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).
If you were a passenger in a motor vehicle accident on the Central Coast and did not wear a seatbelt, your claim for treatment costs under NSW's Compulsory Third Party (CTP) scheme may be affected. The NSW CTP rules determine whether your injury qualifies for funding, and how long you can claim treatment benefits. This article explains how seatbelt non-use impacts your claim, what evidence matters, and when to seek legal advice.
How Seatbelt Non-Use Affects CTP Claims
NSW's CTP scheme covers injuries caused by motor vehicle accidents, but the extent of funding depends on the injury's nature. If you were not wearing a seatbelt, the injury must still meet the scheme's threshold injury criteria to qualify for treatment costs. The Motor Accident Injuries Act 2017 defines threshold injuries as soft tissue injuries, such as whiplash or muscle strains, that require medical treatment. However, the scheme does not automatically fund treatment costs for all injuries. For example, if your injury is classified as a 'threshold injury' but your treatment costs exceed the scheme's limits, you may need to cover the difference.
Funding Treatment Costs Under CTP
Under the CTP scheme, treatment benefits are generally available for 52 weeks after the injury date, provided the injury meets the threshold injury definition. If your injury is more severe and results in a whole person impairment (WPI) of 10% or more, treatment benefits may continue beyond 52 weeks. However, if you were not wearing a seatbelt and your injury does not meet the threshold injury criteria, you may not be eligible for any treatment funding. This is because the scheme assumes seatbelt use reduces the likelihood of injury, and non-use could affect the injury's classification.
Practical Steps and Evidence for Your Claim
To support your claim, you must provide evidence that your injury meets the threshold injury definition. This includes:
- Medical records confirming your injury and treatment
- A statement from your doctor linking the injury to the accident
- Proof of the accident (e.g., police report, witness statements)
- Evidence of your treatment costs (e.g., invoices, receipts)
If you were not wearing a seatbelt, your claimant must also demonstrate that the injury would have been less severe or prevented if the seatbelt had been used. This is a key consideration under the Motor Accident Guidelines, which state that seatbelt non-use may affect the injury's classification.
Time Limits and Dispute Options
You must notify the at-fault driver's insurer within 52 weeks of the accident to claim treatment benefits under the CTP scheme. If you fail to notify them within this period, you may lose your right to claim. However, if your injury is classified as a threshold injury, you may still be eligible for limited benefits. If your claim is disputed, you can request a review by the NSW Civil and Administrative Tribunal (NCAT). This process allows you to challenge the insurer's decision and provide additional evidence.
When to Seek Legal Advice
If your injury is more severe than a threshold injury, or if you believe the insurer is underestimating your treatment costs, it is important to seek legal advice. A solicitor can help you understand your options, including whether you may be eligible for additional compensation beyond the CTP scheme. For example, if your injury results in long-term impairment, you may have a claim for damages under common law, which is separate from the CTP scheme.
Example: How Seatbelt Non-Use Impacts a Claim
Consider a passenger who was not wearing a seatbelt and suffered a soft tissue injury. Under the CTP scheme, the injury would be classified as a threshold injury, and treatment benefits would be available for 52 weeks. However, if the injury was not caused by the accident (e.g., pre-existing condition), or if the injury was not related to the accident, the claim may be denied. In such cases, the insurer may argue that the injury does not meet the threshold injury criteria, and the claimant may need to provide additional evidence to support their case.
Next Steps
CTP claims depend on the specific facts of your case, including the injury's nature, the accident circumstances, and whether you were wearing a seatbelt. If you are unsure whether your claim is eligible for funding, or if you need help with the claims process, complete the quick, no obligation enquiry form to request contact about your circumstances.
Summary
NSW's CTP scheme may fund treatment costs for passengers not wearing seatbelts, but only if the injury meets the threshold injury criteria. The 52-week limit applies to treatment benefits, and disputes can be resolved through NCAT. If your injury is more severe, you may have additional options for compensation. Always seek legal advice if you are unsure about your claim's eligibility.