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).
Under the Motor Accident Injuries Act 2017 (MAI Act), transitional claims cover motor accidents occurring before 1 January 2017. This article explains how injured people in Newcastle and Hunter can claim funding for treatment costs under the transitional regime. The NSW State Insurance Regulatory Authority (SIRA) manages these claims, with specific processes for assessing medical expenses. Understanding the evidence required, SIRA’s evaluation criteria, and time limits is essential for claimants seeking treatment funding in regional NSW.
How Transitional Claims Fund Treatment Costs
Transitional claims under the MAI Act cover treatment costs for injuries sustained in accidents before 2017. SIRA funds medical treatment, including consultations, scans, and therapy, provided the injury meets the 'threshold injury' definition. For Newcastle and Hunter claimants, regional healthcare providers must submit detailed treatment plans to SIRA for approval. Unlike standard CTP claims, transitional claims require evidence that the injury resulted from the accident and that treatment is necessary.
Evidence Required for Treatment Funding
To claim treatment costs, claimants must provide:
- Medical records confirming the injury and its link to the accident
- Itemised bills from healthcare providers
- A treatment plan outlining the necessity of each service
- Proof of the accident (e.g., police report, witness statements)
SIRA assesses whether the treatment is 'reasonably necessary' and directly related to the injury. In regional areas, claimants should ensure all documentation is submitted promptly to avoid delays.
SIRA’s Role in Regional Claims
SIRA evaluates funding requests by comparing the injury to the MAI Act’s threshold injury criteria. For Newcastle and Hunter, claimants may need to engage local medical practitioners familiar with SIRA’s requirements. If a treatment is denied, claimants can request a review or seek independent medical opinions. SIRA’s regional offices in Newcastle and Sydney handle these matters, ensuring claims are processed according to the transitional regime.
Time Limits and Dispute Options
Transitional claims must be submitted within 52 weeks of the accident, unless an extension is granted. If a claimant disputes SIRA’s decision, they can request a review by writing to SIRA within 28 days. For complex cases, legal advice may help challenge a funding denial, particularly if the claimant believes the injury meets the threshold criteria.
When to Seek Legal Advice
Claimants should consult a solicitor if:
- SIRA denies funding despite medical evidence
- The injury involves long-term treatment (e.g., chronic pain management)
- There are disputes over the accident’s circumstances
Legal professionals can help navigate SIRA’s processes and ensure all evidence meets the transitional claim requirements. This is especially important in regional areas where claimants may face additional administrative hurdles.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.