Disputes About Travel and Accommodation Costs in NSW CTP Claims
If you were injured in a motor accident in New South Wales and had to travel or stay away from home to receive medical treatment, you may be entitled to claim reasonable travel and accommodation expenses under the Compulsory Third Party (CTP) insurance scheme. These costs are part of the treatment and care benefits available under the Motor Accident Injuries Act 2017 (MAIA). Disputes may arise when an insurer denies the claim, reduces the amount payable, or fails to respond. In Greater Sydney, claimants can use formal dispute resolution processes managed by the State Insurance Regulatory Authority (SIRA) to seek a binding decision.
How to Resolve a Dispute About Travel and Accommodation Expenses
The primary process for resolving disputes over travel and accommodation costs is through the Personal Injury Commission (PIC), an independent tribunal established under the MAIA. The PIC has jurisdiction to review decisions made by CTP insurers, including those involving the reasonableness and necessity of travel and accommodation expenses.
The process begins with an internal review by the insurer. You must request this review in writing within 28 days of receiving a decision that denies or reduces your claim. If the internal review does not resolve the dispute, you may apply to the PIC for a formal determination. The application must be made within 12 months of the insurer’s initial decision. Missing this deadline may prevent access to a binding resolution.
What the Personal Injury Commission Considers
The PIC assesses whether travel and accommodation expenses were reasonable and necessary. It examines the distance travelled, the mode of transport, the cost of accommodation, and whether the treatment was medically required. For example, if you live in the Eastern Suburbs and must travel to a specialist in the Central Coast for treatment, the PIC will consider whether the travel was essential and whether the cost was appropriate for the journey and stay.
The PIC may also consider whether equivalent treatment was available closer to home. However, if a medical practitioner has confirmed that specialist care is only available at a distant location, the claim is more likely to be upheld. The Commission may require evidence such as itemised receipts for travel and accommodation, a medical letter confirming the need for treatment, and a travel log showing dates, locations, and reasons for travel.
Practical Steps to Take
To strengthen your claim and meet procedural requirements:
- Submit a written request for an internal review to the insurer within 28 days of receiving a decision.
- Preserve all original documentation, including receipts, booking confirmations, and medical letters.
- Maintain a travel log detailing each journey, including dates, departure and destination points, and purpose.
- If the internal review is unsuccessful, apply to the Personal Injury Commission within 12 months of the insurer’s decision.
You may seek assistance from a legal practitioner or independent claims assessor to help prepare your evidence and submissions. The PIC does not provide legal representation, but it offers guidance on how to present a case.
When to Seek Independent Advice
Disputes over travel and accommodation costs can be complex, particularly when the insurer challenges the reasonableness of the expenses. A clear paper trail and medical evidence significantly strengthen your position. However, the PIC does not guarantee a favourable outcome, and a challenge does not automatically result in a change to the insurer’s decision.
If the claim involves a substantial amount, or if the insurer has refused to pay a significant portion of the expenses, it may be prudent to seek advice from a legal practitioner or claims assessor experienced in CTP law and SIRA’s dispute resolution processes. The decision to seek advice should not delay the submission of a formal application to the PIC.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.