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 suffered a shoulder injury in a car accident in NSW and need funding for treatment costs, the Compulsory Third Party (CTP) scheme may cover your expenses. This article explains how the NSW CTP scheme funds treatment costs for shoulder injuries, including what documentation is required and how SIRA assesses claims. It also outlines time limits and when to seek legal advice.
How the NSW CTP Scheme Funds Shoulder Injury Treatment Costs
Under the Motor Accident Injuries Act 2017, the NSW CTP scheme provides funding for treatment costs related to injuries caused by motor vehicle accidents. For shoulder injuries, this includes physiotherapy, medical imaging, and specialist consultations. The Scheme for the Injured Road (SIRA) administers these benefits, and treatment costs are typically funded through the 'treatment and care' category.
SIRA guidelines state that treatment costs must be directly related to the injury and supported by medical evidence. For example, if your shoulder injury requires a physiotherapist to rebuild strength, the cost of those sessions is generally covered. However, the scheme does not cover treatment for pre-existing conditions or injuries unrelated to the accident.
What Documentation is Required for Shoulder Injury Claims?
To claim treatment costs under the CTP scheme, you must provide evidence that the injury is a direct result of the accident. This includes:
- Medical records confirming the shoulder injury
- A diagnosis linking the injury to the accident
- Receipts or invoices for treatment costs
- Police reports or accident reports
- Witness statements if available
SIRA requires these documents to assess whether the treatment is 'reasonably necessary' and 'directly related' to the injury. For instance, if your shoulder injury was caused by a collision and you received treatment for it, the costs of that treatment are generally funded.
Time Limits and Dispute Options
You must notify SIRA of your claim within 52 weeks of the accident. If your injury is classified as a 'threshold injury' (a minor injury under the Motor Accident Guidelines), treatment benefits are typically limited to 52 weeks. However, this does not apply to all shoulder injuries, only those meeting the specific criteria outlined in the guidelines.
If SIRA denies your claim or you disagree with the assessment, you can request a review. In some cases, legal advice may be necessary to challenge a decision, especially if the injury involves complex treatment or long-term care.
When to Seek Legal Advice
While the CTP scheme covers many treatment costs, not all claims are straightforward. For example, if your shoulder injury involves a rotator cuff tear or requires surgery, the treatment costs may be higher, and SIRA's assessment may vary. A legal professional can help ensure you meet all requirements and understand your options.
Example: Funding for Shoulder Physiotherapy
Consider a scenario where a driver collides with a car and sustains a shoulder injury. The driver receives physiotherapy for six weeks to rebuild strength. Under the CTP scheme, the cost of these sessions is generally funded, provided the physiotherapist documents the injury's connection to the accident. However, if the injury was pre-existing, the treatment costs may not be covered.
Next Steps
CTP entitlements depend on the accident date, injury type, and claim history. To request contact about your circumstances, complete the quick, no obligation enquiry form.