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).
In New South Wales, rehabilitation treatment costs for motor accident injuries are funded through the Compulsory Third Party (CTP) scheme. This article explains how CTP insurers cover treatment expenses, the criteria for approved rehabilitation providers, and the steps injured persons must take to access funding. The information applies to claims under the Motor Accident Injuries Act 2017 and SIRA guidelines.
How CTP Funding Works for Rehabilitation
NSW CTP insurers cover treatment costs for injuries resulting from motor vehicle accidents. This includes physiotherapy, occupational therapy, and other rehabilitation services approved by the State Insurance Regulatory Authority (SIRA). Funding is available for both immediate and long-term treatment needs, provided the services are medically necessary and directly related to the accident.
Under the CTP scheme, rehabilitation providers must be approved by SIRA to ensure they meet specific standards of care and expertise. Approved providers are listed on the SIRA website, and claimants must use these providers to access funding. This process ensures that treatment costs are managed efficiently and in line with NSW health guidelines.
Criteria for Approved Rehabilitation Providers
To be eligible for CTP funding, rehabilitation providers must meet strict criteria outlined in SIRA’s Motor Accident Guidelines. These include:
- Holding a valid accreditation from the Australian Health Practitioners Regulation Agency (AHPRA)
- Having a proven track record in treating motor accident injuries
- Adhering to SIRA’s clinical guidelines for rehabilitation
- Being registered with the NSW Health Practitioner Regulation Board
Providers must also submit treatment plans to SIRA for approval before services are provided. This ensures that all rehabilitation activities are directly related to the injury and meet the scheme’s requirements.
Steps to Access CTP Funding
Claimants seeking treatment must take the following steps to ensure costs are covered:
- Notify the CTP insurer within 52 weeks of the accident. Delays beyond this period may result in reduced or denied funding.
- Obtain a referral from a registered medical practitioner. The referral must specify the type of rehabilitation needed and its connection to the accident.
- Choose an approved provider from SIRA’s list. Unapproved providers cannot claim CTP funding for their services.
- Submit treatment records to the insurer. This includes invoices, progress notes, and any clinical assessments required to justify the treatment.
Failure to follow these steps may result in the insurer refusing to cover costs. Claimants should also keep copies of all correspondence with the insurer to support their claim.
Time Limits and Dispute Resolution
CTP claims must be made within 52 weeks of the accident for treatment costs to be eligible for funding. This applies to all rehabilitation services, including those for soft tissue injuries or long-term recovery. If a claimant exceeds this period, they may need to seek alternative funding through private insurance or out-of-pocket payments.
Disputes over funding decisions can be resolved through SIRA’s dispute resolution process. Claimants should request a review if they believe their treatment was wrongly denied. SIRA provides a formal process for challenging decisions, which includes submitting additional medical evidence and a written appeal.
Example: Rehabilitation Funding for a Soft Tissue Injury
Consider a driver who sustains a soft tissue injury (e.g., whiplash) in a car accident. The injured person’s GP refers them to an approved physiotherapist. The physiotherapist submits a treatment plan to SIRA, which is approved within 10 business days. The CTP insurer then covers 100% of the physiotherapy costs, provided the treatment is completed within 52 weeks of the accident.
When to Seek Legal Advice
While most claims can be managed through SIRA, complex cases may require legal assistance. This includes situations where:
- The claimant has multiple injuries requiring long-term rehabilitation
- The CTP insurer denies funding without a valid reason
- The claimant needs to dispute a decision through the NSW Civil and Administrative Tribunal (NCAT)
Legal professionals can help claimants navigate the CTP process, challenge incorrect decisions, and ensure they receive all available funding.
Next Steps
CTP funding for rehabilitation depends on the accident date, injury type, and claimant actions. To request contact about your circumstances, complete the quick, no obligation enquiry form.