A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
If you've suffered an ankle fracture in a car accident in New South Wales, you may be eligible for funding to cover your treatment costs under the Compulsory Third Party (CTP) scheme. The NSW CTP scheme, governed by the Motor Accident Injuries Act 2017, provides financial support for injuries caused by motor vehicle accidents. This article explains what treatment costs are covered, how SIRA assesses claims, and what evidence you need to support your claim.
How CTP Funding Covers Ankle Fractures
Under the NSW CTP scheme, treatment costs for injuries like ankle fractures are covered as part of the statutory benefits. This includes medical treatment, physiotherapy, and other necessary care. The Motor Accident Guidelines (MAG) outline the criteria for assessing treatment needs, ensuring that funding aligns with clinical necessity. For example, if your ankle fracture requires surgery or prolonged rehabilitation, these costs are typically included.
SIRA (State Insurance Regulatory Authority) manages CTP claims and evaluates whether treatment is 'reasonably necessary' under the Motor Accident Injuries Act 2017. This means your treatment plan must be supported by medical evidence showing a direct link between the ankle fracture and the accident. SIRA also considers the severity of the injury, such as whether the fracture is a 'threshold injury' under the guidelines.
What Documentation Is Needed for Treatment Costs?
To claim funding for your ankle fracture treatment, you must provide specific evidence. This includes:
- Medical records confirming the ankle fracture and treatment plan
- A detailed treatment plan from your doctor or physiotherapist
- Itemized invoices for medical services, medications, and equipment
- Accident reports and witness statements to establish the injury's connection to the crash
For instance, if your ankle fracture required a cast and physiotherapy, your treating doctor must document that these interventions were necessary to manage your injury. SIRA may also request proof of your income to assess whether your treatment costs exceed your usual expenses.
Time Limits and Dispute Options
You have 52 weeks from the date of your accident to claim weekly benefits for treatment costs. After this period, benefits for 'only injuries' (such as ankle fractures) are generally limited, as the scheme prioritizes long-term rehabilitation over ongoing weekly payments. However, this does not apply to claims for permanent impairment or significant functional loss.
If your claim is disputed, you can request a review by SIRA or seek independent medical advice. It's important to act promptly, as delays may affect your ability to claim certain benefits. For example, if your treatment plan was not submitted within the 52-week window, you may lose entitlement to weekly payments for that period.
When to Seek Legal Advice
While the CTP scheme covers many treatment costs, individual circumstances vary. If your claim is denied or you're unsure about your entitlements, consider consulting a legal professional. A solicitor can help you understand whether your ankle fracture meets the threshold injury criteria or if you qualify for additional compensation under common law.
Next Steps
CTP funding for ankle fractures depends on the accident date, injury severity, and evidence provided. To request contact about your circumstances, complete the quick, no obligation enquiry form.