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).
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 spinal injury in a motor accident in NSW, you may be eligible for treatment costs covered under the Compulsory Third Party (CTP) scheme. This article explains how SIRA funds treatment for spinal injuries, what evidence is needed, and practical steps for claimants in Armidale.
How SIRA Funds Spinal Injury Treatment
Under the Motor Accident Injuries Act 2017, the NSW CTP scheme covers treatment costs for injuries resulting from motor vehicle accidents. For spinal injuries, SIRA evaluates coverage based on medical reports and the Motor Accident Guidelines. This includes:
- Medical treatments like physiotherapy, chiropractic care, and specialist consultations
- Rehabilitation services and equipment (e.g., braces, mobility aids)
- Transportation to medical appointments
SIRA uses the 'whole person impairment' assessment in the Motor Accident Guidelines to determine coverage. For example, if a spinal injury causes chronic pain requiring ongoing therapy, treatment costs may be funded.
Practical Steps for Claimants in Armidale
- Notify your insurer immediately after the accident. SIRA requires a claim form (Form 1) within 52 weeks of the incident.
- Document all medical records. Keep copies of treatment plans, specialist reports, and invoices. SIRA may request these to assess coverage.
- Seek independent medical opinions if your treatment plan is disputed. SIRA may arrange an independent assessment.
- Submit a claim through SIRA's online portal or by post. Include details of your treatment needs and how they relate to the spinal injury.
Time Limits and Dispute Resolution
You must notify SIRA of your claim within 52 weeks of the accident. If your claim is denied, you can:
- Request a review within 28 days of receiving the decision
- Apply to the NSW Civil and Administrative Tribunal (NCAT) for a review
- Seek legal advice if your claim involves complex issues like long-term care needs
When to Seek Legal Advice
Consult a solicitor if:
- Your treatment costs exceed the 52-week benefit limit
- You need assistance with dispute resolution
- You have overlapping claims with workers' compensation or other schemes
Example Scenario
A car accident in Armidale causes a spinal injury requiring three months of physiotherapy. SIRA would fund the treatment if medical reports confirm the injury is directly related to the accident. However, if the injury is classified as a 'threshold injury' (under the Motor Accident Guidelines), benefits may be limited after 52 weeks.
Next Steps
Time limits and coverage rules depend on the accident date and injury type. To discuss your circumstances, complete the quick, no obligation enquiry form. Every claim depends on its own facts.