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).
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're experiencing chronic pain after a motor accident in Albury, you may be eligible to claim funding for treatment costs under NSW's Compulsory Third Party (CTP) scheme. This article explains how chronic pain claims are funded, what evidence is needed, and how to navigate the process using SIRA guidelines.
How Chronic Pain Claims Are Funded Under NSW CTP
Under the Motor Accident Injuries Act 2017, treatment costs for chronic pain are funded if the injury meets the 'threshold injury' definition in the Motor Accident Guidelines. SIRA confirms that chronic pain resulting from a motor accident can qualify as a threshold injury if it requires ongoing treatment, such as physiotherapy, medication, or specialist care. However, the injury must be directly linked to the accident and not pre-existing.
The CTP scheme covers treatment costs for injuries that meet the threshold, including chronic pain. This includes expenses like medical consultations, scans, and prescribed medications. If your chronic pain is due to a motor accident and you're receiving ongoing treatment, you may claim funding for these costs through the CTP insurer.
Practical Steps to Claim Treatment Costs
To claim funding for chronic pain treatment, you must:
- Document your treatment: Keep records of all medical appointments, prescriptions, and therapy sessions.
- Provide medical evidence: A doctor's report confirming your chronic pain is a direct result of the accident and requires ongoing treatment.
- Notify the insurer: Contact the CTP insurer (usually the at-fault driver's insurer) to request funding for your treatment.
- Follow SIRA guidelines: Use SIRA's What you can claim page to confirm your treatment costs are eligible.
Time Limits and Dispute Options
You have 52 weeks from the accident date to claim treatment costs under the CTP scheme. After this period, benefits for threshold injuries are generally limited unless your injury is above the threshold. If your chronic pain is not classified as a threshold injury, you may need to pursue a separate common law claim for damages, though this requires individual assessment.
If the insurer disputes your claim, you can request a review through SIRA. The Motor Accident Injuries Regulation 2017 outlines procedures for disputing claims, including submitting additional medical evidence or a second opinion.
Example: Chronic Pain After a Motor Accident
Consider a scenario where a driver in Albury suffers chronic back pain after a low-speed collision. A doctor confirms the pain is due to a spinal nerve-root injury, meeting the threshold injury definition. The driver can claim funding for physiotherapy and pain management treatments through the CTP insurer. If the insurer disputes the claim, the driver can submit the doctor's report for review.
When to Seek Legal Advice
While the CTP scheme covers many treatment costs, eligibility depends on the injury's nature, the accident's circumstances, and the treatment's direct link to the accident. If you're unsure whether your chronic pain qualifies, or if your claim is disputed, seek legal advice to explore options like a common law claim or dispute resolution.