Navigating Treatment and Rehabilitation Planning Under the MAI Act for Transitional Claims
If you were injured in a motor accident in Greater Sydney before 1 December 2017, and your claim is now being managed under the Motor Accident Injuries Act 2017 (MAIA), you may be navigating a transitional claim. These claims are governed by the MAIA, but the injury and treatment may have occurred under the old Motor Accidents Compensation Act 1999 (MACA) framework. The process for treatment and rehabilitation planning in such cases is managed by the State Insurance Regulatory Authority (SIRA), which oversees all CTP claims in NSW.
SIRA is responsible for ensuring that injured people receive appropriate treatment and rehabilitation services, regardless of when the accident occurred. For transitional claims, the focus remains on restoring function and supporting recovery, in line with the MAIA’s objectives. The process begins with a formal assessment of your injury and recovery needs, followed by a structured plan developed by your medical practitioner and approved by the insurer or SIRA.
How Treatment and Rehabilitation Planning Works in Transitional Claims
Under the MAIA, treatment and rehabilitation planning is a formal process that must be evidence-based and coordinated. It starts when you notify your insurer of your injury and begin receiving medical treatment. Your medical practitioner must complete a treatment and rehabilitation plan form, which outlines your diagnosis, treatment goals, recommended therapies, and expected recovery timeline.
This plan must be submitted to your insurer or to SIRA if the insurer is not managing the claim. SIRA may review the plan to ensure it complies with the Motor Accident Injuries Regulation 2017 and the Motor Accident Guidelines. The plan may include physiotherapy, psychological support, medical assessments, and allied health services. Importantly, the plan must be reviewed periodically to reflect changes in your condition or recovery progress.
For claimants in Greater Sydney, access to specialist services through public and private providers is available, but approval from the insurer or SIRA is required before treatment can be funded. You are not required to use a specific provider, but you must ensure that the provider is qualified and that the treatment is clinically appropriate.
Key Considerations for Claimants in Greater Sydney
If you are managing a transitional claim in Greater Sydney, several practical points are essential. First, keep detailed records of all medical appointments, treatment notes, and correspondence with your insurer or SIRA. These documents may be required to support your claim for treatment and care benefits.
Second, be aware that the MAIA introduced a threshold for claiming damages. Only injuries that exceed this threshold may qualify for damages. However, treatment and rehabilitation planning is not limited by this threshold. All eligible claimants, including those with only threshold injuries, are entitled to treatment and care benefits under the MAIA.
Third, if your injury involves a spinal nerve-root injury, the Motor Accident Guidelines clarify that neurological signs other than radiculopathy may still qualify as a soft-tissue injury under the MAIA. This means that even if you do not have radiculopathy, you may still be eligible for treatment and rehabilitation services.
Fourth, if your claim is not progressing as expected, or if you believe your treatment plan is not appropriate, you may request a review. SIRA provides a formal process for disputing a decision about treatment or rehabilitation. You can also seek independent medical advice to support your case.
Practical Steps and Evidence That Matter
To ensure your treatment and rehabilitation plan is properly managed, take the following steps:
- Immediately seek medical attention after the accident and keep all medical records.
- Notify your insurer of your injury within a reasonable time, even if you are not yet claiming benefits.
- Provide your medical practitioner with a copy of the treatment and rehabilitation plan form so they can complete it accurately.
- Maintain a log of all communications with your insurer, SIRA, or medical providers.
- Gather photographs of the accident scene, vehicle damage, or any visible injuries.
- Collect witness contact details if available.
These records are critical to establishing the nature and extent of your injury, and to supporting any claim for treatment and care benefits. SIRA may request this evidence during a review or dispute process.
Time Limits and When to Seek Advice
There is no fixed deadline for initiating treatment and rehabilitation planning under the MAIA, but delays may affect the timing of benefit payments. It is best to begin the process as soon as possible after the accident.
If your claim is not being managed properly, or if you are experiencing delays in receiving treatment, you should contact SIRA directly. SIRA provides a claims contact service for injured people and can assist with clarifying processes, reviewing decisions, or escalating concerns.
A common issue in transitional claims is the mismatch between old and new legal standards. For example, a claimant may have received treatment under MACA but now needs to comply with MAIA requirements for plan approval. In such cases, it is advisable to seek guidance from a qualified professional who understands both the old and new frameworks.
Hypothetical Example: A Transitional Claim in Sydney
Consider a claimant who was injured in a car accident in the Sydney CBD on 15 November 2016. They were treated for neck pain and headaches, and were diagnosed with a soft-tissue injury. Their claim was not resolved before 1 December 2017, so it became a transitional claim under the MAIA.
In 2024, they applied for a treatment and rehabilitation plan. Their doctor submitted a plan including physiotherapy, MRI scans, and psychological counselling. The insurer initially declined coverage for the psychological support, citing a lack of documented mental health impact. The claimant appealed to SIRA, who reviewed the medical evidence and confirmed that the treatment was clinically necessary. The plan was approved, and the services were funded.
This example illustrates how SIRA ensures that transitional claims are managed fairly and in accordance with the MAIA, even when there are differences in how injuries were initially assessed.
Next Steps for Your Claim
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.