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 traumatic brain injury (TBI) in a motor vehicle accident in Newcastle or Hunter, you may be eligible for treatment cost funding through NSW's Compulsory Third Party (CTP) scheme. This article explains how SIRA funds medical expenses for TBI claims, outlines the process for seeking treatment costs, and highlights key considerations under NSW law.
What Treatment Costs Are Covered for TBI Claims?
Under the NSW CTP scheme, SIRA funds treatment costs related to a traumatic brain injury. Eligible expenses include:
- Medical consultations and specialist appointments
- Diagnostic tests (e.g., MRI scans, CT scans)
- Rehabilitation therapy (physical, occupational, speech)
- Medications prescribed for TBI-related symptoms
- Assistive devices (e.g., mobility aids, communication tools)
- Transportation to and from medical appointments
SIRA covers both immediate and long-term treatment costs, provided they are directly related to the injury. For example, a patient requiring ongoing cognitive therapy would have their treatment expenses funded through the CTP scheme.
How Are TBI Treatment Costs Assessed Under NSW Guidelines?
SIRA applies the Motor Accident Guidelines 2023 to assess treatment needs. A medical practitioner must confirm the TBI meets the 'threshold injury' criteria, which includes:
- A diagnosis of traumatic brain injury
- Clinical evidence of neurological impairment
- A documented impact on daily functioning
The guidelines also specify that treatment must be 'reasonably necessary' and 'directly related' to the injury. For instance, a patient with post-concussion syndrome requiring cognitive assessments would qualify for funding, while unrelated mental health treatment might not.
Practical Steps for Claiming TBI Treatment Costs
To claim treatment costs in Newcastle or Hunter:
- Document all medical records - Ensure your treating physician documents the TBI and its impact on your daily life.
- Keep receipts and invoices - Retain all records of treatment costs, including prescriptions and therapy sessions.
- Notify SIRA promptly - Submit a claim through SIRA's online portal within 52 weeks of the accident (or 10 years if the injury wasn't discovered immediately).
- Request a treatment plan - Provide a detailed plan outlining the necessity of each treatment, including expected outcomes.
Time Limits and Dispute Resolution
You have 52 weeks from the accident date to claim treatment costs under the CTP scheme. If your injury wasn't discovered within this period, you may still have a claim if you can prove the injury was not reasonably discoverable within 52 weeks.
If SIRA disputes your claim, you can request a review by submitting new evidence. For complex cases involving long-term treatment needs, seeking legal advice early is advisable to ensure all documentation meets the scheme's requirements.
When to Seek Independent Advice
While SIRA provides a clear funding framework, claims involving complex TBI cases may require legal assistance. A solicitor can help:
- Navigate the claims process
- Challenge denied claims
- Ensure all treatment costs are included
- Understand long-term implications of your injury
Final Considerations
NSW CTP funding for TBI treatment is based on objective medical evidence and the Motor Accident Guidelines. While the scheme covers a wide range of treatment costs, disputes often arise over the necessity of specific therapies. If you're unsure whether your treatment costs qualify, contact SIRA directly or seek legal advice to explore your options.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.