Funding Treatment Costs for CRPS Injuries in NSW CTP Claims
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 developed chronic regional pain syndrome (CRPS) after a road trauma in New South Wales, you may be eligible for treatment cost funding through the NSW Compulsory Third Party (CTP) scheme. This article explains how the CTP scheme covers medical expenses for CRPS injuries, what evidence is needed, and how funding differs from general treatment claims.
How CTP Covers CRPS Treatment Costs
Under the Motor Accident Injuries Act 2017, the NSW CTP scheme funds medical treatment, rehabilitation, and related costs for injuries caused by motor vehicle accidents. For CRPS, which is classified as a 'threshold injury' under the Motor Accident Guidelines, treatment costs are generally covered if they are directly related to the accident. This includes specialist consultations, physiotherapy, pain management, and diagnostic tests like MRI scans.
SIRA (State Insurance Regulatory Authority) administers CTP claims and outlines that treatment costs must be 'reasonably necessary' for recovery. For example, if your CRPS requires ongoing physiotherapy to manage pain and mobility issues, these costs are typically funded. However, the scheme does not cover treatment for pre-existing conditions or unrelated health issues.
Documentation Needed for CRPS Claims
To claim treatment costs for CRPS, you must provide:
- A medical report confirming your diagnosis of CRPS and its link to the accident
- Records of all treatment received, including invoices and receipts
- Evidence of the accident, such as police reports or witness statements
- A treatment plan from your medical practitioner outlining the necessity of ongoing care
SIRA requires these documents to assess whether the treatment is 'reasonably necessary' under the CTP scheme. For instance, if your doctor has prescribed a specific therapy to address CRPS-related symptoms, this must be clearly documented.
Key Differences from General Treatment Claims
Unlike general treatment cost claims, CTP funding for CRPS is limited to injuries caused by motor vehicle accidents. If your CRPS is not directly related to a road trauma, you may need to pursue other avenues, such as private health insurance or a personal injury claim. Additionally, CTP benefits for threshold injuries like CRPS are generally limited to 52 weeks after the accident, unless the injury results in long-term impairment.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident, though extensions may apply for complex cases. If your treatment costs exceed this period, you may need to seek independent medical advice to challenge the 52-week limit. SIRA also allows disputes over claim amounts, and you can request a review if you believe your treatment costs are not being fully funded.
When to Seek Legal Advice
While SIRA provides a framework for CTP claims, navigating the process can be complex. For example, if your CRPS treatment involves experimental therapies or specialist equipment, you may need legal guidance to ensure these costs are covered. A solicitor can also help if your claim is denied or if you face disputes over the necessity of treatment.
Next Steps
CTP funding for CRPS injuries depends on the specific circumstances of your accident and treatment. To request contact about your circumstances, complete the quick, no obligation enquiry form.