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).
Dependants of deceased Compulsory Third Party (CTP) claimants in New South Wales may access funding for medical treatment costs under the NSW CTP scheme. This guide explains what treatment costs are covered, how to apply, and legal limitations under the Motor Accident Injuries Act 2017.
What Treatment Costs Are Covered Under NSW CTP Death Benefits?
Under the NSW CTP scheme, dependants can claim funding for medical treatment costs directly related to the deceased’s injury. This includes:
- Medical consultations and specialist appointments
- Diagnostic tests (e.g., MRI scans, X-rays)
- Rehabilitation therapies (e.g., physiotherapy, occupational therapy)
- Medications prescribed for the deceased’s injury
Funding is available only if the deceased’s injury meets the threshold injury definition in the Motor Accident Guidelines. This typically requires a diagnosed soft tissue injury (e.g., whiplash) or a spinal nerve-root injury with neurological signs. Costs must be incurred within 52 weeks of the accident, as benefits for threshold injuries are generally limited after this period.
How to Apply for Funding of Medical Treatment Costs
Dependants must apply to the CTP insurer through the State Insurance Regulatory Authority (SIRA). Key steps include:
- Submit medical records confirming the deceased’s injury and treatment needs
- Provide evidence of treatment costs (e.g., invoices, receipts)
- Complete a claim form through SIRA’s online portal or by contacting the CTP insurer directly
- Include proof of dependant relationship (e.g., birth certificates, family records)
Applications must be submitted within 52 weeks of the accident. SIRA assesses claims based on the deceased’s injury severity and the dependant’s financial need.
Legal Limitations on CTP Funding for Treatment Costs
Several restrictions apply:
- 52-week limit: Benefits for threshold injuries stop after 52 weeks. If the deceased’s injury is a whole person impairment (WPI) of 10% or more, treatment costs may continue beyond this period.
- No coverage for pre-existing conditions: Funding is only available for injuries caused by the accident.
- No lump sum payments: CTP funding is limited to specific treatment costs, not general living expenses.
- No coverage for dependant’s own injuries: Funding is strictly for the deceased’s injury-related treatment.
Example: Funding for a Child’s Therapy After a Fatal Accident
If a child was a passenger in a fatal car accident with a diagnosed soft tissue injury, their parent could claim funding for:
- Physiotherapy sessions to address whiplash
- Psychological counseling for trauma-related anxiety
- Medical equipment (e.g., a cervical collar)
However, if the child’s injury was not a threshold injury, funding may not be available.
When to Seek Legal Advice
Dependants should consult a solicitor if:
- The CTP insurer denies the claim
- The deceased’s injury meets the WPI threshold but benefits are limited
- There are disputes over the dependant’s financial need
- The accident occurred before 1 December 2017 (under the former Motor Accidents Compensation Act 1999)
Legal professionals can help navigate SIRA’s application process and challenge decisions based on the Motor Accident Injuries Act 2017.
Next Steps
CTP funding for dependants depends on the accident date, injury type, and claim timing. To request contact about your circumstances, complete the quick, no obligation enquiry form.