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've suffered a shoulder injury in a car accident in NSW, you may be eligible for funding to cover medical treatment costs through the Compulsory Third Party (CTP) scheme. The NSW CTP scheme, governed by the Motor Accident Injuries Act 2017, provides financial support for injuries caused by motor vehicle accidents. This article explains what treatment costs are covered, how to claim funding, and the evidence needed to support your claim.
What Treatment Costs Are Covered Under NSW CTP Claims?
The CTP scheme covers medical treatment costs for injuries sustained in a motor vehicle accident. For shoulder injuries, this includes:
- Medical consultations with doctors, physiotherapists, and specialists
- Diagnostic tests like X-rays, MRIs, and ultrasounds
- Physiotherapy and rehabilitation sessions
- Medication prescribed for pain management
- Medical equipment such as braces or slings
Under the Motor Accident Guidelines, soft tissue injuries like rotator cuff tears or shoulder trauma are classified as 'threshold injuries' if they meet specific clinical criteria. These injuries are eligible for treatment funding under the CTP scheme, but benefits may be limited after 52 weeks if they are the only injuries.
How to Claim Funding for Shoulder Injury Treatment
To claim funding for shoulder injury treatment, you must:
- Seek immediate medical attention to document the injury. A medical report from a registered medical practitioner is essential.
- Notify your insurer or the at-fault driver's insurer within 52 weeks of the accident. Delays may affect your ability to claim certain benefits.
- Submit evidence of your treatment costs, including invoices, receipts, and medical records. SIRA (State Insurance Regulatory Authority) requires these documents to assess your claim.
- Complete the CTP claim form through SIRA's online portal or by contacting their claims team.
Evidence Needed for a Shoulder Injury CTP Claim
To support your claim, you'll need to provide:
- Medical records confirming the shoulder injury and its connection to the accident
- Accident report from the police or insurance company
- Witness statements if available
- Photographs of the accident scene or injury
- Income records if you're claiming lost wages
For example, if you sustained a rotator cuff tear requiring physiotherapy, your treating doctor's notes must detail the injury, treatment plan, and how it relates to the accident. This evidence helps SIRA determine the scope of your treatment costs.
Time Limits and Disputes
CTP claims must be submitted within 52 weeks of the accident for certain benefits. If your injury is classified as a 'threshold injury' (e.g., a minor rotator cuff tear), treatment benefits may stop after 52 weeks unless you have a major injury or long-term impairment.
If you dispute the assessment of your claim, you can request a review through SIRA or seek legal advice. A solicitor can help you challenge an adverse decision or negotiate a fair outcome.
When to Seek Legal Advice
Consult a legal professional if:
- You're unsure whether your injury qualifies for CTP funding
- Your claim has been denied or is under review
- You need help navigating the SIRA claims process
- You have a complex injury requiring long-term treatment
Legal experts can also help you understand how your injury compares to the threshold injury criteria and whether you're eligible for additional benefits.
Next Steps
CTP funding for shoulder injuries depends on the nature of your injury, the timing of your claim, and the evidence you provide. If you're unsure about your options, contact LegalAdvice.com.au for a free, no-obligation assessment of your circumstances. Every claim depends on its own facts, and the right guidance can help you secure the support you need.