Understanding MAI Act Transitional Claims in NSW
A motor accident that occurred before 1 March 2017 may be subject to transitional arrangements under the Motor Accident Injuries Act 2017 (MAI Act). These transitional claims differ from standard CTP claims because they are governed by a mix of pre-2017 and post-2017 laws. The MAI Act introduced new rules for compensation, but for accidents that happened before the new law came into effect, the old system continues to apply in certain respects. This means that claimants may still be eligible for treatment and care benefits, weekly income payments, and damages under the old framework, even if the claim is made after 2017.
The distinction matters because the old system allowed broader access to treatment funding, particularly for non-threshold injuries. Under transitional arrangements, claimants who were injured in a motor accident before 1 March 2017 and who have not yet finalised their claim may continue to access CTP benefits under the pre-2017 rules, including funding for medical treatment, rehabilitation, and care.
How Treatment Costs Are Funded Under Transitional Claims
Under transitional arrangements, treatment and care benefits for motor accident injuries are funded through the CTP insurer of the at-fault vehicle, or through the Nominal Defendant if no insurer can be identified. These benefits cover reasonable and necessary medical and allied health treatment, including physiotherapy, psychology, occupational therapy, and specialist consultations.
For claimants in regional NSW, access to treatment may be more challenging due to distance from specialist services. However, the CTP insurer is required to fund treatment that is reasonable and necessary, regardless of location. This includes travel to and from treatment, accommodation if required, and telehealth services where appropriate. The insurer must approve treatment plans and cover costs directly, or reimburse the claimant after payment.
The SIRA (State Insurance Regulatory Authority) provides guidance on what constitutes reasonable and necessary treatment. The insurer must assess treatment plans against the Motor Accident Injuries Guidelines and the terms of the CTP policy. If a treatment provider is not approved, the claimant can request a review or seek a second opinion through the insurer’s dispute resolution process.
Practical Steps to Secure Treatment Funding
To ensure treatment costs are funded under a transitional claim, claimants should:
- Immediately seek medical attention and keep all records, including diagnosis, treatment plans, and progress notes.
- Notify the CTP insurer of the accident and claim as soon as possible, even if the claim is not yet finalised.
- Submit a treatment plan from a qualified medical practitioner, including a description of the treatment, its purpose, and expected duration.
- Keep copies of all invoices, receipts, and correspondence related to treatment.
- Request a written approval from the insurer for each treatment or service, and retain this documentation.
In regional NSW, claimants may need to provide evidence of travel time, distance, and accommodation costs to support claims for travel and accommodation. Photographic evidence of travel routes, transport bookings, and accommodation receipts may be required.
Time Limits and Dispute Resolution
There is no fixed deadline for making a transitional claim under the MAI Act, but delays may affect the availability of evidence or the ability to obtain timely treatment. The SIRA advises that claimants should not delay notifying the insurer, as delays can impact the approval of treatment and the recovery of costs.
If an insurer refuses to fund a treatment, the claimant may request an internal review. If the review is unsuccessful, the claimant can apply to the SIRA for a determination. The SIRA has the authority to assess whether a treatment is reasonable and necessary under the terms of the CTP policy and the MAI Act.
For example, a regional resident who was injured in a car accident in 2016 and has since required ongoing physiotherapy and psychological support may apply for funding under transitional arrangements. If the insurer denies coverage for a specialist consultation in Sydney, the claimant can request a review and, if necessary, seek a determination from the SIRA.
When to Seek Independent Advice
Transitional claims involving treatment funding in regional NSW can be complex, particularly when the claimant lives far from medical services, or when the insurer disputes the necessity or cost of treatment. The legal framework, including the interaction between pre-2017 and post-2017 rules, may not be clear without expert review.
Claimants should consider seeking independent advice if:
- The insurer denies funding for treatment that a medical practitioner deems necessary.
- There is a dispute over the cost, duration, or type of treatment.
- The claimant has not received a response to a funding request within 28 days.
- The claim has been pending for more than 12 months without progress.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.