Funding for Hearing Loss Treatment Under CTP in NSW
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).
Hearing loss caused by acoustic trauma in a motor accident may be covered by the Compulsory Third Party (CTP) insurance scheme in New South Wales. If the injury resulted from crash forces, airbag deployment, or loud noise during the accident, treatment and care benefits may be available to cover medical and allied health services. These benefits are funded under the Motor Accident Injuries Act 2017 and administered by the State Insurance Regulatory Authority (SIRA). The availability of funding depends on the nature of the injury, the timing of treatment, and whether the injury meets the criteria for coverage under the CTP scheme.
How Treatment Costs Are Covered
Under the CTP scheme, treatment and care benefits cover reasonable and necessary medical and allied health services related to injuries sustained in a motor accident. This includes audiological assessments, hearing aids, tinnitus management, and specialist consultations for acoustic trauma. These benefits are not limited to Greater Sydney and apply across NSW, including metropolitan and regional areas. The insurer must fund treatment that is clinically appropriate and directly linked to the accident. Funding is not automatic and requires a formal claim and approval process.
Practical Steps to Claim Funding
To access funding for hearing loss treatment, you should:
- Seek medical assessment from an audiologist or ear, nose and throat specialist as soon as possible after the accident.
- Obtain a written report detailing the diagnosis, the likely cause of the hearing loss, and the recommended treatment plan.
- Notify your CTP insurer in writing within a reasonable time, providing the medical report and any supporting evidence such as accident scene photographs, witness statements, or vehicle damage assessments.
- Keep all records of treatment, including receipts for hearing aids, appointments, and travel costs related to medical visits.
SIRA advises that claims should be made promptly to avoid delays in funding approval. While there is no fixed deadline for notifying the insurer, delays may affect the insurer’s ability to verify the connection between the accident and the injury.
Legal Boundaries on Funding
Funding for hearing loss treatment is subject to the legal framework of the Motor Accident Injuries Act 2017. The injury must be directly attributable to the motor accident. Acoustic trauma is recognised as a valid injury type under the scheme, particularly when it results from sudden loud noise during impact or airbag deployment. However, funding is not available for pre-existing conditions unless they were aggravated by the accident.
If the hearing loss is classified as a threshold injury, the claim may be limited to treatment and care benefits and weekly income payments, depending on the severity and duration of the injury. The threshold injury definition includes injuries that result in a permanent impairment of 10% or more of the whole person, or injuries that meet specific criteria under the Motor Accident Injuries Regulation 2017. For hearing loss, a permanent impairment rating must be established by a qualified medical assessor.
Where a person’s only injuries are threshold injuries, treatment and care benefits are generally limited to 52 weeks from the date of the accident, unless a medical certificate extends the period. This 52-week limit does not apply to injuries that are not threshold injuries or to claims that proceed to damages.
When to Seek Advice
If your claim for hearing loss treatment funding is denied, or if you believe the insurer is not covering reasonable and necessary treatment, you may seek a review through SIRA or apply for a determination. Disputes may arise over the medical evidence, the causation of the injury, or the reasonableness of treatment costs.
A realistic example: A driver in Sydney sustained acoustic trauma during a front-end collision when the airbag deployed forcefully. The driver experienced immediate hearing loss and tinnitus. After being assessed by an audiologist, a report confirmed a 25% permanent impairment of hearing in the right ear. The insurer initially refused to fund a hearing aid, citing a lack of medical urgency. The driver submitted the medical report, a treatment plan, and evidence of travel costs. After a review, the insurer approved funding for the hearing aid and associated audiology appointments.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.