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).
Under NSW's green slip CTP insurance, treatment and rehabilitation planning are central to motor accident claims. The Motor Accident Injuries Act 2017 (MAIA) and SIRA guidelines determine what services are funded, how care is coordinated, and how claimants access support. This article explains how injured people in Greater Sydney navigate treatment planning, including steps to take, evidence that matters, and time limits for claims.
How SIRA Approves Treatment and Rehabilitation Services
SIRA assesses treatment eligibility based on medical reports and the Motor Accident Guidelines. Eligible services include physiotherapy, occupational therapy, and psychological support, provided they are clinically necessary and directly related to the accident. Doctors must document how the treatment addresses the injury, such as pain management or restoring mobility.
For example, if a claimant requires physiotherapy after a whiplash injury, their treating doctor must confirm that the therapy is needed to prevent long-term disability. SIRA may also require a rehabilitation plan outlining goals, timelines, and expected outcomes.
Steps for Claimants to Plan Recovery
After an accident, claimants should:
- Seek immediate medical attention and ensure all treatment records are kept.
- Notify their insurer or SIRA within 52 weeks of the accident to avoid missing weekly benefits.
- Work with healthcare providers to create a rehabilitation plan aligned with SIRA's funding criteria.
Coordination between insurers and doctors is key. SIRA may request medical reports to verify treatment necessity, so claimants should ensure their doctors communicate clearly about the injury's impact.
How Insurers Fund Treatment and Rehabilitation
Insurers fund treatment through weekly benefits and direct payments to healthcare providers. Under the MAIA, weekly benefits cover 60% of lost income for injuries meeting the 'threshold injury' definition. For more severe injuries, additional compensation may cover specialist care.
Insurers must approve treatment within 52 weeks of the accident. If a claimant's injuries are not yet fully assessed, SIRA may delay funding until a medical report confirms the injury's severity.
Time Limits and Dispute Options
Claimants must notify SIRA within 52 weeks of the accident to access weekly benefits. After this period, benefits for threshold injuries are generally limited, though more severe injuries may qualify for ongoing support.
If a claimant disagrees with a decision, they can request a review through SIRA or seek legal advice. Disputes over treatment coverage often require medical evidence to show the service meets funding criteria.
When to Seek Legal Advice
Legal assistance is recommended if:
- The claimant's injuries are not being funded.
- There are disputes over treatment coverage.
- The claimant needs help navigating SIRA's requirements.
A solicitor can help ensure all evidence is submitted correctly and that the claimant's rights under the MAIA are protected.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.