How SIRA Approves Treatment and Rehabilitation Plans Under the MAC Act 2017 in Rural NSW
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).
The Motor Accident Injuries Act 2017 (MAC Act) governs statutory benefits for motor accident injuries in NSW. Section 3.28 of the Act outlines how the New South Wales Motor Accident Claims Authority (SIRA) determines eligible treatment and rehabilitation plans. For rural and remote claimants, this process involves unique challenges such as limited access to specialist services, longer travel times, and potential delays in securing approved care.
SIRA evaluates treatment plans based on clinical necessity, evidence of injury, and alignment with the Motor Accident Guidelines. For example, if a claimant requires physiotherapy but the nearest provider is 200km away, SIRA may approve alternative options like telehealth consultations or local physiotherapy services. However, all proposed treatments must meet the 'threshold injury' criteria under the Act, which requires neurological signs or radiculopathy (nerve-related symptoms) to qualify.
Practical Steps for Rural CTP Claimants
If you're in a rural area, take these steps to support your treatment plan:
- Document all medical records, Ensure your treating doctor provides detailed notes about your injury, treatment goals, and how your condition impacts daily activities.
- Submit evidence of location-based barriers, Include information about travel distances, availability of local services, or specialist referrals that highlight the need for alternative care.
- Communicate with SIRA, Request a meeting or written explanation if your treatment plan is delayed or denied. SIRA must provide a written response within 28 days of receiving your application.
Time Limits and Dispute Options
Under the MAC Act, weekly benefits and treatment benefits are generally limited after 52 weeks if your injuries are classified as 'threshold injuries' (per s 4.4). However, if your treatment plan involves long-term rehabilitation, SIRA may extend benefits if your condition meets the 'whole person impairment' threshold. Always submit a written request for review if you believe your case requires further assessment.
Disputes over treatment approval can be escalated to the NSW Civil and Administrative Tribunal (NCAT) under s 12 of the MAC Act. This process is available if SIRA's decision is based on incorrect information or fails to consider your rural circumstances.
When to Seek Legal Advice
Consider consulting a solicitor if:
- SIRA denies your treatment plan without clear reasoning.
- You face delays exceeding 52 weeks despite ongoing treatment.
- You need assistance navigating SIRA's rural-specific guidelines.
Legal professionals can help ensure your claim aligns with the MAC Act and SIRA's interpretation of 'eligible treatment' in remote areas.
Example: Rural Claimant's Treatment Plan
A claimant in a remote NSW town sustained a soft-tissue injury (per the Motor Accident Guidelines) after a car accident. Their treating doctor recommended a 12-week physiotherapy program, but the nearest clinic was 300km away. SIRA approved a local physiotherapist's plan after the claimant provided evidence of travel barriers and the specialist's agreement on treatment equivalence. This demonstrates how rural claimants can secure approved care under the MAC Act.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.