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).
In New South Wales, a lump sum settlement from a Compulsory Third Party (CTP) motor accident claim can cover ongoing treatment costs, but the process depends on specific legal rules. This article explains how injured individuals in Albury can ensure their treatment expenses are funded through a lump sum settlement, based on NSW law and SIRA guidelines.
How CTP Lump Sum Settlements Cover Treatment Costs
Under NSW law, a lump sum settlement from a CTP claim can include funding for medical treatment, but this is not automatic. The amount depends on the injury’s severity, medical evidence, and SIRA’s assessment. For example, if a claimant requires surgery or long-term therapy, the settlement may allocate funds to cover these costs. However, SIRA must determine that the treatment is necessary and directly related to the accident.
Factors SIRA Considers for Treatment Funding
SIRA evaluates several factors when deciding whether to include treatment costs in a lump sum. These include:
- Medical reports confirming the need for specific treatments
- Evidence of ongoing care requirements (e.g., physiotherapy, specialist consultations)
- The claimant’s ability to pay for treatment independently
- The type of injury (e.g., soft tissue injuries vs. more severe impairments)
For instance, a claimant with a spinal nerve-root injury requiring surgery would likely have treatment costs included, while a minor soft tissue injury might not. SIRA’s guidelines emphasize that treatment funding is only available if it is essential to the claimant’s recovery.
Practical Steps to Ensure Treatment Costs Are Covered
Injured individuals should take these steps to maximise the chance of treatment funding in their lump sum settlement:
- Obtain detailed medical records from treating specialists
- Provide evidence of treatment costs incurred or expected
- Consult SIRA to confirm whether your treatment qualifies for inclusion
- Seek advice from a legal professional if you disagree with SIRA’s assessment
It is crucial to submit all documentation promptly, as delays can affect SIRA’s ability to assess the claim accurately.
Time Limits and Dispute Options
NSW law imposes strict time limits for CTP claims. Most claims must be submitted within 52 weeks of the accident, though extensions may be granted in exceptional circumstances. If SIRA refuses to include treatment costs in your lump sum, you may request a review or seek independent legal advice. However, disputes over funding decisions are rare and typically require strong medical evidence.
When to Seek Legal Advice
While SIRA handles most CTP claims, complex cases, such as those involving long-term treatment needs or disputes over funding, may require legal assistance. A solicitor can help you:
- Challenge SIRA’s decision if you believe it is unfair
- Negotiate a higher lump sum to cover all treatment costs
- Understand your rights under the Motor Accident Injuries Act 2017
Example Scenario
Consider a cyclist in Albury who sustains a soft tissue injury requiring three months of physiotherapy. SIRA may include the physiotherapy costs in the lump sum if medical records confirm the treatment is essential. However, if the injury is minor and treatment is not required, funding may be denied. This highlights the importance of thorough medical documentation.
Next Steps
CTP lump sum settlements in NSW depend on the accident date, injury type, and evidence provided. To ensure your treatment costs are funded, gather all relevant medical records and consult SIRA or a legal professional. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.