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 your CTP claim in Balmain NSW is disputed over travel or accommodation expenses, you have legal options to resolve the issue. Under NSW law, claimants may seek reimbursement for reasonable travel costs to medical appointments and overnight stays for treatment. Disputes typically involve proving the necessity of these expenses and their direct link to the accident. This article explains how to challenge denied claims using SIRA guidelines and legal pathways.
NSW CTP Rules Governing Travel and Accommodation Claims
The Motor Accident Injuries Act 2017 (s 4.4) and SIRA guidelines define what expenses are recoverable. Travel costs include public transport fares, taxi receipts, and reasonable parking fees for medical visits. Overnight accommodation is allowed if treatment requires overnight stays, but must be directly related to the injury. SIRA’s What you can claim page confirms that these costs are recoverable under CTP, provided they are 'reasonably necessary' and documented.
Evidence to Support Your Claim
Insurers often dispute travel/accommodation costs by questioning their necessity or cost. To challenge this, you must provide:
- Original receipts for all travel and accommodation expenses
- Medical records showing the need for the treatment
- A letter from your treating medical practitioner confirming the necessity of travel
- Proof of income loss if the travel affected your work
- A timeline showing the connection between the accident and the treatment
For example, if you needed a specialist MRI in Sydney after a Balmain accident, your insurer must accept the travel cost if the MRI was essential for diagnosis.
Dispute Resolution Options
- Internal Review: First, request your insurer to review the decision in writing. SIRA guidelines require insurers to consider 'reasonably necessary' expenses, so clearly explain how your costs meet this standard.
- SIRA Mediation: If the dispute persists, contact SIRA’s dispute resolution team. They may arrange a meeting with your insurer to review your evidence.
- Formal Complaint: Submit a written complaint to the NSW Civil and Administrative Tribunal (NCAT) if the insurer refuses to reconsider. NCAT can order the insurer to pay disputed amounts.
- Legal Challenge: A solicitor may pursue a court application if the insurer ignores legal obligations. This is rare but possible under the Motor Accident Injuries Act 2017.
Time Limits and Practical Steps
You must notify your insurer of your claim within 90 days of the accident (s 3.11). If your insurer disputes your travel/accommodation costs, act quickly: SIRA guidelines state that disputes must be resolved within 28 days of the insurer’s decision. Keep all records, as the burden of proof lies with the insurer to demonstrate that your expenses are unreasonable.
When to Seek Legal Advice
Consult a solicitor if:
- Your insurer refuses to pay any travel/accommodation costs
- You have a history of denied claims
- You need to challenge a decision to stop payments after 52 weeks
- You are unsure whether your expenses meet the 'reasonably necessary' threshold
Legal professionals can help you prepare evidence, challenge unreasonable rejections, and ensure your claim aligns with SIRA’s guidelines.
Example Scenario
Imagine you suffered a soft-tissue injury in Balmain and needed to travel to a specialist in Sydney. Your insurer denied the travel cost, arguing it was 'unnecessary.' You could dispute this by:
- Submitting taxi receipts and a medical letter confirming the specialist visit was essential
- Showing that local doctors could not provide the required treatment
- Requesting an internal review and then SIRA mediation
This demonstrates how evidence and legal guidance can resolve disputes.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.