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).
Children injured in motor accidents in NSW are entitled to treatment costs covered by the State Insurance Regulatory Authority (SIRA) under the Compulsory Third Party (CTP) scheme. This guide explains how SIRA funds medical expenses for child injury claims on the Illawarra and South Coast, including eligible treatment types, time limits, and practical steps to claim.
How SIRA Funds Treatment Costs for Child Injuries
SIRA administers NSW’s CTP scheme, which covers medical treatment costs for injuries caused by motor vehicle accidents. For children, this includes specialist consultations, therapy, medications, and diagnostic tests. The scheme also covers ongoing treatment needs, such as physiotherapy or psychological support, if required after the accident.
Under the Motor Accident Injuries Act 2017, SIRA must fund treatment costs that are reasonably necessary to address the injury. This includes both immediate and long-term care, provided the treatment is directly related to the accident. For example, a child with a soft tissue injury may receive coverage for MRI scans, physiotherapy sessions, and specialist follow-ups.
What Medical Expenses Are Covered?
SIRA covers all medically necessary treatment costs, including:
- Specialist medical consultations (e.g., paediatricians, orthopaedic surgeons)
- Diagnostic tests (e.g., X-rays, MRIs)
- Rehabilitation services (e.g., physiotherapy, occupational therapy)
- Medications prescribed for injury-related conditions
- Transportation to and from medical appointments (if required)
Expenses must be documented by a medical practitioner and submitted to SIRA. Parents or guardians should retain all receipts and medical records to support the claim.
Practical Steps for Illawarra and South Coast Claimants
- Seek immediate medical attention - Ensure the child receives treatment from a registered medical practitioner. Document all appointments and treatment plans.
- Notify SIRA promptly - Contact SIRA within 52 weeks of the accident to report the injury and initiate the claim. Delays may affect coverage.
- Submit medical records - Provide detailed records showing the injury’s connection to the accident and the necessity of treatment.
- Keep records of expenses - Retain all invoices, prescriptions, and correspondence with healthcare providers.
Time Limits and Dispute Resolution
SIRA must fund treatment costs within 52 weeks of the accident, unless the injury is classified as a 'threshold injury' (soft tissue injury with no lasting impairment). For threshold injuries, benefits are generally limited to 52 weeks. If a claimant disputes a decision, they may request a review through SIRA’s internal process or seek legal advice.
When to Seek Legal Advice
Parents should consult a solicitor if:
- SIRA denies coverage for necessary treatment
- The child’s injury requires long-term care not covered by the scheme
- There are disputes over the extent of coverage
Legal professionals can help navigate SIRA’s requirements and ensure all eligible treatment costs are claimed.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.