How Treatment Costs Are Funded in Legacy MAC Act Claims
If your motor accident occurred before 1 December 2017, you may be governed by the Motor Accidents Compensation Act 1999 (MAC Act), which remains in force for claims arising from those earlier incidents. Under this legacy framework, funding for treatment costs is managed through the Motor Accident Injuries Act 2017 (MAIA) and administered by the State Insurance Regulatory Authority (SIRA), even though the original claim was made under the MAC Act. This means that while the legal basis for your claim may be older, the process for accessing treatment funding follows current SIRA guidelines and procedures.
SIRA continues to oversee compensation for motor accident injuries across NSW, including legacy claims. For individuals with MAC Act claims, treatment and care benefits are still available and are funded through the CTP (Compulsory Third Party) insurance system. These benefits cover reasonable and necessary treatment for injuries sustained in a motor accident, including medical consultations, physiotherapy, rehabilitation, and allied health services.
What Treatment Costs Are Covered
Under the current SIRA framework, eligible treatment costs for legacy MAC Act claims include:
- Medical assessments and diagnostic tests
- Physiotherapy, occupational therapy, and psychological support
- Medications prescribed for accident-related injuries
- Rehabilitation services, including specialist programs
- Treatment provided by registered medical practitioners, including specialists
These benefits are not limited to a specific timeframe or provider, as long as the treatment is directly related to injuries from the motor accident and is deemed reasonable and necessary by SIRA’s criteria. The focus remains on restoring function and managing ongoing injury impact, not on covering unrelated health expenses.
How SIRA Manages Funding Compared to Current CTP Claims
SIRA administers treatment funding for both legacy MAC Act claims and current CTP claims under the same principles. However, there are key differences in how benefits are accessed and managed:
- For current CTP claims (post-1 December 2017), treatment funding is automatically processed through the SIRA claims portal, with streamlined approval for eligible services.
- For legacy MAC Act claims, funding may still require submission of claims through SIRA’s legacy processes, which may involve paper forms or direct contact with a claims assessor.
Despite these procedural differences, the standard for eligibility remains consistent: treatment must be directly related to the accident, medically justified, and not duplicative of services already funded. SIRA maintains that all claims, regardless of the original legislative framework, are assessed against the same evidentiary standards, including medical reports and treatment plans.
Practical Steps and Evidence That Matter
To access funding for treatment costs under a legacy MAC Act claim, you should:
- Obtain a formal medical report from your treating practitioner detailing the nature of your injuries and the treatment plan
- Keep all receipts and invoices for treatment services, including provider details and dates of service
- Submit a claim for treatment funding through SIRA’s official channels, using the appropriate forms for legacy claims
- Maintain a record of all correspondence with SIRA, insurers, or legal representatives
SIRA may request additional documentation, including a copy of your original accident report, a police statement if available, and evidence of ongoing injury impact. Witness statements, photographs of the accident scene, and employer records of time off work may also support your claim.
Time Limits and Dispute Options
There is a time limit for making a claim under the MAC Act. Claims must generally be made within three years of the accident date, although exceptions apply in cases involving minors or delayed injury diagnosis. If you have not already made a claim, it is important to act promptly, as delays may affect eligibility.
If your claim for treatment funding is denied or partially approved, you may request a review from SIRA. You can also apply to the NSW Civil and Administrative Tribunal (NCAT) for a formal review of the decision. The review process allows you to present new evidence, such as updated medical reports or expert opinions, to support your case.
Hypothetical Example
A pedestrian was struck by a car in Sydney on 15 March 2016. They sustained a back injury and have since undergone physiotherapy, MRI scans, and psychological counselling. Their claim was made under the MAC Act and remains active. They now seek funding for a specialist rehabilitation program. SIRA will assess whether the treatment is reasonable, necessary, and directly related to the accident, using the same criteria as for current CTP claims. The claimant must provide a medical report from a specialist confirming the need for the program and submit all supporting invoices.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.