How Treatment Costs Are Funded in Hit-and-Run 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).
If you were injured in a motor accident in Greater Sydney and the at-fault driver fled the scene or cannot be identified, you may still be entitled to funding for treatment costs under the NSW Compulsory Third Party (CTP) insurance scheme. This funding is available through the Motor Accident Injuries Act 2017 (MAIA), which provides for treatment and care benefits regardless of whether the responsible driver can be identified. These benefits cover reasonable and necessary medical, allied health and rehabilitation services incurred as a result of the accident.
What Treatment Costs Are Covered
Under the CTP scheme, eligible treatment costs include physiotherapy, chiropractic care, psychological counselling, medical assessments, diagnostic imaging, and prescribed medications. These must be directly related to injuries sustained in the motor accident and provided by a registered health practitioner. The treatment must also be reasonable and necessary, as determined by the Motor Accident Injuries (Treatment and Care) Guidelines issued by the State Insurance Regulatory Authority (SIRA). Funding is not available for treatments that are purely preventative, cosmetic, or unrelated to the accident.
Steps to Claim Treatment Funding
To access funding for treatment costs after a hit-and-run accident, you must first notify your insurer or the SIRA claims portal within a reasonable time. You should also:
- Seek medical attention immediately and keep a record of all treatment received.
- Obtain a formal treatment plan from your medical practitioner outlining the nature, duration and necessity of the treatment.
- Submit a claim form through the SIRA claims portal or via your insurer, including supporting evidence such as invoices, prescriptions and medical reports.
- Report the accident to the police and obtain a police incident number, if possible, to support your claim.
Time Limits and Procedural Requirements
There is no fixed deadline for making a claim for treatment and care benefits under the MAIA, but delays may affect the insurer’s ability to verify your claim. It is advisable to begin the process as soon as possible after the accident. If you have not yet received a response from the insurer, you may contact SIRA directly to request an update on your claim status.
What If the At-Fault Driver Is Identified Later?
If the at-fault driver is later identified and found to be insured, your claim for treatment costs may still proceed under the CTP scheme. However, if the driver is found to be uninsured or underinsured, you may be eligible to apply for a claim under the Nominal Defendant scheme, which provides a safety net for victims of hit-and-run and uninsured motor vehicle accidents. This scheme is administered by SIRA and ensures that treatment and care benefits are not denied due to the driver’s insurance status.
Disputes and Review Options
If your claim for treatment funding is denied or limited, you may request a review from the insurer or apply to SIRA for a formal review. You can also seek a review under the Motor Accident Injuries Act 2017, which allows for independent assessment of eligibility and benefit levels. You may wish to seek advice from a legal professional or a community legal centre if you believe the decision is incorrect or not in line with the Motor Accident Injuries Guidelines.
Hypothetical Example
A pedestrian in Sydney was struck by a vehicle that fled the scene in a car park in the Inner West. The person sustained a back injury and required six weeks of physiotherapy and a psychological assessment. The individual reported the incident to police, obtained a police report number, and submitted a claim for treatment funding through the SIRA claims portal. The insurer approved coverage for all treatment costs, including a prescribed medication, based on medical evidence and a treatment plan from a physiotherapist.
When to Seek Independent Advice
While the CTP scheme provides funding for treatment costs in hit-and-run cases, the process can be complex, particularly when injuries are ongoing or when disputes arise over the necessity or cost of treatment. You may benefit from independent legal advice if:
- Your claim for treatment funding is denied.
- The insurer disputes the reasonableness or necessity of a treatment.
- You have sustained a threshold injury and are considering a claim for damages.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.