Under NSW's Compulsory Third Party (CTP) scheme, claimants may seek reimbursement for travel and accommodation costs related to medical treatment following a motor accident. However, disputes over what expenses are covered are common, particularly in regional areas like Newcastle and Hunter. This guide explains what the Personal Injury Commission (PIC) typically considers reasonable, how to support your claim, and steps to take if your insurer disagrees.
What Travel and Accommodation Costs Are Covered?
The CTP scheme covers travel and accommodation expenses that are reasonably necessary for medical treatment. This includes:
- Travel costs for attending medical appointments, such as taxi fares, public transport tickets, or car hire for essential travel.
- Accommodation costs for overnight stays if treatment requires overnight attendance (e.g., specialist appointments, overnight rehabilitation).
- Transport to and from treatment if it is not practical to travel by public transport or personal vehicle.
The PIC evaluates these costs based on the necessity of the expense and whether it aligns with the treatment plan. For example, a 30-minute drive to a clinic would not justify a hotel stay, but a 2-hour journey to a specialist in a remote area might.
How PICs Assess Reasonableness in Disputes
PICs use the Motor Accident Guidelines to determine what is reasonable. Key factors include:
- Medical necessity: Evidence from healthcare providers confirming the travel/accommodation is essential for treatment.
- Cost-effectiveness: Whether the chosen mode of transport or accommodation is the most cost-efficient option.
- Documentation: Receipts, medical records, and travel itineraries must clearly link the expense to the treatment.
In disputes, insurers may challenge claims by arguing the cost is excessive or not directly related to treatment. For instance, a claimant might dispute a PIC decision to deny travel costs for a 15-minute trip, arguing that public transport was unavailable.
Practical Steps to Resolve Disputes
If your insurer disputes your travel or accommodation costs, take these steps:
- Review the PIC's decision letter to understand the specific grounds for rejection.
- Gather additional evidence such as medical notes confirming treatment necessity, travel receipts, and witness statements.
- Submit a formal objection to the PIC within 28 days of receiving the decision, explaining why the cost should be approved.
- Seek independent medical review if the PIC disputes the treatment's necessity.
In Newcastle and Hunter, claimants should also consider the SIRA Regional Office for guidance on local dispute resolution processes. The PIC's regional offices in these areas may have specific procedures for handling claims.
Time Limits and When to Seek Advice
You have 28 days to challenge a PIC decision in writing. If the dispute escalates, you may need to apply for a review through the Personal Injury Commission or seek legal advice. Note that the 52-week statutory benefit period applies to weekly payments, but travel/accommodation disputes are not subject to this time limit.
Example: A Cyclist's Dispute in Hunter
Consider a cyclist injured in a Newcastle car park who requires a specialist MRI in Sydney. The PIC may dispute the cost of a taxi for the 2-hour trip. To resolve this, the claimant must provide:
- A medical report confirming the MRI is essential for treatment.
- Taxi receipts showing the fare for the 2-hour journey.
- Evidence that public transport was not a viable option (e.g., lack of wheelchair access on trains).
This example illustrates how documentation and medical necessity are central to resolving disputes.
Final Steps for Claimants
If your insurer denies travel or accommodation costs, act quickly to challenge the decision. The PIC's regional offices in Newcastle and Hunter can provide tailored advice on resolving disputes. Remember, the PIC's role is to assess the reasonableness of expenses based on the evidence, not to make decisions on the merits of your claim.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.