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've suffered a motor accident resulting in chronic pain and are seeking funding for treatment costs in the Illawarra or South Coast regions, understanding NSW CTP rules is critical. Under the Motor Accident Injuries Act 2017, treatment costs for chronic pain injuries may be covered, but claimants must meet specific criteria. This article explains how SIRA assesses funding for chronic pain-related treatment, what evidence is required, and practical steps to take.
How CTP Funds Treatment Costs for Chronic Pain
The NSW Compulsory Third Party (CTP) scheme covers treatment costs for injuries resulting from motor accidents. For chronic pain claims, SIRA evaluates whether the injury meets the 'threshold injury' definition under the Motor Accident Guidelines. This includes conditions like persistent musculoskeletal pain, nerve-related symptoms, or functional limitations that require ongoing treatment.
Treatment costs may include physiotherapy, specialist consultations, pain management therapies, and medical equipment. However, funding is limited to 'reasonably necessary' treatments directly related to the accident. SIRA considers clinical evidence, such as medical reports and treatment plans, to determine coverage.
Evidence Required for Chronic Pain Claims
To support your claim, you must provide:
- Detailed medical records showing a link between the accident and your chronic pain
- A treatment plan from your healthcare provider outlining the necessity of ongoing care
- Invoices or receipts for treatment costs (where applicable)
- Evidence of how the injury impacts your daily life or work capacity
In the Illawarra and South Coast regions, claimants should ensure their treating physicians document the connection between the accident and chronic symptoms. SIRA may request additional information if the injury appears to fall below the threshold.
SIRA's Role in Assessing Funding
SIRA assesses whether your chronic pain injury qualifies for funding under the CTP scheme. Key factors include:
- Whether the injury meets the 'threshold injury' definition in the Motor Accident Guidelines
- Whether treatment is 'reasonably necessary' and directly related to the accident
- Whether the injury has persisted beyond the 52-week statutory benefit period (for certain claims)
If SIRA determines your injury does not meet the threshold, you may need to pursue a common law damages claim separately. However, this requires legal advice to assess your case.
Practical Steps for Claimants
- Seek immediate medical attention to document your injury and treatment needs
- Keep all medical records and correspondence with your treating professionals
- Notify your insurer about your claim within the required time limits
- Request a formal assessment from SIRA if your treatment costs are disputed
- Consult a legal professional if your claim is denied or if you need to pursue additional remedies
Time Limits and Dispute Options
You have 52 weeks from the accident date to claim certain benefits under the CTP scheme. However, chronic pain claims may require longer-term evidence. If SIRA denies your claim, you can:
- Request a review of their decision
- Appeal to the NSW Civil and Administrative Tribunal (NCAT)
- Seek legal advice to explore alternative remedies
When to Seek Legal Advice
Complex cases involving chronic pain may require legal assistance to:
- Navigate SIRA's assessment process
- Challenge decisions that appear to unfairly limit coverage
- Pursue additional compensation through common law claims
If your injury has persisted beyond the initial recovery period, it's essential to act promptly. Chronic pain claims often require detailed evidence to demonstrate the ongoing impact of the injury.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.