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).
If you've suffered a vision loss injury in a motor accident on the Central Coast, you may be eligible for treatment costs covered under NSW's Compulsory Third Party (CTP) scheme. This guide explains how SIRA funds medical expenses for eye injuries, what evidence is needed, and how Central Coast claims differ from other NSW regions.
How SIRA Funds Eye Injury Treatment Costs
Under the Motor Accident Injuries Act 2017, the State Insurance Regulatory Authority (SIRA) administers CTP claims in NSW. For vision loss injuries, SIRA covers treatment costs including specialist eye care, glasses, contact lenses, and rehabilitation. This applies whether your injury resulted in partial or total vision loss.
To qualify, your injury must meet the 'threshold injury' definition in the Motor Accident Guidelines. This includes conditions like retinal detachment, optic nerve damage, or traumatic brain injury affecting vision. SIRA typically funds treatment costs for 52 weeks after the accident, unless your injury is classified as a 'threshold injury' under the guidelines.
Evidence Required for Eye Injury Claims
To claim treatment costs for vision loss, you must provide:
- Medical records confirming your eye injury and vision loss
- A specialist report linking your injury to the accident
- Receipts for approved treatments like eye surgery or therapy
- Evidence of ongoing treatment needs beyond 52 weeks (if applicable)
Your doctor must also document how your vision loss impacts daily activities, such as reading, mobility, or work. This helps determine the extent of treatment funding.
Central Coast CTP Claim Processing
While CTP claim procedures are standard across NSW, Central Coast claimants should note:
- SIRA offices in Gosford handle claims for the Central Coast region
- Claims involving vision loss may require specialist assessments by ophthalmologists
- Processing times may vary depending on the complexity of your injury and treatment needs
Unlike some regions, Central Coast claims must be submitted to SIRA within 52 weeks of the accident to access weekly benefits. However, this deadline does not apply to claims for permanent vision loss or long-term treatment.
Disputes and When to Seek Advice
If your claim is denied or you dispute the funding amount, you can:
- Request a review from SIRA within 28 days of the decision
- Submit a formal objection to the NSW Civil and Administrative Tribunal (NCAT)
- Seek legal advice if your injury involves complex issues like permanent vision loss or lifetime care needs
It's important to act quickly. SIRA may reduce or stop weekly benefits after 52 weeks unless your injury is classified as a 'threshold injury' under the Motor Accident Guidelines. For example, a claimant with a detached retina requiring ongoing treatment may qualify for extended funding.
Practical Example
Consider a Central Coast resident who suffered a traumatic eye injury in a car accident. Their ophthalmologist confirmed permanent vision loss requiring regular laser treatments. SIRA funded the initial 52 weeks of care, but the claimant's specialist argued the injury met the 'threshold injury' definition. After a review, SIRA approved extended funding for ongoing treatment.
Next Steps
CTP funding for vision loss depends on your injury type, treatment needs, and claim timing. To discuss your circumstances, complete the quick, no obligation enquiry form. Every claim depends on its own facts.