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).
Elderly pedestrians involved in motor accidents in NSW may be eligible for treatment funding through the Compulsory Third Party (CTP) scheme. Under the Motor Accident Injuries Act 2017 (MAIA), treatment costs for injuries sustained in a motor vehicle accident are covered, but eligibility depends on medical evidence and specific criteria. This article explains how CTP funding works for elderly victims, what costs are covered, and practical steps to claim treatment support in Greater Sydney.
What Treatment Costs Are Covered Under NSW CTP Funding?
CTP insurance covers medical treatment costs for injuries caused by motor vehicles. For elderly pedestrians, this includes:
- Emergency care and hospital treatment
- Specialist consultations and diagnostic tests
- Physiotherapy, occupational therapy, and rehabilitation
- Medications prescribed for injury-related conditions
- Assistive devices like walking aids or mobility equipment
The scheme does not cover unrelated costs such as dental work, cosmetic procedures, or treatment for pre-existing conditions. SIRA (State Insurance Regulatory Authority) assesses each claim based on medical evidence, not the claimant’s age.
How SIRA Determines Eligibility for Treatment Funding
SIRA evaluates claims using the Motor Accident Guidelines and clinical assessments. For elderly victims, the focus is on:
- Proving the injury resulted from the motor accident
- Demonstrating the injury’s impact on daily activities
- Showing a need for ongoing treatment
SIRA considers factors like recovery time, mobility limitations, and medical reports. For example, a broken leg requiring surgery and prolonged rehabilitation would qualify, while a minor bruise without long-term effects might not. Age alone does not determine eligibility, medical evidence must show a genuine need for treatment.
Documentation Required to Claim Treatment Costs
To support a CTP treatment claim, claimants must provide:
- Police report or accident statement
- Medical records from doctors, specialists, and hospitals
- Receipts for approved treatments
- Evidence of income loss (if applicable)
- Any correspondence with insurers or SIRA
Medical professionals must document how the injury affects the elderly person’s ability to perform daily tasks. This is critical for proving the need for ongoing care or equipment.
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident, unless an extension is granted. For elderly victims with complex injuries, time limits may be extended if:
- The injury was not immediately apparent
- The claimant required ongoing treatment beyond 52 weeks
If a claim is disputed, claimants can request a review by SIRA or seek mediation through the NSW Civil and Administrative Tribunal (NCAT). Legal advice may be necessary to challenge a decision.
When to Seek Independent Legal Advice
While SIRA provides a clear framework, claimants should consult a solicitor if:
- The injury involves long-term or permanent impairment
- There are disputes over medical evidence
- The claimant is unsure about their eligibility
A lawyer can help navigate SIRA’s assessment process and ensure all documentation meets legal standards. This is particularly important for elderly victims, whose injuries may require more detailed medical evaluation.
Next Steps for Elderly Pedestrian Claimants
CTP funding for treatment costs is available to elderly pedestrians in NSW, but the process requires careful documentation and adherence to time limits. If you or a loved one has been injured in a motor accident, it’s essential to:
- Seek immediate medical attention to document the injury
- Collect all relevant accident and medical records
- Submit a claim to SIRA within 52 weeks
- Contact LegalAdvice.com.au for assistance with claim assessments or disputes
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.