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 you're seeking compensation for treatment costs after a fatal motor accident in Newcastle or Hunter, the NSW Compulsory Third Party (CTP) scheme provides funding through the State Insurance Regulatory Authority (SIRA). This article explains how treatment costs are funded, the legal boundaries of claims, and regional considerations under NSW law.
How SIRA Funds Treatment Costs for Fatal Accidents
SIRA administers CTP claims under the Motor Accident Injuries Act 2017. For fatal accidents, dependants may claim treatment costs incurred before the deceased’s death, provided the treatment was necessary for the deceased’s condition. This includes medical bills, therapy, and other related expenses.
Under SIRA guidelines, treatment costs must be directly related to the injury caused by the accident. For example, if a pedestrian died from internal injuries sustained in a car crash, their dependants could claim the cost of emergency care and specialist consultations. SIRA evaluates claims based on medical records and invoices, ensuring costs are reasonable and necessary.
Legal Boundaries for Funding Treatment Costs
Claims for treatment costs are limited to injuries resulting from the accident. If the deceased’s condition worsened due to pre-existing issues, SIRA may reduce the claim. Additionally, treatment costs must be incurred within 52 weeks of the accident, unless the injury is classified as a 'threshold injury' under the Motor Accident Guidelines.
For fatal accidents, dependants cannot claim treatment costs for injuries that occurred before the accident. SIRA also requires evidence that the treatment was directly related to the accident. For instance, if a cyclist died from a head injury, dependants could claim costs for neurosurgery but not for unrelated dental treatment.
Newcastle and Hunter CTP Claims: Regional Considerations
While SIRA applies statewide, regional factors may influence claims. In Newcastle and Hunter, SIRA’s local offices handle claims and may have specific procedures for assessing treatment costs. For example, regional hospitals may have different billing practices, and SIRA may require additional documentation to verify expenses.
A key difference in these regions is the availability of local SIRA representatives to assist with claims. Dependants should contact SIRA directly to confirm whether their treatment costs fall within the funded scope. This ensures claims align with both general CTP rules and regional practices.
Practical Steps and Evidence Needed
To claim treatment costs, dependants must provide: medical records confirming the injury’s link to the accident, itemized bills, and proof of the deceased’s death date. Witness statements or accident reports may also strengthen the claim.
For example, if a motorcyclist died after a collision, their family would need to show that the treatment (e.g., ICU care) was directly caused by the accident. SIRA may also request a medical opinion to confirm this connection.
Time Limits and When to Seek Advice
Claims must be submitted within 52 weeks of the accident, unless the injury is a threshold injury. For fatal accidents, dependants have 52 weeks to claim treatment costs incurred before the deceased’s death. Missing this deadline may result in denied claims.
If disputes arise, dependants can request a review by SIRA or seek legal advice. A solicitor can help navigate complex issues, such as proving the necessity of treatment costs or challenging SIRA’s decision.
Next Steps
CTP claims for treatment costs depend on the accident date, injury type, and regional SIRA procedures. In Newcastle and Hunter, dependants should contact SIRA directly to confirm their eligibility. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.