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).
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).
If you've been injured in a motor accident in Bathurst and need funding for treatment costs, the NSW Compulsory Third Party (CTP) scheme may cover your expenses. The Personal Injury Commission (PIC) administers claims under the Motor Accident Injuries Act 2017, which outlines what treatment costs are eligible. This article explains how PIC applications work, what documentation is needed, and time limits to consider.
How PIC Applications Fund Treatment Costs
Under the CTP scheme, treatment costs are covered if they are directly related to your injury caused by a motor vehicle accident. This includes medical treatments like physiotherapy, scans, and specialist consultations. The PIC assesses claims based on the Motor Accident Guidelines, which define what expenses are claimable. For example, if you need ongoing physiotherapy after a car accident, the PIC may fund this if your injury meets the 'threshold injury' criteria.
SIRA Guidelines for Funding Treatment Expenses
The State Insurance Regulatory Authority (SIRA) provides detailed guidance on what treatment costs are eligible. According to SIRA, you must provide medical records confirming your injury and treatment plans. For instance, if your MRI scan shows a soft-tissue injury, this may qualify. However, the PIC may dispute claims if the treatment is not directly related to the accident or if the injury does not meet the threshold injury definition.
Documentation Required for a PIC Application
To claim treatment costs, you must submit evidence such as medical reports, invoices, and treatment plans. A doctor’s report detailing your injury and recommended care is essential. For example, if you need a series of physiotherapy sessions, your treating physiotherapist must confirm this in writing. You should also keep records of all communication with the PIC, including any correspondence with your insurer.
Time Limits and Dispute Options
The CTP scheme has time limits for certain benefits. If your injury is a 'threshold injury' and your treatment costs are covered under the 52-week statutory benefit period, the PIC may stop funding after 52 weeks. If you believe this decision is incorrect, you can dispute it by submitting additional evidence or requesting a review. However, time limits apply, so it’s important to act promptly.
When to Seek Legal Advice
If your treatment costs are being disputed or you’re unsure about your eligibility, consider seeking legal advice. A solicitor can help you understand your options and ensure your claim meets all requirements. Remember, every claim depends on its own facts, and the PIC’s decision may vary based on your specific circumstances.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.