How Treatment Costs Are Funded in CTP Partial Fault Claims
In a motor accident in NSW where more than one party shares fault, treatment costs are generally funded through the Compulsory Third Party (CTP) insurance scheme. This applies regardless of the degree of fault, including in Greater Sydney. The Motor Accident Injuries Act 2017 (MAIA) ensures that eligible treatment and care benefits are available to injured persons, even if they contributed to the accident. The insurer of the vehicle that caused the injury, whether fully or partially at fault, is responsible for funding treatment under the CTP scheme. This includes medical treatment, allied health services, and rehabilitation, provided they are reasonable and necessary for recovery.
The Role of Shared Liability in Funding
Shared liability does not prevent access to treatment funding. Under the MAIA, a person’s entitlement to treatment and care benefits is not barred by their own contribution to the accident. The insurer must still fund treatment that is directly related to injuries sustained in the motor accident. The degree of fault may affect the amount of damages awarded later if a claim proceeds to court, but it does not reduce or deny access to treatment benefits. The CTP scheme is designed to ensure injured persons receive necessary care without delay, regardless of fault.
What Treatment Costs Are Covered
Treatment and care benefits cover reasonable and necessary medical and allied health services. This includes visits to a medical practitioner, physiotherapy, psychology, chiropractic care, and other therapies aimed at recovery. The insurer must fund treatment that is recommended by a qualified health professional and that forms part of a treatment plan approved under the Motor Accident Injuries Regulation 2017. The insurer may require a treatment plan to be submitted before approving funding. In Greater Sydney, access to specialist services and private treatment providers is not restricted, provided the treatment is clinically appropriate and documented.
Practical Steps to Claim Treatment Funding
To secure funding for treatment costs, you must notify the insurer of the CTP policyholder within a reasonable time after the accident. This includes providing details of your injuries, the treatment you are receiving, and the name and contact details of your treating health professional. You should keep copies of all medical reports, invoices, and correspondence with the insurer. The insurer may request a treatment plan from your medical practitioner to assess whether the proposed treatment is reasonable and necessary.
If the insurer refuses to fund a treatment, you can request a review. You may also seek a determination from the State Insurance Regulatory Authority (SIRA) if the dispute remains unresolved. It is important to act promptly, as delays may affect the approval process.
Time Limits and Procedural Requirements
There is no strict deadline for notifying an insurer about a claim for treatment and care benefits under the MAIA. However, it is advisable to notify the insurer as soon as possible after the accident. Delays may make it more difficult to establish a direct link between the accident and the injury, particularly if medical records are not contemporaneous. The insurer may still assess and approve treatment funding even if the notification is delayed, but evidence of a timely claim is critical.
Common Misconceptions About Partial Fault
A common misunderstanding is that a person who contributed to an accident cannot access treatment funding. This is incorrect under NSW law. The CTP scheme is not fault-based in its provision of treatment benefits. Even if you were 30% at fault, you are still entitled to treatment and care benefits. The insurer’s obligation to fund treatment is not reduced by your share of fault. This principle applies uniformly across Greater Sydney and the rest of NSW.
Hypothetical Example: Shared Fault in a Sydney Car Park
A driver was involved in a collision in a car park in North Sydney. The driver was turning left and was partially at fault due to not yielding to another vehicle. The other driver was speeding and failed to stop. The injured driver required physiotherapy and psychological support. The insurer of the speeding driver was responsible for funding the treatment, despite the claimant’s partial fault. The treatment was approved under the CTP scheme because it was reasonable, necessary, and directly related to the accident.
When to Seek Independent Advice
While treatment funding is available in partial fault claims, the process can be complex, particularly if the insurer disputes the need for treatment or the cost. You may benefit from independent advice if:
- The insurer refuses to fund a treatment you believe is necessary.
- You are unsure whether a treatment is covered under the CTP scheme.
- You are receiving conflicting information from the insurer or your treating practitioner.
- You are considering a claim for damages and want to understand how shared liability may affect the outcome.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.