How Treatment Costs Are Funded in NSW CTP Partial Fault Claims
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).
If you were injured in a motor vehicle accident in Bankstown and the crash involved more than one party, you may be eligible to claim funding for your treatment costs under NSW’s Compulsory Third Party (CTP) scheme. The CTP rules apply differently when fault is shared, and the injured person’s ability to claim treatment costs depends on the nature of the injury and how fault is allocated.
Under the Motor Accident Injuries Act 2017, the CTP insurer of the at-fault driver must cover treatment costs for injuries that meet the scheme’s threshold. This includes medical treatment, therapy, and other necessary care. However, if the injury is a ‘threshold injury’, a soft tissue injury with specific neurological signs, funding is limited to 52 weeks unless the injury meets the whole person impairment (WPI) threshold. This distinction is critical in partial fault cases where the injured person’s own actions may have contributed to the accident.
Practical Steps and Evidence for Funding Treatment Costs
To claim treatment costs under CTP, you must provide evidence that:
- Your injury meets the threshold injury definition under the Motor Accident Guidelines.
- The injury resulted from the accident and is not due to pre-existing conditions.
- You received treatment from a registered medical practitioner.
- The treatment was necessary and directly related to the injury.
Documents such as medical records, accident reports, and invoices from healthcare providers are essential. If fault is shared, the CTP insurer will assess the proportion of fault attributed to each party. This may affect how treatment costs are funded, particularly if the injured person’s own actions contributed to the crash.
Time Limits and Dispute Resolution
You must notify the CTP insurer within 52 weeks of the accident to claim treatment costs for threshold injuries. If the injury meets the WPI threshold, there is no time limit, but the insurer may dispute the claim if the injury is not clearly linked to the accident. Disputes over funding or fault should be resolved through the NSW Civil and Administrative Tribunal (NCAT) or by seeking independent legal advice.
When to Seek Advice
If your claim involves shared liability or you are unsure whether your injury meets the threshold, it is important to consult a legal professional. Partial fault claims can be complex, and the CTP insurer may challenge the extent of your treatment costs. An experienced solicitor can help you understand your rights and ensure you meet all requirements for funding.
Example: Shared Fault in Bankstown
Consider a scenario where a driver and a cyclist are both at fault in a Bankstown collision. The driver’s insurer must cover the cyclist’s treatment costs if the injury meets the threshold. However, if the cyclist’s own actions (e.g., jaywalking) contributed to the crash, the insurer may reduce the funding based on the proportion of fault. This highlights the importance of accurate fault assessment and evidence collection.
Next Steps
CTP claims involving partial fault require careful attention to the nature of the injury, the allocation of fault, and the evidence supporting your treatment costs. If you are in Bankstown and need assistance with a claim, complete the quick, no obligation enquiry form to request contact about your circumstances.