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 pre-existing injury that worsened in a motor accident, you may be eligible for treatment costs under NSW's Compulsory Third Party (CTP) scheme. This article explains how SIRA evaluates claims for aggravated injuries, what evidence is needed, and practical steps for Albury residents. Time limits and dispute options are also covered.
How CTP Covers Aggravated Pre-Existing Injuries
NSW CTP claims cover treatment costs for injuries aggravated by a motor accident, but only if the aggravation is directly caused by the accident. SIRA's guidelines state that pre-existing injuries must be 'aggravated', meaning the accident worsened the condition beyond its original state. For example, if you had a pre-existing back injury and a car accident caused additional damage, treatment costs for the new injury may be funded.
Under the Motor Accident Injuries Act 2017, CTP insurers must cover reasonable treatment costs for injuries caused by the accident. This includes medical consultations, scans, physiotherapy, and medications directly related to the aggravated injury. However, treatment for the original pre-existing condition (not worsened by the accident) is not funded under CTP.
Evidence Required to Prove Aggravation
To claim treatment costs for an aggravated pre-existing injury, you must provide:
- Medical records showing the original injury and its pre-accident condition
- Evidence the accident caused a worsening (e.g., worsened pain, new symptoms, or diagnostic test results)
- A medical opinion linking the aggravation to the accident
- Proof of treatment costs incurred after the accident
SIRA requires a 'medical opinion' from a treating practitioner confirming the aggravation. This is distinct from NDIS claims, which cover long-term support for pre-existing conditions unrelated to a motor accident.
Practical Steps for Albury Residents
- Seek immediate medical attention after the accident, ensuring records document both the original injury and any new symptoms
- Gather accident details: police reports, witness statements, and photos of the scene
- Contact the at-fault driver's CTP insurer to request treatment cost approval
- Keep all medical bills, prescriptions, and treatment records
- If treatment costs are denied, request a review through SIRA's dispute process
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident for treatment costs to be funded under the 'only injuries' rule. If your claim is denied, you can:
- Request a review from SIRA's review panel
- Apply for a court review under the Motor Accident Injuries Act 2017
- Seek independent medical opinions to challenge the insurer's assessment
When to Seek Legal Advice
Consult a solicitor if:
- Your claim is denied and you need to challenge the decision
- You're unsure if your injury qualifies as 'aggravated'
- You need help navigating SIRA's complex review process
CTP funding for aggravated pre-existing injuries depends on precise medical evidence and timing. Always act quickly to preserve your claim rights under NSW law.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.