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've been injured in a roundabout collision in Bathurst NSW, you may be wondering how the Compulsory Third Party (CTP) scheme covers your treatment costs. Under NSW law, the CTP insurer of the at-fault driver must fund medical expenses, rehabilitation and other treatment costs related to your injuries. This article explains how SIRA (State Insurance Regulatory Authority) administers these claims, what evidence is needed and how to access funding for treatment costs after a roundabout collision.
How CTP Funding Covers Treatment Costs
NSW's CTP scheme, governed by the Motor Accident Injuries Act 2017, ensures injured parties receive funding for treatment costs regardless of fault. This includes medical bills, physiotherapy, specialist consultations and other necessary care. SIRA administers these claims, ensuring treatment costs are paid directly to healthcare providers.
For injuries meeting the 'threshold injury' criteria in the Motor Accident Guidelines, treatment costs are covered for 52 weeks from the accident date. This includes both immediate medical attention and ongoing care. If your injuries result in a whole person impairment (WPI) of 10% or more, you may also be eligible for additional compensation for treatment costs beyond the 52-week period.
Evidence Needed for Treatment Cost Claims
To claim treatment costs, you'll need to provide:
- Medical records confirming your injuries and treatment
- A statement from your doctor outlining the necessity of each treatment
- Receipts or invoices for medical expenses
- Evidence of the accident (e.g., police report, witness statements, photographs)
- Proof of your relationship to the injured person if claiming on their behalf
SIRA requires these documents to assess the medical necessity of treatment and ensure costs are reasonable. Keep all records until your claim is resolved.
Practical Steps After a Roundabout Collision
- Seek immediate medical attention, even if injuries seem minor
- Document the accident scene, including vehicle positions and road conditions
- Report the collision to the police and obtain a report
- Notify the at-fault driver's CTP insurer within 52 weeks of the accident
- Provide SIRA with all medical records and treatment cost evidence
If you're unsure whether your treatment costs qualify, contact SIRA directly. Their claims team can help determine if your injuries meet the threshold for coverage.
Time Limits and Dispute Resolution
You have 52 weeks from the accident date to claim treatment costs under the CTP scheme. After this period, you may need to pursue a separate claim for ongoing treatment costs, depending on the severity of your injuries. If you dispute the insurer's assessment of your treatment costs, you can request a review through SIRA's internal appeals process.
When to Seek Legal Advice
While SIRA handles most CTP claims, complex cases may require legal assistance. A solicitor can help if:
- Your injuries result in a whole person impairment of 10% or more
- You're facing a dispute over the reasonableness of treatment costs
- You need to challenge the insurer's decision to limit coverage
- You've been denied a claim and want to appeal
Legal professionals can also help navigate the 52-week time limit and ensure you receive all available treatment funding.
Example: Funding a Broken Arm from a Roundabout Collision
Consider a scenario where a pedestrian in Bathurst is injured when a car enters a roundabout at high speed. The pedestrian sustains a broken arm and requires surgery, followed by six weeks of physiotherapy. Under the CTP scheme, the at-fault driver's insurer must cover:
- The cost of the surgical procedure
- Physiotherapy sessions
- Medication and pain management
- Transportation to medical appointments
This example shows how the CTP scheme covers both immediate and ongoing treatment costs, ensuring injured parties can access necessary care without financial strain.
Next Steps for Claimants
If you've been injured in a roundabout collision in Bathurst, start by gathering all medical records and evidence of the accident. Contact SIRA to submit your claim for treatment costs, and ensure you act within the 52-week time limit. If you face challenges with your claim, consider seeking legal advice to protect your right to treatment funding.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.