Funding Treatment Costs in Fatal Motor Accident Claims
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).
In a fatal motor accident in New South Wales, treatment costs incurred by the deceased before death may be funded under the Compulsory Third Party (CTP) insurance scheme, but only if those costs were directly related to injuries sustained in the accident. The funding is not available to the deceased’s family members for their own treatment, nor for costs incurred after death. The claim is made by the deceased’s estate or a person acting on behalf of the estate, such as a legal personal representative. Funding is limited to reasonable and necessary medical treatment received by the deceased up to the time of death.
Legal Framework for Treatment Cost Funding
The Motor Accident Injuries Act 2017 (MAIA) governs CTP claims in NSW. Under this law, treatment and care benefits are available to a person who suffered injury in a motor accident. In a fatal accident, the deceased is treated as having suffered injury up to the time of death. Therefore, any medical treatment received by the deceased in the period immediately before death, including hospital care, emergency treatment, surgery, and specialist consultations, may be eligible for funding under the CTP scheme.
Funding is not automatic. The claim must be made through the appropriate insurer, usually the insurer of the vehicle that caused the accident. The claim must be supported by medical records showing that the treatment was directly related to injuries from the motor accident. The insurer may require a medical report to confirm the nature and timing of the injuries and treatment.
How This Differs from Non-Fatal Claims
In non-fatal claims, treatment and care benefits are available to the injured person for a period of up to 52 weeks from the date of the accident, subject to the threshold injury rules. In fatal claims, the treatment cost funding is not limited to 52 weeks. Instead, it covers treatment received by the deceased up to the time of death, regardless of the time elapsed since the accident. However, funding does not extend to treatment received after death.
The deceased’s estate may also claim for reasonable funeral expenses, but this is a separate entitlement under the MAIA and does not cover medical treatment costs incurred before death. The estate must provide evidence such as itemised medical bills, hospital invoices, and a death certificate to support the claim.
Practical Steps and Evidence
To secure funding for treatment costs in a fatal motor accident, the following steps and evidence are typically required:
- Obtain a copy of the deceased’s medical records from the treating hospital or medical practitioner. These should include admission notes, treatment plans, surgical reports, and discharge summaries.
- Gather itemised invoices or receipts for all medical services provided to the deceased in the period leading up to death.
- Confirm the date of the accident and the date of death, as the claim must demonstrate that treatment was received in connection with the accident.
- Identify the insurer of the vehicle that caused the accident. This information may be found in the police report or on the CTP green slip (insurance certificate) for the vehicle.
- Notify the insurer in writing as soon as possible, ideally within 6 months of the accident, to preserve the right to claim.
A legal personal representative of the estate must act on behalf of the deceased. This may be an executor named in a will, an administrator appointed by the Supreme Court, or a person with legal authority under the Succession Act 2006.
Time Limits and Dispute Options
There is no fixed deadline for making a claim for treatment costs in a fatal motor accident, but delays may affect the insurer’s ability to investigate and verify the claim. It is advisable to begin the process as soon as possible after the accident.
If the insurer refuses to fund treatment costs, the claimant may request a review under the insurer’s internal dispute resolution process. If the dispute remains unresolved, the claimant may apply to the State Insurance Regulatory Authority (SIRA) for a determination. SIRA provides a formal process for resolving disputes over CTP claims, including those involving treatment cost funding.
Hypothetical Example
A 45-year-old man was involved in a collision in Sydney’s Inner West on 15 March 2026. He was taken to a major hospital in the city and underwent emergency surgery for a fractured pelvis and internal injuries. He remained in intensive care for 10 days and died on 25 March 2026. His medical records show that he received treatment for injuries sustained in the accident. His estate may claim for the cost of this treatment under the CTP scheme, provided the insurer has not already paid the hospital directly. The claim would be supported by hospital invoices, surgical reports, and a death certificate.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.