Time Limits for Physiotherapy Approval in NSW CTP Claims
A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
Under New South Wales law, securing approval for physiotherapy treatment under a Compulsory Third Party (CTP) motor accident claim must be done within specific timeframes. The NSW Motor Accident Injuries Act 2017 and SIRA guidelines outline that treatment and care benefits, including physiotherapy, are generally limited to 52 weeks after the accident date unless the injury meets certain criteria. This applies to all claims, including those in Bathurst.
Key Time Limits for Physiotherapy Approval
The 52-week rule applies to all treatment and care benefits, including physiotherapy, unless the injury is classified as a 'threshold injury' under the Motor Accident Guidelines. To qualify for ongoing treatment, the injury must meet the spinal nerve-root qualification: a spinal nerve-root injury producing neurological signs other than radiculopathy may still fall within the soft-tissue definition. If the injury does not meet this threshold, treatment benefits typically stop after 52 weeks.
SIRA determines the timeframe based on the date of the accident, not the date of treatment. For example, if a claimant in Bathurst seeks physiotherapy approval 60 weeks after the accident, they may lose eligibility for ongoing treatment benefits. However, if the injury meets the threshold injury criteria, the 52-week limit does not apply.
Practical Steps for Securing Approval
To ensure approval, claimants should:
- Submit a treatment plan to their insurer within 52 weeks of the accident.
- Provide medical evidence confirming the injury's connection to the accident.
- Keep records of treatment dates, costs, and progress notes.
- Contact the local SIRA office in Bathurst if the insurer denies approval.
Consequences of Missing Deadlines
If a claimant misses the 52-week deadline for treatment approval, they may lose access to weekly income payments and treatment benefits. However, if the injury is classified as a threshold injury, the 52-week limit does not apply. For example, a claimant with a confirmed spinal nerve-root injury may qualify for ongoing treatment regardless of the 52-week period.
When to Seek Legal Advice
Claimants in Bathurst should seek legal advice if:
- The insurer denies treatment approval without explanation.
- The injury may qualify as a threshold injury but the insurer disputes this.
- The claimant needs to dispute a decision to stop treatment benefits.
Example Scenario
A cyclist in Bathurst sustains a soft-tissue injury after a collision. They seek physiotherapy approval 45 weeks after the accident. The insurer approves treatment, but denies further benefits after 52 weeks. The claimant must prove the injury meets the threshold injury criteria to challenge the decision.
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