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, injured road users in NSW can claim funding for medical treatment costs following a motor accident. This includes expenses for doctors, physiotherapists, and other specialists related to the injury. The NSW government agency SIRA (State Insurance Regulatory Authority) manages these claims, ensuring treatment costs are covered as part of the Compulsory Third Party (CTP) scheme. This article explains what treatment costs are covered, how SIRA assesses claims, and practical steps to claim funding in Auburn.
What Treatment Costs Are Covered?
The Motor Accident Injuries Act 2017 covers medical treatment costs that are directly related to the injury caused by the motor accident. This includes:
- Doctor consultations and diagnostic tests
- Physiotherapy, occupational therapy, and other rehabilitation services
- Medication prescribed for the injury
- Specialist treatments such as chiropractic care or psychology services
SIRA considers all treatment costs that are reasonable, necessary, and directly connected to the injury. For example, if you sustained a whiplash injury in a car accident, physiotherapy sessions and prescribed pain medication would be covered.
How SIRA Assesses Medical Treatment Claims
SIRA evaluates claims based on the Motor Accident Guidelines, which outline what is considered a reasonable treatment cost. Key factors include:
- Medical records confirming the injury and treatment
- A statement from your treating practitioner explaining the necessity of the treatment
- Receipts or invoices for treatment costs
SIRA may also require a report from a medical expert to determine if the treatment is appropriate. If the injury meets the 'threshold injury' criteria (a defined level of harm), treatment costs are typically covered for up to 52 weeks. More severe injuries may qualify for longer-term funding.
Practical Steps to Claim Treatment Funding in Auburn
To claim treatment costs, injured road users in Auburn should:
- Seek immediate medical attention and document all treatment received
- Keep detailed records of all medical expenses, including invoices and receipts
- Notify SIRA of the claim within 52 weeks of the accident, as time limits apply
- Submit all required documentation to SIRA, including medical reports and treatment records
If you're unsure whether your treatment costs qualify, contact SIRA directly for clarification. Delays in submitting claims may affect eligibility for funding.
Time Limits and Dispute Options
Claims for treatment costs must be submitted to SIRA within 52 weeks of the accident. If the injury is classified as a 'threshold injury, ' benefits are generally limited to this period. For more severe injuries, funding may extend beyond 52 weeks, but this depends on the assessment of the injury's impact.
If SIRA denies a claim, you may request a review or appeal. In complex cases, consulting a solicitor who specializes in NSW CTP claims can help ensure your rights are protected.
When to Seek Legal Advice
While SIRA handles most claims, some cases may require legal assistance, especially if:
- The injury is severe and requires long-term treatment
- There are disputes over the extent of coverage
- The claim is denied and you need to challenge the decision
A solicitor can help navigate the process, ensure all evidence is properly submitted, and advocate for your treatment needs.
Next Steps
Understanding how SIRA funds treatment costs is essential for injured road users in NSW. By gathering the right evidence and submitting claims promptly, you can access the support you need. If your circumstances are complex or you're unsure about your options, seek professional advice to ensure your claim is handled correctly.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.