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).
In New South Wales, treatment costs for injuries caused by partial fault motor accidents are funded through the Compulsory Third Party (CTP) scheme. If you were injured in a crash where more than one party contributed to the incident, you may be eligible for funding of medical treatment costs under the Motor Accident Injuries Act 2017. This article explains how shared liability works in NSW CTP claims, the process for claiming treatment costs, and the legal boundaries of funding in partial fault cases in Albury.
How Treatment Costs Are Funded in Partial Fault Claims
Under NSW CTP rules, treatment costs are funded by the at-fault driver’s insurer, even if the accident involved multiple parties. The Motor Accident Injuries Act 2017 (s 4.4) ensures that injured parties can claim for necessary medical treatment, including specialist consultations, scans, and therapies, regardless of who was at fault. However, the funding is limited to the costs directly related to the accident, and the insurer must be notified of all treatment expenses.
If the accident involved shared liability, the CTP insurer will cover treatment costs proportionally based on the fault apportionment determined by the court or a registered claims assessor. For example, if a driver and a cyclist both contributed to the crash, the CTP insurer will fund treatment costs according to the percentage of fault assigned to each party.
Practical Steps for Claiming Treatment Costs
To claim funding for treatment costs, you must:
- Notify the CTP insurer of your injuries within 52 weeks of the accident (s 3.11). Delays beyond this period may result in limited or denied funding.
- Provide medical evidence confirming the treatment is necessary for your injury. This includes medical reports, scan results, and therapist notes.
- Submit itemised bills from healthcare providers. The insurer will assess whether the treatment is reasonable and directly related to the accident.
- Keep records of all correspondence with the insurer, including claims forms, medical reports, and payment receipts.
If your treatment costs exceed the CTP insurer’s funding limit, you may need to seek additional compensation through a personal injury claim. However, this requires a separate legal process and is not automatically funded by the CTP scheme.
Shared Liability and Funding Limits
When multiple parties are at fault, the CTP insurer will fund treatment costs based on the proportion of fault assigned to each party. If the court or a claims assessor determines that the fault is shared, the funding is split accordingly. For instance, if a driver is 60% at fault and a cyclist is 40% at fault, the CTP insurer will cover 60% of the treatment costs.
Funding is limited to the costs of treatment directly related to the accident. If your injuries require ongoing care, such as physiotherapy or occupational therapy, you must ensure these services are documented and submitted within the 52-week window.
Legal Boundaries of Funding in Partial Fault Claims
The CTP scheme has specific rules that limit funding for treatment costs in partial fault cases:
- Threshold injuries (soft tissue injuries like whiplash) are funded for 52 weeks, after which benefits are generally limited unless the injury meets the whole person impairment threshold (s 4.4).
- Contributory fault may reduce the amount of funding you receive. If you were also at fault, the insurer may reduce your claim based on the percentage of your own fault.
When to Seek Legal Advice
If you are unsure whether your treatment costs are covered, or if the CTP insurer is disputing your claim, it is important to seek legal advice. A solicitor can help you:
- Determine whether your injuries qualify for CTP funding.
- Challenge an insurer’s refusal to cover treatment costs.
- Navigate the process for claiming additional compensation if your injuries are not covered by the CTP scheme.
Example of a Partial Fault Claim
Consider a scenario where a driver and a cyclist both contributed to a crash in Albury. The driver ran a red light (60% fault), and the cyclist failed to yield (40% fault). The CTP insurer will fund 60% of the treatment costs for the driver’s fault, and 40% for the cyclist’s fault. If the cyclist’s injuries require ongoing physiotherapy, the insurer will cover the costs for 52 weeks, after which funding may be limited unless the injury meets the whole person impairment threshold.
Next Steps
CTP funding for treatment costs in partial fault claims depends on the accident date, fault apportionment, and the nature of your injuries. If you are in Albury and need assistance with a claim, complete the quick, no obligation enquiry form to request contact about your circumstances.