Funding Medical Treatment for Pregnancy-Related Injuries in NSW
If you were injured in a car accident while pregnant in New South Wales, you may be entitled to funding for medical treatment related to that injury through the Compulsory Third Party (CTP) insurance scheme. This includes treatment for injuries to you, your unborn child, or complications arising from the accident that affect your pregnancy. The Motor Accident Injuries Act 2017 (MAIA) and the Motor Accident Injuries Regulation 2017 govern how these claims are processed. Funding is available regardless of fault, provided the injury occurred in a motor vehicle accident and you have notified the insurer within the required timeframes.
How Treatment Costs Are Funded Under NSW CTP Law
Under the CTP scheme in NSW, treatment and care benefits cover reasonable and necessary medical treatment, including specialist consultations, diagnostic tests, physiotherapy, and mental health services. For pregnant individuals, this includes care related to injuries that may impact the pregnancy, such as preterm labour, placental complications, or fetal distress following trauma. The insurer must fund treatment that is directly linked to the accident, as confirmed by a medical practitioner. This applies whether the injury occurred to the pregnant person, the fetus, or both.
SIRA, the State Insurance Regulatory Authority, confirms that treatment for injuries sustained during pregnancy as a result of a motor accident is covered under the CTP scheme. The insurer is responsible for arranging and funding treatment that is clinically appropriate and necessary. This includes treatment for injuries that may not be immediately apparent, such as internal trauma or psychological injury from the accident.
Evidence and Records That Matter
To support a claim for treatment funding, you should preserve and provide:
- A medical certificate from your treating practitioner confirming the injury and its connection to the accident.
- A record of all treatments received, including dates, providers, and reasons for treatment.
- Any diagnostic reports, such as ultrasounds, MRI scans, or fetal monitoring results, that show injury to the fetus or pregnancy complications.
- A copy of the police accident report, if one was filed.
- Details of any witnesses to the accident.
- Photographs of vehicle damage or the scene, if available.
SIRA advises that all evidence should be kept and shared with the insurer as soon as possible. Delay in providing evidence may affect the approval of treatment funding.
Time Limits and Procedural Requirements
You must notify the insurer of your claim within 3 months of the accident. Failure to do so may result in the claim being denied. If you were injured during pregnancy, the 3-month period begins from the date of the accident, not from when symptoms first appeared or when a diagnosis was made.
If treatment is delayed due to pregnancy-related factors, such as waiting for a specialist appointment or a scheduled scan, the insurer must still fund treatment that is medically necessary and directly linked to the accident. However, you must provide a clear medical explanation for any delay in seeking treatment.
What Differs in Pregnancy Injury Claims
Pregnancy-related injuries in motor accidents are not treated differently under the CTP scheme in principle. However, the nature of the injury and the medical evidence required may differ. For example, injuries to the fetus may require specialist obstetric assessment, and treatment may involve close monitoring of fetal development. The insurer must fund these assessments if they are clinically indicated and related to the accident.
Unlike non-pregnant claimants, pregnant individuals may need to demonstrate that the injury was not pre-existing or unrelated to the accident. A medical practitioner must confirm that the injury or complication arose from the motor vehicle incident. This is particularly important if the pregnancy was already high-risk or if there were pre-existing conditions.
Hypothetical Example: A Claim for Fetal Injury Treatment
A 32-week pregnant woman was a front-seat passenger in a rear-end collision in Sydney. She experienced abdominal pain and reduced fetal movement the next day. An ultrasound revealed placental abruption, and she was hospitalised for 48 hours. The treating obstetrician confirmed that the injury was caused by the impact of the crash. The insurer approved funding for the hospital stay, follow-up scans, and specialist care. The treatment was funded under the CTP scheme because it was directly related to the accident and medically necessary.
When to Seek Independent Advice
While the CTP scheme covers treatment for pregnancy-related injuries, the process of obtaining approval can be complex, particularly when the injury involves the fetus or when there are delays in diagnosis. If your claim for treatment funding is denied, or if you are unsure whether a treatment is covered, it is advisable to seek independent legal advice. The insurer may not always accept a medical practitioner’s assessment, and disputes may arise over whether treatment is reasonable or necessary.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.