Seatbelt Non-Use and Treatment Cost Funding in NSW CTP Claims
A passenger who was not wearing a seatbelt at the time of a motor accident in NSW may still be entitled to have treatment costs funded under the Compulsory Third Party (CTP) insurance scheme. This entitlement depends on whether the injury was caused by the accident, not on the passenger’s seatbelt use. The CTP scheme provides funding for reasonable and necessary treatment related to injuries sustained in a motor accident, regardless of whether the passenger was wearing a seatbelt, as long as the injury is not excluded under the Motor Accident Injuries Act 2017.
Legal Framework for Treatment Cost Funding
Under the Motor Accident Injuries Act 2017, a person injured in a motor accident may be entitled to treatment and care benefits to cover reasonable and necessary medical treatment. These benefits are available to drivers, passengers, pedestrians, cyclists and motorcyclists, including those who were not wearing a seatbelt at the time of the accident. The scheme does not exclude a claim based solely on seatbelt non-use, provided the injury was caused by the impact of the accident.
The key legal principle is that the CTP scheme is not fault-based for treatment and care benefits. This means that even if a passenger was not wearing a seatbelt, and even if they were partially at fault for not wearing one, they may still be eligible for funding of treatment costs if the injury resulted from the motor accident.
When Seatbelt Non-Use May Affect a Claim
Seatbelt non-use may affect a claim only in limited circumstances. If a passenger’s injury was caused or significantly worsened by not wearing a seatbelt, and that injury would not have occurred otherwise, the insurer may argue that the passenger contributed to their own injury. In such cases, the insurer may seek to reduce or deny treatment and care benefits under the principle of contributory fault.
However, the Motor Accident Injuries Act 2017 does not automatically exclude a claim based on seatbelt non-use. The insurer must demonstrate that the injury was caused by the failure to wear a seatbelt, not merely that the passenger was not wearing one. For example, if a passenger suffered a neck injury from a rear-end collision and was not wearing a seatbelt, but the injury was due to the sudden impact and not to the absence of a seatbelt, the claim for treatment costs would still proceed.
Practical Steps and Evidence
To support a claim for treatment cost funding, a passenger should:
- Seek medical treatment immediately after the accident and keep all medical records, including diagnosis, treatment plans and progress notes.
- Preserve any photographs of the vehicle, injury scene, or visible injuries taken at the time.
- Gather contact details of any witnesses to the accident.
- Notify the CTP insurer as soon as possible, providing a copy of the accident report if available.
- Keep records of all treatment costs, including receipts and invoices.
A medical practitioner’s report confirming that the injury was caused by the motor accident, and not by pre-existing conditions or non-accident factors, is critical. If the insurer disputes the claim, a medical report that addresses the causal link between the accident and the injury will be essential.
Time Limits and Dispute Options
There is no fixed time limit for making a claim for treatment and care benefits under the CTP scheme, but it is important to notify the insurer as soon as possible. Delays may affect the insurer’s ability to investigate the claim and assess entitlements.
If the insurer refuses to fund treatment costs, the passenger may dispute the decision by requesting a review under the Motor Accident Injuries Act 2017. If the dispute remains unresolved, the passenger may apply to the NSW Civil and Administrative Tribunal (NCAT) for a determination.
Hypothetical Example
A passenger in a car in Greater Sydney was not wearing a seatbelt when the vehicle was struck from behind. The impact caused a whiplash injury and neck pain. The passenger sought medical treatment within 48 hours and received a diagnosis of soft-tissue injury. The CTP insurer initially refused to fund treatment on the grounds that the passenger was not wearing a seatbelt. However, a medical report confirmed the injury was caused by the sudden deceleration and impact, not by the absence of a seatbelt. The insurer later agreed to fund the treatment costs after reviewing the medical evidence.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.