Funding Treatment Costs for Ankle Fractures in NSW CTP Claims
If you have suffered an ankle fracture in a car accident in Bankstown, NSW, your treatment costs may be funded under the state’s Compulsory Third Party (CTP) insurance scheme. This includes medical treatment, rehabilitation, and allied health services such as physiotherapy, osteopathy, and orthotics. The funding is available regardless of who was at fault, provided the accident occurred in NSW and you were involved as a driver, passenger, pedestrian, cyclist, or motorcyclist.
How the CTP Scheme Funds Treatment Costs
Under the Motor Accident Injuries Act 2017, treatment and care benefits are available to cover reasonable and necessary treatment for injuries sustained in a motor accident. Ankle fractures are commonly recognised as eligible injuries for these benefits. The insurer of the at-fault vehicle (or the Nominal Defendant if fault is not established) must fund treatment through the CTP scheme.
Treatment and care benefits cover all reasonable medical and allied health services needed to treat the injury, including surgery, hospital stays, imaging (X-rays, MRIs), and ongoing rehabilitation. These benefits are not limited to the initial treatment phase and may continue as long as treatment remains medically necessary and supported by a treating medical practitioner.
Practical Steps to Secure Funding
To access funding for treatment costs, you must take the following steps:
- Seek medical attention immediately after the accident and keep all records, including diagnosis, treatment plans, and progress notes.
- Notify the CTP insurer (or the Nominal Defendant if fault is disputed) as soon as possible. This can be done through the SIRA website or by contacting the insurer directly.
- Provide your treating medical practitioner with a completed CTP claim form and request they submit a treatment plan to the insurer.
- Keep copies of all invoices, receipts, and correspondence related to treatment, including payments made out of pocket.
- If treatment is not approved or funded, request a written explanation and consider seeking a second medical opinion.
Evidence That Supports a Claim
The following evidence is typically required to secure funding:
- A medical certificate confirming the ankle fracture and its treatment.
- Imaging reports (X-ray, MRI) showing the injury and its progression.
- A treatment plan from your medical practitioner detailing the type, frequency, and duration of treatment.
- Invoices and receipts for all treatment services, including private physiotherapy, orthotics, or surgery.
- A record of any out-of-pocket expenses, such as transport to appointments or home modifications.
Time Limits and Procedural Requirements
There are time limits for claiming treatment and care benefits. You must notify the insurer within 6 months of the accident. While treatment benefits can be claimed after this period in limited circumstances, it is strongly advised to act promptly.
If you are seeking funding for treatment that began more than 6 months ago, you may still be eligible if you can show that you were unable to notify the insurer earlier due to the nature of the injury (e.g., delayed diagnosis or worsening symptoms). In such cases, a formal application to SIRA may be required.
Disputes and Review Options
If your claim for treatment funding is denied or delayed, you have the right to request a review from the insurer. If the review is unsatisfactory, you may apply to the State Insurance Regulatory Authority (SIRA) for a determination. SIRA provides guidance and dispute resolution services to help resolve disagreements about treatment funding.
An example: A pedestrian in Bankstown sustained an ankle fracture after being struck by a car in a car park. The injury was not immediately apparent, and treatment began three months after the accident. The insurer initially refused to fund physiotherapy, citing the 6-month notification limit. The claimant submitted medical records showing delayed onset of symptoms and a specialist’s report confirming the injury was directly linked to the accident. SIRA reviewed the evidence and ordered the insurer to fund the treatment.
When to Seek Independent Advice
While the CTP scheme is designed to cover treatment costs, the process can be complex, particularly if the injury is not immediately apparent or if the insurer disputes the need for treatment. If you are unsure whether a treatment is covered, or if your claim has been denied, it is advisable to seek independent legal or claims advice.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.