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).
Spinal injuries in motor accidents in New South Wales may qualify for treatment funding under the Compulsory Third Party (CTP) scheme, but claimants must understand how the NSW government funds medical expenses. This article explains how injured individuals in regional NSW can claim treatment costs for spinal injuries, what evidence is required, and how to navigate the claims process under SIRA guidelines.
How SIRA Funds Treatment Costs for Spinal Injuries
Under the NSW CTP scheme, treatment costs for spinal injuries are funded through the State Insurance Regulatory Authority (SIRA). SIRA covers medical treatment, physiotherapy, and specialist care for injuries that meet the 'threshold injury' criteria outlined in the Motor Accident Guidelines. For spinal injuries, this includes conditions like herniated discs, spinal cord damage, or nerve-related impairments that require ongoing treatment.
SIRA's funding is limited to 'treatment and care benefits, ' which cover medical expenses directly related to the injury. This includes scans, consultations, and rehabilitation. However, claims for treatment costs must be submitted within 52 weeks of the accident, as per the Motor Accident Injuries Act 2017. After this period, benefits are generally limited unless the injury is classified as a 'whole person impairment' (WPI) of 10% or more.
Evidence Required for Spinal Injury Claims
To claim treatment costs for a spinal injury, claimants must provide:
- Medical records confirming the injury and treatment
- A diagnosis of a threshold injury under the Motor Accident Guidelines
- Evidence of ongoing treatment needs (e.g., physiotherapy records)
- Proof of the accident (e.g., police report, witness statements)
In regional NSW, access to specialist care may be limited, so claimants should ensure they receive treatment from registered medical practitioners. SIRA may require a second opinion if the injury's severity is disputed.
Practical Steps for Regional Claimants
Claimants in regional areas should:
- Seek immediate medical attention to document the injury
- Keep all medical records and treatment receipts
- Notify the at-fault driver's insurer within 52 weeks of the accident
- Submit a claim through SIRA's online portal or by mail
Regional claimants may face additional challenges, such as longer travel times to specialist clinics. In such cases, SIRA may approve alternative treatment arrangements if the injury requires ongoing care.
Time Limits and Dispute Resolution
The 52-week time limit for treatment benefits applies to all spinal injury claims under the CTP scheme. After this period, claimants may need to pursue a separate common law damages claim if their injury meets the WPI threshold. However, this requires independent legal advice, as the CTP scheme does not cover compensation for pain and suffering.
If a claim is disputed, claimants can request a review by SIRA or seek mediation through the NSW Civil and Administrative Tribunal (NCAT). It is essential to act quickly, as delays can reduce the chances of securing funding for treatment.
When to Seek Legal Advice
While SIRA provides a clear framework for funding treatment costs, claimants should consult a solicitor if:
- Their injury exceeds the threshold injury criteria
- They face disputes over the extent of their treatment needs
- They want to pursue additional compensation for long-term impairments
Legal professionals can help claimants understand their rights under the CTP scheme and ensure they meet all requirements for funding.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.