What Treatment Costs Are Covered Under the Motor Accident Injuries Act 2017 in NSW?
Under the Motor Accident Injuries Act 2017, treatment costs incurred as a result of a motor accident in New South Wales are generally funded if they are reasonable, necessary and directly related to injuries sustained in the accident. This includes medical treatment, allied health services, rehabilitation, and certain support services. The funding is provided through the Compulsory Third Party (CTP) insurance scheme, which is administered by the State Insurance Regulatory Authority (SIRA).
Treatment costs may cover services such as physiotherapy, chiropractic care, psychological counselling, occupational therapy, and specialist medical consultations. The Act also allows for funding of diagnostic tests, medications, and equipment such as mobility aids or splints, if they are prescribed and required for recovery. The focus is on treatment that supports recovery and helps the injured person return to normal function, not on cosmetic or elective procedures.
How to Claim Funding for Treatment Costs Under the MAI Act 2017
To claim funding for treatment costs, the injured person must first notify their CTP insurer or the SIRA claims portal. This notification must be made as soon as possible after the accident, ideally within 28 days, to avoid delays. The insurer will then assess whether the treatment is eligible under the Act.
The claimant must provide a treatment plan from a qualified medical practitioner, which outlines the nature of the injury, the proposed treatment, and its expected duration. This plan must be submitted with a claim form and supporting documentation, including medical reports, prescriptions, and itemised invoices from service providers.
SIRA requires that treatment be authorised in advance, where possible, to ensure funding is not denied later. If treatment is urgent and cannot be pre-approved, the claimant must seek approval within 14 days of starting treatment. Failure to obtain approval may result in the insurer refusing to fund the costs.
Limits on Treatment Cost Funding Under the Act
There are limits on the funding of treatment costs under the Motor Accident Injuries Act 2017, particularly where the injuries are classified as threshold injuries. A person who has only threshold injuries (such as soft tissue injuries that do not meet the threshold for damages) may have their treatment and care benefits limited to 52 weeks from the date of the accident, unless a medical practitioner certifies that continued treatment is necessary for recovery.
Even if treatment is approved, the insurer may only fund services that are reasonable and necessary. This means that treatment must be evidence-based, clinically appropriate, and not excessive. SIRA provides guidelines on what constitutes reasonable treatment, and insurers are required to follow these to ensure consistency across claims.
If a claimant seeks treatment that is not on the approved list of services, or that exceeds the recommended duration, the insurer may refuse to fund it. In such cases, the claimant may request a review, but funding will only be granted if the treatment is clinically justified and supported by medical evidence.
Practical Steps and Evidence That Matter
The most critical steps after a motor accident are to seek medical attention immediately, document all injuries and symptoms, and preserve evidence. This includes keeping copies of all medical reports, treatment invoices, correspondence with the insurer, and any notes about the accident, including witness details and photographs of the scene or vehicle damage.
A claimant should also keep a record of all communication with the insurer, including email, letters, and call logs. This documentation may be essential if a dispute arises over funding eligibility.
In a hypothetical case, a pedestrian struck by a car in Sydney in May 2024 sustained a whiplash injury and required six months of physiotherapy. The treating physiotherapist submitted a treatment plan to the CTP insurer, which was approved under the MAI Act 2017. The insurer funded all sessions, provided the claimant submitted itemised invoices and progress reports every four weeks.
Time Limits and Dispute Options
There is no strict time limit for making a claim for treatment costs under the MAI Act 2017, but delays may affect the insurer’s ability to verify the claim. It is best to begin the process within 28 days of the accident.
If an insurer refuses to fund a treatment cost, the claimant may request a review under the SIRA claims process. If the review is unsuccessful, the claimant may apply to the NSW Civil and Administrative Tribunal (NCAT) for a determination. The tribunal can order the insurer to fund the treatment if it finds the treatment is reasonable and necessary.
When to Seek Independent Advice
While the MAI Act 2017 provides a clear framework for funding treatment costs, the application of the law can vary depending on the nature of the injury, the insurer’s interpretation, and the medical evidence. If a claim is denied, or if the claimant believes the treatment plan is not being properly funded, it is advisable to seek independent legal or claims advice.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.