What travel and accommodation costs are covered under NSW CTP claims for rehabilitation?
A threshold injury under the Motor Accident Injuries Act 2017 (NSW) includes a soft tissue injury and a psychological or psychiatric injury that is not a recognised psychiatric illness (adjustment disorder and acute stress disorder are the usual examples; s 1.6 and Motor Accident Guidelines Part 5).
In New South Wales, the Compulsory Third Party (CTP) scheme covers travel and accommodation expenses incurred for treatment and rehabilitation following a motor accident. These costs are funded by the insurer of the at-fault driver, not the claimant’s own insurance. Under the Motor Accident Injuries Act 2017, claimants may receive reimbursement for necessary travel to and from medical appointments, as well as overnight accommodation if treatment requires overnight stays. However, eligibility depends on the nature of the injury, the necessity of the travel, and adherence to SIRA’s guidelines.
How SIRA determines eligibility for travel and accommodation costs
The State Insurance Regulatory Authority (SIRA) oversees the CTP scheme and provides detailed guidelines on what is covered. For travel costs, SIRA considers:
- Necessity: Travel must be essential for treatment, such as attending specialist appointments or therapy sessions.
- Reasonable expenses: Costs must be proportionate to the distance travelled and the mode of transport (e.g., taxi, bus, or car travel).
- Documentation: Claimants must provide receipts, medical records, and a treatment plan to justify the travel.
For accommodation, SIRA requires:
- Overnight stays: Expenses are only covered if treatment necessitates an overnight stay, such as for intensive therapy or overnight hospitalization.
- Accommodation type: Costs must relate to a registered medical facility or approved rehabilitation center.
- No luxury claims: Expenses for luxury hotels or non-essential upgrades are not covered.
Practical steps for claimants in Newcastle and Hunter
Claimants in the Newcastle and Hunter regions should take the following steps to document and claim travel and accommodation costs:
- Keep detailed records: Retain all receipts for travel (e.g., taxi invoices, bus tickets) and accommodation (e.g., hotel bills).
- Obtain medical documentation: Ensure your treating medical practitioner provides a written statement confirming the necessity of travel or accommodation for your treatment.
- Submit claims promptly: Notify your insurer of your intention to claim travel and accommodation costs within the 52-week statutory period for threshold injuries (see below).
- Seek clarification: If unsure about coverage, contact SIRA directly or consult a legal professional to avoid disputes.
Time limits and disputes
Under the Motor Accident Injuries Act 2017, claimants must submit their CTP claim within 52 weeks of the accident if the injury is classified as a threshold injury. For non-threshold injuries, the 52-week limit does not apply, but all claims must be submitted within 5 years of the accident. Delays can jeopardize eligibility for certain benefits.
If a claimant disputes a decision regarding travel or accommodation costs, they can request a review through SIRA. The review process involves submitting additional evidence and may require a formal application to the NSW Civil and Administrative Tribunal (NCAT) if the matter escalates.
Example: Rehabilitation costs in the Hunter region
Consider a claimant in the Hunter region who requires weekly physiotherapy sessions at a specialist clinic in Newcastle. The travel time is 45 minutes by car, and the claimant incurs taxi fares to attend these sessions. Under SIRA’s guidelines, these taxi costs would be reimbursed as they are necessary for treatment. However, if the claimant chooses to stay overnight in Newcastle for a therapy session, the accommodation cost would also be covered, provided the medical team deems it necessary.
When to seek legal advice
While SIRA provides clear guidelines, claimants may face challenges in documenting their expenses or understanding their rights. Legal professionals can assist with:
- Navigating SIRA’s complex claim process.
- Challenging decisions that deny or limit coverage.
- Ensuring compliance with time limits and procedural requirements.
Next steps
CTP entitlements depend on the specific circumstances of each claim, including the date of the accident, the nature of the injury, and the evidence provided. To request contact about your circumstances, complete the quick, no obligation enquiry form.