If you were injured as a pedestrian at a marked crossing in Ballina, NSW, you may be entitled to funding for treatment costs under the NSW Compulsory Third Party (CTP) scheme. This article explains how treatment expenses are covered, how SIRA assesses claims, and what to do if your funding is disputed.
How CTP Covers Treatment Costs
Under the Motor Accident Injuries Act 2017, CTP claims in NSW cover all reasonable medical treatment costs related to your injury. This includes:
- Emergency care and hospital treatment
- Specialist consultations and diagnostic tests
- Physiotherapy, occupational therapy, and rehabilitation
- Medications prescribed for your injury
- Travel expenses for medical appointments
SIRA (State Insurance Regulatory Authority) manages these claims. They assess whether your injury meets the 'threshold injury' definition in the Motor Accident Guidelines. For example, a broken leg or soft tissue injury (like a sprain) would typically qualify. However, injuries below this threshold, such as minor bruises, are not funded.
SIRA’s Role in Funding Decisions
SIRA evaluates claims based on medical evidence. You must provide:
- A doctor’s report confirming your injury
- Details of all treatment costs incurred
- Proof of income if you’re claiming weekly payments
SIRA uses the 'only injuries' rule: if your only injuries are threshold injuries, benefits like weekly payments stop after 52 weeks. However, treatment costs for threshold injuries are funded indefinitely, as they are considered 'treatment and care benefits' under the Act.
What to Do If Funding Is Disputed
If SIRA denies or limits your treatment funding, you can:
- Request a review of their decision
- Submit additional medical evidence
- Seek independent medical opinion
Note: You must act within 52 weeks of the accident to claim weekly benefits. However, treatment cost claims can be made at any time, provided you have ongoing medical needs.
Practical Steps for Claimants
To support your claim:
- Keep all medical records and receipts
- Document the accident date, location, and vehicle details
- Notify your treating doctor about the accident
- Contact SIRA directly to submit your claim
If you’re unsure whether your injury qualifies, seek legal advice. SIRA’s guidelines are complex, and delays can affect your entitlements.
When to Seek Help
If your treatment costs are not being funded, or if you’re unsure about your claim’s progress, contact SIRA’s claims team or consult a solicitor. Time limits apply, and evidence must be submitted promptly to avoid losing your right to claim.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.