident to the police, you need to do two things.

1. It is important that you explain to us the reasons why the incident was not reported, as this may affect the result of your claim. If you don’t have enough room on the application form, please provide an attachment.
2. Provide other evidence that will help prove that the act of violence did happen, in the manner you have described. For example, this could be:

• statutory declarations from family or friends;
• reports on a Department of Community Services (DoCS) file;
• school reports;
• other evidence.

Qu. 35: If you did not report the matter to the police immediately, you will need to tell us why there was a delay eg you were in hospital recovering from your injuries.

Qu. 37: If you have a copy of the statement you made to the police, attach it to your application form. It may delay your claim if we have to wait for a copy to be forwarded from the police.

Part 9 Court Proceedings

If you are not sure of any details, such as dates, offences, name of defendant, please provide as much information as you can.

Part 10 Injuries

There is a list of injuries and amounts that can be awarded for each injury in Schedule 1, Victims Support and Rehabilitation Act 1996. You can view this Schedule of Injuries on our website (www.lawlink.nsw.gov.au/vs) or call our enquiry line, (02) 8688 5511 or 1800 069 054 and ask to have a copy posted, faxed or emailed to you.

Please remember:

• Compensation can generally only be awarded if you have an injury(ies) listed in the Schedule. If your injury does not appear in the Schedule you may make a claim for a compensable injury that is similar to the injury you sustained, but it must have caused symptoms or a disability lasting at least six weeks;
• Compensation can only be awarded for a maximum of three injuries. However, if you have more than three injuries (as listed in the Schedule) you can write down all your injuries on the application form and the assessor will decide the three most serious injuries if an award is to be made;
• There is a threshold that must be reached before an award can be made. This means that your injuries must total at least $7,500 before you can receive an award;
• When you are adding up your injuries claimed to see if you reach the threshold you must remember that only the most serious injury will receive the full amount that is listed in the schedule. The second most serious injury claimed will receive 10% of the amount listed in the schedule and the third most serious injury will receive 5% of the amount listed;
• You may refer to the Injury Award Calculator Page on the website to help with calculating your injury award you are claiming.

Example 1 (Not Eligible:below threshold)
1st injury (100%): Facial:fractured mandible and/or maxilla - jaw bones	$7,200
2nd Injury (10%): teeth: loss of one tooth other than front tooth (10% of $2,400)	$240
Total (below the threshold of $7,500)	$7,440

________________________________________________________________ Example 2 ( Eligible:above threshold)
1st injury (100%): Lung:puncture of lung	$7,200
2nd Injury (10%): Facial:fractured mandible and/or maxilla-jaw bones (10% of $7,200)	$720
3rd Injury (5%): Teeth: loss of one tooth other than front tooth (5% of $2,400)	$120
Total Injuries claimed (above threshold)	$8,040

If you do not have the evidence now to support your injuries, you need to send it to us before your claim is finalised. Note: Do not send in actual x-rays – only the written report showing the results of the x-ray is needed.

If you are claiming scarring you must show that the scarring is permanent. Please do not send in photos taken immediately after the assault. The photos must be recent, dated, clear, and in colour and can be used together with hospital notes to determine your claim.

If you are claiming any ongoing disabilities as a result of an injury, examples of evidence that may be provided include:

• copies of records from a workplace rehabilitation provider;
• reports from a treating doctor or counsellor;
• reports from a school;
• statutory declarations from friends and family.

Qu. 40: If you are claiming the compensable injury of psychological or psychiatric disorder you will need a report from an Authorised Report Writer (ARW). Information about Authorised Report Writers can be found on our website. You will need to choose a name from the ARW list found on our website. We cannot choose an ARW for you.

For more details about claiming this injury please see our information sheet, ARW Guide for Applicants, which will be sent out to you when you lodge your application.

Part 11 Monies from other sources

You must tell us if you have received money from any other source for the injury you have suffered, or if you receive money in the future.

Examples of how you may receive money from another source in ‘civil’ court actions include:

• Civil court action against either the person who injured you or from the owners of the location (eg licensed club or hotel) where the injury occurred
• Legal action against a school or religious organisation who did not exercise adequate duty of care.

Part 12: Late Applications (for compensation claims only)

Write your reasons on a separate piece of paper if there is not enough room on the application form.

You will need to complete the questions on the rest of the form, even if you are applying for leave to lodge a late application.

Part 13 Expenses

It is important that you provide receipts or invoices as proof of all expenses claimed.

We will only pay the difference between the rebates you can claim from a private health fund or Medicare, and the total on the invoice or receipt. If you do not have any health fund benefits you can write on the form “no health fund”. If you do not know the Medicare rebate allowed we will automatically deduct 75%.

Note: Medicare and your health fund can provide you with a printout of the benefits you have received.

Part 14 Statutory Declaration

It is very important that every box of the statutory declaration is filled in. Your claim will be rejected if it is not correctly signed, witnessed and dated.

You application can be witnessed by either a solicitor or a Justice of the Peace. Justices of the Peace are located at most court houses, post offices, chemist shops, local council offices, libraries and government agencies. The Justice of Peace register on the Community Relations website lists some of the Justices of Peace. If you bring your application form personally into the Victims Services office (Level 1, 160 Marsden Street, Parramatta), a Justice of the Peace should be available to witness your declaration.

Application checklist