If you've suffered a motor accident that worsened a pre-existing injury, you may be eligible for treatment costs under NSW's Compulsory Third Party (CTP) scheme. This article explains how the NSW CTP system handles claims for aggravated injuries, the evidence needed to support your claim, and the steps to seek funding for treatment. The information is based on the current legal framework and SIRA guidelines.
How NSW CTP Claims Handle Aggravated Pre-Existing Injuries
Under the Motor Accident Injuries Act 2017, the NSW CTP scheme covers treatment costs for injuries caused by a motor accident. However, if your injury was aggravated by the accident, the treatment costs must be directly related to the aggravation. SIRA (State Insurance Regulatory Authority) assesses whether the treatment is for the aggravated injury, not the original pre-existing condition.
For example, if you had a pre-existing back injury and the accident caused additional damage, the treatment costs for the new injury may be covered. However, if the treatment is for the original injury, it may not be funded. SIRA uses medical evidence to determine this.
Practical Steps to Seek Funding for Aggravated Injuries
To claim treatment costs for an aggravated injury, you must:
- Document the aggravation: Obtain medical records showing the pre-existing injury and how the accident worsened it.
- Secure a specialist report: A doctor must confirm the aggravation and link it to the accident.
- Submit a claim to SIRA: Complete the CTP claim form and include all medical evidence.
- Provide treatment cost details: Include invoices or estimates for treatment directly related to the aggravated injury.
SIRA may also require a statement from your treating medical practitioner explaining the connection between the accident and the treatment.
Time Limits and Dispute Resolution
You have 5 years from the date of the accident to claim treatment costs under the CTP scheme. However, this period may start earlier if you knew or should have known about the injury's aggravation.
If SIRA denies your claim, you may request a review or seek independent legal advice. The NSW Civil and Administrative Tribunal (NCAT) can also review disputes about claim eligibility.
When to Seek Legal Advice
If your claim is denied or you're unsure about your entitlements, consult a solicitor. A lawyer can help you:
- Challenge SIRA's decision with additional evidence.
- Navigate the claims process.
- Understand your options if your claim is rejected.
Example: Aggravated Injury Claim in Bathurst
Consider a cyclist in Bathurst who had a pre-existing knee injury. After a motor accident, they experience increased pain and require surgery. The surgeon confirms the accident aggravated the injury. SIRA may fund the surgery costs, but not treatment for the original injury.
Next Steps
CTP claims depend on the date of the accident, the nature of the injury, and the evidence you provide. To request contact about your circumstances, complete the quick, no obligation enquiry form.