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, the funding of treatment costs for partial fault motor accident claims is governed by the Motor Accident Injuries Act 2017 (MAIA) and administered by the State Insurance Regulatory Authority (SIRA). If you've been involved in a crash where multiple parties share responsibility, understanding how treatment costs are funded is critical. This article explains how SIRA covers medical expenses, what evidence is needed, and how partial fault claims differ from full fault scenarios in the Newcastle and Hunter region.
How SIRA Funds Treatment Costs in Partial Fault Claims
Under the MAIA, SIRA funds treatment costs for injuries caused by motor vehicle accidents, regardless of fault. However, in partial fault claims, the funding is split based on the percentage of liability assigned to each party. For example, if a driver is 60% at fault and a pedestrian is 40% at fault, the injured pedestrian would receive 60% of the treatment costs from the driver’s insurer and 40% from their own insurance (if applicable).
SIRA covers a wide range of treatment costs, including medical consultations, scans, physiotherapy, and specialist care. However, claimants must provide evidence that the treatment is directly related to the accident. This includes medical records, invoices, and a report from a medical practitioner confirming the injury’s connection to the crash.
Practical Steps to Recover Treatment Costs
To claim treatment costs in Newcastle and Hunter, injured persons should:
- Notify SIRA immediately after the accident. Delays may reduce the amount recovered.
- Keep all medical records and treatment invoices. SIRA requires detailed documentation to assess claims.
- Submit a claim form through SIRA’s online portal or by post. The process typically takes 4-8 weeks, though regional offices may have different processing times.
- Cooperate with SIRA’s assessors. They may request additional evidence, such as accident reports or witness statements.
In partial fault cases, claimants must also provide a liability assessment from a legal or insurance professional to determine the percentage of fault. This is crucial for splitting the funding correctly.
Key Differences Between Partial and Full Fault Claims
In full fault claims, the at-fault party’s insurer covers 100% of treatment costs. In partial fault claims, the funding is proportionate to each party’s liability. For example:
- Full fault: Driver’s insurer pays all treatment costs.
- Partial fault: Driver’s insurer pays 60% of costs, and the pedestrian’s insurer (if applicable) pays 40%.
This distinction affects how much SIRA funds and how quickly claims are processed. Partial fault claims may also involve more complex negotiations, especially if multiple insurers are involved.
Time Limits and Dispute Resolution
SIRA has strict time limits for claims. Most treatment cost claims must be submitted within 52 weeks of the accident. After this period, benefits for threshold injuries (e.g., soft tissue injuries) are generally limited, though long-term claims may still be possible.
If a claim is disputed, claimants can request a review by SIRA or seek mediation through the NSW Civil and Administrative Tribunal (NCAT). Legal advice is recommended to navigate disputes, especially in partial fault cases where liability percentages are contested.
Example: A Partial Fault Claim in Newcastle
Consider a cyclist who collides with a car at a traffic light. The cyclist is 30% at fault for running the light, and the driver is 70% at fault for failing to yield. SIRA would fund 70% of the cyclist’s treatment costs, such as physiotherapy and scans, from the driver’s insurer. The cyclist’s own insurance (if applicable) would cover the remaining 30%. This example illustrates how liability percentages directly impact funding.
When to Seek Legal Advice
While SIRA handles most claims, partial fault cases can be complex. Legal advice is recommended if:
- The claim involves multiple insurers.
- The liability percentage is disputed.
- The injury requires long-term treatment beyond 52 weeks.
- The claim is denied or delayed.
A solicitor can help negotiate with insurers, challenge liability assessments, or pursue a legal claim if necessary. However, legal advice is not a guarantee of success and should be sought early to avoid missing time limits.
Next Steps for Claimants
If you’ve been involved in a partial fault crash in Newcastle or Hunter, start by contacting SIRA to report the accident and submit a claim. Gather all medical and accident-related evidence, and consider seeking legal advice if the claim is denied or if liability is contested. Understanding how SIRA funds treatment costs in partial fault cases is essential to securing the support you need.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.