Traumatic brain injury treatment under NSW CTP claims
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).
Traumatic brain injuries (TBIs) following motor vehicle accidents in New South Wales are covered under the Compulsory Third Party (CTP) scheme. SIRA’s guidelines outline how treatment and rehabilitation planning are funded for TBIs, but the process depends on medical evidence, injury severity, and claim timing. This article explains what treatment options are available, how rehabilitation planning works, and steps to ensure funding.
Key CTP rules for traumatic brain injuries
Under the Motor Accident Injuries Act 2017, CTP claims cover treatment for injuries caused by motor vehicle accidents. For TBIs, treatment includes medical care, therapy, and rehabilitation services. SIRA’s guidelines specify that rehabilitation planning must be based on a medical practitioner’s assessment of the injury’s impact. This includes:
- Neurological assessments to confirm TBI severity
- Rehabilitation goals tied to functional recovery
- Ongoing treatment for cognitive, physical, or emotional impairments
The CTP scheme does not cover treatment for injuries not directly caused by the accident. For example, pre-existing conditions or injuries from unrelated incidents are excluded.
Practical steps for treatment and rehabilitation funding
To ensure treatment and rehabilitation are funded under CTP, injured individuals should:
- Seek immediate medical attention and document all treatment records. A specialist’s report confirming TBI is essential.
- Provide evidence of rehabilitation needs. This includes:
- Doctor’s notes outlining recovery goals
- Rehabilitation plans with timelines
- Evidence of ongoing treatment costs
- Notify the at-fault driver’s insurer within 52 weeks of the accident. Delays may affect funding for long-term care.
SIRA’s guidelines emphasize that rehabilitation planning must be ‘reasonably necessary’ and ‘proportionate’ to the injury. For example, a TBI requiring speech therapy or cognitive retraining is typically funded, while cosmetic treatments are not.
Time limits and dispute resolution
CTP claims must be submitted within 52 weeks of the accident. If treatment extends beyond this period, benefits may be limited unless the injury is classified as a ‘threshold injury’ under the Motor Accident Guidelines. For TBIs, which are classified as serious injuries, this rule does not apply. However, disputes over treatment funding may arise if:
- The insurer disputes the necessity of rehabilitation
- Medical records are incomplete or delayed
- The claimant fails to meet CTP’s evidentiary standards
In such cases, independent medical assessments or legal review may be required. SIRA provides a dispute resolution process for claims under the Motor Accident Injuries Act 2017.
Example: Rehabilitation planning for a TBI claim
Consider a scenario where a cyclist sustains a TBI after a car accident. The injured person’s treatment includes:
- Emergency care for head trauma
- Neurological scans confirming TBI
- Cognitive therapy to address memory loss
- Vocational rehabilitation to return to work
Under CTP, all these treatments are funded if the medical team documents their necessity. However, if the claimant delays seeking treatment or fails to provide rehabilitation plans, the insurer may dispute funding.
When to seek legal advice
CTP claims for TBIs can be complex, especially when disputes arise over treatment funding or rehabilitation planning. Legal advice is recommended if:
- The claimant is unsure whether their injury qualifies
- The insurer denies a claim without explanation
- The injured person needs help preparing medical evidence
A solicitor can help navigate SIRA’s guidelines and ensure all requirements are met.
Next steps
CTP claims for traumatic brain injuries depend on accurate medical documentation, timely submission, and adherence to SIRA’s guidelines. If you or a loved one has suffered a TBI in a motor accident, it is important to:
- Gather all medical records and treatment plans
- Submit a claim within 52 weeks of the accident
- Seek legal advice if the claim is denied or disputed
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.