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).
Residents of Bathurst, NSW who suffered shoulder injuries in a car accident may be eligible to claim funding for treatment costs under the NSW Compulsory Third Party (CTP) scheme. The CTP scheme covers medical expenses, including physiotherapy, scans and specialist consultations, as long as the injury is directly related to the accident. This article explains how to claim treatment costs, what evidence is needed and how SIRA guidelines apply to shoulder injuries in rural NSW.
How CTP Covers Shoulder Injury Treatment Costs
Under the Motor Accident Injuries Act 2017, the CTP scheme funds treatment costs for injuries caused by motor vehicle accidents. Shoulder injuries, such as rotator cuff tears or dislocations, are typically covered if they result from a collision. SIRA guidelines state that treatment costs must be directly related to the injury and medically necessary. This includes diagnostic imaging, physiotherapy, occupational therapy and specialist consultations. For example, a patient with a torn rotator cuff may claim funding for MRI scans and rehabilitation sessions.
Practical Steps to Claim Treatment Funding
To claim treatment costs, injured persons must: 1) Obtain medical records documenting the injury and treatment plan, 2) Keep receipts for all medical expenses, 3) Notify the at-fault driver’s insurer within 52 weeks of the accident, and 4) Submit a claim through SIRA’s online portal. Evidence such as accident reports, witness statements and photographs of the scene can strengthen the claim. If treatment costs exceed the 52-week limit for threshold injuries, claimants may need to pursue a common law damages claim separately.
SIRA Guidelines for Shoulder Injuries in Bathurst
SIRA’s What You Can Claim page confirms that treatment costs are covered for injuries meeting the 'threshold injury' definition in the Motor Accident Guidelines. Shoulder injuries are classified as threshold injuries if they involve soft tissue damage, such as sprains or strains, but not fractures or dislocations. For more severe injuries like a torn rotator cuff, claimants may qualify for long-term benefits. Rural areas like Bathurst may face delays in processing claims, so it’s important to submit documentation promptly.
Time Limits and Dispute Resolution
Claimants must notify the insurer within 52 weeks of the accident to claim treatment costs under the CTP scheme. If a dispute arises over the validity of the injury or treatment costs, claimants can request a review through SIRA’s dispute resolution process. In some cases, legal advice may be necessary to challenge an insurer’s decision to limit benefits.
When to Seek Independent Advice
While the CTP scheme covers many treatment costs, claimants should seek legal advice if they believe their injury meets the 'whole person impairment' threshold or if treatment costs exceed the 52-week limit. A solicitor can also help navigate disputes with insurers and ensure all evidence is submitted correctly.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.