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 burn injuries in a vehicle fire in Balmain, you may be eligible for funding of medical treatment costs under New South Wales' Compulsory Third Party (CTP) scheme. This article explains how the NSW CTP rules apply to burn injuries, what treatment costs are covered, and the steps to claim funding. It also outlines time limits, dispute resolution options, and when to seek legal advice.
How NSW CTP Covers Burn Injuries
Under the Motor Accident Injuries Act 2017, the NSW CTP scheme provides funding for medical treatment costs related to injuries caused by motor vehicle accidents. Burn injuries from vehicle fires fall under this scheme, provided they meet the definition of a 'threshold injury' or require ongoing treatment. The New South Wales Motor Accident Guidelines define burn injuries as injuries caused by thermal or chemical exposure, including scarring and nerve damage. SIRA (State Insurance Regulatory Authority) assesses whether treatment costs qualify under the scheme.
What Medical Costs Are Covered?
CTP funding covers:
- Hospital treatment, including specialist consultations and procedures
- Medications prescribed for burn recovery
- Physiotherapy and wound care
- Equipment like pressure garments or mobility aids
- Travel expenses for medical appointments
Costs must be directly related to the burn injury and approved by SIRA. For example, if a burn injury requires skin grafting, the associated medical bills would be covered. However, treatment costs not directly linked to the burn, such as unrelated physiotherapy, may not qualify.
Practical Steps to Claim Funding
- Seek immediate medical attention and document all treatment. Burn injuries often require specialist care, so ensure your medical team records the injury's severity and treatment plan.
- Collect evidence of the accident, including:
- Police reports or accident statements
- Witness contact details
- Photographs of the fire damage and injuries
a - Medical records detailing the burn's impact
- Notify the at-fault driver's insurer through the CTP scheme. SIRA manages claims under the scheme, so contact them directly.
- Submit a treatment cost claim to SIRA with all supporting documents. This includes itemized bills and a medical report confirming the injury's link to the accident.
Time Limits and Dispute Resolution
You have 52 weeks from the accident date to claim certain benefits under the CTP scheme. After this period, weekly income benefits and treatment costs may be limited unless the injury meets the 'whole person impairment' threshold. If SIRA disputes the approval of your treatment costs, you can request a review or seek independent medical opinion. Disputes often arise when treatment is not clearly linked to the burn injury or when costs exceed approved limits.
When to Seek Legal Advice
While the CTP scheme covers many treatment costs, it has strict rules. For example, if your burn injury requires long-term care or you believe your claim is undervalued, a lawyer can help. Legal advice is particularly useful if:
- You're unsure if your injury meets the threshold for benefits
- Your treatment costs are being disputed
- You need assistance with the claims process
Example Scenario
Consider a Balmain resident injured in a vehicle fire. Their burn injury requires skin grafting and physiotherapy. The medical team documents the injury as a 'threshold injury' under the Motor Accident Guidelines. The patient submits itemized bills to SIRA, which approves the treatment costs. However, if the insurer disputes the physiotherapy as 'not directly related, ' the patient may need to provide additional evidence or seek a medical review.
Next Steps
CTP claims depend on the accident date, injury type, and evidence collected. To request contact about your circumstances, complete the quick, no obligation enquiry form.