Seatbelt non-use and treatment cost funding in NSW CTP claims
If you were a passenger in a motor vehicle accident in New South Wales and were not wearing a seatbelt at the time, your claim for treatment and care benefits under the Compulsory Third Party (CTP) insurance scheme may still be funded. The Motor Accident Injuries Act 2017 (MAIA) and the Motor Accident Injuries Regulation 2017 provide that funding for treatment and care is not automatically denied because a passenger was not wearing a seatbelt. However, the insurer may assess whether the injury was caused or worsened by the failure to wear a seatbelt, and this assessment can affect the extent of funding provided.
How CTP funding works for treatment and care
Under the CTP scheme in NSW, treatment and care benefits cover reasonable and necessary medical, allied health, and rehabilitation services resulting from a motor accident. These benefits are available regardless of fault and are not limited to injuries that meet the threshold for damages. This means that even if you were not wearing a seatbelt, you may still be entitled to funding for treatment such as physiotherapy, chiropractic care, medical consultations, and psychological support, provided the treatment is directly related to injuries sustained in the accident.
The insurer must assess whether the treatment is reasonable and necessary in accordance with the Motor Accident Guidelines. This includes considering whether the treatment is clinically appropriate, not excessive, and proportionate to the injury. The insurer may also require evidence from your medical practitioner to confirm the treatment is required.
The impact of not wearing a seatbelt on CTP claims
Failing to wear a seatbelt does not automatically disqualify you from receiving treatment and care benefits. However, the insurer may argue that the injury was caused or made worse by the absence of seatbelt use. This is not a bar to funding, but it may affect the insurer’s assessment of whether the injury was directly caused by the accident.
The Motor Accident Guidelines state that a passenger who was not wearing a seatbelt may still be entitled to benefits if the injury would have occurred even if the seatbelt had been worn. The insurer must consider the nature of the injury, the circumstances of the accident, and medical evidence to determine whether the failure to wear a seatbelt contributed to the injury.
For example, if a passenger suffered a whiplash injury in a low-speed rear-end collision, and medical evidence shows that the injury is consistent with such an impact, the insurer is unlikely to argue that not wearing a seatbelt caused or worsened the injury. However, if the passenger sustained a more severe injury, such as a spinal fracture, and there is evidence that the injury occurred due to impact with the vehicle interior, the insurer may investigate whether the seatbelt would have prevented or reduced the injury.
Practical steps and evidence to support your claim
To ensure your treatment costs are funded under CTP, you should:
- Seek medical attention as soon as possible after the accident and keep all medical records, including diagnosis, treatment plans, and progress notes.
- Provide your insurer with a completed claim form and any supporting documents, including a medical certificate confirming the injury and the need for treatment.
- Retain copies of all invoices and receipts for treatment, therapy, and related expenses.
- Record details of the accident, including the time, location, weather, road conditions, and any witness statements.
- Take photographs of the vehicle damage, your injuries, and any visible impact points on the vehicle interior.
If your insurer refuses to fund a treatment you believe is necessary, you may request a review. You can also seek an independent medical assessment if you disagree with the insurer’s decision.
Time limits and dispute resolution
There is no strict time limit for applying for treatment and care benefits under the CTP scheme, but it is important to notify your insurer as soon as possible after the accident. Delays in notification may affect the insurer’s ability to assess your claim and could result in a delay in funding.
If you dispute the insurer’s decision on treatment funding, you can request a review under the CTP scheme. If the dispute remains unresolved, you may apply to the State Civil and Administrative Tribunal (SCAT) for a determination. You may also seek assistance from a legal practitioner or a community legal centre to help you navigate the process.
Hypothetical example
A 34-year-old passenger was involved in a side-impact motor accident in Sydney on 15 August 2026. The vehicle was travelling at 40 km/h, and the passenger was not wearing a seatbelt. The passenger sustained a soft tissue injury to the neck and was treated by a physiotherapist for six weeks. The medical practitioner confirmed that the injury was consistent with a whiplash mechanism and that the treatment was reasonable and necessary. The insurer approved the treatment costs under the CTP scheme, noting that the injury would have occurred regardless of seatbelt use. The passenger was not required to contribute to the cost of treatment.
Next steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.