How SIRA Funds Treatment Costs for Child Injuries in NSW
If your child was injured in a motor accident in New South Wales, the State Insurance Regulatory Authority (SIRA) funds eligible medical treatment costs under the Compulsory Third Party (CTP) scheme. This article explains how SIRA covers treatment expenses, what medical costs are included, and practical steps for claimants in Armidale.
What Medical Expenses Are Covered by SIRA?
SIRA covers treatment costs for injuries resulting from a motor accident, including:
- Specialist consultations (e.g., orthopaedic surgeons, neurologists)
- Diagnostic tests (e.g., MRI scans, X-rays)
- Rehabilitation therapies (e.g., physiotherapy, occupational therapy)
- Medications prescribed for injury-related conditions
- Assistive devices (e.g., braces, mobility aids)
Coverage depends on the injury meeting the 'threshold injury' definition under the Motor Accident Injuries Act 2017. This includes soft tissue injuries with neurological signs, such as a spinal nerve-root injury producing symptoms like numbness or weakness.
Practical Steps to Secure Funding
To ensure treatment costs are funded:
- Document all medical records showing the injury's connection to the accident.
- Notify SIRA within 52 weeks of the accident to claim weekly benefits for treatment costs.
- Keep receipts for all medical expenses, including out-of-pocket costs not covered by Medicare.
- Report the accident to the NSW Police if there were injuries or property damage.
Time Limits and Dispute Resolution
You have 52 weeks from the accident date to claim weekly benefits for treatment costs. After this period, SIRA typically stops funding weekly payments unless the injury meets the 'whole person impairment' threshold (e.g., permanent disability). If your child's treatment costs exceed the 52-week limit, you may need to pursue a separate claim for ongoing care.
Disputes over coverage can be resolved by:
- Requesting a review from SIRA
- Seeking independent medical opinion
- Consulting a solicitor if the claim is denied
When to Seek Legal Advice
Speak to a solicitor if:
- Your child's injury exceeds the threshold injury definition
- You need assistance navigating SIRA's claims process
- You believe the insurer is withholding funding
- You require advice on long-term care costs
Example Scenario
A 9-year-old child involved in a car accident in Armidale suffers a soft tissue injury requiring three months of physiotherapy. SIRA would fund the treatment costs if the injury meets the threshold definition. However, if the child later develops chronic pain requiring ongoing therapy, additional steps may be needed to secure funding.
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.