How SIRA Resolves CTP Treatment Provider Disputes in NSW
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).
- When a treatment provider disputes the terms of your Compulsory Third Party (CTP) claim in NSW, the
- State Insurance Regulatory Authority (SIRA)* oversees the resolution. SIRA ensures treatment costs align with the
- Motor Accident Injuries Act 2017* and the
- Motor Accident Guidelines*. If your provider refuses to accept approved treatment or limits services, SIRA will review your case based on medical evidence, treatment plans, and the nature of your injury.
Common Scenarios Leading to Treatment Provider Disputes
Disputes often arise when:
- A provider refuses to treat a condition deemed a 'threshold injury' under the Motor Accident Guidelines.
- A claimant requests additional therapy beyond the approved treatment plan.
- A provider caps treatment costs without medical justification.
In Bankstown, claimants have reported conflicts over physiotherapy sessions or specialist consultations. SIRA evaluates whether the treatment is 'reasonably necessary' and 'reasonably appropriate' under the guidelines.
Practical Steps for Claimants in Bankstown
To resolve disputes, gather:
- Your full medical records, including GP notes and specialist reports.
- A detailed treatment plan from your treating doctor.
- Evidence of the provider's refusal, such as correspondence or invoices.
If your provider disputes coverage, contact SIRA directly. They will assign a case manager to review your evidence and mediate between you and the provider. You may also request a medical review if your injury meets the 'whole person impairment' threshold.
Time Limits and When to Seek Advice
You have five years from the accident date to challenge a treatment decision under the Motor Accident Injuries Act 2017. However, disputes over treatment costs must be resolved within five years of the claim being made. If your provider refuses to accept approved treatment, act promptly: SIRA requires evidence to be submitted within this timeframe.
Example: Resolving a Physiotherapy Dispute
A claimant in Bankstown sought 12 weeks of physiotherapy for a soft-tissue injury. Their provider refused to continue treatment after 8 weeks, arguing the injury was 'threshold' under the guidelines. SIRA reviewed the claimant's medical records and found the injury met the 'spinal nerve-root' criteria for soft-tissue injury. The provider was instructed to continue treatment, demonstrating how SIRA balances medical evidence with CTP rules.
Next Steps
CTP treatment disputes depend on the accident date, injury type, and evidence submitted. If your provider refuses to accept approved treatment, contact SIRA immediately. For personalized guidance, complete the quick, no obligation enquiry form to request contact about your circumstances.