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've suffered hearing loss due to acoustic trauma in a motor accident and live in regional NSW, you may be wondering how the Compulsory Third Party (CTP) scheme funds your treatment costs. Under the Motor Accident Injuries Act 2017, the State Insurance Regulatory Authority (SIRA) manages claims for treatment expenses related to injuries like acoustic trauma. This article explains how SIRA assesses funding for hearing loss treatment, what evidence you need to submit, and how rural claimants can address delays in accessing care.
How SIRA Funds Hearing Loss Treatment Costs
SIRA determines whether treatment costs are funded under the CTP scheme by assessing whether the injury meets the 'threshold injury' criteria. For hearing loss caused by acoustic trauma, this involves evaluating whether the injury results from a motor vehicle accident and meets the medical standards outlined in the Motor Accident Guidelines. SIRA considers evidence such as audiograms, ENT specialist reports, and treatment plans to determine if the injury qualifies for funding.
If your hearing loss is linked to a motor accident and meets the threshold injury definition, SIRA will cover the cost of necessary medical treatments, including hearing aids, cochlear implants, and speech therapy. However, the approval process may take longer in regional NSW due to limited access to specialist services and delays in obtaining medical documentation.
Evidence Needed for Hearing Loss Claims
To claim treatment costs for acoustic trauma, you must provide evidence that directly links your injury to the motor accident. Key documents include:
- Medical records confirming the diagnosis of hearing loss
- Specialist reports detailing the cause and severity of the injury
- A treatment plan from an audiologist or ENT specialist
- Proof of treatment costs (e.g., invoices, prescriptions)
In regional areas, claimants may face challenges accessing specialists or obtaining timely medical assessments. If your treatment requires a specialist in a major city, you may need to provide evidence that local services are unavailable or insufficient.
Time Limits and Dispute Resolution
You have 52 weeks from the date of the accident to claim treatment costs under the CTP scheme. After this period, SIRA may limit benefits unless your injury meets the 'whole person impairment' threshold. If your claim is denied, you can request a review or seek mediation through SIRA's dispute resolution process.
In rural NSW, delays in accessing medical experts or submitting evidence can affect the timeline. For example, if a specialist in Sydney is required to assess your hearing loss, you must demonstrate that local services cannot provide the necessary diagnosis. This can prolong the approval process but does not automatically disqualify your claim.
Practical Steps for Regional Claimants
- Seek immediate medical attention to document your injury and treatment needs.
- Request a specialist referral if your local doctor cannot assess the full extent of your hearing loss.
- Submit all evidence promptly to SIRA, including copies of medical records and treatment invoices.
- Contact SIRA directly if you face delays in accessing specialists or submitting documents.
Example Scenario
Consider a claimant who suffered hearing loss after an airbag deployed during a car crash in a regional town. Their local GP referred them to a specialist in Sydney for a detailed audiogram. SIRA approved the treatment costs but delayed funding for six weeks due to the specialist's unavailability. This example shows how rural claimants may need to advocate for timely specialist access while meeting SIRA's evidentiary requirements.
When to Seek Legal Advice
While SIRA handles most CTP claims, complex cases involving disputes over injury severity, treatment costs, or access to specialists may require legal assistance. A solicitor can help you navigate the process, challenge a denied claim, or negotiate a fair outcome.
Next Steps
CTP entitlements depend on the date of your accident, the nature of your injury, and the evidence you provide. If you're unsure whether your hearing loss claim meets the funding criteria, complete the quick, no obligation enquiry form to request contact about your circumstances.