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).
If you've been injured in a motor accident in Auburn and are facing ongoing medical treatment costs after hospital discharge, you may be eligible for funding under NSW's Compulsory Third Party (CTP) scheme. This article explains what treatment costs are covered, how SIRA assesses eligibility, and steps to request funding. The information applies to all NSW residents, including Auburn, and is based on the Motor Accident Injuries Act 2017 and SIRA guidelines.
What Treatment Costs Are Covered Under CTP Funding?
NSW CTP insurers fund medically necessary treatment costs after hospital discharge, including:
- Physiotherapy and occupational therapy sessions
- Medications prescribed for recovery
- Specialist consultations and diagnostic tests
- Assistive devices like braces or mobility aids
- Some home modifications for long-term care
Funding is limited to treatment directly related to your injury, not general health care. SIRA's guidelines state that costs must be 'reasonably necessary' and 'directly related to the injury' to qualify.
How SIRA Determines Eligibility for Post-Discharge Funding
SIRA evaluates claims based on medical evidence, including:
- Your hospital discharge summary
- Treatment plans from your GP or specialist
- Medical reports confirming ongoing care needs
- Evidence of financial hardship (for certain benefits)
For example, if you need regular physiotherapy to recover from a soft tissue injury, your treating doctor must document how this treatment is essential to your recovery. SIRA will review this documentation to determine funding.
Practical Steps to Request CTP Funding
- Obtain medical records from your treating specialist, including discharge summaries and treatment plans
- Submit a written request to the CTP insurer, clearly outlining your ongoing care needs
- Provide evidence of treatment costs (e.g., invoices, prescriptions, equipment quotes)
- Follow up in writing if you don't receive a response within 28 days
Note: You must request funding within 52 weeks of the accident if your injury is classified as a 'threshold injury' under SIRA guidelines. This applies to soft tissue injuries with minimal long-term impact.
Time Limits and Dispute Resolution
CTP claims must be submitted within 52 weeks of the accident if you're seeking benefits for threshold injuries. For more severe injuries, there's no strict time limit, but delays may affect your ability to claim certain benefits.
If your funding request is denied, you can:
- Request a review from SIRA's internal review body
- Seek independent medical opinion to challenge the decision
- Contact LegalAdvice.com.au for assistance with dispute resolution
When to Seek Legal Advice
Consult a solicitor if:
- You're unsure whether your treatment qualifies
- You've been denied funding despite medical evidence
- You need help navigating SIRA's complex claims process
A lawyer can help you understand your rights and ensure you receive all available benefits.
Example Scenario
Consider a cyclist in Auburn who suffered a whiplash injury. After hospital discharge, they need regular physiotherapy sessions. Their doctor documents that these sessions are essential to prevent chronic pain. The CTP insurer must fund these sessions if they meet SIRA's medical necessity criteria. If the insurer denies the request, the claimant can request a review or seek legal assistance.
Next Steps
CTP funding for post-discharge treatment depends on the specifics of your injury, medical evidence, and claim timing. To request contact about your circumstances, complete the quick, no obligation enquiry form.