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 regional NSW, you may be eligible to claim treatment costs through the NSW Compulsory Third Party (CTP) scheme. This article explains what treatment costs are covered, how to claim them, and what evidence you'll need. The NSW CTP scheme covers medical bills, physiotherapy, and other treatment costs for injuries like ankle fractures, but the process differs for regional residents. Understanding the rules and deadlines is critical to securing funding for your recovery.
What Treatment Costs Are Covered for Ankle Fractures?
Under the NSW CTP scheme, treatment costs for ankle fractures include medical bills, physiotherapy, and other necessary care. The Motor Accident Injuries Act 2017 (s 4.4) specifies that statutory benefits cover injuries meeting the 'threshold injury' definition. Ankle fractures typically qualify as threshold injuries, meaning treatment costs are funded through the CTP scheme. However, the scheme does not cover all treatment costs, only those directly related to the injury. For example, if your ankle fracture required surgery, the CTP scheme will cover the surgeon's fees and hospital costs. If you needed physiotherapy, that would also be funded. However, costs for unrelated treatments, such as dental care or vision tests, are not covered.
How to Claim Funding for Ankle Fracture Treatment in Regional NSW
Claiming treatment costs in regional NSW involves contacting the State Insurance Regulatory Authority (SIRA) directly. Unlike metropolitan areas, regional residents may face additional challenges accessing services, so it's important to act quickly. To claim, you'll need to provide:
- Medical records confirming your ankle fracture and treatment
- Receipts for all treatment costs
- A copy of the accident report
- Evidence of your income if you're claiming weekly benefits
SIRA will assess your claim based on the Motor Accident Guidelines, which outline what constitutes a threshold injury. If your ankle fracture meets the guidelines, you'll be eligible for funding. However, if your injury is not classified as a threshold injury, you may need to pursue a common law damages claim through a solicitor.
Documentation and Evidence for Ankle Fracture Claims
Proper documentation is essential to support your claim. Key evidence includes:
- Medical records from your treating doctor or physiotherapist
- Accident reports from the police or the other driver's insurance
- Witness statements if available
- Photographs of the accident scene and your injury
- Receipts for all treatment costs, including prescriptions and therapy sessions
If you're unsure whether your injury meets the threshold injury definition, consult a medical practitioner. SIRA's guidelines state that a spinal nerve-root injury producing neurological signs may still qualify as a soft-tissue injury, but radiculopathy requires specific clinical signs. Your doctor can confirm whether your ankle fracture meets these criteria.
Time Limits and Disputes
You have 52 weeks from the date of the accident to claim statutory benefits for threshold injuries. After this period, weekly benefits and treatment costs are generally limited unless your injury results in a whole person impairment (WPI) of 10% or more. If your ankle fracture does not meet the threshold injury definition, you may still have a claim under common law, but this requires a solicitor's assistance. Disputes over treatment costs are resolved by SIRA, and you can request a review if your claim is denied. It's important to act promptly, as delays can affect your eligibility for funding.
When to Seek Legal Advice
While the CTP scheme covers many treatment costs, not all injuries qualify as threshold injuries. If your ankle fracture does not meet the definition, you may need to pursue a common law damages claim. This involves proving fault and seeking compensation for pain, loss of income, and other losses. A solicitor can help you assess whether your injury meets the threshold injury criteria and guide you through the claims process. In regional NSW, where access to legal services may be limited, it's important to seek advice early to ensure you don't miss any deadlines.
Next Steps
If you're in regional NSW and have suffered an ankle fracture in a car accident, start by gathering all relevant documentation and contacting SIRA. If your injury does not meet the threshold injury definition, consider seeking legal advice to explore your options. Every claim depends on its own facts, and the available options may depend on the evidence and applicable law. To request contact about your circumstances, complete the quick, no obligation enquiry form.