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).
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).
Amputation injuries resulting from motor vehicle accidents are covered under NSW's Compulsory Third Party (CTP) scheme, but claimants in regional areas face unique challenges. This article explains how SIRA evaluates amputation claims, what evidence is critical, and how regional factors impact the process.
What Types of Amputation Injuries Are Covered Under NSW CTP Claims?
NSW CTP claims cover amputation injuries caused by motor vehicle accidents, including limb loss or the need for a prosthetic. SIRA assesses injuries based on the Motor Accident Guidelines, which define 'threshold injuries' as those requiring medical treatment. Amputations typically meet this threshold, as they involve significant medical intervention and long-term care.
How Does SIRA Assess the Severity of Amputation Injuries?
SIRA evaluates amputation claims by considering the injury's impact on the claimant's daily life, mobility, and ability to work. For example, a lower limb amputation may affect mobility and require a prosthetic, while an upper limb amputation could impact fine motor skills. SIRA also considers the need for ongoing treatment, such as physiotherapy or prosthetic adjustments.
Regional Challenges for CTP Amputation Claims
Injured people in regional NSW may face delays in accessing specialist medical care or specialist legal advice. Rural hospitals may have limited trauma services, and claimants may need to travel for assessments. SIRA requires medical evidence confirming the injury's severity, which can be harder to obtain in areas with fewer specialists.
Evidence to Support an Amputation Injury Claim
To strengthen a claim, gather: medical records detailing the injury and treatment, a detailed accident report, witness statements, and proof of income to assess lost earnings. Photographs of the accident scene and vehicle damage may also be relevant. SIRA may request additional documentation if the injury's impact on daily life is unclear.
Time Limits and Dispute Options
Claimants must notify their insurer within 52 weeks of the accident. If the injury is a 'threshold injury' (as defined by SIRA), benefits are generally limited after 52 weeks unless the claimant has a whole person impairment rating of 10% or more. Disputes over claim value or evidence can be resolved through SIRA's review process or by seeking independent legal advice.
When to Seek Legal Advice
Injured people in regional NSW should consult a solicitor if they face difficulties accessing medical care, have complex injury needs, or need help navigating SIRA's requirements. A lawyer can also assist with disputes over claim value or delays in processing.
Every claim depends on its own facts. To request contact about your circumstances, complete the quick, no obligation enquiry form.