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 a lumbar disc herniation in a motor vehicle accident in NSW, you may be eligible for treatment costs covered under the Compulsory Third Party (CTP) scheme. This article explains how the NSW CTP scheme funds medical treatment for lumbar disc injuries, how SIRA assesses claims, and key deadlines to be aware of.
How CTP Covers Lumbar Disc Herniation Treatment Costs
Under the Motor Accident Injuries Act 2017, the NSW CTP scheme covers treatment costs for injuries resulting from motor vehicle accidents. For lumbar disc herniation, this includes:
- Medical imaging (e.g., MRI scans)
- Physiotherapy and rehabilitation
- Specialist consultations
- Pain management treatments
- Surgical procedures if required
SIRA (State Insurance Regulatory Authority) determines funding based on the Motor Accident Guidelines. A lumbar disc herniation is classified as a 'threshold injury' under these guidelines if it meets specific clinical criteria, such as neurological signs or radiculopathy. If your injury qualifies, you may receive weekly income payments and treatment benefits.
SIRA's Role in Funding Decisions
SIRA evaluates claims by reviewing:
- Medical records confirming the lumbar disc injury
- Treatment plans from your doctor or physiotherapist
- Evidence of how the injury affects your daily life
- The date of the accident and when treatment began
If your injury is not a 'threshold injury' (e.g., it's a minor disc bulge without neurological signs), you may still receive funding for treatment costs, but the benefits may be limited after 52 weeks. This is because the scheme prioritizes claims for injuries that meet the threshold criteria.
Time Limits for Claiming Treatment Costs
You must notify your insurer of your injury within 52 weeks of the accident. If you fail to report your injury within this period, you may lose access to certain benefits. However, if your injury is not a threshold injury, the 52-week rule does not apply, and you may still claim treatment costs.
Practical Steps to Take
- Seek immediate medical attention to document your lumbar disc herniation.
- Keep all medical records related to your injury and treatment.
- Notify your insurer within 52 weeks of the accident.
- Submit a claim form through SIRA's online portal or by contacting your local SIRA office.
- Request a review if you disagree with SIRA's decision.
When to Seek Legal Advice
If your claim is denied or you're unsure about your entitlements, consider consulting a solicitor. Legal professionals can help you understand your options, challenge decisions, or negotiate a better outcome.
Example Scenario
Imagine you were in a car accident and later diagnosed with a lumbar disc herniation requiring physiotherapy. SIRA would assess your medical records to determine if your injury meets the threshold criteria. If it does, you'd receive weekly payments and funding for your treatment. If not, you may still claim costs for your therapy but may not qualify for income support.
Next Steps
Time limits and procedural requirements can affect your claim. To request contact about your circumstances, complete the quick, no obligation enquiry form.