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 treatment costs with a CTP insurer on the Central Coast, retaining specific evidence is critical. Under NSW law, you must document medical records, invoices, communication with insurers, and evidence of treatment necessity to support your claim. This guide explains what records to keep, how to preserve them, and when to seek legal advice.
What Evidence Matters in CTP Treatment Disputes?
CTP insurers may dispute treatment costs or refuse approval. To challenge this, you must provide evidence that the treatment is medically necessary and directly related to your injury. Key documents include:
- Medical records showing diagnosis, treatment plan, and progress notes
- Invoices from healthcare providers with itemized costs
- Communication with insurers, including letters and emails
- Witness statements from doctors or specialists confirming treatment necessity
- Accident reports and medical opinions linking treatment to the accident
How to Document Treatment Costs Under NSW CTP Rules
Under the Motor Accident Injuries Act 2017, you must prove treatment is 'reasonably necessary' for your injury. Keep records showing:
- Dates of all treatment sessions
- Specific treatments provided (e.g., physiotherapy, scans, medications)
- Correspondence with insurers disputing cost caps or rejections
- Evidence of alternative treatment options explored
SIRA Guidelines for Evidence Retention
SIRA (State Insurance Regulatory Authority) advises claimants to:
- Submit all medical records within 52 weeks of the accident (unless extended)
- Keep copies of all correspondence with insurers
- Document any delays in treatment approval
- Retain receipts for out-of-pocket expenses
Practical Steps to Preserve Evidence
- Organise documents by date and treatment type
- Photograph any damaged equipment or facilities where treatment occurred
- Request written confirmation from insurers about denied claims
- Consult a medical expert if insurers dispute the need for treatment
When to Seek Legal Advice
If insurers refuse to approve treatment or dispute costs, you may need to:
- Request a review of the insurer's decision
- Challenge the decision through the Personal Injury Commission
- Seek legal assistance to dispute a 'no claim' decision
Example Scenario
A cyclist on the Central Coast receives physiotherapy for a soft-tissue injury. The insurer rejects the treatment, claiming it's 'not cost-effective'. The claimant must provide:
- A doctor's note confirming the treatment is 'reasonably necessary'
- Evidence of alternative treatments explored
- Records showing the treatment was recommended within 52 weeks
Time Limits and Dispute Options
CTP insurers must respond to claims within 28 days under the Motor Accident Injuries Act 2017. If you believe your treatment was wrongly denied, you can:
- Request a review of the insurer's decision
- Lodge a complaint with SIRA
- Seek legal advice to challenge the decision
Next Steps
CTP treatment disputes depend on the date of the accident, injury type, and evidence retained. To request contact about your circumstances, complete the quick, no obligation enquiry form.