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).
Facial scarring injuries in NSW CTP claims may entitle injured persons to cover treatment costs and rehabilitation planning. Under the Motor Accident Injuries Act 2017, treatment expenses for scarring injuries are generally recoverable if they are reasonably necessary to address the injury. Rehabilitation planning must demonstrate a clear link between treatment and long-term recovery goals. This article explains how SIRA evaluates claims for facial scarring injuries in Illawarra and South Coast, including documentation requirements and time limits.
What Treatment Costs Are Covered for Facial Scarring Injuries?
Under NSW CTP rules, treatment costs for facial scarring injuries are recoverable if they are:
- Reasonably necessary to treat the injury
- Directly related to the motor accident
- Incurred within 52 weeks of the accident (unless the injury is a threshold injury requiring longer treatment)
SIRA considers medical evidence such as dermatologist reports, surgical records, and cosmetic treatment invoices. For example, a person with a facial laceration requiring skin grafting would be entitled to cover the cost of the procedure, provided it is medically necessary. However, elective procedures like Botox injections for cosmetic improvement are generally not recoverable unless they are part of a therapeutic treatment plan.
How SIRA Assesses Rehabilitation Planning for Facial Scarring
SIRA evaluates rehabilitation planning by considering:
- The nature and severity of the scarring
- Medical evidence showing a need for ongoing treatment
- A documented rehabilitation plan from a registered medical practitioner
- Evidence of long-term care needs (if applicable)
In Illawarra and South Coast, claimants must provide evidence of treatment by registered practitioners in the region. For instance, a claimant with extensive facial scarring requiring multiple dermatology consultations would need to submit records from local specialists. SIRA may also require a psychologist's report if the scarring causes psychological distress.
Documentation Needed for CTP Claims
To support a CTP claim for facial scarring, claimants must provide:
- Police accident report or witness statements
- Medical records detailing the injury and treatment
- Receipts for treatment costs
- Rehabilitation plan from a medical practitioner
- Evidence of income loss (if applicable)
For example, a claimant who underwent multiple laser treatments for scarring would need to submit invoices from the treating dermatologist, along with a doctor's note explaining the necessity of each procedure.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident unless the injury is a threshold injury requiring longer treatment. For non-threshold injuries, weekly benefits and treatment costs are generally limited after 52 weeks. If a claimant believes their treatment extends beyond this period, they must provide medical evidence to justify the delay.
Disputes over treatment costs or rehabilitation planning can be resolved through SIRA's dispute resolution process. Claimants should seek legal advice if they receive a notice of disagreement from SIRA.
When to Seek Legal Advice
Claimants should consult a solicitor if:
- They are unsure whether their treatment costs are recoverable
- They face a dispute with SIRA
- They need help preparing documentation
- They have overlapping claims with workers' compensation or other schemes
A solicitor can help ensure all evidence meets SIRA's requirements and that the claimant complies with time limits.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.