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).
If you were injured in a motor vehicle accident in Illawarra or South Coast NSW before 2017, you may be eligible for treatment cost funding under the Motor Accident Injuries (MAI) Act transitional claims regime. This article explains how victims of road trauma in these regional areas can claim funding for medical treatment, the differences from standard CTP claims, and what evidence is needed. The NSW government’s SIRA guidelines outline the process for transitional claims, which apply to accidents occurring before 1 January 2017.
What treatment costs are funded under MAI Act transitional claims?
Under the MAI Act, transitional claims cover treatment costs for injuries sustained in accidents before 2017. Eligible costs include medical consultations, diagnostic tests, specialist treatments, and rehabilitation services. SIRA’s guidelines specify that funding is available for injuries meeting the 'threshold injury' criteria under the Motor Accident Guidelines. This includes soft tissue injuries with spinal nerve-root involvement, as defined in the guidelines. For example, a pedestrian injured in a car park who requires physiotherapy and MRI scans may qualify for funding.
How does funding differ for Illawarra and South Coast claims?
While the MAI Act applies uniformly across NSW, regional areas like Illawarra and South Coast may face delays in processing claims due to limited SIRA office locations. SIRA’s website states that claims in these areas are handled through the same statutory framework as metropolitan claims, but practical challenges such as access to medical records or specialist assessments may affect timelines. Claimants should ensure all treatment records are submitted promptly and request a case manager if delays occur.
What evidence is required for treatment cost claims?
To support a transitional claim, you must provide: medical records confirming the injury and treatment, a detailed accident report from the NSW Police or relevant authority, witness statements if available, and proof of treatment costs (e.g., invoices). SIRA emphasizes that claims must demonstrate a direct link between the accident and the treatment. For instance, a cyclist injured in a driveway collision must show that the injury resulted from the accident, not a pre-existing condition.
Time limits and dispute resolution
Transitional claims must be submitted within 52 weeks of the accident, as per the MAI Act. If a claim is submitted after this period, SIRA may refuse it unless exceptional circumstances apply. Disputes over treatment costs can be resolved by submitting a formal objection to SIRA, supported by medical evidence. In complex cases, claimants may need to seek independent medical opinions to challenge a decision.
When to seek legal advice
While SIRA provides a claims process, navigating transitional claims can be complex, especially for regional claimants. Legal advice is recommended if you face disputes over injury severity, treatment eligibility, or delays in funding. A solicitor can also assist with interpreting SIRA’s guidelines and ensuring all evidence is submitted correctly.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.