Funding Treatment Costs in Legacy MAC Act 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 your motor accident occurred before 1 December 2017, you may be governed by the Motor Accidents Compensation Act 1999 (MAC Act), which remains in effect for certain claims. Under this legacy framework, treatment and care benefits are available to cover reasonable and necessary medical, allied health and rehabilitation expenses arising from your injury. These benefits are funded through the Compulsory Third Party (CTP) insurance scheme, which applies across Greater Sydney and the rest of New South Wales.
The funding of treatment costs under the MAC Act is not automatic and depends on the nature of your injury, the timing of your treatment, and whether your claim has been formally accepted by the insurer. Unlike the current Motor Accident Injuries Act 2017 (MAIA) scheme, which introduced a more structured approach to benefits, the MAC Act framework allows for broader discretion in determining what constitutes a reasonable and necessary treatment. However, the insurer must still provide funding for treatment that is directly related to injuries sustained in the accident.
Legal Framework for Treatment Funding
Under the MAC Act, treatment and care benefits are payable to cover the cost of medical treatment, including consultations with medical practitioners, physiotherapy, psychological services, and other allied health interventions. These benefits are not limited to a fixed number of sessions or a set duration, as they were under the MAIA threshold injury rules. Instead, funding continues for as long as the treatment is deemed reasonable and necessary in relation to your injury.
To qualify for treatment funding under the MAC Act, you must demonstrate a direct link between the treatment and the motor accident. This means that treatment must be provided for injuries that were caused by the accident, not for pre-existing conditions or unrelated health issues. The insurer may request medical evidence to assess whether the treatment is appropriate and proportionate to the injury.
Practical Steps and Evidence
To secure funding for treatment costs under a MAC Act legacy claim in Greater Sydney, you should:
- Immediately seek medical attention after the accident and keep all records of treatment, including prescriptions, appointment notes, and invoices.
- Provide the insurer with a completed claim form and a medical certificate confirming the nature and cause of your injury.
- Maintain a detailed log of all treatment sessions, including dates, services received, and the provider’s name and contact details.
- Submit itemised invoices for all treatment costs, including those for specialist consultations, imaging, and rehabilitation programs.
Insurers may request a medical report from an independent practitioner if they dispute the necessity or relevance of a treatment. It is important to respond promptly to such requests to avoid delays in funding.
Time Limits and Dispute Resolution
There is no fixed time limit for claiming treatment and care benefits under the MAC Act, but claims must generally be made within three years of the accident date. This is governed by the Limitation Act 1969 (NSW), which applies to all personal injury claims in NSW, including legacy MAC Act claims.
If your claim for treatment funding is denied or partially approved, you may request a review from the insurer. If the dispute remains unresolved, you can apply to the NSW Civil and Administrative Tribunal (NCAT) for a determination. NCAT has jurisdiction to review decisions on treatment funding and can order the insurer to pay for specific treatments or services.
Comparison with Current CTP Claims
Under the current MAIA scheme, treatment and care benefits are subject to a 52-week time limit if the only injuries sustained are threshold injuries. This does not apply to MAC Act legacy claims, which are not bound by the same statutory limits. As a result, claimants under the MAC Act may continue to receive funding for treatment over a longer period, provided the treatment remains reasonable and necessary.
Additionally, the MAC Act does not impose the same threshold injury requirements as MAIA. This means that claimants with soft-tissue injuries, including those involving spinal nerve-root injuries with neurological signs, may still qualify for ongoing treatment funding without needing to meet a whole person impairment threshold.
Hypothetical Example
A pedestrian in Sydney’s Inner West was struck by a car in June 2016. They sustained a whiplash injury and were treated by a physiotherapist and a psychologist for ongoing pain and anxiety. Their claim was accepted under the MAC Act in 2017. They continued receiving treatment funding for 18 months, including a course of cognitive behavioural therapy, which was approved by the insurer based on medical evidence linking the treatment to the accident. The claim was not subject to a 52-week cap because it was governed by the MAC Act.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.