If a pre-existing injury is worsened by a motor accident in Balmain, NSW, treatment costs may be funded through the Compulsory Third Party (CTP) scheme. This article explains how the NSW CTP rules apply to such claims, what evidence is needed, and how SIRA assesses aggravation claims.
Can treatment costs be funded for aggravated pre-existing injuries?
Under the Motor Accident Injuries Act 2017, the CTP scheme covers treatment costs for injuries caused or aggravated by a motor accident. If your pre-existing condition worsened due to the accident, you may be eligible for funding. However, the injury must be directly linked to the crash, and SIRA will assess whether the aggravation is significant enough to qualify.
Proving an aggravated injury
To claim treatment costs, you must provide evidence showing the pre-existing injury was worsened by the accident. This includes:
- Medical records documenting the original injury and its worsening after the accident
- A doctor's report linking the aggravation to the crash
- Accident reports or witness statements confirming the incident
- Evidence of treatment costs incurred (e.g., invoices, receipts)
SIRA will review these documents to determine if the aggravation meets the legal threshold. For example, if a pre-existing back injury led to new nerve damage after the accident, treatment costs for physiotherapy or scans may be funded.
How SIRA assesses aggravation claims
SIRA evaluates whether the aggravation is 'more than minimal' under the Motor Accident Guidelines. This involves:
- Comparing pre-accident and post-accident medical assessments
- Determining if the injury's severity increased due to the crash
- Assessing whether the aggravation caused additional treatment needs
If SIRA concludes the injury was aggravated, treatment costs will be funded. However, if the aggravation is minor or the injury is already a 'threshold injury' (as defined in the Motor Accident Injuries Act 2017), benefits may be limited after 52 weeks.
Funding limits for treatment costs
The CTP scheme covers treatment costs for injuries caused or aggravated by the accident. However, if the injury is a 'threshold injury' (e.g., soft tissue damage with neurological signs), weekly benefits and treatment funding may stop after 52 weeks. This is because the scheme is designed to cover injuries directly caused by the accident, not pre-existing conditions that were only worsened.
Practical steps for claimants
- Seek immediate medical attention and document all treatment
- Keep detailed records of the accident, including photos and witness details
- Notify your insurer or SIRA as soon as possible
- Obtain a medical report explicitly linking the aggravation to the accident
When to seek legal advice
If SIRA denies your claim or disputes the extent of the aggravation, consider consulting a solicitor. They can help challenge the decision or negotiate a fair outcome. Time limits for disputes depend on the specific circumstances of your case.
Example scenario
A person with a pre-existing knee injury (from a previous sports activity) experiences increased pain and swelling after a Balmain car accident. Their doctor confirms the injury has worsened, requiring additional physiotherapy. Under the CTP scheme, treatment costs for the aggravated injury may be funded, provided SIRA accepts the link between the accident and the worsening condition.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.