What travel and accommodation costs are covered 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).
In New South Wales, the Personal Injury Commission (PIC) covers travel and accommodation costs for treatment related to a motor accident under the Compulsory Third Party (CTP) scheme. This includes reasonable expenses for medical appointments, specialist visits, and overnight stays if required for treatment. The exact amount depends on the nature of the injury, the necessity of the travel, and the guidelines set by the State Insurance Regulatory Authority (SIRA).
NSW CTP rules governing travel and accommodation claims
Under the Motor Accident Injuries Act 2017, the PIC must cover travel and accommodation costs that are 'reasonably necessary' for treatment. SIRA guidelines specify that costs must be directly related to medical care and not for convenience. For example, travel to a specialist clinic or overnight stays at a hospital are generally covered, but discretionary travel (e.g., visiting family) is not.
Key considerations include:
- Reasonable necessity: Costs must be essential for treatment, not for comfort or convenience.
- Documentation: Medical records must explicitly link travel/accommodation to treatment.
- SIRA's internal review: Disputes over costs are resolved through SIRA's internal review process, not the courts.
Practical steps and evidence to support claims
To claim travel and accommodation costs, you must provide:
- Medical records confirming the need for travel or overnight stays.
- Receipts or invoices for travel expenses (e.g., taxi fares, train tickets).
- Accident reports or witness statements supporting the necessity of the travel.
- Proof of accommodation costs (e.g., hotel receipts, booking confirmations).
If the PIC disputes the claim, you may need to submit additional evidence, such as a doctor's note explaining why the travel was essential.
Time limits, disputes and when to seek advice
Claims must be submitted within 52 weeks of the accident if they involve only 'threshold injuries' (minor injuries under SIRA guidelines). For more severe injuries, there is no strict time limit, but delays can reduce the chances of a successful claim.
If the PIC rejects a claim, you can request an internal review with SIRA. However, it's important to note that challenges do not guarantee a changed decision. In complex disputes, seeking legal advice is advisable to ensure your rights are protected.
Example: Dispute over overnight accommodation
Consider a scenario where a person in Ballina requires surgery in Sydney. The PIC may dispute the cost of a hotel stay if the medical records do not explicitly state that overnight accommodation was necessary for treatment. In such cases, providing a detailed explanation from the treating doctor can help resolve the dispute.
Next steps
Understanding what travel and accommodation costs are covered under NSW CTP claims can help you prepare a strong case. However, each claim is unique, and disputes often require careful review of medical evidence and SIRA guidelines. To request contact about your circumstances, complete the quick, no obligation enquiry form.