If you're disputing travel or accommodation costs under a NSW Compulsory Third Party (CTP) claim, understanding your options is critical. Under the Motor Accident Injuries Act 2017, claimants may seek reimbursement for reasonable travel and overnight stays related to medical treatment. Disputes over these costs often arise when insurers question the necessity, frequency, or cost of trips. This article explains how to resolve such disputes in Bathurst, including SIRA’s guidelines, formal review processes, and when to seek legal advice.
What Travel and Accommodation Costs Are Covered?
Under NSW CTP rules, you may claim travel expenses for medical appointments, including taxi fares, public transport costs, and car parking. Overnight stays are allowed if treatment requires overnight hospital admission or if travel to a specialist necessitates overnight accommodation. SIRA’s guidelines (https://www.sira.nsw.gov.au/claims/motor-accidents/what-you-can-claim) specify that expenses must be 'reasonable' and directly related to treatment. For example, a claimant with a fractured leg requiring a specialist MRI in Sydney might be reimbursed for a one-way train ticket and overnight stay, but not for a luxury hotel.
How SIRA Handles Disputes Over These Costs
SIRA assesses claims based on the 'reasonable necessity' test. If an insurer denies a claim, you can request a written explanation and submit additional evidence, such as medical records or receipts. SIRA’s internal review process allows claimants to challenge decisions by submitting a formal objection within 28 days of receiving the response. For instance, if an insurer rejects a claim for a 100km trip to a specialist, you could provide a doctor’s note confirming the necessity of the journey.
Formal Dispute Resolution Options in Bathurst
- Internal Review: Start by requesting a review of the insurer’s decision using the form on SIRA’s website. This is free and must be submitted within 28 days.
- Mediation: If the dispute persists, you may seek mediation through the NSW Civil and Administrative Tribunal (NCAT). Mediation is voluntary but can help resolve conflicts without court.
- a Formal Complaint: If mediation fails, you can file a complaint with the Financial Ombudsman Service (FOS) or the NSW Ombudsman. These bodies can investigate and recommend resolution.
- Court Action: As a last resort, you may pursue a court claim, though this is costly and time-consuming. Courts will assess whether the insurer’s refusal was unreasonable.
Practical Steps to Challenge Denied Costs
To challenge a denied claim, gather evidence such as:
- Medical records confirming the need for travel or accommodation.
- Receipts for travel and accommodation expenses.
- Witness statements from healthcare providers or family members.
- Communication with the insurer showing the denial of your claim.
For example, if an insurer refuses to cover a trip to a physiotherapist, a doctor’s note stating that the treatment is essential for recovery could overturn the decision.
Time Limits and When to Seek Advice
You have 28 days to request an internal review of a denied claim. If the insurer fails to respond within this timeframe, you may need to escalate the matter. Delays in resolving disputes can affect your ability to claim benefits, especially if your injury requires ongoing treatment. Seek legal advice if the insurer’s refusal is based on unclear reasoning or if you face repeated rejections.
Example of a Dispute Resolution Pathway
Consider a claimant in Bathurst who was denied reimbursement for a 200km trip to a specialist in Sydney. After submitting a doctor’s note confirming the necessity of the trip, the insurer agreed to cover the cost. This example shows how evidence and communication can resolve disputes without escalating to formal complaints.
Next Steps
CTP disputes over travel and accommodation costs depend on the specific circumstances of your claim. While SIRA provides clear guidelines, resolving conflicts often requires evidence, negotiation, and sometimes legal intervention. To request contact about your circumstances, complete the quick, no obligation enquiry form.