Funding Treatment Costs for Defence Personnel in NSW CTP Claims
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).
Military personnel in New South Wales who sustain injuries in a motor accident may be eligible for funding of treatment costs through the Compulsory Third Party (CTP) insurance scheme. This funding is available regardless of fault and applies across NSW, including in areas such as Sydney, Newcastle, Wollongong and regional centres. The CTP scheme, governed by the Motor Accident Injuries Act 2017, provides coverage for medical treatment, rehabilitation and related expenses when injuries result from a motor vehicle accident. Service members are not excluded from this entitlement simply because of their employment status.
How the CTP Scheme Applies to Military Personnel
The CTP scheme in NSW operates under the Motor Accident Injuries Act 2017 and applies uniformly to all individuals injured in a motor accident on NSW roads, including members of the Australian Defence Force. There is no separate CTP pathway for military personnel. The same rules apply to claim eligibility, treatment funding, and benefit limits. This means that service members who are injured in a motor accident are entitled to treatment and care benefits, including funding for medical treatment, allied health services, and rehabilitation, provided the injury occurred in a motor accident involving a motor vehicle.
The scheme covers treatment costs for injuries that result from a motor accident, regardless of whether the person was driving, a passenger, a pedestrian, or a cyclist. This includes injuries sustained while on active duty, on leave, or in a personal capacity, as long as the accident occurred on a public road or road-related area in NSW.
What Treatment Costs Are Covered
Under the CTP scheme, funding for treatment costs includes medical services such as visits to a general practitioner, specialist consultations, diagnostic imaging (X-rays, MRIs), surgical procedures, and ongoing rehabilitation. Allied health services such as physiotherapy, psychology, and occupational therapy are also funded if they are directly related to the accident and recommended by a medical practitioner.
Funding is not limited to initial treatment. It extends to ongoing care where a medical practitioner determines that treatment is necessary to manage or improve the injury. This includes treatment for chronic pain, mental health conditions, and long-term physical impairments resulting from the accident. The scheme does not cover treatment for pre-existing conditions unless they were aggravated by the accident.
Practical Steps and Evidence to Support a Claim
To access funding for treatment costs, military personnel should take the following steps:
- Seek medical attention immediately after the accident and keep all medical records, including treatment notes, prescriptions, and referrals.
- Notify the CTP insurer of the claim as soon as possible. This can be done through the insurer’s online portal or by contacting them directly.
- Provide a completed claim form, which can be obtained from the insurer or SIRA’s website.
- Retain copies of all correspondence with the insurer, medical providers, and employers.
- If the injury affects work capacity, keep records of time off work, pay slips, and any communication with the employer.
Evidence that supports a claim includes:
- A medical report confirming the injury and its connection to the accident.
- Photographs of the accident scene, vehicle damage, or injury manifestations.
- Witness statements, if available.
- A copy of the police report, if one was filed.
- Documentation of out-of-pocket expenses related to treatment, such as transport to appointments or medication costs not covered by the scheme.
Time Limits and Procedural Requirements
There is a time limit to begin a CTP claim. A claim must generally be made within three years of the accident date. However, the insurer may not be required to pay benefits if the claim is not made within a reasonable time, particularly if the delay affects the insurer’s ability to investigate.
For treatment and care benefits, funding is generally available for up to 52 weeks from the date the injury occurred, unless the injury is classified as a threshold injury. If the injury is a threshold injury, funding for treatment and care benefits may be limited to 52 weeks, and damages may not be available unless the injury meets the threshold criteria under the Motor Accident Injuries Act 2017.
If the injury is not a threshold injury, treatment and care benefits may continue beyond 52 weeks if ongoing treatment is clinically necessary and supported by a medical practitioner.
Disputes and Support for Military Personnel
If an insurer denies a claim for treatment funding, the claimant may request a review under the Motor Accident Injuries Act 2017. Disputes can be referred to the State Insurance Regulatory Authority (SIRA), which oversees the CTP scheme in NSW. SIRA provides guidance and dispute resolution services to help resolve disagreements about claim eligibility or benefit amounts.
Military personnel may also seek support from Defence Health, which provides medical care to service members, or from the Defence Injury Management and Rehabilitation Service. These services may assist in coordinating care and ensuring that treatment is properly documented and claimed under CTP.
A hypothetical example: A Defence member was injured in a car accident on the M2 motorway in Sydney. They were treated for a whiplash injury and required physiotherapy and psychological support. The claim was submitted through the insurer’s online portal, supported by medical reports and a police report. The insurer approved funding for 12 months of treatment, including allied health and medication, as the injury was not classified as a threshold injury.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.