Facial Scarring Treatment Costs Covered Under NSW CTP Claims
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).
If you've suffered a facial scarring injury in a motor accident in NSW, the Compulsory Third Party (CTP) scheme may cover your treatment costs. Under the Motor Accident Injuries Act 2017, treatment expenses for injuries like lacerations, skin grafts, or cosmetic procedures are generally funded by CTP insurers. However, the amount and type of treatment covered depend on medical evidence and SIRA's assessment guidelines.
How NSW CTP Rules Apply to Facial Scarring Injuries
The CTP scheme covers treatment costs for injuries that meet the 'threshold injury' definition in the Motor Accident Guidelines. For facial scarring, this includes:
- Surgical repairs (e.g., skin grafts, scar revision)
- Cosmetic treatments to address appearance or function
- Psychological support if scarring impacts mental health
SIRA assesses whether treatment is 'reasonably necessary' for recovery. For example, a 2023 case in Bankstown saw a claimant receive funding for laser therapy to reduce scarring after a car accident. Medical records must clearly link the treatment to the injury.
Evidence Needed for Treatment Cost Claims
To support your claim, you'll need:
- Detailed medical records showing the injury's cause and treatment
- Itemized receipts for all medical procedures
- A treatment plan from your doctor outlining necessity
- Evidence of how the scarring affects your daily life (e.g., photos, psychologist reports)
If your injury involves soft tissue damage, SIRA may require a spinal nerve-root assessment to confirm it meets the threshold injury definition.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident for certain benefits. However, ongoing treatment costs may be funded beyond this period if the injury is not 'threshold' in nature. Disputes over funding decisions can be escalated to SIRA's review process or resolved through mediation.
When to Seek Legal Advice
CTP funding decisions are complex. A solicitor can help if:
- Your insurer refuses to cover necessary treatment
- You're unsure if your injury meets the threshold criteria
- You need assistance with claims for long-term care or psychological support
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To discuss your circumstances, complete the quick, no obligation enquiry form.