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 sustained a pregnancy-related injury in a car accident in New South Wales, you may be eligible for funding to cover medical treatment costs through the Compulsory Third Party (CTP) scheme. Under the Motor Accident Injuries Act 2017 (MAIA), CTP claims cover treatment expenses for injuries caused by motor vehicle accidents, including those affecting maternal or fetal health. This article explains what treatment costs are covered, how SIRA assesses claims, and practical steps to ensure your medical expenses are funded.
What Treatment Costs Are Covered for Pregnancy Injuries?
NSW CTP claims cover all reasonable and necessary medical treatment costs directly related to the accident. For pregnancy-related injuries, this includes:
- Prenatal care and specialist consultations for maternal health
- Diagnostic tests (e.g., ultrasounds, blood work) to monitor fetal development
- Emergency treatments for complications like preterm labor or placental abruption
- Ongoing medical care for injuries such as spinal trauma or internal bleeding
- Specialist therapies like physiotherapy or occupational therapy
SIRA guidelines state that treatment costs must be directly attributable to the accident. For example, if a car crash caused a spinal injury requiring MRI scans and specialist care, those costs would be funded. However, unrelated expenses like routine prenatal vitamins are generally not covered.
How SIRA Determines Funding for Pregnancy Injuries
SIRA assesses claims based on medical evidence showing a direct link between the accident and the injury. Key considerations include:
- Medical documentation: Your treating physician must confirm the injury caused by the accident. For example, a doctor might note that a car crash led to a cervical spinal injury requiring treatment.
- Fetal injury assessments: If the accident caused harm to the fetus, a specialist report detailing the extent of the injury is required. This could include ultrasound findings or fetal monitoring data.
- Threshold injury criteria: Under the MAIA, injuries must meet specific clinical thresholds to qualify for benefits. For instance, a spinal nerve-root injury producing neurological signs (even without radiculopathy) may still count as a threshold injury.
SIRA also evaluates whether the treatment is 'reasonable and necessary' under the guidelines. This means the care must be:
- Provided by a qualified medical practitioner
- Directly related to the injury caused by the accident
- Not a standard, routine procedure for the pregnancy stage
Practical Steps to Ensure Treatment Costs Are Funded
To maximize funding for your pregnancy-related injury, take these steps:
- Seek immediate medical attention: Document all treatments, including specialist consultations and diagnostic tests. For example, if you experienced abdominal pain after the accident, ensure you receive a full medical assessment.
- Preserve accident evidence: Keep records of the accident, including police reports, witness statements, and photographs of the vehicle damage. This helps establish the incident's circumstances.
- Notify the insurer: Contact the at-fault driver's CTP insurer within 52 weeks of the accident (per MAIA s 4.4). Delays may affect your ability to claim certain benefits.
- Request a medical report: Ask your doctor to prepare a report linking the injury to the accident. For instance, a report stating that a car crash caused a pelvic fracture requiring specialist care.
Time Limits and Dispute Options
CTP claims must be submitted within 52 weeks of the accident if the injury is a 'threshold injury' (per MAIA s 4.4). If your injury doesn't meet the threshold criteria, you may still claim for treatment costs under the 'only injuries' rule. However, benefits typically stop after 52 weeks unless you have a permanent impairment.
If SIRA denies your claim, you can:
- Request a review of the decision
- Seek mediation through the NSW Civil and Administrative Tribunal (NCAT)
- Consult a legal professional to explore further options
When to Seek Legal Advice
While many claims are resolved through SIRA, complex cases involving:
- Fetal injuries requiring long-term care
- Multiple injuries from the same accident
- Disputes over the extent of treatment costs
- Claims exceeding 52 weeks
may benefit from legal assistance. A solicitor can help ensure all evidence is properly submitted and that you understand your rights under the MAIA.
Conclusion
Funding for pregnancy-related injuries in NSW CTP claims depends on the direct link between the accident and your medical treatment. By gathering proper evidence and following the correct procedures, you can ensure your treatment costs are covered. Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.