How SIRA Funds Treatment Costs for Fatal Motor Accidents in NSW
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).
If a motor accident results in a fatality, the NSW government’s State Insurance Regulatory Authority (SIRA) administers the Compulsory Third Party (CTP) scheme to fund treatment costs for dependants. Under the Motor Accident Injuries Act 2017, SIRA covers eligible medical and therapeutic expenses incurred by the deceased’s family or dependants. This includes treatments like physiotherapy, specialist consultations, and medications directly related to the injury caused by the accident.
What Treatment Costs Are Eligible for Funding?
SIRA funds treatment costs that are:
- Directly related to the injury caused by the motor accident
- Reasonable and necessary for the dependant’s recovery
- Incurred within the time frame of the claim
Eligible costs include:
- Medical imaging (e.g., X-rays, MRIs)
- Specialist consultations (e.g., neurologist, orthopaedist)
- Physiotherapy and occupational therapy
- Medications prescribed for the injury
- Transportation to and from treatment (if required)
Costs not directly related to the injury, such as general healthcare or unrelated procedures, are not funded.
Regional Considerations in the Blue Mountains and Nepean
While SIRA applies the same funding rules across NSW, regional factors like access to specialist services or travel distances may influence treatment cost assessments. For example, if a dependant in the Blue Mountains requires specialist care in Sydney, SIRA may consider travel costs as part of the treatment expenses. However, all claims must meet the legal threshold of being 'reasonably necessary' under the CTP scheme.
Practical Steps to Support a Treatment Cost Claim
To ensure treatment costs are funded:
- Document all medical records (e.g., GP notes, specialist reports, therapy plans)
- Keep invoices and receipts for all treatment-related expenses
- Submit a detailed treatment plan outlining how each cost benefits the dependant
- Notify SIRA promptly about any treatment decisions or changes
Time Limits and Dispute Resolution
Claims must be submitted within 52 weeks of the accident, unless an extension is granted. For fatal claims, the 52-week limit applies to the funding of treatment costs, not the time to submit the claim. If a dependant’s treatment extends beyond this period, SIRA may reassess eligibility based on the injury’s ongoing impact.
Disputes over treatment costs can be resolved by:
- Requesting a review from SIRA
- Seeking independent medical opinion
- Consulting a legal professional if the claim is complex
When to Seek Legal Advice
Legal counsel is recommended if:
- The claim involves multiple dependants or complex financial needs
- There are disputes over the reasonableness of treatment costs
- The accident occurred in a car park, driveway, or private property (which may affect CTP coverage)
- The claimant is unsure whether the injury meets the 'threshold injury' definition under the Motor Accident Guidelines
Next Steps
CTP funding rules can vary based on the accident date, injury type, and regional factors. To request contact about your circumstances, complete the quick, no obligation enquiry form.