Where a person's only injuries resulting from the accident are threshold injuries, weekly benefits and treatment and care generally cease after 52 weeks (ss 3.11 and 3.28).
If you've suffered an ankle fracture in a car accident in Newcastle or Hunter, you may be eligible for treatment funding through NSW's Compulsory Third Party (CTP) scheme. This article explains how CTP insurers cover medical costs for broken ankles, what evidence you need, and key considerations for claimants in these regions.
How CTP Covers Ankle Fracture Treatment Costs
Under the Motor Accident Injuries Act 2017 (MAIA), CTP insurers must fund treatment for injuries caused by motor vehicle accidents. For ankle fractures, this includes:
- Medical imaging (X-rays, MRIs)
- Specialist consultations (orthopaedics, physiotherapy)
- Medications prescribed for pain or recovery
- Transportation to medical appointments
SIRA guidelines confirm that treatment costs must be 'reasonably necessary' and directly related to the ankle injury. For example, a broken ankle requiring a cast and physiotherapy would be covered, while unrelated treatments like glasses for vision issues would not.
Practical Steps to Claim Treatment Funding
To claim CTP funding for your ankle fracture:
- Notify your insurer within 52 weeks of the accident (MAIA s 4.4). Delays may reduce your entitlement.
- Provide medical evidence showing your ankle injury was caused by the accident. This includes:
- Doctor's report linking the fracture to the crash
- Imaging reports showing the injury
- Records of treatment received
- Keep all receipts for medical expenses, as CTP insurers may request them.
In Newcastle and Hunter, local clinics like Hunter Medical Centre or St George Hospital often treat CTP claims. Ensure your medical team documents the injury's connection to the accident.
Regional Considerations for Newcastle and Hunter
While CTP rules apply statewide, claimants in Newcastle and Hunter should note:
- Local clinics may have different billing practices; confirm your treatment is coded correctly.
- Transportation costs to regional hospitals may be covered under 'reasonable and necessary' expenses.
- Language barriers may affect communication with insurers; consider using a professional interpreter if needed.
Time Limits and Dispute Resolution
CTP claims must be made within 52 weeks of the accident (MAIA s 4.4). If your injury was not immediately apparent, you have 52 weeks from when you became aware of the injury (s 4.5). Disputes over coverage can be resolved through:
- SIRA's dispute resolution process (https://www.sira.nsw.gov.au/claims/motor-accidents/dispute-resolution)
- NSW Civil and Administrative Tribunal (NCAT) for formal reviews
When to Seek Legal Advice
Consult a solicitor if:
- Your insurer refuses to cover treatment costs
- You're unsure if your injury meets CTP criteria
- You need help navigating SIRA's claims process
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.