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).
Elderly pedestrians involved in motor accidents in NSW may be eligible for treatment funding through the Compulsory Third Party (CTP) scheme. The NSW government’s State Insurance Regulatory Authority (SIRA) administers CTP claims, which cover medical treatment costs for injuries caused by motor vehicles. This article explains how SIRA funds treatment for elderly victims, the evidence required, and practical considerations for claimants in Ballina.
How SIRA Funds Medical Treatment for Elderly Pedestrians
Under the Motor Accident Injuries Act 2017, SIRA provides funding for treatment costs incurred as a result of a motor accident. For elderly pedestrians, this includes medical tests, specialist consultations, and rehabilitation services. The CTP scheme covers all treatment costs, regardless of the injury’s severity, as long as the injury is directly linked to the accident.
SIRA’s role is to assess the medical necessity of treatment and ensure that funds are allocated to cover documented expenses. This includes both immediate care (e.g., emergency treatment) and long-term recovery (e.g., physiotherapy). The scheme does not require claimants to prove fault, as CTP is a no-fault insurance system.
Evidence Required for Treatment Funding Claims
To support a treatment funding claim, claimants must provide:
- Medical records confirming the injury and treatment
- A statement from a medical practitioner detailing the necessity of treatment
- Proof of treatment costs (e.g., invoices, receipts)
- Details of the accident, including the date, location, and vehicle involved
For elderly victims, additional documentation may be required to demonstrate age-related vulnerabilities, such as pre-existing conditions or mobility limitations. SIRA may also request evidence of how the injury impacts the individual’s daily activities.
Time Limits and Dispute Resolution
Claimants must notify SIRA of their intention to claim within 52 weeks of the accident. This deadline applies to all CTP claims, including those involving elderly pedestrians. If treatment costs are incurred beyond this period, funding may be limited or denied.
Disputes over treatment funding can be resolved through SIRA’s internal review process or by lodging a complaint with the NSW Civil and Administrative Tribunal (NCAT). Claimants should seek legal advice if they believe their treatment needs are not being adequately addressed.
When to Seek Legal Advice
While SIRA handles most CTP claims, elderly pedestrians may face unique challenges, such as age-related health complications or disputes over long-term care needs. Legal advice is recommended if:
- The claimant’s injuries are classified as a 'threshold injury' under the Motor Accident Guidelines
- There are disputes over the extent of treatment funding
- The claimant requires assistance with navigating SIRA’s application process
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.