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).
If you're disputing a treatment provider's assessment of your ability to return to daily activities after a motor accident in NSW, you're not alone. This article explains how SIRA evaluates such disputes, what evidence is needed to support your claim, and when to seek legal advice. The focus is on resolving conflicts between claimants and treatment providers under the NSW CTP scheme.
How SIRA Handles Treatment Provider Disputes
SIRA assesses disputes by examining medical documentation to determine whether a claimant's restricted daily activities meet the threshold for compensation. Under the Motor Accident Injuries Act 2017, treatment providers must provide evidence that supports their assessment of functional recovery. If there's a disagreement about the medical evidence, SIRA will review the records to decide whether the claimant is entitled to additional benefits or a revised treatment plan.
Key factors SIRA considers include:
- Medical reports detailing the claimant's ability to perform daily tasks
- Evidence of restricted activities (e.g., inability to walk, cook, or manage personal care)
- Whether the treatment provider's assessment aligns with the Motor Accident Guidelines
Evidence to Prove Restricted Daily Activities
To challenge a treatment provider's assessment, you'll need to provide clear evidence that your daily activities are restricted. This includes:
- Detailed medical records from your treating practitioner
- Statements from family members or carers about your functional limitations
- Evidence of reduced mobility or pain affecting daily tasks
- Any documentation from the treatment provider that contradicts their assessment
For example, if a treatment provider claims you can return to work but your medical records show persistent pain preventing this, you may need to submit additional evidence to support your case.
Time Limits and Dispute Resolution Options
There are strict time limits for CTP claims. Most disputes must be resolved within 52 weeks of the accident, as weekly benefits and treatment benefits are generally limited after this period under the Motor Accident Injuries Act 2017. If your claim is denied or capped, you can:
- Request a review from SIRA
- Seek a second medical opinion
- Lodge a formal dispute with the Personal Injury Commission
However, it's important to note that disputing a treatment provider's assessment does not guarantee a change in their decision. SIRA will evaluate the evidence based on the Motor Accident Guidelines and the specific facts of your case.
When to Seek Legal Advice
If you're unsure whether your evidence meets SIRA's requirements or if your dispute is taking longer than expected, it's wise to consult a legal professional. A solicitor can help you:
- Identify gaps in your evidence
- Challenge improper treatment assessments
- Navigate the CTP claims process
Final Steps
CTP disputes involving treatment provider assessments can be complex. Ensure you submit all relevant medical records and evidence promptly. If your claim is denied or capped, act quickly to challenge the decision before time limits expire. For personalized advice, complete the quick, no obligation enquiry form to request contact about your circumstances.