Understanding Travel and Accommodation Claims in NSW CTP Claims
If you were injured in a motor accident in Greater Sydney and need to travel for medical treatment, or require overnight accommodation to access that care, your CTP insurer may assess your claim for travel and accommodation expenses. Insurers decide whether to fund these costs based on the Motor Accident Injuries Act 2017 and the Motor Accident Injuries (MAI) Guidelines issued by the State Insurance Regulatory Authority (SIRA). The decision depends on whether the travel and accommodation are reasonable, necessary, and directly related to your treatment for injuries sustained in the accident.
What Factors Influence Insurer Decisions
Insurers assess travel and accommodation claims using several key criteria. First, the travel must be necessary for you to receive medical treatment that is directly related to your accident injuries. This includes travel to and from medical appointments, rehabilitation services, or specialist assessments. The cost must be reasonable in relation to the journey and the type of transport used.
Accommodation is generally only approved if it is required because the treatment location is more than 50 kilometres from your home, or if you are unable to return home on the same day due to the nature of the treatment. For example, if you need to stay overnight for a specialist assessment or a course of inpatient rehabilitation, the insurer may approve reasonable accommodation costs.
The insurer will also consider whether alternative arrangements, such as public transport or a family member’s vehicle, could have been used. The cost of travel must not exceed what is reasonable for the journey and the type of service used. For instance, a first-class train ticket or a private car service may not be approved if a standard bus or economy flight would have been sufficient.
Role of SIRA Guidelines in Decision-Making
SIRA’s Motor Accident Injuries (MAI) Guidelines provide the framework for insurer decisions on travel and accommodation. These guidelines state that travel and accommodation expenses are compensable if they are reasonable and necessary for the treatment of injuries resulting from a motor accident. The guidelines also clarify that travel must be for the purpose of receiving treatment, not for administrative or non-essential purposes.
The guidelines set out that travel expenses may include fuel, tolls, public transport fares, and reasonable parking fees. Accommodation costs must be for a standard room and must not exceed the average cost for the area and time of year. Insurers are expected to assess these costs against standard rates for Greater Sydney, which may vary depending on the suburb and the time of year.
Insurers must also consider whether the travel and accommodation were incurred in a reasonable timeframe. For example, if you delayed booking accommodation for several weeks after being advised to travel for treatment, the insurer may question the necessity or reasonableness of the claim.
Practical Steps to Support Your Claim
To improve your chances of approval for travel and accommodation costs, you should gather and preserve the following evidence:
- A medical certificate or letter from your treating practitioner confirming the need for travel and the necessity of overnight accommodation.
- A detailed itinerary showing the date, time, and purpose of each journey, including the destination and reason for travel.
- Itemised receipts for all travel and accommodation expenses, including transport tickets, hotel bills, and parking or toll receipts.
- A copy of the travel booking or confirmation, including the cost and date.
- If using a private vehicle, a record of kilometres travelled and the rate per kilometre used (as per SIRA’s prescribed rate for CTP claims).
Photographs of the treatment facility, or a note from a witness confirming your travel, may also support your claim. Always keep a copy of all correspondence with your insurer and any medical appointments.
Time Limits and Dispute Options
There is no fixed deadline for claiming travel and accommodation expenses under the CTP scheme, but it is best to submit your claim as soon as possible after incurring the costs. Delaying may make it harder to prove the connection between the travel and your accident injuries.
If your insurer refuses to pay for travel or accommodation, you may request a review of the decision. You can ask for a formal review by the insurer, or if the dispute remains unresolved, you may apply to the NSW Civil and Administrative Tribunal (NCAT) for a determination. You must keep all documentation and correspondence to support your case.
Hypothetical Example
A 38-year-old woman was injured in a car accident in North Ryde. Her treating specialist, located in the Sydney CBD, recommended a series of weekly physiotherapy sessions and a follow-up MRI at a private imaging centre in East Sydney. The specialist wrote a letter confirming that she needed to travel to these appointments for her recovery, and that she would need to stay overnight in a hotel near the clinic on two occasions due to the length of the treatment sessions.
She submitted itemised receipts for train travel, a standard hotel room, and parking. The insurer approved the travel costs but challenged the accommodation cost, arguing it was not necessary. After providing a second medical certificate confirming the need for overnight stay due to the cumulative effect of treatment on her mobility, the insurer revised its decision and approved the accommodation.
Next Steps
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.