Understanding MAI Act Transitional Claims in NSW
A transitional claim under the Motor Accident Injuries Act 2017 (MAIA) arises when a motor accident occurred before 1 December 2017, but the claim for compensation is made under the new scheme introduced by MAIA. These claims are governed by transitional provisions in the Act and apply to individuals who were injured in a motor accident prior to the 2017 law change but have not yet received a final determination of their entitlements. In Greater Sydney, as across NSW, transitional claims are subject to the SIRA (State Insurance Regulatory Authority) framework, which ensures consistency in the administration of CTP compensation. The key distinction from standard CTP claims is that transitional claims follow a hybrid approach: they apply the new MAIA rules for benefits and entitlements, but may retain elements of the old Motor Accidents Compensation Act 1999 (MACA) for certain procedural or evidentiary matters, depending on the claim’s status and timing.
How Treatment Costs Are Funded in Transitional Claims
Under the MAIA, treatment and care benefits are available to individuals who have suffered injury in a motor accident, including those with transitional claims. For claimants in Greater Sydney, treatment costs are funded through the CTP insurer, not directly by SIRA. The insurer is responsible for authorising and paying for reasonable and necessary treatment, including medical consultations, physiotherapy, psychological services, and allied health interventions. This includes treatment for injuries that were not initially diagnosed but later identified as related to the accident.
For transitional claims, the funding process follows the MAIA framework, meaning that treatment must be approved by the insurer or, if disputed, by SIRA. The insurer must assess whether the treatment is reasonable and necessary in relation to the injury. If the insurer refuses to fund a treatment, the claimant may apply to SIRA for a determination. SIRA has the authority to review the insurer’s decision and may order funding if the treatment meets the criteria under the Motor Accident Injuries Regulation 2017.
Practical Steps for Claimants in Greater Sydney
To secure funding for treatment costs, claimants in Greater Sydney should take the following steps:
- Notify the CTP insurer as soon as possible after the accident, or within a reasonable time if the claim is transitional and not yet formally lodged.
- Obtain written approval from the insurer for any treatment before commencing it, to ensure it will be funded.
- Keep detailed records of all treatment, including dates, provider names, treatment plans, and invoices.
- Provide medical evidence, such as a treating practitioner’s report, to support the need for treatment.
- If an insurer refuses to fund treatment, request a written reasons statement and apply to SIRA for a review.
In Greater Sydney, claimants may also seek assistance from a legal practitioner or an independent advocate to help navigate the process, particularly if there is a dispute over funding. The SIRA website provides guidance on how to make a claim, what to include in a treatment funding request, and how to apply for a review.
Time Limits and Dispute Resolution
Time limits apply to transitional claims, although they differ from standard claims. For claims made under MAIA, a claim must generally be made within three years of the accident date. However, for transitional claims, the three-year period may begin from the date the claimant first became aware of the injury, or from the date the claimant was first informed of a new injury related to the accident.
If a dispute arises over treatment funding, the claimant may apply to SIRA for a determination. SIRA will assess whether the treatment is reasonable and necessary in relation to the injury, and whether it was provided in accordance with the Motor Accident Injuries Guidelines. The process is free and can be initiated online or by post. SIRA may also mediate disputes between claimants and insurers.
A hypothetical example: A pedestrian in Sydney’s inner west was struck by a car in June 2016. The injury was not immediately apparent, but in late 2023, a diagnosis of a spinal nerve-root injury was made. The claimant has not yet made a formal claim under MAIA. The treatment for this condition is not funded by the insurer. The claimant can apply to SIRA for a determination on treatment funding, using medical evidence and a report from a neurologist.
When to Seek Independent Advice
The legal framework for transitional claims can be complex, particularly regarding the interaction between old and new law. Claimants should seek independent legal advice if:
- The insurer refuses to fund treatment despite medical evidence.
- The claim has been pending for more than 12 months without progress.
- There is a dispute over whether the injury is related to the accident.
- The claimant has a history of prior injuries or pre-existing conditions.
SIRA provides information and support, but it does not represent claimants. An independent legal practitioner can help assess the strength of the claim, prepare documentation, and advocate for funding.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.