How the 10% Impairment Threshold Affects Funding for Treatment Costs in NSW
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've suffered a motor accident in NSW and are seeking treatment costs funded by the Compulsory Third Party (CTP) scheme, understanding the 10% whole person impairment threshold is critical. This threshold determines whether your injury qualifies for ongoing treatment funding under the Motor Accident Injuries Act 2017. In Greater Sydney, the process follows the same rules as other NSW regions, but local SIRA offices may handle claims differently.
What Is the Permanent Impairment Threshold?
The 10% threshold means your injury must result in a whole person impairment rating of 10% or more to qualify for funded treatment. This rating is determined by a medical practitioner using the Motor Accident Guidelines and must be confirmed by a SIRA-appointed assessor. For example, a fractured wrist that heals with full function would likely fall below the threshold, while a spinal injury causing chronic pain might reach or exceed 10%.
How Does the Threshold Affect Funding?
If your injury meets or exceeds the 10% threshold, the CTP scheme will fund your treatment costs, including physiotherapy, specialist consultations, and medical equipment. This funding covers all reasonable and necessary treatment, but only if the injury is directly caused by the motor accident. Claims below the threshold are not eligible for funded treatment, though you may still seek compensation for other losses like lost income.
Practical Steps for Claimants in Greater Sydney
To qualify for treatment funding, you must:
- Obtain a medical report documenting your injury and its impact
- Get a whole person impairment assessment from a qualified practitioner
- Submit your claim to SIRA within the required timeframe
- Provide evidence of treatment costs (e.g., invoices, receipts)
SIRA typically requires a SIRA-registered medical practitioner to assess your injury. If your claim is denied, you can request a review or seek independent advice to challenge the impairment rating.
Time Limits and Dispute Options
You have 52 weeks from the accident date to claim certain benefits, but treatment funding is not time-limited if your injury meets the threshold. However, delays in seeking treatment or documentation may affect your claim. If you disagree with SIRA's decision, you can:
- Request a review from the SIRA office handling your claim
- Apply to the NSW Civil and Administrative Tribunal (NCAT) for a review
- Seek legal advice to challenge the impairment rating
When to Seek Legal Advice
The threshold rules are complex, and misinterpreting your injury's rating can lead to denied claims. A legal professional can help you:
- Navigate SIRA's assessment process
- Challenge incorrect impairment ratings
- Ensure all treatment costs are properly documented
If your claim involves a 10% or higher impairment rating, funding for treatment is available under the CTP scheme. However, each case depends on its own facts, including the injury's nature, medical evidence, and the accident's circumstances.
Next Steps
Time limits and procedural requirements may apply. To request contact about your circumstances, complete the quick, no obligation enquiry form.