Elderly pedestrians involved in road accidents on the Central Coast may be eligible for funding of medical treatment costs through NSW's Compulsory Third Party (CTP) scheme. Under the Motor Accident Injuries Act 2017, injured persons can claim treatment and care benefits, weekly income payments, and other statutory support. This article explains how SIRA assesses funding for elderly road users, the evidence required, and key considerations for claims.
How NSW CTP Covers Treatment Costs for Elderly Pedestrians
NSW CTP insurers fund medical treatment costs through the Motor Accident Injuries Act 2017. SIRA covers treatment for injuries caused by motor vehicles, including soft tissue injuries, fractures, and neurological conditions. For elderly pedestrians, treatment costs such as physiotherapy, scans, and specialist consultations are typically funded if the injury meets the 'threshold injury' definition in the Motor Accident Guidelines.
The threshold injury criteria include spinal nerve-root injuries producing neurological signs, such as radiculopathy, or injuries requiring specific clinical signs under the guidelines. SIRA evaluates whether the injury is 'reasonably foreseeable' as a result of the accident. Elderly individuals may face longer recovery periods, which can affect the duration of treatment funding.
Documentation Needed for Treatment Claims
To claim treatment costs, claimants must provide evidence of the injury and its connection to the accident. Key documents include:
- Medical records confirming the injury and treatment
- Accident reports from police or witnesses
- Photographs of the scene and vehicle damage
- Income records to assess financial impact
- Correspondence with insurers or SIRA
Medical professionals must also complete the 'Medical Certificate of Injury' form, which outlines the injury's nature and treatment requirements. For elderly pedestrians, additional documentation such as pre-existing health records may be required to establish the injury's direct link to the accident.
Time Limits and Dispute Resolution
Claims must be submitted within 52 weeks of the accident for certain benefits, though this period may extend for complex cases. If a claimant's only injuries are threshold injuries, weekly benefits and treatment funding are generally limited after 52 weeks under s 4.4 of the Motor Accident Injuries Act 2017. Disputes over funding decisions can be escalated to SIRA's review process or the NSW Civil and Administrative Tribunal (NCAT).
Example: Funding a Fracture Claim
Consider an elderly pedestrian who breaks a leg after being hit by a car. SIRA would fund treatment costs for X-rays, a cast, and physiotherapy. If the injury meets the threshold criteria, the claimant may also receive weekly income payments during recovery. However, if the injury is deemed a minor soft tissue injury, treatment funding may be limited to 52 weeks.
When to Seek Legal Advice
While SIRA handles most claims, elderly pedestrians may benefit from legal assistance to navigate complex documentation or disputes. A solicitor can help challenge decisions, ensure all evidence is submitted, and advise on extending time limits for exceptional circumstances.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.