How Treatment Costs Are Funded in CTP Claims with Shared Liability
In New South Wales, if you were injured in a motor accident where more than one party contributed to the crash, your treatment and care costs may still be funded under the Compulsory Third Party (CTP) insurance scheme. The Motor Accident Injuries Act 2017 (MAIA) provides that treatment and care benefits are available regardless of fault, as long as the injury occurred in a motor vehicle accident. This means that even if you were partly responsible for the crash, you may still receive funding for medical treatment, rehabilitation, and allied health services.
The CTP insurer of the vehicle you were in at the time of the accident is generally responsible for funding your treatment and care. If the insurer disputes your claim on grounds of shared liability, they must still provide treatment and care benefits unless a formal determination is made that you are not entitled. This is because the CTP scheme is designed to ensure injured people receive timely medical support, irrespective of fault.
The Role of Shared Liability in CTP Claims
Shared liability in a motor accident means that more than one driver or party contributed to the crash. Under the CTP scheme, fault is assessed by the insurer, often with input from the Motor Accident Commission (MAC) or the State Insurance Regulatory Authority (SIRA). However, the assessment of fault does not prevent you from receiving treatment and care benefits.
If your claim is determined to involve shared liability, the insurer may still fund treatment and care costs. The insurer will assess the degree of your contribution to the accident when determining any future entitlement to damages, but this does not affect your right to medical treatment under the CTP scheme.
Practical Steps to Claim Treatment Costs
To access treatment and care benefits in a shared liability claim, you should:
- Seek medical attention as soon as possible after the accident and keep all records of treatment.
- Notify the CTP insurer of the vehicle you were in at the time of the accident, or the insurer of the vehicle that caused the crash, as soon as possible.
- Provide the insurer with a completed claim form and supporting evidence, including medical reports, treatment plans, and invoices.
- Request a treatment and care plan from your medical practitioner, which must be approved by the insurer before funding is released.
Insurers are required to assess claims within 21 days of receiving a completed application. If your claim is delayed or denied, you can request a review or apply to the Civil and Administrative Tribunal (NCAT) for a determination.
Evidence That Supports Treatment Cost Claims
The following evidence is typically required to support a claim for treatment and care benefits:
- Medical records showing the nature and extent of your injury.
- A treatment plan from your medical practitioner detailing the recommended care.
- Invoices and receipts for treatment, including physiotherapy, psychology, and allied health services.
- A statement from your treating practitioner confirming that the treatment is necessary and related to the accident.
Photographs of the accident scene, witness statements, and a police report (if available) may also help establish the circumstances of the crash, particularly if fault is disputed.
Time Limits and Dispute Options
There is no time limit for claiming treatment and care benefits under the CTP scheme. However, it is advisable to notify the insurer as soon as possible after the accident to avoid delays in receiving treatment.
If your claim is denied on grounds of shared liability, you may request a review from the insurer. If the review is unsuccessful, you can apply to NCAT for a determination. The application must be made within 12 months of the insurer’s decision, unless an extension is granted.
A common issue in shared liability claims is the insurer’s refusal to fund treatment on the basis that you contributed to the accident. In such cases, you may still be entitled to treatment and care benefits, as the CTP scheme does not require a finding of no fault for access to medical support.
Hypothetical Example: Shared Liability and Treatment Funding
A 35-year-old cyclist was struck by a car while crossing a road at a traffic light. The police report indicated that the driver had run a red light, but the cyclist had been distracted by a mobile phone and did not fully check for traffic. The CTP insurer of the car accepted that both parties contributed to the crash.
The cyclist sought treatment for a back injury and psychological distress. The insurer initially refused to fund physiotherapy, arguing that the cyclist’s distraction contributed to the accident. However, the cyclist submitted medical reports and a treatment plan from a specialist. The insurer was required under the MAIA to fund the treatment, as the CTP scheme provides for treatment and care benefits regardless of fault.
When to Seek Independent Advice
While the CTP scheme provides automatic access to treatment and care benefits in shared liability cases, the process can be complex, particularly if the insurer disputes your entitlement. You may benefit from independent advice if:
- Your claim for treatment and care benefits has been denied or delayed.
- You are uncertain about the impact of shared liability on your claim.
- You are considering a claim for damages and want to understand how fault will affect your entitlement.
Legal advice can help you understand your rights under the MAIA, ensure that your claim is properly documented, and assist in resolving disputes with insurers.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.