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).
Pillion passengers involved in a motor vehicle accident in New South Wales may be eligible to claim treatment costs through the Compulsory Third Party (CTP) scheme. Under the NSW CTP rules, injured passengers can access funding for medical treatments, therapies, and medications. This article explains what treatment costs are covered, how to claim them, and the role of the State Insurance Regulatory Authority (SIRA) in assessing claims.
What Treatment Costs Are Covered Under NSW CTP Claims?
The NSW CTP scheme funds treatment costs for injuries resulting from motor vehicle accidents. For pillion passengers, this includes:
- Medical treatments such as scans, surgeries, and specialist consultations
- Physiotherapy, occupational therapy, and speech therapy sessions
- Medications prescribed for injury-related conditions
- Transportation to and from medical appointments (if approved)
SIRA guidelines state that eligible costs must be directly related to the injury and documented by a medical practitioner. Costs for unrelated treatments, such as cosmetic procedures, are not covered.
How to Claim Treatment Costs as a Pillion Passenger
To claim treatment costs, pillion passengers must:
- Notify the CTP insurer within 52 weeks of the accident. Delays beyond this period may reduce benefits.
- Provide medical evidence showing the injury's connection to the accident. This includes medical reports, imaging results, and treatment records.
- Submit a claim form through the insurer's process. SIRA provides templates and guidance on its website.
- Follow up on the claim status. Insurers must respond within 28 days of receiving a complete application.
Role of SIRA in Funding Pillion Passenger Claims
SIRA oversees the CTP scheme and determines the amount of funding based on:
- The type and severity of the injury
- Medical evidence of treatment needs
- The 52-week statutory limit for weekly benefits
For injuries meeting the 'threshold injury' definition under the Motor Accident Injuries Act 2017, weekly benefits and treatment funding are generally limited after 52 weeks. SIRA assesses whether the injury meets this threshold using the Motor Accident Guidelines.
Practical Steps and Evidence to Gather
Pillion passengers should:
- Document all medical treatments in detail, including dates, providers, and costs
- Preserve accident details such as police reports, witness statements, and vehicle information
- Keep records of income loss if applicable, as this affects weekly benefit calculations
- Request a copy of the insurer's decision if a claim is denied
Time Limits and Dispute Resolution
Claims must be submitted within 52 weeks of the accident. If a pillion passenger misses this deadline, they may lose access to weekly benefits but can still seek treatment funding through the 'only injuries' provision. Disputes over claim decisions can be escalated to SIRA's review process.
When to Seek Legal Advice
While the CTP scheme provides a statutory pathway, complex cases may require legal assistance. A solicitor can help:
- Navigate disputes with insurers
- Challenge decisions based on incorrect medical assessments
- Ensure all eligible treatment costs are included
Example: Funding a Broken Arm Injury
A pillion passenger involved in a collision sustains a broken arm requiring surgery and six weeks of physiotherapy. Under the CTP scheme, they could claim:
- The cost of the surgery
- Physiotherapy sessions
- Medications for pain management
- Transportation to appointments
However, if the injury is classified as a 'threshold injury' (e.g., a minor sprain), weekly benefits may stop after 52 weeks, though treatment costs could still be funded.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.