How Treatment Costs Are Funded for Children Injured on Driveways in NSW
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 child injured as a pedestrian on a driveway in Greater Sydney may be eligible for funding of treatment costs through the NSW Compulsory Third Party (CTP) insurance scheme. This funding is provided under the Motor Accident Injuries Act 2017 and administered by the State Insurance Regulatory Authority (SIRA). The scheme covers injuries sustained in a motor vehicle accident, regardless of fault, if the child was a pedestrian at the time of impact. The legal basis for treatment funding is not limited to public roads; driveways, private property and residential areas are included if the vehicle was being used for transport and the accident occurred during a motor vehicle incident.
What Treatment Costs Are Covered
SIRA funds treatment costs that are reasonable, necessary and directly related to injuries sustained in the accident. This includes medical consultations, diagnostic imaging, physiotherapy, psychological treatment, and allied health services. For children, treatment may also include specialist paediatric care, speech therapy, or occupational therapy if clinically indicated. Funding is not limited to a specific type of injury, but must be supported by a medical practitioner’s assessment and treatment plan. The treatment must be provided by a registered health professional and documented in a formal medical record.
Evidence Required to Claim Treatment Funding
To access treatment funding, families must provide evidence that supports the injury, the treatment received, and its connection to the motor accident. Key evidence includes:
- A detailed medical record from a treating practitioner, including diagnosis, treatment plan, and progress notes.
- A completed SIRA claim form (available through the SIRA website) with details of the accident, injuries, and treatment.
- Photographs of the accident scene, if available, showing the location and conditions at the time.
- A written statement from a witness, if one was present, describing how the child was struck.
- A copy of the police report, if one was filed, or a statement from the driver involved.
- Records of any transport, accommodation, or care costs related to treatment.
SIRA does not fund treatment that is not medically necessary or not directly linked to the accident. Treatment must be provided by a registered practitioner and must not be duplicative or excessive.
How the CTP Funding Process Works for Children
The CTP process for children differs from that for adults in several practical ways. Children are not required to meet the threshold for a permanent impairment to access treatment funding. Unlike adult claims, which may face restrictions on damages if only threshold injuries are sustained, children are not subject to the same limitations under the Motor Accident Injuries Act 2017. This means treatment funding is not capped at 52 weeks solely because the injury is a soft tissue injury or a threshold injury.
Additionally, treatment for children may be funded even if the injury is not severe or long-term, provided it is clinically necessary. SIRA considers the child’s developmental needs, recovery potential, and long-term outcomes when assessing treatment plans. Parents or guardians are responsible for initiating the claim and providing consent for treatment funding, but the child’s best interests are a central consideration in the approval process.
Time Limits and Procedural Requirements
There is a 3-year time limit from the date of the accident to make a claim for treatment funding under the CTP scheme. This period is fixed by law and does not extend for delays in treatment or diagnosis. Families should notify the insurer as soon as possible after the accident, ideally within 28 days, to avoid delays in processing. Failure to notify within this timeframe may result in the claim being rejected, unless there is a valid reason for the delay.
If treatment is already underway, the family should contact the insurer immediately to request funding. The insurer may request a medical report or treatment plan to assess eligibility. Once approved, treatment costs are paid directly by the insurer or reimbursed to the family, depending on the arrangement.
When to Seek Independent Advice
While SIRA provides clear guidelines, the process can be complex, particularly when injuries are not immediately apparent or when treatment is ongoing. Families may benefit from independent advice if:
- The insurer refuses to fund treatment without a clear reason.
- The child’s condition worsens or treatment needs change.
- There is a dispute over whether the injury was caused by the accident.
- The family is unsure about the next steps or documentation required.
SIRA provides free information and guidance through its website and contact centre. Families may also seek assistance from a community legal centre or a solicitor with experience in motor accident claims.
Hypothetical Example
A 7-year-old child was struck by a car while crossing a driveway in North Ryde, Greater Sydney, on 15 March 2024. The driver stopped immediately and called emergency services. The child was treated for a concussion and soft tissue injuries. The family obtained medical records, a police report, and a statement from a neighbour who witnessed the incident. They submitted a claim to the insurer within 30 days. The insurer approved funding for six months of physiotherapy and two sessions of psychological support. The treatment was provided by a registered practitioner and documented in the medical record. The family received reimbursement for all costs incurred.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.